How do you decide CH or NH?

charlie10

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Dec 20, 2018
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Things are moving fast....FiL has shown he has significant problems since he was sent home, and even 4 carers a day isn't going to do it. BiL has finally admitted how bad he is and wants him in care asap as my OH (who has been looking after their dad since he arrived) will be coming home at the end of the week and he doesn't think he will cope on his own. So I have been nominated to research homes to visit and what to look for.....but I don't know where the line comes between CH and NH....ideally I'd look for one which will go from mild to problematic to eliminate any further move, but there seems to be very little with a separate dementia unit (I'm assuming they take the more challenging residents) and I'm not sure how much nursing is done in a CH before it requires a NH.

His main problems are double incontinence (and a refusal to use incontinence products); arterial ulcers on his leg; bed sores; lymphedema (was bad but I think has been controlled while in hospital); he has little mobility (a few steps with zimmer) and is showing signs of not eating much agin and possibly developing swallowing difficulties. Plus COPD, PAD and CAD (sorry, peripheral artery disease and coronary AD.....so many abbreviations these days I go cross-eyed!) not currently a problem. I have a feeling that most of these could be managed in aCH with a DN visit for dressings, but what about the incontinence....would that mean a NH or even the 'heavy duty' dementia unit as he is unwilling to co-operate?

Once I know what I'm looking for I can send a short list for BiL to visit....I've already done a list of how to evaluate a Home....thank you TP! As he's self-funding is he entitled to help from the SS to help find a place? Should we asking for another Needs Assessment to confirm this is best for him (tho I believe they did that on discharge a couple of weeks ago and said he was fit to live alone....got that one wrong!!) I'm the one doing all the research and advice, while OH is the one on the ground, trying to organise things and do repairs etc and convince BiL. What trips me up every time is that everyone says FiL has capacity, so everything is his choice. Trying to do LPA this week before OH comes back, fingers crossed he goes with it cos if he doesn't we may be stuck!

edited to add his social boundaries are few....he swears, has rages and thinks it's ok to use his 'bottle' in company....I'm assuming these aren't going away, and would not be acceptable in a CH? :(
 
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charlie10

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Dec 20, 2018
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thank you Jessbow and Izzy....I think you're probably right about the NH with dementia unit.....as other people have found, saying they take people with dementia doesn't necessarily you inspire you with confidence that this is a one stop shop. Really would like to make this a forever home as he's reacted so badly to the move from hospital to home.

I've been ploughing thro cqc reports but they're not giving me the info I want at the moment....the most glowing review doesn't mean much if they don't deal with the level you want. Have looked at Homes websites and the photos are all of happy smiling seniors who look as if they're on their holidays! Shall keep at it, when I've got a short list CQC will come into its own.....thank you for your early morning replies, don't know how you do it, my brain isn't in gear at that time :confused:o_O
 

mumsgone

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Dec 23, 2015
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hi just a pointer when you do go and look go on spec without appointment you will get a better idea of the home then. Look for dual registered if you are not 100% sure of the needs. With regard to lpa it can be a minefield proving or not proving mental capacity as person with dementia can flip from rational to irrational as you well know. If it's possible a joint bank account is sometimes easier. Good luck in your endeavours.
 

Helly68

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Mar 12, 2018
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If you explain the medical/care needs your PWD has, most homes should be able to say if they can manage these.
A nursing home will be a lot more expensive than a care home, though as you are thinking, there is a logic in finding somewhere that can accommodate future needs. It may be worth being assessed by social services, though if you self-fund you may find you don't get much support, but they should be able to help you identify the kind of home that would have the right level of support.
 

charlie10

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Dec 20, 2018
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thank you mumsgone and Helly.....passing all these ideas on. Glad to hear that there might be a little bit of input from SS.....we might be looking to do this quickly as I'm not sure he can manage at all at home and there's nowhere else he can go :(
 

canary

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Feb 25, 2014
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South coast
The difference between a care home and a nursing home is that a nursing home has at least one trained nurse on duty all the time.

Thinks like incontinence does not need a trained nurse, but a catheter will. Medication prescribed by a doctor that is taken orally, or using drops, can be given routinely by a carer, but medication that is to be given "as required" or with a syringe will need a nurse. Transfers to a wheelchair/chair/bed (including using hoists) can be managed by a carer, but if they are totally immobile and cannot move themselves even to change position in bed, then this requires a nurse.

"Challenging behaviour" is a grey area. Mum was in a care home that could deal with challenging behaviour, but often it requires a nursing home. Not all nursing homes can deal with it, either, though, so the best thing is to ask the home what behaviour they could not deal with.

One solution is to try a home that has different "floors" or sister homes that he could be transferred between in the event of needing nursing care.

