Trying to decide on care home in SW London

[ngirl67]

Hi there, am new to this group but thought it might be helpful to seek advice from others living with this. My Mum has advanced Alzheimer's dementia and needs a care home. We are looking in SW london and have narrowed our choice to 2. I think that they both are good options but am having trouble making a final selection as family views are disparate. One seems to provide more specialized dementia care providing one on one care, music therapy, purposeful activities, a garden, a minibus with daily drives(don't always get off the bus), areas with therapy dolls/places to engage as residents move about. The facility is tired looking and is cramped having all residents together in a main lounge area during the day that includes the dining area, sitting area, "quiet" area and kitchenette in an open setting. One of the stairways is not secure. My Mum wanders much of the day and we're concerned that the facility here is cramped and busy feeling making wandering about a bit risky, not to mention the stair. Staff would be with her but Im sure they can't keep eyes on her 24/7.
The other is part of a chain; it's hotel like in appearance. They have a memory unit that is purpose built and on one floor; plenty of safe space to wander in, They have nurses & from what I could see caring staff. What concerned me was they say they have dementia specific programming but they weren't aware of the need for contrast during meals and on toilet seats to enable residents to be successful with those tasks. They had a pat dog come in, lovely garden, empathy dolls as well but did not provide true purposeful activities, no regular music program like playlists for life and from reading their CQC report they seemed to focus on medical aspects of care more. I do think that the physical environment to be more calm and it would be great for my Mum to move about it. There's a lounge and a separate quiet area with another for activities. They take people out but rarely and do not have a minibus.

So I guess I'm trying to figure out whether one is better because it has a better dementia ethos & care but without the best physical environment vs. the other that has a great one and good care but not as sensitive, responsive to the needs of those living with dementia. The mgr and this latter one is very open to trying new things and would support us bringing in say an iPod with music to do our own playlists. Also I'm trying to figure out whether getting out on a minibus is of great value to those with dementia. I would imagine so but want to be mindful of not projecting what I want for my Mum.
Does anyone have experience with either places? I'd appreciate your thoughts. Many thanks!

 

[love.dad.but..]

I am thinking back to the criteria for my dad as a wanderer and night time pacer when I looked around 16 homes. I decided in my list of priorities for dad what was the most important and what compromises I could make and what in time would become less important as his illness declined. Dad was not a joiner in type person with his dementia and he couldn't ask for anything. Given that I felt reassured that the care would be good, safe and kind , for me layout for easy continuous wandering and independent access without stairs to his room were crucial and in fact dad never lost the wandering aspect until end of life. His NH was probably more along the lines of your second choice a modern purpose built place but with fairly good actvity programme most of the staff with reasonable dementia awareness and no mini bus so no outings However for dad and perhaps some others who were moderate or advanced I didn't feel he would cope well being taken out anyway. So really it is about you weighing up what will bring benefit to your mum now but with keeping in mind those criteria factors could change and quickly as the illness worsens. Good dementia expertise is very important however I can also see that restrictions in the ability for a wanderer to satisfy that compulsion at any time day or night may lead to other problems. It is a difficult judgement

 

[ngirl67]

I am thinking back to the criteria for my dad as a wanderer and night time pacer when I looked around 16 homes. I decided in my list of priorities for dad what was the most important and what compromises I could make and what in time would become less important as his illness declined. Dad was not a joiner in type person with his dementia and he couldn't ask for anything. Given that I felt reassured that the care would be good, safe and kind , for me layout for easy continuous wandering and independent access without stairs to his room were crucial and in fact dad never lost the wandering aspect until end of life. His NH was probably more along the lines of your second choice a modern purpose built place but with fairly good actvity programme most of the staff with reasonable dementia awareness and no mini bus so no outings However for dad and perhaps some others who were moderate or advanced I didn't feel he would cope well being taken out anyway. So really it is about you weighing up what will bring benefit to your mum now but with keeping in mind those criteria factors could change and quickly as the illness worsens. Good dementia expertise is very important however I can also see that restrictions in the ability for a wanderer to satisfy that compulsion at any time day or night may lead to other problems. It is a difficult judgement

Thank you kindly for your response....I hear you on all fronts and have been reading everything I can get my hands on to figure out what aspects of care are most important particularly as one progresses to end of life care. It's tough to know how long she'd get to enjoy the physical aspects of a purpose built place v.s. having staff around who can observe a particular behavior and instinctively know how best to address it based on experience. I've been learning that wandering behaviors ought to be addressed by giving residents purposeful activities to engage in. Given my lack of experience I don't know how successful those efforts might be. I will continue to reach out and try to talk with others who've been there. I so appreciate your willingness to share your experience. It really does help

 

[Scriv]

Whereas I have no knowledge of your two places, we have just been through the business of choosing a home, so fully understand your dilemma.

Neither of them will be a perfect match and assuming it is just between the two of them - (though maybe have another look around just to see if there is another option just in case) think whether you have a 'gut-feel' about either of the places despite any negatives? We found we did have a gut feel for one of them.

