1. jaws

    jaws Registered User

    May 8, 2007
    27
    Hi everyone,
    Quick overview - dad went into nursing home in November last year fully mobile and communicating. Broke his hip in December -no longer mobile and markedly more confused and depressed. He has lost 18lb in the last month - not eating or drinking well. I wonder if there is something physical going on too but he resists all interventions and wont allow blood to be taken. He's only a little man anyway and can't afford to lose more weight. When I went to see him yesterday, he had no dentures in and I found them by his bed - they were disgustingly dirty. He had a very gunky mouth and when I requested mouth care I was told he wouldn't let them do it. I cleaned his teeth and left them to soak. I asked for the stuff to clean his moth and they provided me with this and I managed to clean it a bit. Where does the fine line between accepting someones refusal and being forceful to ensure their wellbeing stand? Surely no-one will eat and drink with a mouthful of gunk!! I just don't want to turn into one of these over complaining relatives but want his welfare to come first. I feel so guilty that this deterioration has happened since he went into care.
    Thanks for listening and I would appreciate any comments or advice.
    XX
     
  2. Grannie G

    Grannie G Volunteer Moderator

    Apr 3, 2006
    69,884
    Kent
    This must be so upsetting to witness.

    When you asked about the way he was being cared for, was it an informal exchange? If so, can I suggest you make an appointment with the CH manager and ask to see your father`s care plan.

    I would also ask where the care begins and ends in respect of challenging or difficult behaviour and what policies they have for managing it.

    You need to know which came first, your father`s refusal of food or his lack of oral hygeine.

    I would also ask if they are happy with the level of care they are providing.

    I know they will say they cannot force him as it would constitute abuse, but does that mean they are willing to abandon all methods of trying.

    To lose 18lbs in a month is unacceptable, if the only cause is refusing to eat.
     
  3. jaws

    jaws Registered User

    May 8, 2007
    27
    Thanks. I do plan to speak to the matron or head of emi care. anything else I should ask? I'll take a list of questions/concerns with me.
    XX
     
  4. DeborahBlythe

    DeborahBlythe Registered User

    Dec 1, 2006
    9,222
    #4 DeborahBlythe, Feb 18, 2008
    Last edited: Feb 18, 2008
    Hello, you could ask them to monitor your dad's food and fluid intake, using daily monitoring charts. That way you can see what was offered and accepted and it will be a small step to ensuring that no-one is leaving the hydration and feeding to someone else as staff have to initial the relevant sections.

    You could also ask for a dietician to visit to suggest ways of encouraging him to eat. My mum was also referred to a speech therapist to check her swallowing reflex and is on a 'soft' diet, with some whole (but soft) vegetables and fruit. She is also on food supplements such as Calogen rcommended by the dietician. She has a passion now for sweet things which I tend to indulge. She particularly enjoys bananas mashed in cream with a spoonful of sugar stirred in.

    You might want to get a dentist in to check whether he has any gum infection and whether his dentures are the right fit for him. If he has any ulcers he may resist wearing the teeth.

    Staff often tell me that my mum won't wear her teeth but I can always get her to accept them without any special effort as long as the teeth themselves are moist and clean. I also give her a quick sip of fruit squash afterwards to take away any unfamiliar taste on the teeth.
     
  5. connie

    connie Registered User

    Mar 7, 2004
    9,519
    Frinton-on-Sea
    Hi, I can only speak from our experience of this.

    The oral hygiene can be a minefield. Lionel will not let anyone near his teeth. Eating well, (pureed food), drinking well from a feeder cup.

    Staff have not given up on his teeth, but certainly do not force/battle him over this. It is so hard to know what to do for the best.

    Do let us know how things go.
     
  6. Skye

    Skye Registered User

    Aug 29, 2006
    17,000
    SW Scotland
    Hi Jaws

    I agree with Connie, oral hygiene is very difficult. John has his own teeth, but sometimes will let either the carer or myself clean them, sometimes not.

    As he has a chest infection, he quite often has phlegm in his mouth and cannot spit. On the one occasion I tried to clear it manually, he bit my finger quite badly. And John is not an aggressive man, he just feels threatened when someone tries to put something in his mouth.

