Aggression in care home - dementia, environment or failure of staff?

Lindyloo57

Registered User
Jan 3, 2019
15
0
Mum, 90, diagnosed with vascular dementia 2013. Lived at home with Dad as carer reasonably successfully til September then fell, broke her hip spent 3 months in hospital. Discharged to a nursing home 2.5 weeks ago. She showed some evidence of aggression in hospital, had some mobility problems and dementia clearly had progressed. Still has ability to converse, joke and enjoy a simple pleasure cup of tea and a chocolate.
I had some reservations about the nursing home, many residents are immobile, uncommunicative or very noisy but there was no choice and it has some good points. After the first few days her behaviour seems to have deteriorated and I’ve now been advised that after repeated examples of verbal and physical aggression she has been prescribed Haloperidol. She is fine with me ( I have seen her every day) but clearly getting more distressed with those around her. I have asked if she can be in a quieter environment but she is very wobbly and they are not keen to leave her on her own in her room, and I understand this. After attempting to discuss things with the owner and manager today, specifically around the issue of not being informed about the move to medication I was advised that if I wanted to take her out and place her somewhere else I could. And maybe somewhere else would be better. Ideally she’d be better in a smaller quieter environment. But the ideal isn’t always available. I know the theory is ‘give it time’ but she’s had a difficult time in hospital and struggles with her reduced mobility and failing memory. So my jumbled thoughts are
Any experience of Haloperidol ?
Any experience of making the wrong decision about a care home and how did you deal with it.?
Once you’ve got examples of aggression is there any way back from that?
how do you find the most suitable place as I think agression would be less if the environment was calmer and she felt respected by staff ( most of whom are professional and fine but several are young and perhaps struggle with her.)
Oh, and no brothers or sisters to share the guilt with..
Thanks.
 

Lindyloo57

Registered User
Jan 3, 2019
15
0
Sorry, ignore my last sentence. Ridiculously self pitying, rest of questions still stand.
 

Amy in the US

Registered User
Feb 28, 2015
4,616
0
USA
I wonder if your mother developed hospital induced delirium and still has it. It is a real problem in persons with dementia who are in hospital. The anesthesia and pain medication can also contribute. It can take a long time to recover from delirium and the environment you describe won't help. Someplace calmer would be better, but I know it's not easy.

I am not a medical professional so take this for what it's worth, but I wouldn't be comfortable with haloperidol (Haldol in the States) for a 90 year old with a recent fracture who is likely a fall risk. I'd be wary of anything sedating, except pain meds. In fact, I'd make sure she is receiving adequate pain medication, especially before things that will hurt such as personal care, moving her, PT, and so on. It can't hurt to talk to the staff, nurses, doctor, consultant, whomever, about this.

A general medication review couldn't hurt. Sometimes with surgery, a hospital stay, and so on, medications get changed and that can wreak havoc.

Sorry not to be of more help and I hope others will have advice for you. Best wishes to you and your family.
 

Grannie G

Volunteer Moderator
Apr 3, 2006
81,447
0
Kent
Hello @Lindyloo57

The care home manager and staff were not as reassuring as they could have been and it seems they are giving up on your mother very easily. It would make me unhappy to be presented with this attitude.

It would be natural for your mum to be very confused after a stay in hospital and then a move to another strange environment and a couple of weeks is not long enough to give her chance to settle. What worries me is the home seems to have resorted to strong medication so quickly. Have they tried to reassure your mum and help her feel safe?

I could be wrong, not knowing the full history but I would ask to see the doctor who had prescribed the Haloperidol but then hope you have an LPA in place so your mother`s condition can be discussed with you.

I would then ask for another meeting with the owner and manager and ask what help your mother has had to encourage her to settle.

I`m not surprised you feel unsupported. It`s so hard to know what to do for the best when you have no one to discuss it with. I hope others here on Talking Point will be able to offer you help and support.
 

Louise7

Volunteer Host
Mar 25, 2016
4,693
0
Welcome to TP. Was the Heloperidol prescribed by a GP or someone with specialist knowledge of dementia, such as the adults mental health team? It is a very 'old' antipsychotic (first generation) and is generally not the first medication of choice for those with dementia.

