Care homes - no Chinese whispers

Discussion in 'ARCHIVE FORUM: Support discussions' started by Brucie, May 7, 2008.

  1. Brucie

    Brucie Registered User

    Jan 31, 2004
    12,413
    near London
    It is important, when a loved one lives in a care home, to establish a good relationship with the care staff, and with the home manager.

    However, even when one does, things can get a mite mangled if messages and instructions are not passed on in person.

    For the past few months, Jan has always been in her special chair when I have visited. I asked that this be the case, because I find we have better communication that way, such communication as we can still manage.

    The alternative has been a 'soft room' - a padded room - where for the first 6 years at the home, Jan was able to crawl about, or simply lie back - and I was able to join her.

    Late last year, it really wasn't working when I joined her there, as she can no longer even crawl. I would find myself sitting away from her and watching, rather than being part of her close up world.

    So I asked staff to try and make sure she was in the chair when I visited - not an easy thing to ensure because I don't go at fixed times. I have thought how well they have managed it because Jan has always been in the chair for my visits.

    Anyway, I popped to the manager's office for a brief meeting today to talk about Jan's care, and I asked when Jan was in the soft room these days. The reply: "she isn't - the care staff said you didn't want her in there".

    Aaaargh! I only said for that to be the case when I am visiting!

    I have now asked the manager always to check directly with me for any matters directly relating to Jan's care, and I'll do the same by seeing the manager, not the staff, or the nurse in charge. Actually, having arrived home, I am also going to commit these things to paper, so they have a reference copy.

    While there I was asked to sign some new parts of Jan's care plan - formally to request no resuscitation, and also to indicate when I want to be informed of any critical happenings - my reply, 'any time, day or night'. I don't think these are imminently needed, but I'm pleased they have formalised things.

    Live and learn, the order of the day!
     
  2. christine_batch

    christine_batch Registered User

    Jul 31, 2007
    3,388
    Buckinghamshire
    Dear Brucie,
    My Grandfather always use to say "if you have something important to deal with go to the Top"
    When I first met the Manager of Peter's Care Home, he took in everything I wanted for Peter and it has always been implemented.
    One year on and I can go in and it is like Home from Home.
    Nothing is too much trouble and if there is anything I wish to discuss or have changed, it is done.
    When I ask to look at the medication prescribed to Peter, it is shown to me.
    Yes I have had to deal with the DNR, which we know is not a very nice part to have to deal with.
    Peter loves his Bounty chocolate and last Thursday he was going to see the Surgeon and Peter's favourite nurse was with him. Which in my opinion was really thinking of Peter.
    Whilst we were waiting for the taxi, Peter was getting agitated and the Manager came out with Bounty bars to occupy Peter.
    It may be the little things but for the patient they are very important.
    I can now loose the guilt factor because my husband is being cared for 24/7 as I want him cared for.
    These kind of Care Homes are rare but they should be available to everyone.
    Best wishes
    Christine
     
  3. Brucie

    Brucie Registered User

    Jan 31, 2004
    12,413
    near London
    Hi Christine

    I have taken a layered approach.

    Contact the manager for things generic for the home - I got them a gazebo last year, and sought her advice on what they wanted. Also for things of major importance - finding and buying Jan's bed and her chair, the appropriating of an area for a soft room.

    Contact the care staff for everyday things about Jan's care - they are the ones who are hands-on. They buy clothes for her and I refund them [I tended to go to Bond Street to buy her things as she would have done, they go to the local shops and get clothes that can be used then junked.] They tell me when Jan needs toiletries and I get them in bulk.

    I regularly ask about Jan's medication and have free access at all times to all her records.

    Sometimes the manager-staff communication is direct and misses me out - which is when misunderstandings can happen.

    I think - hope! - I have an excellent relationship with all levels, but it is clearly something that needs constant attention, which is a good thing as it means it has to be constantly renewed.

