My father's nursing home say they can no longer cope with his behaviour after just 3

[Sindy B]

My father has Alzheimer's and moved to a NH 3 months ago; this followed a prolonged stay in hospital after he contracted Sepsis. The community hospital team insisted he needed residential or nursing home care and so much against our wishes, we finally agreed to him being admitted to a NH. He receives NHS nursing care funding but didn't qualify for CHC. However the home we selected does cater for CHC patients and specialises in dementia. He is in the later stages of the illness, though still reasonably independent and mobile.

Despite our misgivings he settled in well and all the reports we got were very positive and indeed his general health, mobility and social skills improved to the extent that I began to wonder if he could have coped going back home after all.

But in the last week, the NH manager has suddenly told us that his behaviour has become unacceptable and that they are no longer able to cope with him. They have suggested that he will have to move to a nearby home which specialises in mental health patients with challenging behaviour. We visited this home before he moved and rejected it because the clientele was a very mixed range and many were very physically aggressive and violent. My father is a quiet, mild-mannered and polite individual, who whilst strong-willed is neither verbally or physically aggressive in any way. He finds violence in any form distressing.

Compared to many of the residents in his NH, he is also not "difficult", he has good communication and social skills. His behavioural problems seem to be around night time wandering (down the corridor of the NH and also into other residents' rooms) and soiling himself/not using the commode or bathroom facilities. He did also refuse to go on an outing last week, which was purely voluntary and I did suggest he would be unlikely to enjoy it even if they could persuade him to go. In the end he refused to go.

I have noticed a change in his demeanour in the last week - he is much more suspicious and even a little paranoid about what he says is happening in the home. I put this down to lack of sleep (because he is active at night) and also down to the fact that the staff, in dealing with his behaviour, are probably being more assertive with him. He never was a man who liked being told what to do!

There are some new members of staff around, due to holidays and changes in personnel.

But today when my brother visited the NH manager/matron took him to one side and more or less said my Father's behaviour was no longer manageable and he would have to be transferred. They asked him to sign some form (he wasn't sure what it said, naively) and said there was some psychiatric assessment next week (still trying to find out what it is and who is doing it) and this would result in him having to move? No other options - such as medication - seem to have been tried. Though they have apparently tried putting him in another room to sleep, which hasn't worked.

I'm trying not to rush to judgement, particularly as it is half term week and Dad's social worker is on holiday, his GP practice was closed today and my brother hadn't fully understood the implications of what was going on. They read him a report of incidents which took place over a week ago which we were not previously made aware of, which I think shocked him. Perhaps that was the idea.....

So any advice, practical or procedural from anyone who has experienced this scenario. I don't want to have to move my Dad, but neither do I want to fight to keep him somewhere where the staff clearly no longer want to care for him.

Thank you in anticipation.

 

[joggyb]

My father has Alzheimer's and moved to a NH 3 months ago; this followed a prolonged stay in hospital after he contracted Sepsis. The community hospital team insisted he needed residential or nursing home care and so much against our wishes, we finally agreed to him being admitted to a NH. He receives NHS nursing care funding but didn't qualify for CHC. However the home we selected does cater for CHC patients and specialises in dementia. He is in the later stages of the illness, though still reasonably independent and mobile.

Despite our misgivings he settled in well and all the reports we got were very positive and indeed his general health, mobility and social skills improved to the extent that I began to wonder if he could have coped going back home after all.

But in the last week, the NH manager has suddenly told us that his behaviour has become unacceptable and that they are no longer able to cope with him. They have suggested that he will have to move to a nearby home which specialises in mental health patients with challenging behaviour. We visited this home before he moved and rejected it because the clientele was a very mixed range and many were very physically aggressive and violent. My father is a quiet, mild-mannered and polite individual, who whilst strong-willed is neither verbally or physically aggressive in any way. He finds violence in any form distressing.

Compared to many of the residents in his NH, he is also not "difficult", he has good communication and social skills. His behavioural problems seem to be around night time wandering (down the corridor of the NH and also into other residents' rooms) and soiling himself/not using the commode or bathroom facilities. He did also refuse to go on an outing last week, which was purely voluntary and I did suggest he would be unlikely to enjoy it even if they could persuade him to go. In the end he refused to go.

I have noticed a change in his demeanour in the last week - he is much more suspicious and even a little paranoid about what he says is happening in the home. I put this down to lack of sleep (because he is active at night) and also down to the fact that the staff, in dealing with his behaviour, are probably being more assertive with him. He never was a man who liked being told what to do!

There are some new members of staff around, due to holidays and changes in personnel.