My Mum was moved to a nursing home having spent 3 months in hospital following a fall. Finding the right home isn't easy but as she was not self funding we didn't have any choice about which home she went to. Mum doesn't like a too noisy environment but she likes company and stimulation and the home had lots of residents who were bed bound and at 'end of life' and Mum was left sitting in a lounge with no radio/TV and very little staff interaction. This caused her to become distressed. After 3 weeks she was moved (following other safeguarding concerns) and the new nursing home was like the home your Mum is in, and noisier. We had some reservations at first but Mum has settled well and seems to like the 'hustle & bustle' and constant stimulation and the staff are caring and have got to know Mum and she knows them. A few weeks ago the home suggested a move to a quieter floor as a room had become available but we decided to keep Mum where she was as the other floor was too quiet, with almost all bed bound. It is difficult to find the 'perfect' environment and it can take time to settle so if you think that it is the environment which is causing your Mum's change in behaviour then consider looking at other homes. However don't rule out factors other than the environment for the aggression.

As Amy has suggested above, I would ask for a medication review. It seems as though an anti-psychotic has been prescribed as a first resort without much of an attempt to find out what is causing the change in behaviour. Delirium can be a problem but you need to know what has caused it in order to treat it properly. Hospitals should take steps in investigate, and treat, the causes of delirium but from experience they rarely do this. In my Mum's case she was very agitated and occasionally aggressive - and was subsequently prescribed various anti-psychotics - but the cause was eventually established following observations to establish any 'patterns'. For example, certain elements of personal care upset her more than others. We now know that the changes in behaviour where due to her being in pain (the hospital missed a spinal fracture) but now that the pain is being effectively treated Mum is much calmer and frequently smiling. It may be that your Mum is in pain and a review/increase in pain medication will help. It can be a case of 'trial and error' though to find the right balance between reducing the pain without over-sedating and Mum had several changes of pain medication before the right dosage/medication was found. Hope things get better for your Mum but please don't feel guilty. We are all in the position of trying to do the best we can.
 

70smand

Registered User
Dec 4, 2011
269
0
Essex
I agree with the advice given. Haloperidol is generally contra indicated in the elderly with dementia so I am surprised it was prescribed first line. My dad was on anti psychotic medication for aggression in his care home and my mum and I visited daily and never saw any aggression but were told he could be aggressive for no obvious reason when we weren’t there. I think we were more aware of the triggers, and noise and other residents shouting used to upset him. Sometimes I noticed that the staff spoke quite harshly aswell, almost like telling off a child and whether they were talking to him or not it used to upset him. To their credit they did pick up on this and move him to a quieter floor but he had to be moved back after an incident.
Two years down the line dad’s Alzheimer’s has progressed and he is off most medication and doesn’t get aggressive any more but sometimes calls out during personal care if he is scared. The staff have worked out that if they talk to him calmly throughout his care he is less frightened and easier to care for. Not rocket science that a bit of gentle human kindness goes a long way you would have thought, but not all the carers realised this!
We had doubts about dad’s care home at times but at the moment we feel he is well cared for. My mum is there daily and now has a good relationship with the staff, who now know how mum likes things done for dad, because she knows what does and doesn’t work. Maybe more discussion with the staff or manager might help before you think about moving mum?
It’s all very tough and I wish you luck x
 

canary

Registered User
Feb 25, 2014
25,018
0
South coast
I must say that my first reaction was - is she still in pain following the fracture?
I also lifted one eyebrow when I read that she was on Haloperidol - it is usually the drug of last resort. Have they tried anything else?

I would say that she needs a meds review, both in regards to her pain and also the anti-psychotic
 

Jintyf

Registered User
Jun 14, 2013
47
0
Sorry, ignore my last sentence. Ridiculously self pitying, rest of questions still stand.
Not at all self-pitying! We need to be kind to ourselves as its so stressful - but to keep as lighthearted as poss is important too:).
Like yourself, I too am on my own (I have a sister but she is in Australia). This forum really helps to feel connected and the support is fantastic.
My Mum went into hospital on Monday 31/12/18 for assessment before being placed in a care home so I am a little further back in my journey than you are. I will eagerly await news on your progress and hope to provide mutual support.
BTW I was born in 1957 if your address alludes to dob:).
 