    But there is no excuse for not cleaning dentures, and I can understand your dad refusing to have foul-tasting ones in his mouth.

    You certainly need to ask to see the care plan, and discuss oral hygiene with the head of unit. I did this, and my point was that as John is prone to infections, any gum infection could affect him very badly.

    Good luck,
     
  7. DeborahBlythe

    DeborahBlythe Registered User

    Dec 1, 2006
    9,222
    Sorry, I didn't mean to sound like a Know-It-All. Connie and Hazel are right: oral hygiene is a minefield. And my mum feels threatened too when people try to put things in her mouth she doesn't like, especially treatment! She could qualify for 2012 Spitting Olympics. :)
    Battles are rarely fruitful, but a gentle approach can work wonders.
     
  8. connie

    connie Registered User

    Mar 7, 2004
    9,519
    Frinton-on-Sea
    Deborah, you did not sound like a know-it-all but, once again, every case is different.

    Eevn all the gentle cajoling in the world will not let you put a toothbrush in Lionel mouth most days. We had to take his partial dentures out when he hit a very poorly patch last year. They have never been replaced. Even the dentist cannot get him to accept them now.

    My point was that although it can seem like neglect - what do you want every day - a constant battle. I just need my lovely man to be clean, calm and comfortable.
     
  9. jaws

    jaws Registered User

    May 8, 2007
    27
    Thanks for all the support and comments/suggestions. All are gladly welcomed. Can't say enough how helpful this site is.:)
    XXX
     
  10. Margarita

    Margarita Registered User

    Feb 17, 2006
    10,824
    london
    #10 Margarita, Feb 18, 2008
    Last edited: Feb 18, 2008
    from my own experience I believed that when my mother first came to live with me , she was in late stages she also would not let me take her false teeth out of her mouth to brush them, because she was so confused with the change frustrated , that she had became so dependent on me .

    so I just left it , Now then I ask her for them and she gave them to me to bush , when she was not in the mood she say no , leave it its OK

    When the carer came in to wash mum they said " Isabelle you take your teeth out , try to wash them, while I stand near you" . She say " No you do it , while they say No , you have to do it

    she did it ! Now if the carer have not turn up , I say to my mother do you want me to brush your teeth and she give them to me .

    where the carer ask her to do it herself , because they don't want her to lose the skill of doing it for herself

    Your dad had a big change move , I just say give it time .

    If he lets you do as you said above , do it for him .

    May be his just got to get use to all the new people around him, may take longer them expected , then with the broken hip if could of set him back.
     
  11. Margarita

    Margarita Registered User

    Feb 17, 2006
    10,824
    london
    #11 Margarita, Feb 18, 2008
    Last edited: Feb 18, 2008
    PS


    Ask the care home do they ask him to take his teeth out then do it for himself , while they standing they

    Or do they ask him to take them out , they do it for him . so then your find out if still does not want to do it either way with them .

    if you don't ask your never know .
     
  12. Natashalou

    Natashalou Registered User

    Mar 22, 2007
    426
    london
    its dreadful when a relative refuses to be helped with personal care. My mother absolutly refuses to be assisted with washing. She insists she "manages" by using her washand basin and a sponge. She doesnt, and she smells. She has no sense of smell herself so she doesnt accept this.
    However I do know that all reasoning and persusion simply does not work. Therfore, care home staff have the stark choice of leaving her smelly or dragging her struggling, protesting and screaming into the bathroom where she will fight to the death and considering she is small and frail she can be remarkable resilient at resisting efforts to get her to do what she doesnt want to.
    Do I want her dirty and smelly?...no.
    Do I want her in a scrum fighting the staff with all the associated problems..no.
    Its really hopeless and I wish there was a magic solution!
     
