Transition to a nursing home - anyone done it the SPECAL way?

[HelenMG]

Hi all, Ive not posted in a while. We are now at the agonising stage of putting our 92 year old Dad into a care home. My sister and I promised we would look after him in an appartment next to Sis's house but it has become very stressful for all of us and his carers. He has gone downhill so much this past year and become increasiningly unpredictible and unable to do things he once could and his language is very hard to understand now.

I read the book "Contented dementia" mentioned here some time back which I found very useful. They advocate the "SPECAL" method to help keep people with dementia in their "green zones" by focussing on one or two key themes that bring a strong "green/positive response" from them almost every time they are mentioned, keeping them out of the rather distressing "red" zones. Dads key themes are trains, praying and singing.

Their method on the transition to a care home sounds good to me where you introduce the client to the care home a few days before the move, with family members and friends visiting as normal; then you ease them in/shadow them for the first few days or week so they settle more easily and you can keep them in their green zone while letting the care staff gradually take over from you. It takes time but is supposed to make the transition easier for our loved ones.

Has anyone done it this way? I find it so hard to contemplate just leaving Dad there at the home with the care staff as I I know he will be very distressed by being out of his environment.
Helen

 

[Squibbs]

Hello Helen, I haven't heard of this before but it sounds like a good idea. We are moving my father from the local hospital where he has been for 4 weeks to a nursing home this morning so I'm feeling a bit worried about it. I dont think he now knows where he is or what is going on but yesterday we took some furniture, pictures, ornaments and photo's from his house and got everything organised in his new room to try and make it look familiar. We have decided it would be unwise to take him 'home' on the way. We intend to spend most of the day with him but I hate the thought of leaving him in a strange place. On the other hand he has told me (in a rare conversation that made sense) that he likes it in hospital because there are people helping him so maybe he will like the new place too. Good luck with whatever you decide to do. Sue

 

[Royalslady]

Hi Helen

I have read that book (after my Mum moved into her CH) and wish I had read it earlier. It doesn't work for everyone, but if you think the methods will suit your Dad, and the CH/NH can support you with it, then go for it!

I wish you well with everything.

Pat

 

[Skye]

Helen, I haven't read the book, but that technique of easing someone into a care home sounds good to me.

I did something similar with John. I had his room all ready with familiar things before the move. I went to the hospital when he was to be transferred, sat with him untilthey came for him, followed the ambulance to the home, and was there to welcome him at the other end. I spent most of the next few days with him.

I know others have done the same, and it does seem to help the sttling in process.

Some homes advocate leaving the person, and not visiting for a while, to get them to accept the new surroundings and staff, but that seems to me to be unnecessarily cruel.

Of course, if your dad did become very distressed, you might have to leave it too the staff to deal with, as you would become emotional too, whereas they could remain calm. But all being equal, if the home agrees, I'd say do it your way.

All the best,

 

[TinaT]

I too haven't read the book but instinctively did what you say the book tells you when moving my husband to his EMI nursing home.


I took my husband on several visits prior to his admission. We also had lunch there a few times. I increased the length of our stay each time we visited. I made sure we sat in every lounge and the dining room and tried to familiarise him with the layout of the place.


On the day he was admitted I stayed with him about 6 hours. I visted every day for a year afterwards and stayed with him for at least three hours. He is now into his second year there.

I spent a lot of time and energy getting him used to his new home. I put pictures up in his bedroom and also pictures in one of the lounges where he spent the most time. I have now reduced the time I am with him somewhat but still take him out on shopping trips etc as often as his condition allows.

I honestly can't say if this helped him. I'm sure in my heart it did but it was not easy either for him or me. My husband is considerably younger than your dad, the next generation down in fact, but most of the residents in his home are more or less your father's age.

Many of the residents become 'friends' in the lose sense of the word. They often sit together and talk to each other. I'm sure this helps. Sadly my husband has not made friends in this way, but he has never been a person who likes socialising. His 'best friend' is the manager of the care home. Rob is only a little bit younger than my husband. My husband spends many hours with Rob in the manager's office. I think he feels that he is 'at work' himself when he is with Rob. I also think it is important that you get to know the staff and observe how they interract with each other and with the residents. If you are happy with the care he receives, this will go a long way towards helping YOU to come to terms with the situation.

My way of doing this was just as much for myself as for my husband. It was the only way that I could come to terms with our situation and I needed to still be a 'hands on' carer as much as he needed me to be this.

Recently I have been curtailing my visits a little. He now knows where he is and the routine of the place. It will never be 'home' for him but over time I have come to realise that whether I am with him or not, he still has terrible anxiety and mental torment. That is because of his dementia and not because of where he is living or whether I am with him for long periods of time. The staff suggested that I do this and I am now comfortable in visiting for less time and not always every day.

It will be a great upset both for you and him and I can only say, go with what your heart tells you to do. If what you do is working for both him and you, then you know you are doing it 'right'. You are the one who knows your dad best.

xxTinaT

 

[connie]

If that's the SPECAL way, then a lot of us have done that without putting a name to it.