Lindyloo57

Registered User
Jan 3, 2019
15
0
I wonder if your mother developed hospital induced delirium and still has it. It is a real problem in persons with dementia who are in hospital. The anesthesia and pain medication can also contribute. It can take a long time to recover from delirium and the environment you describe won't help. Someplace calmer would be better, but I know it's not easy.

I am not a medical professional so take this for what it's worth, but I wouldn't be comfortable with haloperidol (Haldol in the States) for a 90 year old with a recent fracture who is likely a fall risk. I'd be wary of anything sedating, except pain meds. In fact, I'd make sure she is receiving adequate pain medication, especially before things that will hurt such as personal care, moving her, PT, and so on. It can't hurt to talk to the staff, nurses, doctor, consultant, whomever, about this.

A general medication review couldn't hurt. Sometimes with surgery, a hospital stay, and so on, medications get changed and that can wreak havoc.

Sorry not to be of more help and I hope others will have advice for you. Best wishes to you and your family.
I wonder if your mother developed hospital induced delirium and still has it. It is a real problem in persons with dementia who are in hospital. The anesthesia and pain medication can also contribute. It can take a long time to recover from delirium and the environment you describe won't help. Someplace calmer would be better, but I know it's not easy.

I am not a medical professional so take this for what it's worth, but I wouldn't be comfortable with haloperidol (Haldol in the States) for a 90 year old with a recent fracture who is likely a fall risk. I'd be wary of anything sedating, except pain meds. In fact, I'd make sure she is receiving adequate pain medication, especially before things that will hurt such as personal care, moving her, PT, and so on. It can't hurt to talk to the staff, nurses, doctor, consultant, whomever, about this.

A general medication review couldn't hurt. Sometimes with surgery, a hospital stay, and so on, medications get changed and that can wreak havoc.

Sorry not to be of more help and I hope others will have advice for you. Best wishes to you and your family.
thanks
I wonder if your mother developed hospital induced delirium and still has it. It is a real problem in persons with dementia who are in hospital. The anesthesia and pain medication can also contribute. It can take a long time to recover from delirium and the environment you describe won't help. Someplace calmer would be better, but I know it's not easy.

I am not a medical professional so take this for what it's worth, but I wouldn't be comfortable with haloperidol (Haldol in the States) for a 90 year old with a recent fracture who is likely a fall risk. I'd be wary of anything sedating, except pain meds. In fact, I'd make sure she is receiving adequate pain medication, especially before things that will hurt such as personal care, moving her, PT, and so on. It can't hurt to talk to the staff, nurses, doctor, consultant, whomever, about this.

A general medication review couldn't hurt. Sometimes with surgery, a hospital stay, and so on, medications get changed and that can wreak havoc.

Sorry not to be of more help and I hope others will have advice for you. Best wishes to you and your family.
Thank you for your comments. Post op delirium was mentioned at one point when she was in hospital but I’m not sure any conclusion was reached. I have arranged to speak to the GP next week and I am hoping he/she can give me some assurances about the background to choosing this drug, side effects etc.. Hopefully I can then talk to the home manager again and try to see if they are willing to work with me on or whether they have actually concluded she’s turned out to be more trouble for them than they first anticipated. I think I need an informed medical view as that basis of any discussions. Thanks again.
 

Lindyloo57

Registered User
Jan 3, 2019
15
0
Hello @Lindyloo57

The care home manager and staff were not as reassuring as they could have been and it seems they are giving up on your mother very easily. It would make me unhappy to be presented with this attitude.

It would be natural for your mum to be very confused after a stay in hospital and then a move to another strange environment and a couple of weeks is not long enough to give her chance to settle. What worries me is the home seems to have resorted to strong medication so quickly. Have they tried to reassure your mum and help her feel safe?

I could be wrong, not knowing the full history but I would ask to see the doctor who had prescribed the Haloperidol but then hope you have an LPA in place so your mother`s condition can be discussed with you.

I would then ask for another meeting with the owner and manager and ask what help your mother has had to encourage her to settle.

