What does Duty of Care mean in practice?

[Heather777]

I went to visit my dad in his home on Thursday and I was shocked, he looked like a tramp they and brought in off the streets. It was 6.30 pm and he is clothes were covered in dried food, porridge, spaghetti etc. He had dried food on his face and he was asleep in the lounge (sleeping is common) I noticed that his trousers were coming down and were around his feet. As he had no slippers on I went to pull them up a bit and then noticed his trouser leg and socks was socked with urine, his catheter had slipped and he must of opened it when he was walking. He was seen by the district nurse last week as he has an infection in his foot-urine and infection not a good combination!

I asked a carer to sort him out but my dad refused there help. He can be very aggressive verbally and did actually hit me last weekend so I understand he is hard to manage. I told her that surely she had a duty of care to sort him out. She called another worker who also had a refusal from my dad so wouldn't do anything.

I feel so frustrated by what I can do-I sat there for an hour and no-one did anything, he walked around the dining room leaving wet footprints on the floor and no-one even cleared it up!

I have spoken to the duty manager today and all she says is that they back off when he aggressive. I just don't know what to do- I don't feel that they are meeting his needs but I am not sure what to do.

I have asked to look at his care plan next week and I am going to make an appointment to speak to his doctor as well.

Someone somewhere must know what the procedure is to deal with aggressive patients and meet their needs?

Heather

 

[Grannie G]

It sounds a very sorry state of affairs Heather and seems to have gone from one extreme to another. At one time people were put in straight jackets to protect them selves from themselves, and now they are allowed to be thoroughly neglected of hygiene and nurture.

I really do not know the answer but I do feel you are right to voice your concerns, preferably to the medics in charge of your father`s care. They are the ones who can tell you how your father should be treated and how leaving him in such a state can be avoided.

 

[Nebiroth]

You don't say what sort of care home it is. If it's not a nursing home or specialist EMI (Elderly Mentally Infirm), then it is doubtful whether the staff have the training or experience to deal with an aggressive resident.

Even if it is a home of this sort, then unfortunately, if the resident is not co-operative or becomes agressive then forcing help on them would legally be construed as abuse, and could also lead to actual violence.

It is a horrible dilemma, because obviously to see a loved one in that condition, also makes one think of abuse/neglect.

I think you're doing the right things - it sounds as though there needs to be a meeting with the gp/social worker/care home manager, to see how your dad's care needs can be met.

 

[Natashalou]

Terrible

this is a very sad story and Im sorry to hear it. Im afraid it mirrors the story with my mother..although she was in a home with a dementia unit, she became increasingly difficult and unco operative to the point of violence, which culminated in her being in effect thrown out, she is now in a mental health unit but wont be there for ever, Im already very worried about where she goes from there.
I dont think there ARE any easy solutions..staff do seem to be in a very difficult position if the client wont co operate with care

 

[Sandy]

Hi Heather,

Someone somewhere must know what the procedure is to deal with aggressive patients and meet their needs?

It must be very difficult to see your father in such as state, but it seems that is due to the nature of his condition rather than neglect on the home's part.

It's important to work out what things are unsightly (stained clothes) versus those that might constitute a risk to health.

From reading posts on TP, in cases where aggression does not respond to behavioural approaches, the use of drugs is the next option that is usually explored.

Most homes, even EMI nursing homes, may not have the type of staff trained to deal with the evaluation of new drug regimes, so this can mean admission to a mental health assessment unit.

Obviously, those types of changes carry risks and are usually only undertaken when there is a risk to the health and safety of the person themselves, other residents or staff.

I would mention your concerns to your father's consultant.