Certainly in our case Lionel even chose the home beforehand, and said 'this will do fine when the time is right' He was very much younger than your dad.

I think Tina says it all really:

go with what your heart tells you to do. If what you do is working for both him and you, then you know you are doing it 'right'. You are the one who knows your dad best.

 

[HelenMG]

Relief!

Dear all,
Thank you so much for your comments and shared experiences. This is what I wanted to hear. One brother and one sister, who are less involved with Dads care are a bit more in favour of not getting too involved for the first few weeks so he "settles" but my older sister and I who look after him more think that is too cruel. We see his distress at changes to routine more frequently then they.

My one concern is that if I bring him for a few short visits to start with he might get a notion and react to the home! which is lovely and bright and airy and with a big enclosed garden where he can walk to his hearts content if he wishes. The garden and freedom to walk is the big issue for us as he walks for hours every day and now someone has to be with him all the time as he goes a bit astray and is more feeble on the feet. I think in fact I will bring him there and go for a big walk around and around the garden with him.

The SPECAL method advocate not personalising the room too much to start with as it is "temporary" in the clients mind but I cant help feeling a few familier items to start with would help.

Has anyone experience of not telling their loved one that they are going into a care home (which is often a very negastive association for older people) but rather that its a hotel or B&B where we are "staying for a while until the roof is fixed" (my planned excuse)?

Many thanks again, this is such a great site for comfort and support. I had a great hour with dad this morning so I am more upbeat today!
Helen

 

[TinaT]

My husband has no idea that he won't be coming home to live again. For me it would be too cruel and like yourself, I had my own prepared, 'white lie' which was that he had been ill in hospital for a long time( he'd been on an assessment mental health ward) and that the doctors had said he needed some 'convalesance'.

In your case, your 'white lies' sound very appropriate and that is exactly what I would say. Once dad is in the home and any further questions are asked, I would improvise and say the roof now needed some more work or such like.

I think with this illness, the truth is just too unbearable and if I was in his shoes, I would rather be told a 'white lie'. Over time I would hope that as dad settles in, the memory of his former home would fade. If he is anything like my husband, he will not remember how long he has been in the home and the same excuse will do for a very long time.

Good luck and well done for preparing so thoroughly.

xxTinaT

 

[Skye]

John also was transferred directly from hospital, so he was there 'until he was a bit better'. Of course, that time never came.

If he had been admitted from home, I'd have made the excuse of repairs to the house too.

I personalised John's room before he moved in, I think it helped to have some of his favourite things there, also photos, and a CD player with his favourite music.

It's also helpful to the staff to do this, it gives them things to talk about with the resident -- never easy if they have little background info.

I'm sure your dad will be fine, you are doing everything right.

 

[Margarita]

The SPECAL method advocate not personalising the room too much to start with as it is "temporary" in the clients mind but I cant help feeling a few familier items to start with would help.

Has anyone experience of not telling their loved one that they are going into a care home (which is often a very negastive association for older people) but rather that its a hotel or B&B where we are "staying for a while until the roof is fixed" (my planned excuse)?

Has anyone experience of not telling their loved one that they are going into a care home (which is often a very negastive association for older people)

I have no experience of transition of my mother going into care home permanently, only for respite.

Where my mother is going to go permanently sometime this year.

I was told by a practitioner dementica nurse at the memory clinic.

To tell my mother she only they for a few weeks , then after the 2 weeks another 2 weeks so on from there .

The SPECAL method advocate not personalising the room too much to start with as it is "temporary" in the clients mind but I cant help feeling a few familier items to start with would help.

So that book has made a good point, as I was told by practitioner Demetria nurse it be to traumatic for my mother to know she be staying there permanently, could confuse my mother more.

Has dad ever had any respite care home before, while his been on this journey with his Dementia ?

 

[erik]

This would never work for my mother. She does not have any insight into her own condition and constantly says that "she's just feeling a bit under the weather" and that she'll be fine in day or two. She still thinks she pays the bills, does the shopping, the cooking, the cleaning, the laundry...

In her mind there is nothing wrong with her and telling her that she's going into a NH would upset her quit a lot.

When we have taken her to respite care (2 times) we have told her that her doctor has ordered the stay to sort out her medication and to see if they can find something better for her pain. That she accepts.

She is actually going in to a NH on May 6th. and I'm meeting with the manager of the NH this week to discuss various things: especially what we are going to tell her on the day. It will be easier for everyone (especially for my mother) if we stick to the usual story about staying for a while to adjust her medication. Then take it gradually from there.

Erik

 

[Margarita]

When we have taken her to respite care (2 times) we have told her that her doctor has ordered the stay to sort out her medication and to see if they can find something better for her pain. That she accepts

we have told her that her doctor has ordered the stay to sort out her medication and to see if they can find something better for her pain. That she accepts

I also have to come up with excuses like that with my mother to get her into respite, other wise mum not going, as mum also says there nothing wrong with her .

It will be easier for everyone (especially for my mother) if we stick to the usual story about staying for a while to adjust her medication. Then take it gradually from there.

Yes it will, as it be less distressing for your mother .

let us know how it all go on with the transition of your mother going into care home on the 6 May .