What to expect from a care home

[Dollydaydream1]

My mother has moved into a care home, firstly for respite, but potentially to be a long term resident for however long she has left. My question is what should we expect in terms of care? The home is beautiful and mum seems settled already. Lots of activities and pleasant staff but my concern is over how closely they monitor her food and fluid intake etc. They have not been forthcoming with information and I get the feeling that the level of supervision and record keeping may not be as detailed or close as I would like. Are there any baseline standards that homes should follow? It would be useful to know what to expect - the home is very expensive and is a nursing home but I feel a little disappointed with the level of communication from staff. It feels like it's down to me to ask how she is all the time. I would have thought they would offer this information, especially to relatives of a new resident who is poorly. I hope she is not being forgotten about. I do not want to keep bothering the staff as I know they are busy but it is my mother and I want the best for her. Any advice on how best to broach my concerns with the home would be appreciated.

 

[Pete R]

The general staff do not always know the complete picture but should be a bit more forthcoming. They should be filing in a Daily sheet in a folder of each visit into your Mother documenting Food, Drink, Bowel Movement, Repositioning and in fact anything that relates to her care.

I have always spoken to the Nursing staff who should know everything about each patient in their care and have the information readily to hand. On the occasions there has been a "new" Nurse on duty then I would speak to the manager.

You do have to be careful with Food & Drink though. In one NH they used to write down what my Mom was given and not what she had actually consumed. It was only when her weight dropped that I noticed.

 

[lemonjuice]

My mother has moved into a care home, firstly for respite, but potentially to be a long term resident for however long she has left. My question is what should we expect in terms of care? The home is beautiful and mum seems settled already. Lots of activities and pleasant staff but my concern is over how closely they monitor her food and fluid intake etc. They have not been forthcoming with information and I get the feeling that the level of supervision and record keeping may not be as detailed or close as I would like. Are there any baseline standards that homes should follow? It would be useful to know what to expect - the home is very expensive and is a nursing home but I feel a little disappointed with the level of communication from staff. It feels like it's down to me to ask how she is all the time. I would have thought they would offer this information, especially to relatives of a new resident who is poorly. I hope she is not being forgotten about. I do not want to keep bothering the staff as I know they are busy but it is my mother and I want the best for her. Any advice on how best to broach my concerns with the home would be appreciated.

Oh how I sympathize Dollydaydream.
Communication , or lack of it, was my biggest complaint about my own mother's NH. It seems they assume 'you wouldn't want to know details, especially if they're negative' and you really have to push for openness. honesty and getting accurate information. In 6 years I still never cracked that one.

The number of times I would phone up and be told, 'Your mother's had a good week, been eating well' etc, which told me absolutely nothing. Even when she was recently dying on phoning up I would be told 'she is comfortable' . Occasionally I would speak to a member of staff who I had known a long time and talked about how I wanted the truth rather than platitudes and would then cope with whatever they told me. however unfortunately often it was different staff and I knew not to even bother asking. Until recently they had a 'book system' and I found out and checked up on my mother by looking in the book myself. I found it really frustrating in the past 2 months when she really deteriorated when they started transferring all that information to a tablet and the staff were still learning to use it and we hadn't yet been been passwords to access it.

If your mother's condition is made worse by the cancer I would see if you can get her referred to some Hospice oversight, whilst still residing at the NH. They refused my mother and I know that my f-I-l's care was superb in the hospice, whereas despite being prescribed 'just-in-case' meds for emergencies some of the NH staff were reluctant to initiate these without the Dr visiting and authorising them. Caused a lot of unnecessary stress for my mother a few week's back when she was experiencing breathing difficulties and I feel if hospice had been involved that could have been avoided, But hey ho, 'It is what it is' as my son was fond of saying and as she has just passed away just under a week ago irrelevant now.

 

[SnowWhite]

Dollydaydream - I don't think you're expecting too much to be kept totally in the picture about your Mum. I would be just the same.

Sadly, Mums care home shared no information unless you constantly asked and then they turned it round so that "I" was complaining. Other people told me the same so it wasn't just me. On many occasions I would get there and the owners car would be in the car park so I know she was there but she could see who was arriving and she made herself scarce. I would find another staff member and ask to see her or the Manager and I was always told they were in meetings. They were in fact, hiding near the kitchens!

You could try writing a letter to the managemement saying that you are really concerned about your Mum and you would welcome either more information or maybe a regular short meeting. It didn't work for me but maybe your Mums home is more approachable.

Does it say anything in their brochure about liaising with families?

Much is made in most brochures I've seen about residents rights and them treating it like their own home but in reality it often falls far short. Mums home definitely thought she was there to suit them not the other way round and that they always knew best, which they didn't.

I do hope you have some luck with this.

 

[jaymor]

My husband had a folder in which was recorded his day. It covered food consumed and how much he had eaten, visits to toilet and what was produced. Time of drinks offered and what they were and how many mmls taken. Baths, showers or bed baths recorded daily and what time they were carried out. Activities offered and participated in plus moods and any changes in presentation that were not normal.

I could see this every time I went and when he became bedbound, turning was added to the records, left side/back/ rightside. Any dressings or additional temporary medication such as antibiotics were also recorded.

