Mum's care home not coping - Suggesting High Dependency Home

[iworry]

Mum is only 3 months into her care home residence. Dad has lived with mum's illness for nearly 10 years and in October last year the decision to put mum in a home was made for us.

(You can see various posts from me on these forums leading up to this and after the move to the home)

Well - After only 3 months the Care Home have said they cannot cope as mum's condition has continued to deteriorate and suggest we have to look for a high dependency unit.

We are self funding.

Mum is aggressive and was this week punched in the face by another resident probably in retaliation to mums behaviour. Mum has also bitten staff so they have removed her false teeth (CAN THEY DO THIS???)

ANYHOW...If we are told they cannot cope surely we are entitled to Continuing Health Care Funding - as on top off mums condition I can see how dad despairs at their savings going down the pan at £1K a week funding this.

I know it seems cold to mix money with mums best interests but we are trying to consider every aspect of moving her and potentially to a place that is no longer local to us.

thoughts???

and as always

thanks

 

[fizzie]

You are having a difficult time.
The care home sound as though they are particularly inept which won't be helping your Mother's behaviour either. I believe that removing someones teeth (false or otherwise ) is both cruel and unacceptable and there are other ways of helping people who have challenging behaviour. If they can't manage her behaviour they should be asking for emergency help from the mental health nurses.. Have you told them that they are not allowed to remove her teeth?

Are there enough staff at this place? How can residents go around punching each other with no intervention - unbelievable! They must have been 'at it' for a while with noone taking any notice before it escalated to that level. It isn't ok for anyone to be punched in the face or anywhere else in a place of care or safety

There are threads on here about CHC funding - people have given a lot of detailed information - just put it into the search box. I know it is complicated but have very little experience of it.

I am surprised that other relatives aren't complaining to the care home.

 

[Beate]

Violence can happen very quickly and without warning. It isn't always neglect from care home staff! My OH is lovely and calm. His Day Centre is brilliant. And yet, last year I've received a call from them saying another resident had hit him on the jaw. They'd previously got on great! He wasn't really hurt and laughed it off so I wasn't too concerned, especially as it was a one-off.

I agree with the false teeth subject though. If they can't cope with her, then you need to find somewhere else, and preferably not wait for any CHC decision as that could take ages, if you are at all successful.

 

[iworry]

The punching incident took place in one of the residents bedrooms. Mum had been going into other people's bedrooms.
Unless there is 1:1 staffing I can't see how this could be avoided.
There is approx 15 residents to a wing and usually 1:4 approx ratio to staff

The teeth - I really don't know - it does seem an antiquated approach.

It just happened on that day that the mental nurse was visiting so was a witness to all of this

We have been told to find a big dependency unit. The current care home is dementia focuses. First high dependency we contacted said they cannot take her she is too advanced. I can see mum ending up in hospital as her final home...

 

[fizzie]

Yes that is true Beate both sudden escalation and the months of waiting for CHC funding and my understanding is that the success rate isn't too good either!
.
If it happened because she is wandering most care homes have ways of dealing with it and if this is dementia focussed then they should too. They clearly can't cope.

I'm surprised a high dependency unit say she is too advanced - is that based on her memory clinic testing or a conversation with the mental health nurse - ask the mental health nurse to intervene if you like the place and it is nearby?

 

[notsogooddtr]

As Beate says violence can come from nowhere and doesn't necessarily suggest poor care,there simply aren't enough staff to monitor every resident 24/7.They have been honest with you which is something.Have they given any timescale for when your mum needs to move?When my father was very agitated NH requested visit from psychiatrist who changed meds,agitation under control now but downside is that Dad is sleeping most of the time and barely eating or drinking.

 

[Witzend]

.
If it happened because she is wandering most care homes have ways of dealing with it and if this is dementia focussed then they should too. They clearly can't cope.

?

Wandering is often a normal and accepted aspect of dementia. My mother's very good specialist dementia CH was purpose built, with plenty of wander-room linking the main sitting room areas, and residents were frequently in and out of each others' rooms.

