1. amberence

    amberence Registered User

    Mar 15, 2008
    28
    Barton upon Humber
    This is no way a criticism of the care home step-father at or any in fact as realise they have a job to do but have noticed the amount of paperwork carers always seems to be doing and attending with over say attending to residents in their care.

    Residents majority of cases seem happy and the carers do a wonderful job with them seeing to their needs but they do always seem when visit to be immersed in paper work (filling out care plans, diet sheets, residents activites done in a day) when I think be more benficial to the residents if more hands on with them then putting their resources into a constantly filling and updating care plans which have to be done to meet various SS and Local Health Authority requirements.

    Just an observation made while visiting the care home step-father at which do like and happy with but feel a little more time could be given to residents, especially those who don't receive many or no visitors at all rather than carers having to spend precious time on care plans and sheets, etc.

    Keith.
     
  2. Brucie

    Brucie Registered User

    Jan 31, 2004
    12,413
    near London
    Hi Keith

    I agree this happens, but the homes have no choice since they are expected to keep the records, which are used in inspections, and also as a means of handover when the shifts change.

    They prove useful for people like me to run through as well.

    Yesterday I made a special check and found that everything I had said to the manager on Tuesday had been entered in my Jan's care plan, and there were full details of the dreadful burning of her face when they left her outside. So I was able to check doctor's records, staff records on what they were doing and when, for her.

    In Jan's home most of the residents are well advanced in their dementia, so require relatively little hands-on care minute-by-minute, other than feeding, toileting, engaging in conversation etc. Those who can, walk about, those who can't always have staff nearby to tend to them, and it is relatively easy to organise completion of peperwork in between other tasks.
     
  3. amberence

    amberence Registered User

    Mar 15, 2008
    28
    Barton upon Humber
    Hi Bruce. Did say had no fault or criticism with the carers or the way my step-father cared for but wondered is the really a need for carers to involved in doing paper work rather than caring in itself but with the reply given, do understand now why required.

    Some of the residents have such severe dementia unable to be involved in any of the care home's activites or make any type of conversation and always acarers on hand to carry out and tend to their basic caring needs.

    Some residents though haven't dementia at all and in the home because its local and nearby and be nice sometimes see a carer involved with them one-to-one than busy with care plans ... that was my point trying to make.

    What I will say my step-father gets well looked after, better than I could do if at home and is happy and ease with himself these days.

    Keith.
     
  4. jc141265

    jc141265 Registered User

    Sep 16, 2005
    836
    Australia
    #4 jc141265, May 13, 2008
    Last edited: May 13, 2008
    Just a note: This doesn't seem to happen so much in Australia, at least not where my Dad stayed...
    The RN (resident nurse) used to appear to be doing a lot of paperwork, but the other staff (the majority) used to just be involved in the hands on caring...so I think Keith has a relevant criticism...though no doubt there are restrictions depending upon the legislation in place in your own areas.
    Dad's file never used to be updated very regularly at all, and what was in it was a load of wasted paper anyways, I could have written it for them and argued with them about most of their observations.
    Good on you Keith for bringing the topic up, because frankly I think the systems should always be examined and ways to improve it considered. How else would improvements occur. The home my Dad was in had a suggstions form you could fill in, if you had ideas for any improvements, perhaps anyone feeling the way Keith does could write a letter, and like Keith point out that they aren't criticising, just wondering if something could be done, to perhaps get one person dedicated to paperwork, to free others up or other such suggestions. I know that the staff used to put all the patients in Dad's ward to bed awfully early, surely a lot of paperwork could be done during the night when carers weren't so busy?
     
  5. Tender Face

    Tender Face Account Closed

    Mar 14, 2006
    5,379
    NW England
    Keith, I am entirely in agreement with you ...... in my very limited knowledge of care homes I have only ever wanted to see carers/nurses with mum or anyone else NOT in the 'office' ....... I have been forced into doing some homework to look at alternative care for mum and to be honest my first priority was to find somewhere with an 'army of ants' type staff marauding around the residents dealing directly with their needs - just a little bit of conversation or any other appropriate stimulation wouldn't have gone amiss ..... (don't worry - I've had a very quick bang down to earth reality check in the last week or so!:rolleyes:) ........ I know paperwork is a prerequisite of any type of health or social care these days (trying to bury my cynicism that is more about staff and organisations 'covering their backs' in case something goes wrong than for the purposes of the person needing the care) - but agree - it could be managed far better ......

