Right, I am back. We have been looking through the box of things I have saved from when M (now 6) was a baby
Scan pictures, silver spoon, first shoes, name tag from hospital, etc. One little miss book and he is now snuggling down. He seems to have an off switch for 9pm!
Mum's DST took place in hospital. She had been diagnosed with vascular dementia and started on medication to assist with her mood, anxiety, behaviour etc. When they decided she was ready for discharge, the hospital filled out quite a long form about mum and made a referral to Social Services (now Adult Care in this area - not sure about everywhere else). They allocated a social worker who came out to see her and she was also seen by a mental health worker. and a multi disciplinary meeting was set up. I should mention that because of her repeated demands to leave - mum had been seen by DoLS (deprivation of liberties safeguarding) who had assessed it was in her best interests to keep her in hospital and in addition, because of her falls in hospital and her shouting, anxiety and and trying to get up despite being unable to walk, mum had 1:1 care in hospital 24/7 in a side room. While the DST was being set up, mum became ill again with the stricture so at the time of the assessment she was very poorly. She did pick up again before being discharged to the care home in Nov 2011.
The DST assessment was led by a Sister. Also in attendance was the social worker, mental health nurse, staff nurse and me.
Mum scored as follows:-
1. Behaviour - Severe
Risk to others including aggressive behaviour, throwing things, scratching/pinching. Risk to herself included trying to get out of bed, climb over the bars, get out of the chair etc.
She would probably score the same now. She no longer tries to get up as she is mostly immobile but she is frequently aggressive and violent especially when staff give personal care or medication. In between she is relatively calm. She does sometimes pull her skin and scratches causing bruising.
2. Cognition - Severe
Mum didn't always know where she was, she would constantly ask to go to the toilet and not believe she had just been, she did not understand why she had to be in hospital, thought she could manage or I could/should. Sometimes she would not know she was in hospital asking me to get things from another room. She would accuse people of stealing things, or loosing things. She didn't remember any of her falls and thought I/we were making it up and everyone was being horrible. She accused staff of feeding her dinner for breakfast but it was just that she had no concept of time. She would say where had I been, why hadn't I been all week when I visited every day. She would constantly badger staff about where I was.
Mums cognition has deteriorated. She doesn't know where she is, sometimes a hospital, sometimes a lodging house. She looks mostly puzzled on days when she is more 'with it'. She does not remember things in her recent or even distant past. She talks about my dad and other relatives including her mum as though they are alive. Luckily she still recognises me, M and her sister and is pleased to see us.
3. Psychological and emotional needs - Moderate
Mum had some hallucinations and was very anxious and often tearful. She did sometimes respond to reassurance but often not. I recall the team at the meeting were keen not to put severe if that wasn't accurate as much of mums issues were caused by her cognition and she was also on medication to stabilse her mood and relieve anxiety. We discussed at length whether she might be considered severe but the didn't want to be seen to be overstating things. I can't say I fully understood ths one tbh.
She would probably score the same now. She verbalises less but can be 'distant' like she is dreaming while awake and I wonder where she has 'gone'. She can be anxious or tearful but much less than before. Now though she shows little involvement in where she is. She has no input or interest in her daily activities at all.
4. Communication - Low
At this time, mum was mostly able to communicate her needs although she wore hearing aids and because of her confusion, time needed to be taken to ensure she was following you. Sometimes she was unresponsive but this was infrequent at that time.
I think she would score severe on this now. Sometimes she communicates but this has become less and less and she cannot reliably communicate her needs.
5. Mobility - High
This score was mostly due to her being at high risk of falls. She was unable to walk more than a few steps and required 1 or 2 to transfer from bed to chair or chair to toilet. She was able to stand and mostly co-operative.
She would score severe on this now as she is mostly immobile and requires hoisting and 2 hourly turns.
6. Nutrition, food and drink - High
Dysphasia (SALT assessed). Was on soft food and thickened fluids at time of assessment and was being fed or assisted with meals depending on her energy/mood. She had significant weight loss and there was also the issues with the stricture which required close monitoring.
She would score the same now. She is on puree and stage 2 fluids. She has high cal nutritional supplement and eats reasonably well for someone in her condition but continues to steadily loose weight. She is very under weight now
7. Continence - Moderate
At time of assessment she was doubly incontinent. She was not catheterised hence
the score although she had had a number of uti's and been catheterised on and off since admission.
She would probably score the same now. She is doubly incontinent and no longer asks for the toilet. She appears unaware of her bodily functions. Staff have to check her regularly. She is not catheterised and we have tried to avoid this if at all possible as we found it makes the uti's more severe and her more poorly.
8. Skin - Moderate
At the time, mum was at risk of skin breakdown due to her weight loss.
She would score the same now although she does have some pressure damage which are responding to treatment. She is on 2 hourly turns and has afternoon bed rest so that she is not sitting for so long in the chair. She has an air flow mattress.
9. Breathing - Low
This is the one area mum seems ok, apart from the occasional chest infection. She used to get breathless when walking but this was the exertion or when anxious.
She would score the same. She does become anxious particularly on interventions and this may make her breathless (along with the effort of squeezing someones arm/hand)!
10. Drug therapies and medication - Severe
This was mostly due to her refusal of medication and also that some drugs needed to be given as and when to help with her mood/behaviour. She often refused meds in hospital and needed cajoling/persuading to take them.
She is the same now so would score the same. She takes them but makes a right old fuss. There is a covert medication plan in place. Most of her meds are now liquid which makes them easier to swallow but there are a lot of spoonfuls and it takes ages. She really hates it and as she doesn't understand why she needs them it is understandable and heartbreaking. Her meds are steady at present (no as and when) but regularly monitored by care home staff/nurse clinician/GP/Psychiatrist.
11. Altered states of consciousness - Low
Not sure about this one.
She does drift off sometimes now as described above where she doesn't appear to hear you or see you at all. These episodes are short. Other times she can be very sleepy and really unable to respond. It is hard to know if she hears you or not. She is not at risk though during these episodes being immobile.
12. Other significant care needs to be taken into account - here it was noted that she had a lesion on her lung which may or may not by malignant. She has no symptoms so there was no need to investigate further. Any treatment would be palliative should this develop.
The situation remains the same.
The MDT recommended that mum be granted CHC funding and it went to the panel, who referred it on to the mental health panel. The funding was approved.
Shortly after she moved to the home, she had 18 hours 1:1 care which was reduced to 10 hours and then stopped as she began sleeping at night and became more settled.
It has been an interesting hour or two looking back and seeing how things differ now from this time last year. There have been many ups and downs in between but she has clearly deteriorated bless her. Each time she has us worried though she seems to pick up again, although never quite so much as the last time.
Sorry this is a bit of an essay (I tend to do that). I hope it helps some to understand the assessment process.