I`m not surprised you feel unsupported. It`s so hard to know what to do for the best when you have no one to discuss it with. I hope others here on Talking Point will be able to offer you help and support.
Thanks for your supportive comments. I do have an LPA in place so hope I can have a productive discussion with the GP. I recognise the need to give mum time to settle in. I need to understand what they have done in advance of getting the GP in, it certainly didn’t involve any discussion with me. I don’t want confrontation, I don’t want to be labelled the difficult daughter (of the difficult mother) but I feel I have to intervene and raise a question. This implies lack of trust and I suspect this has upset them, but then if they are upset by legitimate questions maybe that too says it’s not the right place. Thanks again.
 

Lindyloo57

Registered User
Jan 3, 2019
15
0
Welcome to TP. Was the Heloperidol prescribed by a GP or someone with specialist knowledge of dementia, such as the adults mental health team? It is a very 'old' antipsychotic (first generation) and is generally not the first medication of choice for those with dementia.

My Mum was moved to a nursing home having spent 3 months in hospital following a fall. Finding the right home isn't easy but as she was not self funding we didn't have any choice about which home she went to. Mum doesn't like a too noisy environment but she likes company and stimulation and the home had lots of residents who were bed bound and at 'end of life' and Mum was left sitting in a lounge with no radio/TV and very little staff interaction. This caused her to become distressed. After 3 weeks she was moved (following other safeguarding concerns) and the new nursing home was like the home your Mum is in, and noisier. We had some reservations at first but Mum has settled well and seems to like the 'hustle & bustle' and constant stimulation and the staff are caring and have got to know Mum and she knows them. A few weeks ago the home suggested a move to a quieter floor as a room had become available but we decided to keep Mum where she was as the other floor was too quiet, with almost all bed bound. It is difficult to find the 'perfect' environment and it can take time to settle so if you think that it is the environment which is causing your Mum's change in behaviour then consider looking at other homes. However don't rule out factors other than the environment for the aggression.

As Amy has suggested above, I would ask for a medication review. It seems as though an anti-psychotic has been prescribed as a first resort without much of an attempt to find out what is causing the change in behaviour. Delirium can be a problem but you need to know what has caused it in order to treat it properly. Hospitals should take steps in investigate, and treat, the causes of delirium but from experience they rarely do this. In my Mum's case she was very agitated and occasionally aggressive - and was subsequently prescribed various anti-psychotics - but the cause was eventually established following observations to establish any 'patterns'. For example, certain elements of personal care upset her more than others. We now know that the changes in behaviour where due to her being in pain (the hospital missed a spinal fracture) but now that the pain is being effectively treated Mum is much calmer and frequently smiling. It may be that your Mum is in pain and a review/increase in pain medication will help. It can be a case of 'trial and error' though to find the right balance between reducing the pain without over-sedating and Mum had several changes of pain medication before the right dosage/medication was found. Hope things get better for your Mum but please don't feel guilty. We are all in the position of trying to do the best we can.
Thank you. It’s comforting to know that others have struggled down the same road and that there may be the possibility of an improvement. I was thinking ‘this is it’ and my mother was just going to be classed as difficult and trod around warily by staff.
 

Lindyloo57

Registered User
Jan 3, 2019
15
0
I agree with the advice given. Haloperidol is generally contra indicated in the elderly with dementia so I am surprised it was prescribed first line. My dad was on anti psychotic medication for aggression in his care home and my mum and I visited daily and never saw any aggression but were told he could be aggressive for no obvious reason when we weren’t there. I think we were more aware of the triggers, and noise and other residents shouting used to upset him. Sometimes I noticed that the staff spoke quite harshly aswell, almost like telling off a child and whether they were talking to him or not it used to upset him. To their credit they did pick up on this and move him to a quieter floor but he had to be moved back after an incident.
Two years down the line dad’s Alzheimer’s has progressed and he is off most medication and doesn’t get aggressive any more but sometimes calls out during personal care if he is scared. The staff have worked out that if they talk to him calmly throughout his care he is less frightened and easier to care for. Not rocket science that a bit of gentle human kindness goes a long way you would have thought, but not all the carers realised this!
We had doubts about dad’s care home at times but at the moment we feel he is well cared for. My mum is there daily and now has a good relationship with the staff, who now know how mum likes things done for dad, because she knows what does and doesn’t work. Maybe more discussion with the staff or manager might help before you think about moving mum?
It’s all very tough and I wish you luck x
Thank you for your comments. It’s probably more trial and error than i anticipated. At the moment I’m not feeling that I want to work with the home as they didn’t advise me of the extent of her behavioural problems and they called in a GP without advising me and are indicating she’s more problematic than they anticipated but I recognise that’s an emotional reaction on my part and I have to swallow it and try harder. Mum does react differently to different approaches and I need to find the words to explain this without criticising the staff she doesn’t react well to.
I wonder if your mother developed hospital induced delirium and still has it. It is a real problem in persons with dementia who are in hospital. The anesthesia and pain medication can also contribute. It can take a long time to recover from delirium and the environment you describe won't help. Someplace calmer would be better, but I know it's not easy.

