Carers not experienced

[9901dawnb]

My mum has recently been diagnosed with a mix of dementia/alzheimers. We have a care plan 4x a week for 1/2 hour personal care visits. The problem is the carers are asking mum if she’d like a shower and every time she responds with ‘no thank you, I had one last night’. We all know she’s not had one in weeks. Problem is they’re asking and said if she refuses they can’t make her however my argument is that if they give her a choice she will refuse but if they rephrase the question in a way I used to with my kids - I’d ask would you like your carrots chopped or grated? They’d feel like they had a choice when if I’d have said would you like carrots they’d have said no thank you! I’m concerned that they’re just not experienced with how to speak to dementia patients. She’s in an assisted living flat and I wanted to keep the care in house as they know my mum and I don’t want to rock the boat by saying they’re not delivering the care appropriately. Any suggestions on how to manage this? I’ve spoken to the head of care a number of times but they’re still asking in the same way

 

[phill]

If you haven’t done so already, actually write to the head of care, rather than just phoning. A letter on his file is harder for the organisation to overlook than a phone call, especially if the person taking the phone call hasn’t noted down your message correctly, or has forgotten to communicate it to all the relevant carers.

 

[maintience]

My mum has recently been diagnosed with a mix of dementia/alzheimers. We have a care plan 4x a week for 1/2 hour personal care visits. The problem is the carers are asking mum if she’d like a shower and every time she responds with ‘no thank you, I had one last night’. We all know she’s not had one in weeks. Problem is they’re asking and said if she refuses they can’t make her however my argument is that if they give her a choice she will refuse but if they rephrase the question in a way I used to with my kids - I’d ask would you like your carrots chopped or grated? They’d feel like they had a choice when if I’d have said would you like carrots they’d have said no thank you! I’m concerned that they’re just not experienced with how to speak to dementia patients. She’s in an assisted living flat and I wanted to keep the care in house as they know my mum and I don’t want to rock the boat by saying they’re not delivering the care appropriately. Any suggestions on how to manage this? I’ve spoken to the head of care a number of times but they’re still asking in the same way

I don't know about other people but I just flat out tell them. If they are professional, they will understand. I have been caring for my wife with late Dementia from the start but we are both retired and I love taking care of her. People that have to work I am sure it is almost impossible and Kudos to them. I will take care Of my best and closest friend till we or one of use goes to be with JESUS without him it would be harder for me.

 

[canary]

The trouble is that although family carers can insist, professional carers cannot. They have to ask and if the person refuses they cannot make them. OHs carers ask him whether he wants a wash or wants a shower, but if he said he had already had one, they couldnt insist

 

[Rayreadynow]

They can only encourage and will never make someone, they will open themselves to legal action if something went wrong.

Maybe she just doesn't want people watching her ?
Adjustments with the bathroom may help.

 

[Rosettastone57]

As others have said, the carers won't force anything, just encourage. My mother in law was like this, refusing personal care, only washing herself of sorts. Her hair wasn't washed for 3 years when she had home carer visits . This was only resolved when she went into care and the carers had the time to cajole and the patience and time to deal with her, rather than time constrained short visits

 

[Rayreadynow]

I am of the opinion that refusal of help is just someone trying to keep hold of their independence.

 

[TMH]

My mum has recently been diagnosed with a mix of dementia/alzheimers. We have a care plan 4x a week for 1/2 hour personal care visits. The problem is the carers are asking mum if she’d like a shower and every time she responds with ‘no thank you, I had one last night’. We all know she’s not had one in weeks. Problem is they’re asking and said if she refuses they can’t make her however my argument is that if they give her a choice she will refuse but if they rephrase the question in a way I used to with my kids - I’d ask would you like your carrots chopped or grated? They’d feel like they had a choice when if I’d have said would you like carrots they’d have said no thank you! I’m concerned that they’re just not experienced with how to speak to dementia patients. She’s in an assisted living flat and I wanted to keep the care in house as they know my mum and I don’t want to rock the boat by saying they’re not delivering the care appropriately. Any suggestions on how to manage this? I’ve spoken to the head of care a number of times but they’re still asking in the same way

I'm on my second care company in 7 months for the exact same problem. We're paying for care they're not giving. Now I have dad up, showered and breakfast done before they come and I go to work. I've given up stressing over it now. I fought for months and stressed myself so bad and got nowhere so now I do it myself. Broken and useless system unfortunately

 

[Rayreadynow]

It needs to be professionalised.

 

[FrustratedFrog]

Unfortunately while family can insist carers and professionals are not able to. I’ve had the same issues and they explained it’s due to risks of things like pressure and bullying so they have to listen to the client. It’s common but I’d try and settle for a deep wash in the morning instead where it’s a strip wash. Strip wash and clean clothes and teeth brushed. It’s quite a lot mentally for them to shower but if a wash is good enough I’d maybe leave it at that. Make it so it’s only the morning carer that does the wash to keep a routine. Maybe even request only a woman to make her more comfortable and to have the same woman every morning which we have done. I noticed my dad would reject the wash because it was women but now has a man every morning and washes with no issues. He pushed back on the showers sometimes but if he’s washed I don’t push.

