Care Home Observations

[Skye]

Hi Taffy, thanks for the info.

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.

John is in an EMI unit attached to a residential/nursing home. The EMI unit is divided into two sections, elderly frail, and challenging behaviour. The unit has its own specific staff, who change between the two sections.

John is in the frail section, there are fifteen residents. There is always at least one RMN nurse per section, sometimes two. In addition there are four carers during the day. They serve meals and feed those who need it, but they don't deal with laundry at all, laundry staff sort it all and deliver to the rooms. A lot of their time is spent toileting and changing as most residents are incontinent and immobile. But they do spend a lot of time talking to them and giving then one-to-one stimulation.

At night there is one nurse and two carers.


I'm sorry your mum is not doing too well, Taffy. We've talked about the staffing ratio before, and it doesn't sound as if it's improved.

It's a shame you can't trust them enough to have a weekend away. I can't risk it either, but not because I don't trust them. John's condition changes from day to day, and I just wouldn't be able to settle.

Lovely to hear from you again, and I wish you and your mum all the best.

Love,

 

[inkypink]

paperwork pressures

hi everyone,
i work as a senior carer in an emi care home for dementia & mental health,i would like to say that where i work there is an awful lot of paperwork to be done on every shift but the carers only write in the daily recording section of the care programme & it is only done at the end of the shift,also the carers sit with the residents in the lounge while they are writing them & still chat & interact with the residents.
all the other paperwork,which is endless,is done by the senior/duty manager on that shift.
the home i work in is a 'specialist'care home as it is specifically for older people that show 'challenging behaviour',so all the paperwork is vital as there can be incidents of violence between residents & also by residents towards staff so if there was no documentation of these incidents & a relative,friend,doc etc came to the home & saw that someone was injured we wouldn't be able to explain it & there would be alot of questions ask!!
i'm not saying violent behaviour occurs all the time,it's just an example of the need to document everything.
i myself record any changes,good or bad,in the condition of a resident,report any signs of illness & 1 of the most important things we like to write down is if someone has been to the toilet or not as that can play a very important role in the health of a person.we have a 'poo' chart with different pics of types of poo from 1 to 6 so we can record if someone has constipation or has diarrhoea.
the paperwork can be really tedious at times & i hate it as i prefer to be with the residents as much as possible but i believe a good home is 1 that can produce any documentation requested from a specific date within minutes of the request & i know ours can with every detail of events from that date written down.

 

[amberence]

Thank you for the replies ... for opening a discussion on the subject

Hi all. Hadn't realised the replies to my post and the discussion its created regarding carers in homes having to constantly complete and update care plans part of their work.

Haven't had time to read all the threads but be doing so but it seems mixed opnions, some think its a good to have care plans, carers involved updating them and others maybe not.

Raised the subject with the care home at a recent Relatives Quality Care Meeting and as pointed out on here required by law for care plans to be regularly updated. The care manager of the home said it would be impossible for one person to do them all, an adminstrator/assistant care manager even if computersided so has to be done and shared out by carers on their respective shifts. The thing in practice don't mean a thing when see residents looking bored, sometimes agitated and restless, then see a carer filling in a care plan when just a few minutes with a resident be better served and more beneficial.

Thankfully my step-father, bless him a wonderful man whom miss being at home has AD and one of those in his own way motivates himself by still abling to chat and talk to others in the care home and have an interest in his surroundings, especially what's happening in the gardening now spring and summer here.

Again many thanks for opening a discussion on the subject.

Keith.

 

[Skye]

Again many thanks for opening a discussion on the subject.

Thank you, Keith for raising the issue.

And thank you also for referring to the thread as a 'discussion'!

I've been a bit disturbed by people on other threads referring to 'spats'. I don't see this thread, or the TV one, as 'spats'.

We are all different people, in different situations and with different experiences of dementia.

Anything I post is based on my own experience, and people with different experiences can, and no doubt will, disagree with me. In my book, that's discussion, not spat, and I value the opportunity to learn from others' experiences. For me, it's that wide range of experience that makes TP such a wonderful resource. I reckon that among us all we have more knowledge of dementia than many consultants ot researchers.

 

[amberence]

Hi Skye. Thank you for the reply. I don't regard it anything other than a discussion and the whole point and exercise of cominmg on a forum like this to raise certain issues and concerns relating to caring for someone wiith AD be it at home, hospital or a care home.