But today when my brother visited the NH manager/matron took him to one side and more or less said my Father's behaviour was no longer manageable and he would have to be transferred. They asked him to sign some form (he wasn't sure what it said, naively) and said there was some psychiatric assessment next week (still trying to find out what it is and who is doing it) and this would result in him having to move? No other options - such as medication - seem to have been tried. Though they have apparently tried putting him in another room to sleep, which hasn't worked.

I'm trying not to rush to judgement, particularly as it is half term week and Dad's social worker is on holiday, his GP practice was closed today and my brother hadn't fully understood the implications of what was going on. They read him a report of incidents which took place over a week ago which we were not previously made aware of, which I think shocked him. Perhaps that was the idea.....

So any advice, practical or procedural from anyone who has experienced this scenario. I don't want to have to move my Dad, but neither do I want to fight to keep him somewhere where the staff clearly no longer want to care for him.

Thank you in anticipation.

Your tale mirrors that of mine/my dad's almost exactly right now. So although I've no advice, I'll be equally interested in any responses!

 

[kitty62]

I have experience in working in nursing homes, so i hope this helps.
where I work, it's imperative that family are kept up to date AS events happen, with any concerns that the staff have and not days/weeks later.
the situation sounds very upsetting for you all.
are you able to contact the home manager via phone if not in person?
have the staff asked the challenging behaviour team to get involved?
Have the staff requested a review by your dads consultant, to review medication?
have the staff ruled out any chance that infection hasn't returned? has the gp been in and checked for this? have they done any bloods for this?
have the staff completed any behavioural charts regarding your dads behaviour?
I would speak directly to the home manager to find out what behavioural issues they have.
3 months isn't really a long time for somebody to settle into a new environment and if there have been staff changes, what impact has this had on your dad?
what are the staff's expertise and training?
i don't believe the home can do anything about moving your dad without the care managers awareness,( unless in an emegency) as you say she's away on holiday.
it sounds as though they've gone from A - Z very quickly and not tried anything in between.
At the end of the day, if this home feel unable to provide the care your dad needs, then, it's in his best interest to move to a place where they can and where YOU feel happy with, so long as they can meet his needs.
good luck and i hope things get sorted for you all.

 

[Sindy B]

Thanks

I have experience in working in nursing homes, so i hope this helps.
where I work, it's imperative that family are kept up to date AS events happen, with any concerns that the staff have and not days/weeks later.
the situation sounds very upsetting for you all.
are you able to contact the home manager via phone if not in person?
have the staff asked the challenging behaviour team to get involved?
Have the staff requested a review by your dads consultant, to review medication?
have the staff ruled out any chance that infection hasn't returned? has the gp been in and checked for this? have they done any bloods for this?
have the staff completed any behavioural charts regarding your dads behaviour?
I would speak directly to the home manager to find out what behavioural issues they have.
3 months isn't really a long time for somebody to settle into a new environment and if there have been staff changes, what impact has this had on your dad?
what are the staff's expertise and training?
i don't believe the home can do anything about moving your dad without the care managers awareness,( unless in an emegency) as you say she's away on holiday.
it sounds as though they've gone from A - Z very quickly and not tried anything in between.
At the end of the day, if this home feel unable to provide the care your dad needs, then, it's in his best interest to move to a place where they can and where YOU feel happy with, so long as they can meet his needs.
good luck and i hope things get sorted for you all.

Thanks for the reply. It was my brother who spoke to the NH manager today. I'm going to go to visit tomorrow afternoon, to see her face-to-face. Unfortunately I think my brother was so taken by surprise that he didn't really ask any questions - or even know what to ask. So at the moment I have more questions than answers. But certainly getting to the bottom of what medical assessment has happened or is going to happen is top of my list. My Dad was re-registered with a new GP practice when he moved in to the home 3 months ago, so I am wondering if they have actually read all his medical records and previous assessments. My fear is that the alternative place the manager suggested to my brother is one we have already decided Dad wouldn't be happy in. And nothing much has changed with him since then to change our view. Other than this apparent sudden change in his nighttime behaviour, which has only been exhibiting itself for a week or so - which does lead me to think something else has also changed in the last week, such as a UTI or other infection.

 

[Sindy B]

Your tale mirrors that of mine/my dad's almost exactly right now. So although I've no advice, I'll be equally interested in any responses!

It's just so out of the blue - and doesn't fit with anything that we have observed, admittedly whilst we visit everyday our visits are during the day or evening, not at night. Nothing else about his dementia has been sudden or unpredictable - his progression has been very slow and gradual.