I am not a medical professional so take this for what it's worth, but I wouldn't be comfortable with haloperidol (Haldol in the States) for a 90 year old with a recent fracture who is likely a fall risk. I'd be wary of anything sedating, except pain meds. In fact, I'd make sure she is receiving adequate pain medication, especially before things that will hurt such as personal care, moving her, PT, and so on. It can't hurt to talk to the staff, nurses, doctor, consultant, whomever, about this.

A general medication review couldn't hurt. Sometimes with surgery, a hospital stay, and so on, medications get changed and that can wreak havoc.

Sorry not to be of more help and I hope others will have advice for you. Best wishes to you and your family.
Not at all self-pitying! We need to be kind to ourselves as its so stressful - but to keep as lighthearted as poss is important too:).
Like yourself, I too am on my own (I have a sister but she is in Australia). This forum really helps to feel connected and the support is fantastic.
My Mum went into hospital on Monday 31/12/18 for assessment before being placed in a care home so I am a little further back in my journey than you are. I will eagerly await news on your progress and hope to provide mutual support.
BTW I was born in 1957 if your address alludes to dob:).
 

Lindyloo57

Registered User
Jan 3, 2019
15
0
Not at all self-pitying! We need to be kind to ourselves as its so stressful - but to keep as lighthearted as poss is important too:).
Like yourself, I too am on my own (I have a sister but she is in Australia). This forum really helps to feel connected and the support is fantastic.
My Mum went into hospital on Monday 31/12/18 for assessment before being placed in a care home so I am a little further back in my journey than you are. I will eagerly await news on your progress and hope to provide mutual support.
BTW I was born in 1957 if your address alludes to dob:).
Well spotted on the clue in the address although I feel I’ve aged so much with the stress of the last few months I should have used 47. Best of luck to you and your mum.
 

love.dad.but..

Registered User
Jan 16, 2014
4,962
0
Kent
Thanks for your supportive comments. I do have an LPA in place so hope I can have a productive discussion with the GP. I recognise the need to give mum time to settle in. I need to understand what they have done in advance of getting the GP in, it certainly didn’t involve any discussion with me. I don’t want confrontation, I don’t want to be labelled the difficult daughter (of the difficult mother) but I feel I have to intervene and raise a question. This implies lack of trust and I suspect this has upset them, but then if they are upset by legitimate questions maybe that too says it’s not the right place. Thanks again.
If your mum is deemed to lack mental capacity in terms of meaningful decision making for health and welfare then absolutely you should be involved with all her health decisions and be advised of the GP intention to medicate or any other intervention or visit. The GP may still make the medication decision as having poa can only take your authority so far if he/she thinks medication or anything else is in your mum's best interests but the decision should be explained and justified to you. Have the NH given you clear examples of her aggression, thoughts on any triggers such as personal care or their strategies they are trying to minimise her upset without medication? I had poa health for dad and was fully involved with all decisions and monitoring for dad in his NH with nurses and GP practise. As an attorney for a pwd lacking mental capacity your opinion is as valid as though the person themselves were discussing and I would be polite but assertive in reminding the NH manager of this and that you expect to be kept informed. However their knee jerk reaction may suggest inexperience in either being willing or able to handle the behaviour. Dad was verbally aggressive and was frightened by personal care and pushed or flapped his arms at carers and I discovered on one occasion a bank agency carer had described him as physically aggressive to another permanent carer...he wasn't any different to his usual reaction and the carer corrected the agency carer as her quick assessment was reached through inexperience of handling different stages and types of dementia and not knowing how my dad should be approached or revisited in a while if he was resisting.
 

