Thank you for your replies. Does anyone have any examples for what counts as severe cognitive problems and behaviour? I don’t want to miss out examples that are relevant. I’m presuming the time mum tried to climb over a kitchen counter to slap a staff member counts as severe but what about cognition? Mum will sometimes stand in her own room and not recognise it, can’t understand how to put on her coat, couldn’t understand when a staff member asked her to sign a card for another resident etc. Because we’ve been dealing with this disease for so long I feel I have forgotten how far down the well we have fallen.
Hi, yes it is hard to think of everything, we live with it for so long, we tend to take to just accept it all as normal, but I was advised by the Care home and the Social worker to write down everything for each of the criteria I could think of and then bullet it and thin it down. So this is from what I wrote and my experience of the CHC review and what was in the report written for my dad.
For a Severe in Cognitive impairment, here is what it said on the report for level of need:
Cognitive impairment that may, for example, include, marked short-term memory issues, problems with long-term memory or severe disorientation to time, place or person. The individual is unable to assess basic risks even with supervision, prompting or assistance and is dependent on others to anticipate their basic needs and to protect them from harm, neglect or health deterioration.
For Cognitive problems this is what I wrote as evidence in preparation for the meeting, the nurse at the CH also had written evidence to contribute:
- No awareness of day or night.
- Lives in the moment cannot remember things within a few seconds of being spoken. He has no short term memory and long term memory is poor, he confabulates memories (I gave examples).
- Has no awareness of needing to be changed if clothing becomes soiled.
- Cannot understand or comprehend simple questions or instructions, such as do you want a cup of tea or coffee, or can you sit down or get up
- He is emotionally troubled due to believing I'm his wife and not knowing I'm his daughter.
This is some of things that were written in the report as justification of a Severe score:
- He has no short term memory
- Long term memory is very variable, bordering on poor, when he could talk and make sense more he talked about memories that are in fact untrue (they wrote examples which I gave them).
- He has repetitive behaviour, he constantly wanders around the unit and tries to enter one room in particular at every opportunity (CH staff gave this as evidence). He is not orientated to time, place or person. He sometimes thinks that his daughter is his wife.
- Although he sometimes appears to understand simple things, he cannot retain this or communicate with an appropriate response.
- He can follow very simple instructions with guidance, however staff have to be mindful that this could set off his aggression. Staff have to assess his mood daily and act accordingly. Staff will do the action first and then he may follow suit, he appears to respond to visual prompts better than verbal.
- He does not understand personal care, he is easily agitated if staff try to help.
- Does not make simple choices, he will answer yes to anything.
- His daughter undertakes more complex decisions like health and finance.
- Staff state he would not say if he had pain, he just shows more agitation, so staff have to look for non verbal signs along with clinical signs to help diagnose issues.
- DOLS in place.
- Known to LLAMS team, medication was altered due to inappropriate behaviours.
My dad also scored Severe for Behaviour. I and the Care home had lots of evidence for this criteria. But just to help you this is what it says on the report for level of need for Severe:
"Challenging" behaviour of severity and/or frequency that poses a significant risk to self, others or property. The risk assessment identifies that the behaviours require a prompt and skilled response that might be outside the range of planned interventions.
I wont write the full list that was used for justification for his behaviour. But to summarise my dad was very challenging and unpredictable the unpredictability of his behaviour seemed to be what mattered most in the final review. His aggression was sometimes unprovoked and there was not always a predictable trigger so he couldn't easily be managed. Also he sometimes wasn't tolerant of the other residents and staff and this could put them at risk. If you want more examples let me know.
Hope this helps.