If you do have a gut feel for one but still concerns about things lacking, then if there is scope for you to introduce your own ideas with your mum, that would be great. Personally I wouldn't worry too much about going out in a minibus once in a while... the outing may prove to be very stressful and tiring to your mum anyway even though you think it will be good for her.. or she might not be interested.

Good luck

 

[love.dad.but..]

Thank you kindly for your response....I hear you on all fronts and have been reading everything I can get my hands on to figure out what aspects of care are most important particularly as one progresses to end of life care. It's tough to know how long she'd get to enjoy the physical aspects of a purpose built place v.s. having staff around who can observe a particular behavior and instinctively know how best to address it based on experience. I've been learning that wandering behaviors ought to be addressed by giving residents purposeful activities to engage in. Given my lack of experience I don't know how successful those efforts might be. I will continue to reach out and try to talk with others who've been there. I so appreciate your willingness to share your experience. It really does help

All people with dementia have similar and differing challenges. I and the the NH found that dad couldn't be distracted through activities or meals from his need to be somewhere and strong determined compulsion to walk. Best wishes

 

[Hazara8]

Hi there, am new to this group but thought it might be helpful to seek advice from others living with this. My Mum has advanced Alzheimer's dementia and needs a care home. We are looking in SW london and have narrowed our choice to 2. I think that they both are good options but am having trouble making a final selection as family views are disparate. One seems to provide more specialized dementia care providing one on one care, music therapy, purposeful activities, a garden, a minibus with daily drives(don't always get off the bus), areas with therapy dolls/places to engage as residents move about. The facility is tired looking and is cramped having all residents together in a main lounge area during the day that includes the dining area, sitting area, "quiet" area and kitchenette in an open setting. One of the stairways is not secure. My Mum wanders much of the day and we're concerned that the facility here is cramped and busy feeling making wandering about a bit risky, not to mention the stair. Staff would be with her but Im sure they can't keep eyes on her 24/7.
The other is part of a chain; it's hotel like in appearance. They have a memory unit that is purpose built and on one floor; plenty of safe space to wander in, They have nurses & from what I could see caring staff. What concerned me was they say they have dementia specific programming but they weren't aware of the need for contrast during meals and on toilet seats to enable residents to be successful with those tasks. They had a pat dog come in, lovely garden, empathy dolls as well but did not provide true purposeful activities, no regular music program like playlists for life and from reading their CQC report they seemed to focus on medical aspects of care more. I do think that the physical environment to be more calm and it would be great for my Mum to move about it. There's a lounge and a separate quiet area with another for activities. They take people out but rarely and do not have a minibus.

So I guess I'm trying to figure out whether one is better because it has a better dementia ethos & care but without the best physical environment vs. the other that has a great one and good care but not as sensitive, responsive to the needs of those living with dementia. The mgr and this latter one is very open to trying new things and would support us bringing in say an iPod with music to do our own playlists. Also I'm trying to figure out whether getting out on a minibus is of great value to those with dementia. I would imagine so but want to be mindful of not projecting what I want for my Mum.
Does anyone have experience with either places? I'd appreciate your thoughts. Many thanks!

Wherever possible, you seek out the person-centred care, which is really an imperative in dementia care. As we are all different, with differing tastes and backgrounds, this of course applies to anyone entering a care facility and who is compromised by dementia. Thus, Care Plans and a real awareness of a persons' 'history' are a norm, or should be. The fundamental objective must be to sustain and whenever possible, enhance the welfare of the resident, with a close and continuous eye on their health, safety, happiness and very important, dignity of the one concerned. Dementia is very challenging and complex and there are a thousand different stories to be told here on these forums, but the key is to focus on person-centred care.

Trips out, activities, sensory dolls, 'dementia' tools (coloured crockery etc) all of these are used and are important. But because people are different, a given activity or say, a film or TV programme, might prove to be totally counter-productive for some residents. In the 'old days' one would find people sat around gazing into space with a television pumping out inane noise or music. no one looking at it whatsoever. Pointless. I am afraid that what seems so often to be an 'idealistic' model, is really the one which can and does provide a 'quality of life', within the parameters of dementia. To this end, Care Staff need to seriously engage with this specialized care as a given, i.e. they truly want to be in that job. They will also have a real awareness of 'dementia' with all its many, many presentations. The facility will have paid attention to environment and safety (wandering et al) and all of that by default. To a certain extent you can also gauge the 'qualification' of a place just as soon as you walk in through the main door. How were you received? Is it 'open door' policy. Did you engage with other residents at all? It requires careful thought. But if you can find the key elements (cited above) in practice, that goes a very long way to satisfying the overriding needs for your mother. Best of luck.

 

[Scriv]

I so agree with Havara8... our gut feeling for the home we chose was largely because of the wonderful, caring and loving manner of all the staff and their interaction with the residents that we witnessed all over the care home.