    I despair both professionally and personally that too much professionals' time is taken up in administrative tasks .... and that is absolutely not to belittle administrators - they have their specialist skills (include myself as one of them with specialist knowledge in my own field) ......

    If we have managed Chip and Pin Technology at the 'Point of Sale' for the masses - why do we not have online recording at the Point of Care? (the beginnings of which I have evidenced in hospital just today?) ... digital recording to allow for non-urgent recording to be transcribed at any convenient point by someone trained in transcription, not nursing care? The list is probably endless .......

    My gut feel is that Care Homes - as business enterprises (and that's where we have to get to the 'core') would shudder at the prospect that that type of invesment in IT solutions and the associated training, let alone set-up costs, might bring ...... We also have to look to the future 'carers' who have been brought up in ICT classes and not handwriting clubs ... there may be more chance of Care Plans etc being appropriately updated if Care Homes were to move this way ......... ?

    Great thinking .... Karen, x
     
  6. Skye

    Skye Registered User

    Aug 29, 2006
    17,000
    SW Scotland
    I have to say I'm with Bruce here.

    I value the fact that John's care plan is there for me to inspect whenever I want, and every detail of his care is documented. I imagine this also provides protection for the staff, with people being encouraged to sue over any accident.

    I have to say, though, that it doesn't stop the staff doing their job. There is always at least one carer supervising the lounge while others are busy elsewhere. Towards the end of each shift, that carer will have a pile of folders in front of her, making sure thay're all up to date. The staff nurses only update the medical content.

    It wouldn't work to leave it to night shift, how would they know what had happened during the day? The files have to be updated at every shift change, and more frequently if the situation changes.

    Karen, I'm not sure digital recording would help either. I don't think it would be any quicker, and it would be easier to 'forget'. There's nothing like a row of folders staring at you to focus the mind!

    I know hospitals are going over to digital recording, but this is so that information is available to all departments, and to GPs.
     
  7. Tender Face

    Tender Face Account Closed

    Mar 14, 2006
    5,379
    NW England
    I confessed to be cynical earlier ... and will go further ..... those whose loved ones are NOT in care homes with the same levels and care of recording that others obviously have here ...... would surely consider any means to even get paperwork completed .... with quill pens if necessary ..... :mad: ....and know someone had actually taken notice of anything and bothered to record anything by any means ....:mad:

    If there is a means to improving recording in homes that don't meet the standards other find here ...... then surely it should be looked at? - Until we drag every care home 'up by the boot-laces' .......

    Karen, :confused:
     
  8. mica123

    mica123 Registered User

    Apr 30, 2008
    47
    england
    I'm sorry that families with loved ones in care feel this way.as a carer in a home i can only reiterate previous posts,the paperwork is never ending,care plan updates,accident records,daily progress records,fluid intake and elimination records,weight charts!all of which are essential to maintain a residents progress.I personally blame the government and CSCI,for their ratio of staff to residents,especially in a home with residential needs,nursing needs and emi needs.The home i work in has all 3 criteria,registeed residential!government again,relaxing assessment criteria so they don't have to fund emi units.had a rant now.thanks
     
  9. lesmisralbles

    lesmisralbles Account Closed

    Nov 23, 2007
    5,543
    Mica123

    Rant away. Would be good to hear anything from your point of view.
    Barb & Ron
     
  10. christine_batch

    christine_batch Registered User

    Jul 31, 2007
    3,388
    Buckinghamshire
    Although my husband is in a Care Home and in the E.M.I. Unit and final stages.
    For the 4 years of caring for my husband as a disabled person, I would much rather my husband was here with me on a daily basis.
    Christine
     
  11. Natashalou

    Natashalou Registered User

    Mar 22, 2007
    426
    london
    I personally wish the record keeping in my mums home was better. It used to be fair but now it seems chaotic, records cant be found, and sometimes seem to have been hastily filled in for several days retrospectivly.
    I wish there were more efforts to involve young people eg work experience in spending quailty time with residents but I guess there would be CRB and safety issues.
     