I find the problem with forums on the internet can become a substitute and alternative to the real thing, socializing ... meeting and talking to peope in real life, in a natural ennvironment. In doing so we become sensitive to comments made on a message board as we would if made by someone in a normal conversation. This IMO is where the breakdown and ideals fall apart as maybe we expect to much from a forum and forget really the purpose and object of them. I will now get off my high moral ground

Keith

 

[Margaret W]

Dear Nat, what common sense! I agree with everything you say. What is the point of care plans and reports with no proof. The record for my mum says they apply the ointment to her sore bottom three times a day. How do I know if it is true? Mum says J does it in a morning, but nobody else does it. It is in her records that all ointment is to be applied by staff, but I find a huge tub of it in her bedroom.

Records are records. Devised by whoever. No evidence of accuracy or authenticity. And in a care home full of dementia sufferers, there can be no patient acceptance of any records that is reliable. I find it all pointless. What I want for my mum is a team of care workers who sit with her, talk to her, get to know her (she is a person, she has a history, she was once a daughter, a sister, a wife, a mother, an aunt, a sister in law, a daughter in law) - she had a life. A valuable life, an exciting life at times, one worth knowing about. She is still capable of talking about all of this. But nobody ever speaks to her about it. They have an Activities Co-ordinator, last week they played carpet bowls and mum won. Not suprising, mum used to play bowls at the local bowling club, but nobody though to ask.

Far too much, our elderly relatives are deemed to be dying fodder. It is not fair. It is not right. My mum ain't likely to die for 10 years. Forget the care plan, lets have care workers chatting to her, making her feel special, making her laugh, making her happy. Never mind it being recorded. I want my mum to tell me "I sat outside in the sun with Elsie today, it was very enjoyable". I don't need that recorded in a care plan, I just need to know that my mum enjoyed it.

Maybe I am being too simplistic.

Regards to all

Margaret

Sorry,

 

[Charlyparly]

I could go into enormous depth about the pros and cons of completing the seemingly endless amounts of paperwork, because it really does get that complicated.

I understand what people mean when they say that they just want to see carers spending more time with residents as opposed to dealing with paperwork. If planned correctly, the paperwork shouldn’t be all that time consuming and it should be limited to a nominated person(s). Inkypink gave an example of good practice whereby reports etc, are dealt with by senior staff who write these whilst also sitting with the residents in the home.

Apart from being a legal requirement, it is absolutely essential to ensure that staff know exactly what each person’s care needs are. Without having a full and detailed plan of care to refer to (particularly where homes use agency staff / have a very high turnover) it is pretty much impossible.

It is necessary to record what Mrs A has had to eat / drink and how much; what time she got up and went to bed; if and when she’s been to the loo; if she had a restful or disturbed night; what meds she’s had / refused etc. These may seem unimportant and trivial things to be putting down on paper, but they provide everyone involved in Mrs A’s care with absolutely vital information.

If Mrs A is unable to speak and becomes suddenly very ill, the staff, GP, district nurses and paramedics will rely on the information recorded as a guide to what could be the problem. Unfortunately, this is sometimes inaccurately recorded and reads like Billy’s weekly liar, but it does tend to become obvious.

When I review care plans and update assessments, what I’ve often found is certain patterns developing, which I’d never notice if they weren’t there to look at. This is particularly helpful where someone suffers from confusion and memory loss.

Mrs A’s reports might show she complained of having sore knees a few times in the last couple of weeks and I can make a note of when this was, what was done about it and by whom. Then hopefully, we can get this looked at and treated by her GP.

One lady reportedly “slept for long periods throughout the night” every time a particular person on nights was the senior. Every other night when this person wasn’t working, staff reported she was awake on most checks, buzzed frequently and had a generally poor night’s sleep.

Another lady apparently refused her medication whenever the same person was on duty, but never refused for anyone else.

She was eventually sacked and reported for abuse by neglect, due to her refusal to administer medication as prescribed and falsifying documentation.

If I didn’t have the paperwork to refer to, I’d probably have missed it.

 

[Margaret W]

Charlyparly

I assume you are some sort of inspector of homes - can you please advise?

Regards

Margaret

 

[Charlyparly]

Hi Margaret,

Dare I say this??

I’m the manager of a care home.

 

[Skye]

Charlyparly, I think you should prepare yourself for a deluge of applications!

 

[Charlyparly]

I am dressed in full riot gear!

Go easy on me people...