If I noticed anything not recorded then I asked had it been done and by who. I very nicely said that if it was not recorded then as far as I was concerned it had not been done. Telling me yes it had but had not been recorded was not an answer I wanted to hear. They were very busy and as it was a challenging behaviour unit there were times I understood someone who needed to complete a record could be called away to assist another Carer but I found if difficult to understand why 5 hours later it was not filled in and how can someone be really sure what they did when they are constantly on the go and dealing with a lot of residents. I have to say that it was rarely I ever needed to question.

Some things you can let go, I wanted the fluid recorded but as long as it reached the recommended intake then It did not matter if it was not recorded as smoothie, tea or coffee. It really is choosing which battles to fight and which to let go.

We asked that 4 named family members could read and the management were fine with the request.

 

[love.dad.but..]

I felt on the whole Dad's NH had a reasonable balance of recording and communication. Daily records were written by carers in his care plan folder for things like personal care, his moods, activities, sleeping or not, eating etc On the days when he was put on food and fluid charts these were kept with the nurses for monitoring. Another medical file was kept for daily medication given, illness, injuries, GP visits etc. Some carers volunteered info of how he had been, if they had managed personal care ...he was often resistant, eaten etc as soon as I arrived, other carers filled me in when I asked. Anything function wise I spoke to carers, anything medical, care concerns, changes I wanted to care plan was discussed with nurses as they had ultimate responsibility, seemed to work quite well most of the time...occasionally system slipped up but not often. I looked over his files once a month doing a care plan review but always felt I could do so at any time. From day one I made a point of always appearing interested in even the smallest detail in dads care or change in him so I think they just expected that I would always want to know things...I visited every other day so could pick up in things quite quickly and always felt the staff were happy to discuss dad with me. However I also know that some relatives do not want that level of involvement or knowledge of their pwd on a daily basis and staff aware of that sometimes take a more in the background approach. I always took the view if I am friendly and chat about dad, his background, my family and also got to know a little about the staff dads care would be the better for it. I only had the need in nearly 3 years of dad being in the NH to see the manager 3 times on serious issues otherwise carers and nurses resolved most concerns or answered any questions I had. I think with having chemo treatment as well it is very reasonable for you to be kept informed without having to ask and maybe a chat with senior nurse/unit manager or whoever you feel appropriate at this early stage is needed so you know their protocol and they know your expectations.

 

[Saffie]

Carers in a nursing home are not necessarily party to the whole picture of a resident’s needs. The person who is - or at least should be - is the nurse in charge of the care of the relevant person. In my husband’s NH it was the nurse who told the carers what was needed and who had control of the Care Plan but daily records regarding routine matters were completed by the carers. Anything I needed to know I asked the nurse. I was always kept informed of anything affecting my husband’s health or welfare, sometime by phone though I did visit daily.

 

[LizK]

At my husband's nursing home, as he was in bed a lot and fed in bed, also because of weight loss, all of his care sheets were in his room for me to see. This was very helpful to me, as if I could see if he hadn't had enough fluid, I could sit with him offering it to him every few minutes, and he wouldn't remember he had refused it minutes ago. I was occasionally able to get 400ml down him in an hour, which was more than he had had all day. I could also see how much of each meal he had eaten and if he had refused to open his mouth. The sheets also noted pad checking and changing, if wet or soiled and at night every two hours whether he was asleep or awake in bed. His whole day was there for me to see.

Liz

 

[lemonjuice]

His whole day was there for me to see.

That was exactly my experience, before they moved to the 'computer pad system'. Even the staff are still struggling to use it properly.

 

[Dollydaydream1]

Oh how I sympathize Dollydaydream.
Communication , or lack of it, was my biggest complaint about my own mother's NH. It seems they assume 'you wouldn't want to know details, especially if they're negative' and you really have to push for openness. honesty and getting accurate information. In 6 years I still never cracked that one.

The number of times I would phone up and be told, 'Your mother's had a good week, been eating well' etc, which told me absolutely nothing. Even when she was recently dying on phoning up I would be told 'she is comfortable' . Occasionally I would speak to a member of staff who I had known a long time and talked about how I wanted the truth rather than platitudes and would then cope with whatever they told me. however unfortunately often it was different staff and I knew not to even bother asking. Until recently they had a 'book system' and I found out and checked up on my mother by looking in the book myself. I found it really frustrating in the past 2 months when she really deteriorated when they started transferring all that information to a tablet and the staff were still learning to use it and we hadn't yet been been passwords to access it.

If your mother's condition is made worse by the cancer I would see if you can get her referred to some Hospice oversight, whilst still residing at the NH. They refused my mother and I know that my f-I-l's care was superb in the hospice, whereas despite being prescribed 'just-in-case' meds for emergencies some of the NH staff were reluctant to initiate these without the Dr visiting and authorising them. Caused a lot of unnecessary stress for my mother a few week's back when she was experiencing breathing difficulties and I feel if hospice had been involved that could have been avoided, But hey ho, 'It is what it is' as my son was fond of saying and as she has just passed away just under a week ago irrelevant now.

Thank you so much for sharing your experience, especially at a time where you must still be coming to terms with the loss of your mother, and all that you have been through. My condolences and very best wishes to you.