Take care,

 

[living in hope]

Hi
I am in a similar position with my husband, he is in an EMI home and has recently become verbally aggressive and has pushed two residents over, he is only just 60 so is quite strong and still very mobile. The staff are seeking help from many different sources to try to meet his needs, his medication has been changed twice to try and calm him down. The staff are not forcing him to eat when he refuses food and the other day he still had his pyjama top on and no socks and had not had a shave because he was being uncooperative with staff. I do worry that if he refuses food and medication it is going to make matters worst, but can understand them not wanting to put themselves at risk of aggression. No easy answers, but hopefully by care staff, medical staff and family working together we can get him into a more settled state.
love Lorraine

 

[milly123]

hi my husband has gone into a emi nursing home and is very aggressive it takes three or four carers to dress him many times i have gone and he has had food on his clothes but he does have clean clothes every day he is forgeting how to use a knife and fork and spoon i have seen this my self as some time i have been there at meal times so i can understand how his clothes get dirty and how distressing it is to change him but if someone is wet they are changed as soon as possible milly

 

[Grannie G]

Don`t they put disposable aprons on people at meal times any more?

 

[sad nell]

yes hazel they do at trevs home, i was not to happy yesterday though trev was wearing someone eles clothes , all other residents in there 80's so definatley not trevs style, half expected this little old gent to appear wearing trevs designer t shirt,ALL CLOTHES MARKED , so dont understand. he was in lounge obviousley been given lorazipam, dried food stuck in his beard, i just wanted to pick him up and bring him home, but i took him outside into the sun and he rallied a bit, but shall go to see him soon to keep my eye on situation, never been on a weekend before , seemed to be different. sorry did not intend to hijack anothers thread, just no stopping me when i start, sorry. hope you all have as nice a day as you can. love Pam

 

[Mrs Mop]

Heather

Heather I feel so sorry for you seeing your Dad like that. I think some nurses and carers are better than others at coaxing the elderly into taking their medication ,washing or eating. My husband is in an assessment ward in hospital just now and there are days when he refuses medication but some of the staff can jolly him into taking it.I find most of the nursing staff good especially the nursing assistants. I hope you get things sorted out.Your heart breaks for your loved one when you have a visit like that. Thinking of you.

 

[Sam Iam]

Hi Heather, hope this helps. X

Duty of care/code of conduct:

• Make the duty of care to and safety of patients our first concern, and act quickly to protect patients from risk.
• Respect the public, patients, service users, relatives, carers, NHS staff and partners in other agencies.
• Be honest and act with integrity at all times.
• Accept accountability for our own work, and ensure that we inform other appropriate persons within the organisation when problems occur.
• Demonstrate a commitment to team and partnership working by co-operating with colleagues within the NHS and in the wider community.
• Safeguard the health and safety of ourselves, colleagues and anyone else who may be affected by what we do or fail to do
• Help to continually develop the PCT through the generation of ideas at local and organisational level
• Create and maintain an environment free from harassment, victimisation and violence
2
• Work within the guidance of the race equality scheme to
o Eliminate unlawful racial discrimination
o Promote equality of opportunity
o Promote good relations between people of different racial groups.
• The PCT wishes to demonstrate its wider commitment to the promotion of equal opportunities and diversity and will further these aims through the
o Elimination of all discrimination
o Promotion of good relations between all people
o Implementation of best practice in all its policies to ensure that all staff are valued equally and their experience and skills are utilised to the best of their capacity.
4 PATIENT/SERVICE USER CARE
In ensuring that the best service is provided we must:
• Respect and protect patient confidentiality, adhering to the Caldicott principles and Data Protection Acts.
• Use NHS resources in the best interests of the public and patients, ensuring effective and efficient use of resources is achieved.
• Provide excellent patient care by being clear in our communications and proactively involving patients in their care
• Work towards health improvement through developing person centred planning ensuring that patients and service users are included in the development of their care and support and actively listened to regarding their needs.
5 DIGNITY AND RESPECT TOWARDS OTHERS
In working towards promoting good relations between all people, including different racial groups, it is essential that we show respect to each other and guard against any form of discrimination, intentional or otherwise.
To achieve this we must ensure that public, patients, service users, carers, colleagues and partners in other agencies are, as appropriate:
• Informed of issues, in a consistent manner appropriate to needs
• Listened to, and taken seriously
• Given an opportunity to be involved in decisions surrounding their care
• Participate in decision making, with the PCT respecting and valuing diverse opinion, to ensure that services provided reflect the needs of the local population.
The PCT will ensure, as far as it is able, that the environment is free of discrimination and that public, patients, service users, carers, colleagues and partners in other agencies are able to work or receive care in an atmosphere that is free from harassment, bullying, victimisation or intimidation.