  13. DeborahBlythe

    DeborahBlythe Registered User

    Dec 1, 2006
    9,222
    Thanks Connie, I know you are so right about every case being different.And I know too that I am lucky that the challenges I have been faced with in the last few months are not as difficult as those that many others including yourself deal with. Somehow things seem to be getting slightly better for me and my mum. I'm not exactly sure why, but she seems to feed a little better, has put on a little weight, looks more cheerful. Today, out of the blue, as I was wheeling her to her room around a corner of the corridor she said, spontaneously " Um die Ecke!" ; a little phrase that we used to exchange years ago, the German for " round the corner". For weeks I have used this phrase jokingly to reassure her that we were getting close to her room, but she never responded. I can't tell you how elated I was when she suddenly used the phrase herself today spontaneously and at the right part of the corridor. I nearly fell over.

    I suppose what I was trying to say is that rather than accuse carers of neglect and or abuse, it might be a good idea for Jaws to try a few strategies with the loved one to gain acceptance. And then to show the carers, because they may not have the time to persist or they may be agency staff who fly in and out.

    Of course you want Lionel clean, calm and comfortable. That's what we want for all of our loved ones. I don't know the half of what you deal with and I fully accept that each person with dementia is different. Lionel is so lucky to have your devotion. Kindest regards.
     
  14. Louise.D

    Louise.D Registered User

    Apr 13, 2007
    68
    Essex
    I had one hell of a battle with my mums home and teeth cleaning. Nearly everytime I saw her the teeth were in a bad condition. They claimed that she would not let them but i had no problems with brushing them for her and nor did certain carers at her home.

    I guess it's all about the way in which teeth brushing is handled and how well the carer knows the resident. I never asked or gave her the option just said 'It's time for teethbrushing/oral hygeine mum'

    Part of the CSCI recomendations is to maintain oral hygeine, this formed a part of my mums care home contract. When they failed I promptly reminded them.
     
  15. Margarita

    Margarita Registered User

    Feb 17, 2006
    10,824
    london

    I did not know it was part of CSCI recommendations , but it is also in my mother home care contract
     
  16. elaineo2

    elaineo2 Registered User

    Jul 6, 2007
    945
    leigh lancashire
    dental hygiene

    no disrespect is inteneded toward services users relatives in what i am about to say.I know servicee users desrerve the care outlined in their care plans.But please understand that carers are only allowed to perform tasks that the service user agrees to at the given time,thats why care palns are updated all the time
     
  17. jaws

    jaws Registered User

    May 8, 2007
    27
    Once again thanks for the support here.
    Deborah, I hope it doesn't sound like I am accusing care home staff of abuse or neglect - I guess it's myself I am accusing!! Throughout my whole life my Dad has always gone out of his way to help others and never abandoned me or our family and I feel I am abandoning him now. The guilt is tremendous and that's why I say I don't want to turn into a moaning guilt ridden relative. I read about relatives caring for their loved ones at home and I sallute and respect them. I visit him 6 out of 7 days most weeks but still beat myself up.
    Thanks for listening and keep the good work up. :)
    XXX
     
  18. jaws

    jaws Registered User

    May 8, 2007
    27
    PS
    Following your great suggestions a referral has been made to a dietician, a chart is being kept and thay have agreed to 'try' regular mouth care - I hope it eases his situation a little.
    Thanks.
     
  19. Grannie G

    Grannie G Volunteer Moderator

    Apr 3, 2006
    69,884
    Kent
    You are being so unfair on yourself. How can you be abandoning your father when you visit him so often and so regularly, and obviously are deeply concerned about his welfare.
    Just because he`s in residential care does not mean he has been abandoned.
    Your care has ensured the home will concentrate efforts to improve the care your father receives.
    Love xx
     
  20. Margarita

    Margarita Registered User

    Feb 17, 2006
    10,824
    london
    #20 Margarita, Feb 19, 2008
    Last edited: Feb 19, 2008


    No your just coming
    arose as caring loving person , and do not have to justifier yourself to anyone ( if you don't mind me saying ) . sounds like you got a good result from asking that question . keep on asking other question


    you have every right to challenge any services that you think that your father not getting , and every right to preserve it the way your want as abuse or neglect , we all new to this kind of caring and if you did not ask you would of never know .
     

Share This Page

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.