 

[Toopie28]

I had the same trouble with carers - however in my case they would do the minimal and it became a nightmare. I eventually hired them myself, paid them much more than an agency would - and they were worse. There are good ones out there and I know some have had good experiences.

With Ma she was very independent and would not shower and they couldn't force her and I wouldn't want them to, I couldn't either. Sometime I would say, hey I'm showering - why don't you go in before me so I only have to clean the shower once (that worked one time).

She could be embarrassed or just not remember that she didn't have one.

I think writing to them is a good idea as @phill suggested. In fact, give them a script. And add a printed copy to your home somewhere where your mum won't see it. But if they do well in other areas, then I would pick my battles. It's a hard road

Best of luck xx

 

[My Mum's Daughter]

Carers tend to ask closed questions such as "will you take these tablets?" or will you have a shower?" I battled in vain to get these questions changed to a statement, "it's time for your tablet" or "it's shower time" but a PWD has human rights; the right to be dirty or to refuse vital medication. The world's gone mad!
Same happened in the care home, I'd turn up to take Mum out and find her in a short-sleeved top. "We had to ask her and that's what she "chose" to wear". Yeah right, it's a nice top but it's now December and pretty chilly out there.
It's a crazy system that allows a PWD to make poor choice but ridiculously, the carers are doing things correctly.

 

[phill]

But if the PWD lacks the mental capacity to decide whether to accept or refuse the personal care, the carers are meant to make the decision on her behalf and in her best interests. The PWD won’t have the final word. So, for example, the carer might say “ yes, that’s a lovely short-sleeved top, and I’m going to put this cardigan on you too, because it’s a bit nippy in the dining room this morning. It’ll look great with your top”.

 

[My Mum's Daughter]

But if the PWD lacks the mental capacity to decide whether to accept or refuse the personal care, the carers are meant to make the decision on her behalf and in her best interests. The PWD won’t have the final word. So, for example, the carer might say “ yes, that’s a lovely short-sleeved top, and I’m going to put this cardigan on you too, because it’s a bit nippy in the dining room this morning. It’ll look great with your top”.

They did indeed add a cardi but this was inadequate if I was taking her out. As I was aware that the PWD could and would, refuse this additional layer of clothing, instructions were left that in cold weather, 2 options of appropriate clothing were offered. Care home fees are high enough without the added burden of someone who can't understand the weather conditions.

With meds, I've seen a hospital bin tablets because the PWD has refused and on numerous occasions, been left a pot of pills that need taking.

 

[Alisongs]

If you haven’t done so already, actually write to the head of care, rather than just phoning. A letter on his file is harder for the organisation to overlook than a phone call, especially if the person taking the phone call hasn’t noted down your message correctly, or has forgotten to communicate it to all the relevant carers.

And copies to the head of the the whole care organisation and the headof the housing organisation concerned. That's correct and courteous and proper to do

 

[Rayreadynow]

From what I can find out, carers get minimum training ( maybe even just a short video ). Again they cant force anything on anyone so if they get refusals they have done their job by asking.

If they get regular refusals they can then hand it over to the social services who in my opinion have a Zero risk approach. If a person lives alone SS will push for a Care Home placement.

 

[Grannie G]

I`m another who stated a fact rather than gave a choice.

It was `shower time now` or `tablet time now`. If they were refused, so be it, nothing was forced

I followed the advice given on this link and perhaps your carers would be interested @TMH

Compassionate Communication with the Memory Impaired

The following piece was posted a while ago on DSF and made a big impression on me. It is something I have referred to time after time and tried hard to follow. We have many new members who may not have seen it before. Yesterday I posted it on another Thread but thought it might be helpful if...

forum.alzheimers.org.uk

 

[Jaded'n'faded]

Children have human rights too but anyone who's had a defiant little one who says 'No!' to everything will have learned to go about things in a different way.

People with dementia often behave in a similar way. I see nothing wrong with saying, 'Come on - I've got your shower ready! The bathroom is lovely and warm...' rather than, 'Do you want a shower?'

The person can still refuse but there's more chance they'll go along with it.

There's a big difference between being persuasive and frogmarching someone to the bathroom. Carer training should include acting out scenarios like these in order to understand that how they phrase things can make a big difference.

 

[Rishile]

I had a similar issue with the Care Home where my husband was for three months. He was left unwashed hair not combed and unshaven, apparently because he kept refusing. He never refuses care from me so I did everything for him. I also asked for fruit to be offered to him. I was told fruit is always available 'in the cupboard'. That's not much use to a PWD. I asked them to offer ' fruit or cake' and was sure he would chose fruit but they just would not do it.

 

[SAP]

The home my mum is in now have her up showered or washed and dressed most mornings. If she says no they will try again later. She used to kick up quite a fuss over personal care but over time they have been able to coax her into a routine and she trusts them now. Like many have said it’s about wording the right phrase. I would be asking ( in writing) how long the care home will leave a person unwashed before they intervene and work back from that because if the response is we wouldn’t leave a person unwashed then the carers are not following the plan and if they say they would never intervene then it’s probably the wrong home for your mum.