    Sounds like we both fell on our feet home-wise. That is so reassuring - that there are such good places around.
     
  4. Charlyparly

    Charlyparly Registered User

    Nov 26, 2006
    221
    Lancashire
    Hi Bruce,

    I can see how wires became crossed in the first place. It’s easily done.

    I don’t think it is wise to just go directly to the manager with any other issues you might have and would strongly recommend that, wherever possible, you also highlight these things with the care staff as and when you see them on a daily basis.

    The reason I say this is because the manager may not fully explain why you’re asking for something and give the impression it’s you being awkward. Staff may then stop communicating with you, the manager and before you know it, nobody knows who should be doing what or why!!

    It’s best to try and ensure that everyone is being consulted and informed on all levels, especially when, as you point out, care staff are the ones providing the hands on care each day.

    May I also suggest that you do write down exactly what it is you want and ask that this is placed inside Jan’s plan of care and is brought to the attention of all staff.

    I can’t emphasise the importance of communicating with everyone involved.

    Good luck!! :)
     
  5. Brucie

    Brucie Registered User

    Jan 31, 2004
    12,413
    near London
    Hi Charlyparly

    yes, all good thoughts.

    Only downside is that the only person I can't discuss it with - is Jan. :(
     
  6. Margarita

    Margarita Registered User

    Feb 17, 2006
    10,824
    london
    So now am wondering how you have organized it so they know when your arriving, so they can move Jan into the chair ?

    Do you ring them before your leaving to go to see Jan, so they can move her ?
     
  7. Brucie

    Brucie Registered User

    Jan 31, 2004
    12,413
    near London
    Hi Margarita - well recently, since they stopped putting her in the soft room, she has always been in the chair.

    From now on, I will just ask them to help me move her to the chair if she is in the soft room when I arrive.

    Generally in the morning, when I often visit, the time between breakfast and lunch is too short to make it worth putting her in the soft room.
     
  8. Tender Face

    Tender Face Account Closed

    Mar 14, 2006
    5,379
    NW England
    Brucie, I agree with your sentiments entirely - but in one week's experience of mum in an NH ..... which feels like a lifetime ...... where I have already realised it's the Unit Manager I need to speak to as diplomatically as I can with concerns ... and then, as an example, she (the UM) agrees a 'soft food diet' but it still hasn't been comminucated to staff yet several days later .... ....... when I turn up in despair to realise that no-one has helped mum brush her teeth and have dressed her in yesterday's dirty clothes ....... I'm not even bothered about the 'niceties' and the little touches - inspite of me filling out a Social Care Assessment last week ... mum still has no care plan ..... I'm too busy doing battle to get the 'basics' right - 'preferences' aren't even on the menu yet?

    I'm covering the best I can leaving 'post-it' reminders around her room to staff (trying desperately not to be TOO sarcastic!) ... with constantly changing shift patterns and new agency staff appearing on the scene every day .... surely it should not be US having to co-ordinate the vital communications that should exist? Still that helps no-one when there a dozen vulnerable people left in a day-room with no-one (not even agency staff who don't know the residents) to supervise them ... my idea of pro-active caring is clearly a pipe dream ...... and much of my visits are spent running round the place looking for staff to help residents other than mum ......

    Sorry, but I'm nearing total despair ...... mum actually appears to have settled in, has made a great 'new friend' and seems happy. Of course she is blissfully unaware her basic needs aren't being met .... I can tell by the stains on her trousers how many drinks she might have spilled when she has nodded off to sleep unattended .... it's not just she is in stained trousers - I wonder how long she has been left in them wet????? ..... Yes, I am trying very hard to build relationships with the staff who 'care' for her for her benefit ... but I swear if she was an animal I could sue for neglect .....:mad:

    Any suggestions gratefully received ....