Even in a very good CH with very good staffing levels I don't see how this type of incident could necessarily be avoided. I don't think it fair to say that it means the CH 'can't cope'. They only way such an incident could be guaranteed to be prevented would be to have every resident watched every second, and this just isn't possible in the vast majority of CHs, whether specialist dementia or not.

 

[fizzie]

Wandering is often a normal and accepted aspect of dementia. My mother's very good specialist dementia CH was purpose built, with plenty of wander-room linking the main sitting room areas, and residents were frequently in and out of each others' rooms.

Even in a very good CH with very good staffing levels I don't see how this type of incident could necessarily be avoided. I don't think it fair to say that it means the CH 'can't cope'. They only way such an incident could be guaranteed to be prevented would be to have every resident watched every second, and this just isn't possible in the vast majority of CHs, whether specialist dementia or not.

Sorry they clearly can't cope as they've asked her to move her mum! Specialist homes have all sorts of ways of coping, some have as you say lots of wander room, others have the bedroom corridors coded, others have door alarms on the doors and others have an awareness of individuals and offer locks on doors for those who find it upsetting to find someone else in their rooms. There are multiple ways of dealing with the behaviour but all require a commitment on the part of the management to finding the mechanisms to deal with it, some are very good it, some try and are not very good and others can't be bothered - not the carers, the management!

If there are incidents of escalating aggression or physical contact in a care home the first question that is usually asked is are there enough staff - as often that is the reason.

When you add the aggression and biting, to the removal of false teeth, there is a clear indication that whatever the cause the behaviour is not being managed - so that could be lack of training, short staff, not good enough carers - all sorts of reasons

 

[notsogooddtr]

Sorry they clearly can't cope as they've asked her to move her mum! Specialist homes have all sorts of ways of coping, some have as you say lots of wander room, others have the bedroom corridors coded, others have door alarms on the doors and others have an awareness of individuals and offer locks on doors for those who find it upsetting to find someone else in their rooms. There are multiple ways of dealing with the behaviour but all require a commitment on the part of the management to finding the mechanisms to deal with it, some are very good it, some try and are not very good and others can't be bothered - not the carers, the management!

If there are incidents of escalating aggression or physical contact in a care home the first question that is usually asked is are there enough staff - as often that is the reason.

When you add the aggression and biting, to the removal of false teeth, there is a clear indication that whatever the cause the behaviour is not being managed - so that could be lack of training, short staff, not good enough carers - all sorts of reasons

The nature of dementia means that behaviour can be unpredictable and incidents can happen in the best run homes.This home has accepted that they can't meet this ladies needs any longer that doesn't it's badly run,it's just not the right place for her.False teeth are another issue,really have no idea how they should have dealt with that.

 

[fizzie]

The nature of dementia means that behaviour can be unpredictable and incidents can happen in the best run homes.This home has accepted that they can't meet this ladies needs any longer that doesn't it's badly run,it's just not the right place for her.False teeth are another issue,really have no idea how they should have dealt with that.

Didn't say it was badly run please don't put words into my mouth, said they couldn't cope with her mum which is what they have said, can't understand what all the fuss is about - good homes manage challenging behaviour well, nothing is 100 percent anywhere and I simply asked the question about whether there were enough staff or not. I was in a home yesterday where there were 50 residents all mixed up and it was calm - there were people who wandered, people who shouted occasionally, people who had a 'go' at someone but over all of that it was calm and they pride themselves on managing behaviour that other homes cannot cope with - good for them and even better for the residents who end up there. Actually loads of homes manage people wandering into each others rooms very well because unsurprisingly residents on the whole don't like it and so it should be managed. Of course people wander but with the right management it can be sorted - I know because I have seen it working many times

 

[tigerlady]

I haven't read your other posts but I would suggest you try immediately for CHC funding. The prime factors in getting this are unpredictable aggression and severe cognitive disfunction. I'm surprised the care home hasn't suggested this.