PS - the more I read about your dad, the more I think that he has frontal lobe degeneration. If dementia starts in the frontal lobes then memory is not affected until much later and they can pass the Mini Mental State Examination quite easily, often until quite late stages. They also often present as being lucid and having capacity, when they often dont. Their main problems are lack of inhibitions, socially inappropriate behaviour, inability to plan and/or perform tasks, apathy, lack of empathy, repetitive behaviour and changing eating patterns (usually a craving for sweet things).
 

love.dad.but..

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Jan 16, 2014
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Kent
Canary and others have posted my thoughts. I had poa health for dad so was able to decide for him as he would have resisted a home if we had a frank discussion ...he lacked meaningful mental capacity by this point...but had to make the very hard decision as a self funder in his best interests and it was a horrible few months when through my tears love lies were invaluable to me and importantly dad.. However if your FIL is deemed to have mental capacity as you probably know no one can force him except that as he is a vulnerable adult at great risk alone at home presumably even as a self funder SS would surely step in...his care cannot be left if inadequate. I chose a dementia NH because dad had a very unstable iguinal hernia as,well as a few other less serious medical issues and we felt he needed monitoring by nurses and gp who visited the home and indeed a year into his care that decision paid off as he needed an emergency op. I also wanted somewhere that would take him to end of life. Dad had challenges...verbally aggressive...night time pacing...agitation...resistance to personal care...and was refused by a couple of dementia care homes after assessment plus a few I knew within a few minutes of visiting always unannounced were either not suitable for dad or regardless of them saying they dealt with moderate stage and beyond I could tell they didn't. Definitely an experienced dementia setting is needed and outline his behaviour and ask what they cannot deal with.
 

Jaded'n'faded

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Jan 23, 2019
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High Peak
Just a small point about Care Commission reports on care homes: whilst you'd obviously not want to choose a home with a bad rating, the reports are often out of date and a lot can change in a CH/NH in a short time, e.g. new manager, a couple of really good staff leaving, etc, etc.

Also, you might see a 'good' rating but it won't say what the previous report said, so you won't know if the place is improving or actually on the slide!

So, 2 places might be rated 'good', but one might have previously been 'needs improvement' and the other was previously 'very good'. Which would you choose?

The same is true for school league tables... Personally I'd go with a place that seemed to be improving but unfortunately, they don't give you that information!
 

Sirena

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Feb 27, 2018
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I wouldn't worry too much about the way a care home describes itself, because there does not seem to be a 'standard' for that. I would have thought his needs could be dealt with by a district nurse, so I'd start by ringing a few dementia care homes and describing his needs and see what they say. If a few give a negative reply, trying dementia nursing homes (they are less easy to find, and more expensive).

Incontinence is a personal care issue which doesn't require a nursing home. But CHs are all different and some only want 'easy' patients so I'm afraid it is a case of ringing and speaking to each one to see what behaviours and needs they will cope with. Just because one says no, doesn't mean the next one will.
 

charlie10

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Dec 20, 2018
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canary...interesting that you said that about FTD.....I thought that about a year ago but dismissed it cos he seemed much too old for it. However did read that they think it might be more common in elderly now, and his symptoms make me think it's either ftd or at least something with heavy frontal lobe deterioration. Not that it matters too much at the moment...just like to have a diagnosis! Hoping for one on Thursday (assessment at home) tho BiL is not keen :rolleyes: OH leaves at the end of the week so hope something can be sorted and put in place by then.....not holding my breath tho!

love.dad.but, Jaded'n'faded and Sirena....thank you for your helpful advice.....if I can say it without sounding uncaring, 'capacity' is a big drawback when trying to help :( Ideally we'd be able to visit CHs and choose what we think is the best....I'm not sure BiL will be able to do this, so trying to point him to the best ones on paper.....not a level playing field tho. My poor laptop thinks it's in laptop hell from the hours it's been required to work ;)
 

jugglingmum

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Jan 5, 2014
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Chester
...interesting that you said that about FTD

Based on comments made by Canary I think my mum had more frontal lobe issues - she was diagnosed with Alz aged 84, but many issues from years before with lack of empathy, and inability to plan. She could still pass the MMSE when diagnosed but thought it perfectly reasonable to have turned her electricity off and live in an unheated unlit house for 18 months (she always visited us).

2 years after diagnosis she was still able to comment on current affairs in context from daily reading of the newspaper but didn't know how to cook.
 

charlie10

Registered User
Dec 20, 2018
394
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perhaps we ought to volunteer them for research into FTD in the elderly (you really to have to search for anything suggesting that older people can get it too). Sad thing is the retention of self-awareness, at least some of the time.......OH says FiL is aware of how decisions are being taken away from him.....carers come when they want, can't self-manage meds etc Makes him grumpy and OH very upset :(