    Karen, x
     
  9. zoet

    zoet Registered User

    Oh dear Karen....what you are describing sounds to me unacceptable.
    Occasionally clients spill drinks/food, just before your visit or on a busy day when something has happened to prevent care staff attending quickly, but this doesnt sound like that at all. It sounds like neglect, especially as you have highlighted the issue and tried to be pro-active rather than simply complaining. This simply isnt good enough and in my opinion it is time to make a complaint.
    Drinks can be HOT and can scald even through clothing and that is a health risk, especially as the spillage isnt being dealt with straight away.
    Ring the manager and make an appointment rather than complaining on your visit.
    Make a list before hand of the issues you want to discuss and state quite clearly that you are unsatisfied with the standards of care. Leaving people in wet dirty clothes is falling well short of the necessary standards for care.
    Ask the manager what action will be taken, and ask for things to be doccumented in the care plan. Ask to read the care plan right there and then.
    On subsequent visits ask to read the Daily Report Sheets to ensure your complaint is being addressed. If your mum continues to spill food and drink ask for a risk assessment to be done, and ask for protective covering to be provided, plate guards and cup adapters too, so she is no longer at such a great risk.

    Having no one to attend to clients for short periods of time is not unusual either OCCASIONALLY. However if this is apparent every time you visit then the staffing levels need to be looked at. Ask questions about which agency is used for staffing, what levels of the permenant staff are on, and if agency staff are either given a detailed handover regarding the clients, or if the same staff are booked to ensure continuity on both sides.
    At my Home I try to book the same staff repeatedly so they know the home, and I give them a detailed report sheet for all the clients so they have a good idea about the basic care needs of the people they look after.
    Raising the issue more formally will make a manager focus on these areas immediately, and they will probably get a clearer picture of a situation which they may not have otherwise been aware of. This helps the other clients too. Dont be afraid or intimidated......the home gets good money and is responsible for keeping your loved one safe and happy. Its a SERVICE. Remember that. Hope this helps and good luck.:)
     
  10. christine_batch

    christine_batch Registered User

    Jul 31, 2007
    3,388
    Buckinghamshire
    Perhaps I shoudl have mentioned in my post, that the relationship between me and the staff on the E.M.I. in excellent.
    They even phone me to see how I am as I am as disabled.
    Also any concerns the Staff have they phone me.
    Christine
     
  11. Tender Face

    Tender Face Account Closed

    Mar 14, 2006
    5,379
    NW England
    This is where either end of the spectrum gets even broader ... imagine it taking five attempts at a phone ringing out before anyone answers the phone at the NH ...... then no nursing staff are available ... or people are 'too busy' ....... knowing messages are NOT passed on ... knowing you can't leave a message for your loved one because they 'just don't have time' ...... if you can't even 'ring in' what hope for anyone ever 'ringing out'?

    Karen
     
  12. Charlyparly

    Charlyparly Registered User

    Nov 26, 2006
    221
    Lancashire


    Karen,

    Have you read the homes’ most recent inspection report from CSCI? You tend to find that these problems are ongoing and have been for some time.

    I'm of the opinion that they probably have and that you should start considering alternative care for your Mum.

    How can the manager or anyone else communicate your Mum’s needs (including dietary) to all staff without a plan of care for them to refer to?

    The lack of staff and use of agency staff in addition to the lack of written care plans, strongly suggests that nobody has a clue about what each person’s needs are, and/or couldn’t care less.

    I have been in more care homes like this one, than I'd care to mention. :mad:
     
  13. Tender Face

    Tender Face Account Closed

    Mar 14, 2006
    5,379
    NW England
    Thanks Charlyparly ... sadly yes I have .. and what I find most disturbing is that the CSCI class them as meeting all standards almost universally ...... (couple of bedrooms needed repainting apparently at the last inspection :rolleyes: :mad:) ..... and in spite of CSCI concerns about dietary needs not being addressed (my biggest concern for mum just now) the CSCI still scored them as 'meeting standards'?????:mad:

    In between battling for mum I have a shortlist of care homes to visit ASAP for future planning - and yes - I am ignoring everything the CSCI prints and going to find out for myself!!!!!:p

    Thanks, Karen, x
     
  14. Charlyparly

    Charlyparly Registered User

    Nov 26, 2006
    221
    Lancashire
    Good.