As an NHS worker this is what is quite rightly asked of us, each region has their own but they are roughly the same, this one is Westminster's

 

[Kayla]

When my Mum was in the Nursing Home, all the domestic staff wore tabards and at every meal time, the nurses put navy blue tabards on the residents to keep them clean. No fuss was made about it, and as far as I knew, Mum never refused to wear a tabard at meal times. Whenever I went to see her, she always looked clean and her clothes were kept clean and tidy.

The other residents also looked well cared for and many of the nurses were especially trained in dementia care. In fact, the home had an EMI unit upstairs and it hosted EMI training courses.

Good professional training for staff, is probably the best way to promote well being for sufferers of dementia.

The nurses and carers also need help and support from management, to deal sensitively with difficult patients.

I know that staff can't force people to do things, but there must be ways to distract attention and modify bad behaviour into something more manageable.

Kayla

 

[Norman]

Hi SamIam,
I too have read the laid down standards of care whilst employed in the NHS.
They are what we all would like to see achieved.
I wonder how many people are aware of them or have read them?
I would not imagine that they operate out side the NHS,care homes,nursing homes etc
Norman

 

[Trying my best]

This is such a difficult issue - balancing a person's physical needs (ie hygiene) with their emotional/psychological needs (ie the massive distress/fear/anger they must be feeling to provoke this sort of response)... and ensuring that carers are not injured while attempting to help.

I personally think some things (food on clothes, not being dressed 'properly' etc) are really not the end of the world and we, as carers/family have to learn to live with them. It's simply not worth distressing your loved one so much, purely for the sake of rectifying a problem that they are totally unaware of and which will not harm them.

However, with things that pose a real risk (bodily fluids, loose belts etc) action does need to be taken.

My mum can be very agressive too (but before she became ill, you could not have met a more gentle, passive, co-operative soul). It usually only happens in relation to toileting and bathing issues. She shouts/screams, pushes/hits out, throws things, pulls hair, and has (thankfully unsuccessfully, thus far) tried to bite or strangle carers.

These reactions are particularly bad when she is with carers she does not know well - ie in the respite unit or when a new carer is introduced at home. Can you ask the care home to try having one or two 'special' carers to spend a bit of extra time attempting to build up trust with your dad? This has worked wonders with my mum at home. One particular carer is now able to bathe her every day or two, whereas she refused for weeks on end until this approached was introduced. Mum doesn't really know who the carer is, but she knows that she feels safe with her.

Good luck!

 

[Angela66]

This is a hard one and I still don't know what's for the best when it comes to this subject.

I too have witnessed my mum looking unclean and looking like a tramp some days. She is currently in an assessment ward and has been for the last four months now.

On a few visits now mum was particularly "smelly" due to her being doubly incontinent at that time. When I approached the staff and told them it was unacceptable their answer was "it is better to have mum being a bit smelly but calm than clean and distressed!"

Mum gets very distressed when having to have a wash, shower etc so the staff tell me they "dont like to push it" as they dont want mum to see being washed as a bad thing. I kind of understand where they are coming from but it still doesnt seem right.

I still have no idea where her clothes come from half the time ... she is quite often sitting in clothes that arent hers. Yesterday she had a white sparkly top on I know for a fact it wasnt mum's, I know every item of clothing mum owns and I am very particular when I bring her washing back and make sure its all hanging in her cupboard!! I know this seems trivial and she isnt the only patient but at the end of the day we all just want was best for our loved ones. Its hard enough leaving them in someone else's care

Take care all.