  12. Margaret W

    Margaret W Registered User

    Apr 28, 2007
    3,725
    North Derbyshire
    Now I will throw a spanner in the works. As a University lecturer spending more and more of my time on recording stuff rather than lecturing, I personally don't give a Monkeys what records are kept about my mum providing she has kind and gentle staff looking after her, and the doctor is called when needed. I don't care at all about seeing her Care Plan if mum is happy and well loked after. I'd rather the staff spent time talking to my mum than filling out forms.

    Exception Reporting might be appropriate here. Staff only need to record when something happens which is not according to plan, e.g. no bath this week, resident unwell.

    Too much time is spent on paperwork in EVERY walk of life. Give the carers more time to CARE. That is what it is about. If we had our relatives living with us at home, and had to fill in all those forms and reports, wouldn't we just SCREAM with frustration?

    Margaret
     
  13. jc141265

    jc141265 Registered User

    Sep 16, 2005
    836
    Australia
    #13 jc141265, May 15, 2008
    Last edited: May 15, 2008
    Here here Margaret!:D
    I second that.
    Now I am going to be inexcusably cynical:
    I don't know any documentation that was kept on Dad that was ever very useful. Most of the time what documentation was in existence was put there to restrict his freedoms:
    Main Documentation:
    * Tom choked once, never feed him anything but mush again.
    * Tom had a fall, he should not be allowed to walk as we can't have carers hurting their backs if he should fall again.
    * Tom has been angry, up dosage on anti-psychotics so he can make like a vegetable and not cause us any more trouble even though he was probably justified in being angry cos we leave him sit for hours in soiled pants.
    * Tom has had a fever on and off for weeks we keep giving him painkillers (but didn't bother to get the infection properly investigated) - oops they left that last bit out...
    Care Plan Updates??
    Bit like work performance plans, where you write down all this airy fairy stuff that you say you want to do, but never really get round to cos work needs to get done, then when end of year comes round and you get reviewed you manage to somehow make it sound like you did something worthwhile. In Dad's case, they never really could come up with much of a plan, really didn't know what to write when their patient couldn't talk and didn't really interact with others. I would have liked to see a care plan that said something like:
    * Talk to Tom even though he doesn't talk back because the human interaction is nonetheless good for him.
    * Smile and joke with Tom for the same reasons.
    * Ask Tom how he is, even though he probably won't respond cos deep down inside he will possibly recognise that you care.
    * Encourage Tom to interact with you.
    * Put the tv on for Tom so he has something interesting to watch and listen to instead of only crazy talking and moans of despair.
    * Compliment Tom.
    * Encourage Tom to use his hands.
    But even when such a care plan is in place just because it is written doesn't necessarily mean it is being done...
    Daily progress records??
    Aren't we generally dealing with regress here? Or does 'progress' refer to the progress of the disease? And as I said above each time a regression or incident occurred that record just sat in place to ensure Dad never improved or was given the chance to. There was always a certain amount of doomsdayism in his treatment, an attitude that things we just going to get worse so why fight it? I wish that they could have tried to have an attitude that he ain't dead yet, so lets encourage living as much as possible even if that may seem foolish and illogical.
    If they have a standard operating procedure in place,i.e. follow medication regime specified by doctor, bathe patient, involve the patient in activities, put patient to bed, feed patient recommended diet, toilet patients according to schedule or when needed, ensure patients are given fluids # times a day, what is there to record other than exceptions?
    As for carers having to record all these things and more, I have to say I thought homes here in Australia were understaffed but its sounds like its far worse in the UK. In Dad's home there were delegated staff to do that sort of work. The carers just had to take Dad to the delegated staff member to record such things or that staff member came to him.
    I know that being able to check records can be comforting, but what good is it to me to read about it other than so that I can say to myself, phew at least they know what they should be doing and someone is ticking off that they are doing it, even though I don't really know if they are doing it as well as they should be because geez Dad's looking worse and worse...In fact documentation in this situation disempowers us as so long as it was written down I could not claim that my father was not being cared for in the best way possible. It also didn't escape my attention that the most documentation occurred as a reaction to an incident that never should have occurred if caring had of been being performed as it should be.