70smand

Registered User
Dec 4, 2011
269
0
Essex
It can be a balancing act to get staff onside without upsetting them if they think you are criticising them and the way they do things. We’ve had to be quite diplomatic and always are polite and thankful to the staff. I don’t think it is uncommon for care homes to just call in the gp to sort out any challenging behaviour. We had thought he had settled in well but later discovered they had a behaviour chart on him for all the instances he was aggressive, which was usually during personal care in the morning. We didn’t find this out for weeks even though we visited every day for hours. My mum even offered to come in in the morning to observe his aggressive behaviour to see if she could help. Often it was charted that he shouted at them and grabbed staff, but he was always ok with some staff, who said they never had a problem with him, indicating that it was more the way he was dealt with than him being ‘difficult’. It was often documented that he ‘wouldn’t ‘ sit up for them, but he could take no instruction, has poor perception and couldn’t see very well! Sounds very similar to love.dad.but... indeed.
 

Misstep

Registered User
Oct 7, 2015
59
0
South Wales
Mum, 90, diagnosed with vascular dementia 2013. Lived at home with Dad as carer reasonably successfully til September then fell, broke her hip spent 3 months in hospital. Discharged to a nursing home 2.5 weeks ago. She showed some evidence of aggression in hospital, had some mobility problems and dementia clearly had progressed. Still has ability to converse, joke and enjoy a simple pleasure cup of tea and a chocolate.
I had some reservations about the nursing home, many residents are immobile, uncommunicative or very noisy but there was no choice and it has some good points. After the first few days her behaviour seems to have deteriorated and I’ve now been advised that after repeated examples of verbal and physical aggression she has been prescribed Haloperidol. She is fine with me ( I have seen her every day) but clearly getting more distressed with those around her. I have asked if she can be in a quieter environment but she is very wobbly and they are not keen to leave her on her own in her room, and I understand this. After attempting to discuss things with the owner and manager today, specifically around the issue of not being informed about the move to medication I was advised that if I wanted to take her out and place her somewhere else I could. And maybe somewhere else would be better. Ideally she’d be better in a smaller quieter environment. But the ideal isn’t always available. I know the theory is ‘give it time’ but she’s had a difficult time in hospital and struggles with her reduced mobility and failing memory. So my jumbled thoughts are
Any experience of Haloperidol ?
Any experience of making the wrong decision about a care home and how did you deal with it.?
Once you’ve got examples of aggression is there any way back from that?
how do you find the most suitable place as I think agression would be less if the environment was calmer and she felt respected by staff ( most of whom are professional and fine but several are young and perhaps struggle with her.)
Oh, and no brothers or sisters to share the guilt with..
Thanks.
My sympathies on the question of having to deal with everything yourself. I'm also an only child with a 91 year old mother with stage 7a dementia & a recent pelvic fracture, who is being aggressive. Do you have Lasting Power of Attorney, Health & Welfare? If you do, you have some options here. I had an unexpected phone call from the home this week to say that the psychiatrist had visited & prescribed all manner of tranquillisers, which my mother had specifically asked me (verbally) to refuse. I wasn't aware of any reason the psychiatrist might have been called out at the time (I knew she was getting more confused & refusing food, but understood she was otherwise content) , so I called her GP first (who had visited several times recently & was also unaware of a problem), then the psychiatrist. I asked for the prescription to be stopped until I found out what was going on. The psychiatrist arranged a meeting with the home and myself, when I (and the psychiatrist) discovered that this is an occasional problem that arises when they're trying to clean her up during the night & it's suddenly escalated in the last two months, coinciding with her fracture. We put together a new plan, including increasing her pain medication and not checking if her pads need changing during the night unless there's an obvious problem. The other proposed drug has been changed to an anti-anxiety one for now to try to reduce her agitation and the home has promised to phone me if they think they need to try to give her a tranquilliser for now, until we review progress at the end of this month. If she needs a tranquilliser then, at least we'll have tried the alternatives. Sorry to be detailed, but it sounds like the kind of plan that might help your situation, but you'll need the PoA to get the psychiatrist & GP to be able to talk to you freely about it. Nonetheless, if you haven't got PoA, it might be worth dropping a note to the GP on the basis of "I realise you probably can't discuss this all with me, but I'm concerned about Mum & just wonder if ...etc. Best of luck. It's a horrible thing to have to deal with.
 