    If you need any advice along the way, feel free to ask and I'll be more than happy.

    :)
     
  15. daughter

    daughter Registered User

    Mar 16, 2005
    824
  16. Grannie G

    Grannie G Volunteer Moderator

    Apr 3, 2006
    68,654
    Kent
    This is so upsetting. :(

    It is what the majority of us suspected, but to have it confirmed makes depressing reading.

    What is it with these people? Do none of them have parents and grandparents, husbands and wives of their own?
     
  17. Brucie

    Brucie Registered User

    Jan 31, 2004
    12,413
    near London
    I'm a great believer in taking all sorts of reports, tips, etc from all sorts of places - then looking myself, and deciding on the basis of MY impressions what is my own truth.

    We are often the best judges - not always, because I am always willing to be persuaded on evidence I feel is valid - but most particularly so in the case of our loved ones. After all, we know them best.

    There are, of course, practicalities to take into consideration. Care homes will never have the infinite resources we might wish for.

    My Jan will never be cared for as well as I would like, but I can make sure her care is as close to that as is realistically possible.

    I use friendliness and gentle persuasion to change things at Jan's home, when that is needed. I listen when they tell me things, evaluate what they have said, then act accordingly.

    I save Angry Bruce for those occasions when I am truly mad; to do otherwise is to dissipate the effectiveness of Bruce at Full Pelt! I have never had to unleash Angry Bruce at Jan's home.

    When I let Angry Bruce out at the assessment centre where Jan's moving to a care home was made inevitable, the incompetent consultant was quickly moved elsewhere [probably for her own safety], and has never been seen [by me] again.

    Best of luck, Karen
     
  18. CraigC

    CraigC Registered User

    Mar 21, 2003
    6,630
    London
    Hi Bruce,

    Amazing how such a simple conversation can get missinterpreted!
    How annoying for you! Had the same thing happen with both mum and dad in two quite different care homes.

    You can never assume.

    In these cases, wouldn't it be useful to have constant access to the care plan and be able to write your own notes and views on the front page. I kind of dynamic suggestions box.

    When I suggested this in mum's care home they started going on about privacy and other excuses. Basically it wasn't a good idea because it was my idea, not theirs. They were also totally against key workers but that is another story.

    Hence all those meetings I arranged, particular at mum's end of life care stages. I wanted them to assume nothing.

    Sounds like you have it under control now and it is a good lesson for all of us.

    Cheers
    Craig
     
  19. Skye

    Skye Registered User

    Aug 29, 2006
    17,000
    SW Scotland
    I do the same. Most of the time I'm chatty and friendly to the staff, and listen to their problems.

    But angry Hazel has appeared three times in the seven months John has been in care, all documented on TP.

    Twice it was against CH staff who had neglected John's care. The Charge Nurse was not on duty either time, and on both occasions he backed me and the staff were disciplined.

    The third was against the GP practice who decided unilaterally that John should no longer be treated. That decision was reversed too!

    I tend to gently point out missing clothes, etc, and usually they reappear (apart from two missing heel protectors, which mysteriously picked up their heels and walked. Strange, because they were named, and no-one else in the unit uses them).


    I think we have to accept that, while most of the carers genuinely do care for their patients/residents, for the odd one or two it's a job, to be got through with as little hassle as possible, so that they can get home to those families.

    Much the same as in any other 'caring' profession.:(
     
  20. Brucie

    Brucie Registered User

    Jan 31, 2004
    12,413
    near London
    I can - and do - amend Jan's care plan, which is available to me at all times. I read it most days I am there because it also records her care on an hour to hour basis, something I check.
     

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