    Often when the staff had documented that an incident had occurred with Dad, the next shift didn't read it anyways. His care plan did nothing for him, he lost the ability to feed himself, he lost the ability to say any words, he lost the ability to stand by himself and of course the home can say well we tried its there in writing, and unfortunately this is just a natural progression of the disease... But now Dad's living at home, he's walking, he's started to say words again, and he's starting to use his hands again. The fact is that one thing can be written but the act written about may not exactly be delivered with the 'care' one would expect given the documentation. How can it be, when all this time is being devoted to writing about it??

    Do we document all this stuff when we care for our loved ones at home? No, and thats because the documentation is there not to ensure that the person is cared for but to ensure that the home can cover themselves when things go wrong. Unfortunately for that reason it is a necessary evil but that doesn't mean we shouldn't be upset if we feel that the actual hands on care is becoming a second priority. That we feel that the homes need more staff, that we feel that the governments need to provide more funding. Afterall we're next in line, one day it will be us that's sitting in the home, and I know for one, that I'd be wanting someone to change my dirty pants that I've been sitting in rather than write about how my incontinence has evidenced itself 5 times today!
     
  14. Skye

    Skye Registered User

    Aug 29, 2006
    17,000
    SW Scotland
    Hi Nat.


    Yes, I'm afraid it does come across like that.

    I know you had a bad experience with a care home, and took your dad out. Karen too had a bad experience. But I don't think that justifies your broad generalisation.

    For one thing, you are in Australia, and from what you and Taffy have posted, staffing is in fact much lower there, not higher.

    This has certainly not been my experience. John's documentation has all been positive, and any recommendations have been made to try to ensure his safety.

    Don't think so, Nat. I spend enough time in John's home to know that all your recommendations are carried ou, not just for John, but for the many residents who have no regular visitors.
    Not so!

    It also means that if something is written into John's care plan, and it doesn't happen, I have grounds for complaint! I certainly don't feel disempowered.

    John's home operates a 'report' system at each shift change, as happens in hospital, so nothing is missed.

    I know you were very unhappy with your dad's care, and are doing a marvellous job of caring for him. But not all of us are in a position to do that, and it doesn't help to read such negative, judgemental posts.

    We know there are bad homes, but there are also good ones, and by being selective, and finding the best possible care for our loved ones, we can hopefully pressurise the poor ones to improve.

    Money talks!
     
  15. jc141265

    jc141265 Registered User

    Sep 16, 2005
    836
    Australia
    Let me clarify...

    A. It wasn't a bad care home it is considered the best in our city. Money didn't talk in our case.
    B. My experience of homes isn't limited my 102 year old grandmother lives in a different home, she has been in 2 other homes as well.My father also went into different homes for respite.I used to also visit my friend's mother in another home.My other good friend regularly discusses the home her father is in with me. On a daily basis for three years I sat in a room full of people not reciving the care that they deserve despite being in the best place money could buy. Shall I also point out the many many 'incidents' and despairing posts about care homes I have read on here, this experience is not just limited to myself or my father.....guess the response is just that they just must all be bad homes and one off incidents? And in that case, I think I have a right to vent here on mine and others behalf?
    C. How do we know for certain what the staffing levels are? I agree Australian homes are still understaffed, but at least they seem to be getting one thing right and delegating the documentation duties away from the carers. Is it inappropriate for me to suggest that this is a good idea? I was at least attempting to be understanding of UK homes by giving them the excuse that they are under-staffed.
    D. My post was not negative and judgemental, it was a positive :D call to arms. I have agreed again and again that there is not one specific person or institution to blame, it was an observation and keeping quiet when things are bad does not improve situations especially when the root of the problem is not an evil thing but something the people just let slide. I believe that readers on here are adult and can either take an opinion or leave it.
    E. How do we know when something in a care plan or documentation doesn't occur? I think that that is a relevant question and people should be thinking about it. I know it was even harder with my father because he had no means of telling us, but likewise the other 30inmates in his section had no sane voice...How many times do we roll our eyes when our loved one tells us crazy stuff? I remember reading a review report of the home Dad was in and in it the reviewers stated that they talked to residents to discuss how they were being cared for and from that they concluded it was good care. How the hey did they talk to the many like Dad, did they take the crazy lady seriously when she said aliens came in at night? Or are you only guaranteed good care if you can talk and aren't know for being a bit nuts?
    My post is said to be a broad generalisation and based on limited experience but I believe I was rather specific in relating it to my father, so it should have been clear that I was unhappy with his experience and those that I know of. My experience of this disease is 11yrs and counting.