 

[rosycider]

Thanks for the reply. It was my brother who spoke to the NH manager today. I'm going to go to visit tomorrow afternoon, to see her face-to-face. Unfortunately I think my brother was so taken by surprise that he didn't really ask any questions - or even know what to ask. So at the moment I have more questions than answers. But certainly getting to the bottom of what medical assessment has happened or is going to happen is top of my list. My Dad was re-registered with a new GP practice when he moved in to the home 3 months ago, so I am wondering if they have actually read all his medical records and previous assessments. My fear is that the alternative place the manager suggested to my brother is one we have already decided Dad wouldn't be happy in. And nothing much has changed with him since then to change our view. Other than this apparent sudden change in his nighttime behaviour, which has only been exhibiting itself for a week or so - which does lead me to think something else has also changed in the last week, such as a UTI or other infection.

I would suggest a UTI is a distinct possibility or constipation ( sometimes with overflow). They must try and find the cause before assuming this is not copable with. The night time wandering is common; your Dad is looking for someone ( hence going to other residents rooms or something to find familiarity or comfort and to make him feel safe. Or he is trying to communicate something that he is hungry, thirsty wants the toilet etc. He is clearly lost at night and having Alzheimers or other dementia means the difference between day and night is often not clear. So the nursing home should sort this out. Until he has had a full assessment and avenues have been explored then I would resist moving him which will likely make his dementia worse. Kitty 62 has provided a lot of good points and suggestions. Don't give in yet

 

[Sindy B]

I would suggest a UTI is a distinct possibility or constipation ( sometimes with overflow). They must try and find the cause before assuming this is not copable with. The night time wandering is common; your Dad is looking for someone ( hence going to other residents rooms or something to find familiarity or comfort and to make him feel safe. Or he is trying to communicate something that he is hungry, thirsty wants the toilet etc. He is clearly lost at night and having Alzheimers or other dementia means the difference between day and night is often not clear. So the nursing home should sort this out. Until he has had a full assessment and avenues have been explored then I would resist moving him which will likely make his dementia worse. Kitty 62 has provided a lot of good points and suggestions. Don't give in yet

Thank you. These are my feelings exactly. They are a specialist dementia nursing home, so they must have seen this behaviour time and time again. Ironically it is because his general health has improved that he is able to wander about at all; when he first arrived there he was more or less chair-bound. The change of the clocks/darker evenings, the "threat" of going on an outing and possibly some underlying infection or other problem has made my Dad feel the need to wander about, however "challenging" that might be to the staff.

 

[care2share]

Thank you. These are my feelings exactly. They are a specialist dementia nursing home, so they must have seen this behaviour time and time again. Ironically it is because his general health has improved that he is able to wander about at all; when he first arrived there he was more or less chair-bound. The change of the clocks/darker evenings, the "threat" of going on an outing and possibly some underlying infection or other problem has made my Dad feel the need to wander about, however "challenging" that might be to the staff.

Hi Sindy B, Just a guess but, the psychiatric assessment your father is going to have next week could be a mental capacity assessment, possibly one that will be done by an independent assessor, for the purpose of putting in place a Deprivation of Liberty Safeguard, just in case he ends up staying. What makes me think this is the fact the hospital insisted on his move into a care home and you were not really given a choice, which in turn makes me think perhaps you do not have Power of Attorney for his Health & Welfare, hence they were able to override you. Can not be sure but that's what it could be. As for the home wanting to move your father, could it be he's just harder work than they expected? Hope things turn out OK.

 

[Sindy B]

Hi Sindy B, Just a guess but, the psychiatric assessment your father is going to have next week could be a mental capacity assessment, possibly one that will be done by an independent assessor, for the purpose of putting in place a Deprivation of Liberty Safeguard, just in case he ends up staying. What makes me think this is the fact the hospital insisted on his move into a care home and you were not really given a choice, which in turn makes me think perhaps you do not have Power of Attorney for his Health & Welfare, hence they were able to override you. Can not be sure but that's what it could be. As for the home wanting to move your father, could it be he's just harder work than they expected? Hope things turn out OK.

Thanks - I think you're right that the NH is looking at the amount of staffing time his nighttime care is now taking up. I'm not sure what their ratios are at night, but I would imagine, limited. Plus the staff who work nights tend not to be around in the day for me to check with them what's going on. Dad had a mental capacity assessment in hospital; it was the results of that, plus conversations with the psychiatric nurse who carried it out that persuaded me that, perhaps, a NH was the "best" option (even though we didn't really have much option). I am in the process of getting Power of Attorney - but a major stumbling block is getting any of the NHS or social care staff to complete the necessary paperwork - everyone just says it's not their "policy" to complete the forms and passes the buck to someone else. Grrrrr. He is subject to some level of DoLs, but I think that they need greater powers in order to fully restrain or medicate him. Whilst this sounds fairly drastic, it is not as drastic as simply evicting him........