Angela x

 

[Sam Iam]

Hi Norman, I totaly agree with you.
I read them because I want to treat people the way I would want to be treated, more common sense than brains.
There should be training given to everyone on this as I myself worked beside people who would put patients with LD in the shower but never actually washed them Lazy or what?

Hi Angela, "smelly and calm verses clean and distressed" notreally an option, clean and distressed only lasts a while if you know how to distract a patient ( this involves asking family assistance in getting some back ground info) ie finding out if the person likes/liked music or even nice smellies in the bath/shower I have even sang a song or two with people who do not like a shower but hey if it works it makes your job easier and the patient cleaner.
Hope you get something sorted out.

 

[Vonny]

I have to say I think that the smelly v calm thing is a bit of a cop out.

Mum has ponged to high heaven for months now, though we have done our best to try to keep her clean. Since we got the hospital bed and have a carer coming in to help with personal care twice a day, we have learned how to clean her. Mum doesn't like being "rolled" and cries and makes a fuss, but it is very quick and she is now properly washed every day despite being immobile and bed bound. Since the new carers have come in she hasn't been at all whiffy.

I'm delighted to have learnt how to do this properly. Even at weekends when the carers don't come in, dad and I can give her a good wash. This is obviously not going to work with an aggressive person who is fully mobile, but it does show that with a little patience and training, it can be accomplished with no long-term anxiety to the sufferer.

Vonny xx

 

[JPG1]

Hi Sam,

I think you have hit the nut right on the head! If I may say so.

If anyone in a position of “CARE” cannot find a way to treat people placed in their care, in the way that they themselves would wish to be treated ... and it is basic COMMON SENSE ... then what’s the meaning of ‘care’?

And “smelly and calm v. clean and distressed”. A non-starter, really.

Turn it on its head, and call it “smelly and distressed” v. “clean and calm” scenario?

I know which I would prefer ... it’s the clean and calm, not the “smelly and HOW DO YOU KNOW HOW DISTRESSED I AM" or not. How do you really know? But, carer people, just work it out, and work out a way to get to know each and every individual person in your realm, and adapt your methods according to each of them.

Most of us would be able to say which of those two options might be preferable for us. And as you say, Sam, it just takes that ‘working out what works for each person’... and if we find it acceptable to keep saying that if you’ve met one person with dementia, then you’ve met just one person with dementia, then perhaps we should also be able to add

... and I may be a person-with-dementia and with care-needs of a kind that you haven’t met before, carer-world, in your close world, so shift your ...selves off your ... comfort zones and ... do what you would do if it were you here where I am.

But that’s a very difficult message to get across, to the world of careless care. Unless you are very very fortunate.

Thanks, Sam, I would like to perch on your perch! With permission, of course.
.

 

[Sam Iam]

Hey perch here beside me there is loads of space JPG1.

I would rather work a way to do things the right way for the patient, rather than have the guilt of failing them gnawing at my brain & heart.

 

[Heather777]

Thank you all for the various responses that you have given to me. I appreciate that you have given me good information and it has made me realise that perhaps regarding the dirty clothes I will need to bite my tongue. I need to pick my battles and know there are many ahead of me.

Having been the carer for me dad I know how violent he can get and I don't want the carers to be put at risk but I can't help thinking how would they feel if it was their parent looking like that? Surely in 2009 there must be a way of dealing with aggressive dementia suffers? Anyhow, I am going to learn to bite my tongue!!! but I need to practice this a bit.

I have told the home some of the things that I am not happy about. He now has an even worse infection on his foot-possible cellulitus and has a really bad eye infection. Tonight he fell down twice and for the FIRST time ever they called me to tell me. Normally I would go in and see the marks and then I would have to ask what has happened. Perhaps they are going to keep me more informed?

I do appreciate having this forum to air my issues, I'm still really grieving for my mum and feel that it is hard to really understand how I can support my dad at this time without much energy.
Heather