Lindyloo57

Registered User
Jan 3, 2019
15
0
My sympathies on the question of having to deal with everything yourself. I'm also an only child with a 91 year old mother with stage 7a dementia & a recent pelvic fracture, who is being aggressive. Do you have Lasting Power of Attorney, Health & Welfare? If you do, you have some options here. I had an unexpected phone call from the home this week to say that the psychiatrist had visited & prescribed all manner of tranquillisers, which my mother had specifically asked me (verbally) to refuse. I wasn't aware of any reason the psychiatrist might have been called out at the time (I knew she was getting more confused & refusing food, but understood she was otherwise content) , so I called her GP first (who had visited several times recently & was also unaware of a problem), then the psychiatrist. I asked for the prescription to be stopped until I found out what was going on. The psychiatrist arranged a meeting with the home and myself, when I (and the psychiatrist) discovered that this is an occasional problem that arises when they're trying to clean her up during the night & it's suddenly escalated in the last two months, coinciding with her fracture. We put together a new plan, including increasing her pain medication and not checking if her pads need changing during the night unless there's an obvious problem. The other proposed drug has been changed to an anti-anxiety one for now to try to reduce her agitation and the home has promised to phone me if they think they need to try to give her a tranquilliser for now, until we review progress at the end of this month. If she needs a tranquilliser then, at least we'll have tried the alternatives. Sorry to be detailed, but it sounds like the kind of plan that might help your situation, but you'll need the PoA to get the psychiatrist & GP to be able to talk to you freely about it. Nonetheless, if you haven't got PoA, it might be worth dropping a note to the GP on the basis of "I realise you probably can't discuss this all with me, but I'm concerned about Mum & just wonder if ...etc. Best of luck. It's a horrible thing to have to deal with.
Thanks for the detailed reply. Helpful. I have got POA so potentially I’ve got the basis for discussing things with the GP. Still waiting to speak to the GP, who may have been an out of hours one but they are not available till next week. There has been no involvement of a psychiatrist to date. I am happy to work with whoever to develop a plan however I feel the home may have decided that mum is just too much trouble ( and/or I am, although I am well able to be diplomatic and acknowledging of their efforts).
 

Jintyf

Registered User
Jun 14, 2013
47
0
Well spotted on the clue in the address although I feel I’ve aged so much with the stress of the last few months I should have used 47. Best of luck to you and your mum.
Thank you and all the best with your Mum too!
 

Misstep

Registered User
Oct 7, 2015
59
0
South Wales
Thanks for the detailed reply. Helpful. I have got POA so potentially I’ve got the basis for discussing things with the GP. Still waiting to speak to the GP, who may have been an out of hours one but they are not available till next week. There has been no involvement of a psychiatrist to date. I am happy to work with whoever to develop a plan however I feel the home may have decided that mum is just too much trouble ( and/or I am, although I am well able to be diplomatic and acknowledging of their efforts).
Good luck. I've had another phone call today to say that Mum hit a carer in the face this morning, without having shown signs of aggression beforehand. Turns out they were swinging her legs off the bed. It was one of the junior nurses who phoned me, so I explained what had been agreed on Friday, so she'd know we're trying to deal with it. She said she didn't think my Mum is in any pain. If she doesn't the carers don't either. Fortunately, the nurse manager is aware, so I'm going to relate the conversation to her on Tuesday to see if she can speak to the staff. It's two months since she fell and she can't communicate pain, so I'm not surprised they're assuming she's OK now.
 

Lindyloo57

Registered User
Jan 3, 2019
15
0
Thanks for all your comments and suggestions. They confirmed I wasn’t overreacting. The GP who issued the prescription has been unavailable but i finally got to speak to a duty Doctor who stopped the prescription pending a review next week. I’ve discussed the situation with the home and clearly there is a problem about aggression but they have no theories about triggers but suggested the involvement of the mental health team. I must admit to being a bit disappointed at their lack of analysis. I’ve discussed several other points with them and hopefully some of the smaller things can be addressed. In the meantime mum has picked up an infection and is currently in bed and poorly. Hopefully things will clear up over the weekend and get back on track next week.