    How can they improve if we are taking the money out of them? And what about all the people who can't afford or don't have the time to be selective? These people need to be able to express their dismay, and not be shot down for doing so.
    As for my family caring for Dad at home, did I say at anytime that homes should not be used? What relevance does that have? Except to portray me as a lucky outsider, not one of the gang? I lived the 'home' experience, I lived the frustrations, and it would have been a great relief for me to have someone post their rant so that I didn't have to feel alone in the misery that it was. I wouldn't have been upset by such a post, it would have given me more energy to demand more of the home, in what is a very disempowering position if you don't have the time, money or legal know how to fight against.
    Everyone please feel free to post your thoughts, what one person sees as negative another takes great comfort from.
     
  16. daughter

    daughter Registered User

    Mar 16, 2005
    824
    #16 daughter, May 16, 2008
    Last edited: May 16, 2008
    A personal positive recent experience

    Just a week ago I would have said that all Care Homes are not very pleasant places in my limited experience, with tired decor, unhappy staff etc.

    Since then..

    Last week we were visited in Mum's own home by the Manager of a Care Home where Mum is soon to spend a week - what a nice, happy, friendly man. He took detailed notes about Mum and she was happy with the attention. A few days later we visited the Home unannounced, and to say we were pleasantly surprised is an understatement. No obvious "smells" as we walked round, bright decor and a clean 'feel' to the place. We saw the Manager as we walked in and he recognised us and warmly greeted Mum.

    We were shown around the whole of the Home. I lost count, but there are about four or five separate smallish lounges (not all chairs on the outside of a huge room), some appeared quiet while others had quite a few people in. There are people of all kinds of ability mixed in together, including those with dementia (Dad's Home had separate units). In the dining room a number of residents were around a table baking cookies with one of the two entertainments people. The bedrooms are all large, tidy but with personal belongings, they are redecorated before anyone new moves in and one was in the process of being done. The bathrooms were spacious too, there are also a couple of shower rooms.

    Someone on a previous Care Home thread mentioned about a list of the kinds of things we'd like to see in Care Homes. All those things would be a major part of my list!

    Needless to say our jaws were on the floor - we could find no fault! I did not believe it was possible. To actually walk around Care Home and not feel a sense of doom was so good. This is the standard to which they should all be aiming - and should be the norm!

    This is all said before we have had first hand experience of Mum staying there of course, we have no real knowledge of the regime, staff levels, nor how the Staff will behave towards Mum, (**) but I hope this continues to be positive for us and I will let you know how it goes.

    A comparison: After over thirty years, my Mum and Dad moved away from Outer London to the suburbs, a move they might have felt they were pushed into by social changes around them, but when they started living in their bungalow they felt like they were on holiday, it was something quite different, but very pleasant, and it very soon turned into their comfortable familiar home (until Dad got AD, but that's another story).

    That's what I believe Care Homes should feel like - a place that perhaps people would not be in by choice, but is made to feel like the residents are on holiday, in a hotel, and ultimately in a comfortable Home from home. I hope all those desperately looking for one at the moment finds such a Home. x

    (**) P.S. Nor the amount of paperwork and its relevance to Mum's actual care.
     
  17. Skye

    Skye Registered User

    Aug 29, 2006
    17,000
    SW Scotland
    Hi Hazel

    Thanks for such a positive post.

    So many of us have similar experiences, and it's a shame if people are frightened off by the negative ones.

    Of course, the negative ones need to be posted too, both as a vent for the carer, and as an awful warning as to what can go wrong.

    As you say, your mum isn't there yet, and undoubtedly things will go wrong as you all get to know each other. But I hope for you and your mum it will be a happy experience for you both.

    Beautifully put!:)

    But we just have to remember that even in the best hotel, on the best holiday, there will be niggles and irritations. Because it never is actually home!

    All the very best to you and your mum,

    Love,
     
  18. TinaT

    TinaT Registered User

    Sep 27, 2006
    7,095
    Bolton
    I echo the above post. My husband is in a CH and I can't tell you the relief and change it has made, not only for him, but for me as his carer. I know that his needs are being met by friendly, caring staff and he is safe and well taken care of. There are niggles and minor irritations but they pale into insignificance when I count out the good things which the home offers. Keep in touch and let us know how the move goes.