I was advised by the social worker to apply for this for my husband, because after he was sectioned and assessed, I could not find a care home that would take him due to his aggression. He qualified, and with the help of the NHS CHC team, and the In Reach team, he is now in a very good purpose built nursing home specialising in dementia, and wandering is no problem as the bedroom doors are all locked with a system that means the resident can get out if in the room, but cant get in unless they are let in by a staff member with a key. The corridors go round continuously linking the lounges, dining room and secure gardens are accessible at all times. His aggression is still a problem but they are managing it a bit better now with medication.

There is no way we could have afforded this home without the funding - I really dont know what we would have done - so I wish you luck in your applicaton for this

You could find the following links useful

http://www.ageuk.org.uk/health-well...are/assessment-for-nhs-continuing-healthcare/


https://www.alzheimers.org.uk/site/scripts/documents_info.php?&documentID=399

 

[notsogooddtr]

Didn't say it was badly run please don't put words into my mouth, said they couldn't cope with her mum which is what they have said, can't understand what all the fuss is about - good homes manage challenging behaviour well, nothing is 100 percent anywhere and I simply asked the question about whether there were enough staff or not. I was in a home yesterday where there were 50 residents all mixed up and it was calm - there were people who wandered, people who shouted occasionally, people who had a 'go' at someone but over all of that it was calm and they pride themselves on managing behaviour that other homes cannot cope with - good for them and even better for the residents who end up there. Actually loads of homes manage people wandering into each others rooms very well because unsurprisingly residents on the whole don't like it and so it should be managed. Of course people wander but with the right management it can be sorted - I know because I have seen it working many times

Apologies you're right,your actual words were 'particularly inept'.As I say the home accept that they can't meet this ladies needs,doesn't mean it's a bad home,just not right place for her.

 

[notsogooddtr]

It certainly sounds as though your Mum SHOULD qualify for CHC funding but as I'm sure you know it's a minefield and far from transparent.My father has a funding review this month,no expectation that it will be successful though.Take a look at the thread on this topic,there is loads of info there.And good luck with finding a suitable placement for your Mum.

 

[Boo7878]

Boo7878

In respond to I Worry, Our stepfather has been in a care home with Vascular Dementia for 3 years self funding for the first 2 years! then it was funded by the council & himself. We were then told they could no longer cope with him. He was assessed for CHC funding, he did not get the funding even though the home said he was aggressive & they could not manage his needs! We looked around many homes with the help of his social worker, after reading his care plan no home would accept him. Mental health became involved & he was eventually sectioned under section 2 of the mental health act. He was in hospital for 4 weeks then kept in on section 3 for assessment this automatically means you get section 117 free after care. He has been there 8 weeks now. He will be moving to a new care home soon as he is now settled.
We were quite upset at the thought he was to be sectioned, but its been for the best. He will now be cared for in a new home & will no longer have to contribute to the cost. I hope this will help .

 

[iworry]

Boo - thank you. Either coincidence or inevitability mum was detained today under section 2 and removed from the care home and into a hospital. I understand they have max 28 days to 'fix' her or we move to section 3. Awful seeing mum loaded into the ambulance screaming

 

[tigerlady]

Boo - thank you. Either coincidence or inevitability mum was detained today under section 2 and removed from the care home and into a hospital. I understand they have max 28 days to 'fix' her or we move to section 3. Awful seeing mum loaded into the ambulance screaming

How dreadful for you to see your mum so distressed, but with short term memory being so bad, she will probably remember none of the distress once she has been settled there.

Now that is has been taken out of your hands, and she is under a section, she will be probably qualify for CHC, but the check list and the DST still have to be completed. When the section on my husband ran out, I thought he would be put on a section 3, which used to mean automatic qualification for CHC, but he was put on a DoLS instead, so the checklist and the DST had to be completed.

Sending you big hugs as you must be feeling awful, but this often the best route to get the most suitable care for your loved one.

Here is a link to give you more information

http://www.ageuk.org.uk/Documents/E...and_NHS-funded_nursing_care_fcs.pdf?dtrk=true