confused- EMI or nursing care

[kazza73]

At the recent meeting with mum's consultant to discuss discharge the consultant said that mum's dementia has now progressed to a point where her care need are primarily nursing care + said that we should be looking for a nursing bed but that there was no longer a need for it to be EMI.
The manager from our preferred home has been and assessed mum + she also believes they can meet mum's needs in the nursing unit of their home rather than the EMI side.
Yesterday mum's social worker rang us to say she has been in to visit mum again + that she thinks EMI nursing is what mum needs.
She seems very kind + genuine.
She is going to meet with the consultant +question what his reasons are for saying nursing rather than EMI + is going to get back to us.
She was also quite concerned that although mum clearly does not have capacity it does not state this anywhere in her notes. She wants this rectified.
Because dad doesn't have welfare POA ,+ she thinks applying for Guardianship is. Ridiculously expensive + a lengthy process, she is hoping with the consultant's agreement mum can be transfered to a new home under a Section 13.

So, we're back in limbo. Having thought we knew where mum was going to move to we are now unsure. Thank goodness we're in the fortunate position that the unit mum is in is no longer admitting patients so we're not under pressure to free up a bed at the moment. I'm also grateful that the social worker does seem to have mum's best interests at heart and she appears to know what she's talking about. She is also highly thought of by both the care home manager and senior nurses on mum's unit.

Hopefully we'll know more about what's happening after she's spoken to the consultant again.
Karen x

 

[Chemmy]

I'm also grateful that the social worker does seem to have mum's best interests at heart and she appears to know what she's talking about. She is also highly thought of by both the care home manager and senior nurses on mum's unit.

It's sounds as though your SW is a gem; I'd be happy to let her take the lead on this.

 

[grove]

Hello Kazza , Sorry not much advice partly as am not a real "Expert " in this type of thing & also as you live in Scotland what am going to say as you different rules in
Scotland ? ( to English Rules & Regs )

A very good Friend of mine is a "Head Carer " in a new type of "Care Home " & when New Residents have had their "Assement " if they "Score " a "Level 2 " or below they are ok to go but over a "Level 2 " they have to go into a E M I N Home . Sorry if this does not help or you even more etc & did mean to upset you .

Your S Worker sounds very good & has your Mum's best interest 's in mind all the time

Take Care & do hope the" problem " is sorted out soon

Love & Hugs Love Grove x x

 

[PurpleJay]

It is not very clear tbh.

Mum was assessed as requiring EMI nursing or Dementia nursing.

Homes who accept dementia patients have to be registered as such - however not all home which take dementia patients call themselves EMI homes.

General nursing homes which take dementia patients may choose to only take say mild to moderate while others take all levels.

EMI homes tend to take all levels of dementia.

I made a shortlist from the PCT list of those registered for mental health and a brochure from the social worker which detailed the ones registered for dementia. I then looked on the internet and finally started phoning round. I visited EMI and general nursing homes. Some places do residental dementia but only general nursing! I used to be pulling my hair out trying to make sense of it.

On visiting, EMI units tend to be more secure. For example they will have a lock on the door and alarms, they will have a lock on the first gate and the second - you get the idea. In my experience they tend to be more sparsely decorated and a bit more institutional but not all are like that. General nursing homes usually still have locked doors if they take people with dementia. The difference is more obvious in residential homes as EMI ones are very secure whereas in the others people come and go as they please.

The home mum is in does not describe itself as EMI but they do take all levels of dementia patients and I would say the majority of the residents are sufferers. Mum has severe dementia. When visiting homes I would tell them mum was confused, aggressive, aggitated, anxious, tearful, lashes out, refuses her meds, throws things and shouts for help or wants to go to the toilet all the time. At the time mum was in hospital receiving 1:1 care 24/7 because of her acute anxiety and high risk of falls.

If a home showed the slightest hesitation I crossed them off my list. If they said they couldn't get 1:1 care I crossed them off my list. If people were queuing in the corridor for toilets, if the staff seemed very harrassed and didn't smile and if the residents were told to sit down or were just sat around in a circle with no interaction, I crossed them off my list. I went to one where a man was lying across the bottom of his bed with the side rail up and his legs hanging over the bar, I crossed them off my list.

I found 3 where I would have been happy to send her. 1 called itself an EMI nursing home. 1 was a Dementia only nursing home (they had a separate floor for those with severe dementia or requiring palliative care but all their residents had dementia - they said EMI was an outdated term) and the other, the one she is in does everything - they have day care, residential, nursing and end of life care with or without dementia. They have 60+ residents in 3 wings - each with its own nursing station. The staff are pleasant and appear happy in their work. They are lovely with the residents. The manager will fight her corner with the pct and got mum 8 hours 1:1 initially which was increased to 18 hours for a time, currently 10 hours.

In choosing was largely about their approach to dementia, they spoke to the residents with kindness, they use crash mats and alarms - not bed rails and restraints, they ask the pct for what they need, they take an interest in a persons history and their medication.

Your social worker sounds brilliant, ask her about the home you like - are they registered for dementia, do they take severe dementia (I don't know what stage your mum is at but you probably don't want to have to move her again)? If the home thinks they can cope with your mum and know her history then they probably can. If your social worker tells you it isn't suitable, ask her why and then ask for a list of suitable homes so you can visit them. It is not so cut and dry as saying EMI and then looking at homes with EMI nursing home in the name (if only).

It may be that the consultant does not think your mum needs EMI because she does not need the added security bells and whistles they provide. If she is not particularly anxious or aggressive it may be that he feels an general nursing home can meet her needs - it tends to be their ability to cope with the challenging behaviour that makes the difference. It sounds to me like she will need a nursing home registered for dementia patents be this EMI or otherwise.

I hope this is some help. Good luck, it is a nightmare and very time consuming!

Jane x

 

[kazza73]

Thanks for that, very helpful. The home we like caters for all - it has a unit for young people with mental health issues, a secure 'memory lane' dementia unit, a residential unit + a nursing unit.
When we spoke to the consultant before he said mum's need was a nursing need as the dementia has progressed to the point where she no longer has any insight into her condition, her mobility has gone, her communication is largely gone + she is now reasonably content. He said he would say she needs very good nursing rather the psychiatric care. The manager of the preferred home seems to agree with him and feels they can meet mum's needs on the nursing floor.
A locked ward is not important as mum has no mobility so cannot go anywhere. The manager also feels that mum may be happier on the nursing floor as it is quieter than the dementia unit so she is less likely to be disturbed by other patients etc.

I guess we'll know more on Monday once the SW has spoken to the consultant.
Karen x

 

[Jancis]

Levels and quality of care

Hi Karen,

Good luck with your meeting on Monday.

I've tagged this thread so others might find it in the future as I think your last post in particular and Jane's very descriptive account of her experience really helps us to understand the complexity of dementia care and how difficult and confusing for the relative(s) looking for the best solution.

What is clear is that someone who has dementia of the kind that is non-passive will need specialist trained carers but some of the homes claiming they have this may in fact only have one or two specialists who are not always on duty.

And then there are the two different aspects of 'nursing care' - mental nursing care and physical nursing care. I still don't understand how this works in terms of registration. Does anyone else here on TP?
Best wishes,
Jancisx