    Best wishes TinaT
     
  19. merlin

    merlin Registered User

    Aug 2, 2006
    139
    Surrey
    Dear All

    Havn't been on line for a bit as I seem to run out of time at the end of each day(probably due to spending 4/5hrs at the CH). Fascinating to hear both sides the story. The carers at the care home my wife is in also seems to spend a lot of time writing but I have no complaint about the caring and when I make a suggestion to improve a situation it has usually been implemented . I have glanced through some of my wife's documentation but will have a more thorough look after reading this thread.

    I also have suggested more use of IT at a residents meeting but would treat the use of commputers with caution as as much time can be wasted in front of the screen as with writing longhand. I do however put the monthly readings for blood pressure, weight and pulse rate into graphical form which certainly helps me if not the home! Voice transcription however would be a huge leap forward but is that feasible yet for an application to a CH?

    One interestig point that did come to light when inspecting the documentation was when reading the doctors notes which were at the home, all the information from 2 years refferal to the Memory Clinic were missing, turns out she had been discharged back to her GP with no diagnosis and no results of from the many tests carried out. I know the notes exist but still havn't got them but am dealing with the matter through the Patients Affairs Officer. So one good thing came from the CH documentation

    Merlin
     
  20. Taffy

    Taffy Registered User

    Apr 15, 2007
    1,314
    My mum is in a Dementia Specific Hostel (Australia) and has being for twelve months the staffing ratio is one carer to fifteen residents with the exception of the fifteen residents with severe dementia who have two carers. Management did for sometime try to run this ward with one carer and a rover they couldn't cope....so now two carers look after this ward.

    Management however reduced the night staff.... there are four wings bearing in mind all Dementia Specific and from 11pm until 6.30am there are two carers on for the whole facility 66 residents. Alarms on the residents doors have being installed so from 10pm if a resident pokes a body part out the door the carer is alerted by mobile phone.

    I was very concerned about the carer/resident ratio and phoned Aged Care complaints Investigation Scheme only to be told the government only dictates ratio to actual Nursing Homes and that ratio must be heeded to. A little more helpful information was to take up any misgivings with management. Experience has taught me that is a complete waste of time.

    The carers often pass remarks about how much time is involved with documentation having to be put into the computer.

    This is what is expected from a carer on day shift:

    Set the tables for breakfast....make sure the residents are at the table....dish out the cereal....hand out each residents cooked meal....make toast....butter and spread as resident desires.... make coffee and tea.

    Clear and wipe down tables....rinse all plates, etc....before sending back to the kitchen where they go through the dishwasher.

    Shower residents on the list help with dressing..... make beds that have not been made.... two rooms each day are on the list for sheet change. Bag up all the dirty clothes and linen....put fresh towels in each room.

    Hand out medications answer phones address individual problems....residents that smoke are allowed six a day the carer supervisors that also.

    Residents that miss breakfast the carer will get tea toast and cereal for.

    Morning tea and lunch is the same routine the carer sets tables washes cups saucers and plates wipes tables.

    Clothes returned from laundry the carer puts away or leaves on the residents bed.

    Carers don't feel appreciated they type their concerns into the computer and the reply is.... NOTED! basically end of story.

    The thing I hate about all this is to get anyone to listen and take you serious at this place you literally have to change who you are for them to take notice. I like to talk to people the way I would like to be spoken to and that is seen as a easy push over. Poor old mum isn't doing so well at present she was classified high care some weeks back and I asked WHY! Oh... she needs extra care with all her daily needs. I ask when will this take place, Oh... it's already in place.....so when does mum actually benefit from this.....what do you mean?....exactly what I asked. I really hate that I have to use sarcasm..... I usually find mum with bottom teeth missing no glasses hearing aids either missing turned off or in up side down....she puts the aid over the ear OK but twists the tubing and the mould just sits jammed up side down in her ear. Anyway my sarcasm seems to have worked some what.

    I'm truly happy for all of those residents and relatives that have excellent care homes and can only imagine what it would be like to be able to have a weekend away knowing that the loved one left behind would be well cared for, that's not a option for me. Best Wishes to all, Taffy.
     

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