 

[Beate]

Not sure why NHS staff should complete your POA forms? That isn't usually in their job description. You can do this yourself or with the help of a charity, but the real stumbling block is mental capacity. If he is under a DOLS already, I am not sure whether he will hav the necessary capacity to sign the forms.

 

[canary]

I am slightly bemused by this. Is it definitely the wandering, going into other residents rooms and soiling himself that they are worried about, or is there something new that they havent told you about?

If there isnt anything else, then a decent NH that is used to dementia should not be fazed by it. Mum does this all the time and no-one worries, they just go and help her.

I noticed that you say that the NH specialises in dementia. Does this mean that they also have non-dementia residents? Are the dementia residents housed separately, or are they in together? If dementia and non-dementia residents are in together then this could well be the problem. Often, non-dementia residents can be upset by the symptoms of people with dementia, especial if it involves them coming into their room at night. If this is the case then a move to a NH that cares exclusively for people with dementia may solve the problem.

 

[Sindy B]

Not sure why NHS staff should complete your POA forms? That isn't usually in their job description. You can do this yourself or with the help of a charity, but the real stumbling block is mental capacity. If he is under a DOLS already, I am not sure whether he will hav the necessary capacity to sign the forms.

Thanks. Because he has already been assessed as not having capacity, the POA proforma covering an individual who is not able to make a decision for themselves requires a summary of his condition to be provided by either the professional who carried out his most recent assessment, or another health or social care professional who has had oversight of his care, for example his GP or social worker. In other words some independent assessment other than us just saying that we think he doesn't have capacity. It is just this element of the paperwork that I am asking them to complete; all of the other information we have completed.

 

[Beate]

I am confused - are we talking about a lasting power of attorney? Because it's not possible to do this one without mental capacity.

 

[canary]

Thanks. Because he has already been assessed as not having capacity, the POA proforma covering an individual who is not able to make a decision for themselves requires a summary of his condition to be provided by either the professional who carried out his most recent assessment, or another health or social care professional who has had oversight of his care, for example his GP or social worker. In other words some independent assessment other than us just saying that we think he doesn't have capacity. It is just this element of the paperwork that I am asking them to complete; all of the other information we have completed.

Ah, you mean you are applying for Court of Protection deputyship. Its not the same as POA (although quite similar) hence the confusion. I had problems with this too - mums GP said they "didnt do this"!!!! A useful phrase is that they are legally responsible for the welfare of vulnerable adults.

 

[Sindy B]

I am slightly bemused by this. Is it definitely the wandering, going into other residents rooms and soiling himself that they are worried about, or is there something new that they havent told you about?

If there isnt anything else, then a decent NH that is used to dementia should not be fazed by it. Mum does this all the time and no-one worries, they just go and help her.

I noticed that you say that the NH specialises in dementia. Does this mean that they also have non-dementia residents? Are the dementia residents housed separately, or are they in together? If dementia and non-dementia residents are in together then this could well be the problem. Often, non-dementia residents can be upset by the symptoms of people with dementia, especial if it involves them coming into their room at night. If this is the case then a move to a NH that cares exclusively for people with dementia may solve the problem.

Thanks. I too am bemused by the idea that his dementia getting worse (which is presumably what is happening) seems to be a problem to the NH. The facility is only nursing care (not joint residential and nursing care) and so all residents are in the same place and from what I know of the others, they all have dementia-type illness. My father is currently one of the more mobile and able of the residents, with the majority of the others either confined to bed or wheelchair. They are all of a similar age range (80s-90s). The place they suggested he be moved to is not dementia-only; it has a wide range of people with complex mental and physical disabilities and a much wider age range.

 

[Sindy B]

Ah, you mean you are applying for Court of Protection deputyship. Its not the same as POA (although quite similar) hence the confusion. I had problems with this too - mums GP said they "didnt do this"!!!! A useful phrase is that they are legally responsible for the welfare of vulnerable adults.

Yes, sorry I was using POA in its loosest sense; in fact we have gone past the point of POA and are now mired in other legal process. The situation is further complicated by the fact that he only changed GPs 3 months ago, so the old and the new practice have been debating which of them is responsible for form filling, even though neither of them has actually accepted responsibility. I am more than willing to pay a fee, in the same way that you do for private prescriptions, but even that hasn't moved things on. I will try your suggested phraseology with them tomorrow! Thank you for your help.

 

[Sindy B]

I am confused - are we talking about a lasting power of attorney? Because it's not possible to do this one without mental capacity.

Sorry - not POA, but Court of Protection Deputy; my father has gone beyond the point where he can make his own decision about POA, unfortunately.