Contractures

luggy

Registered User
Jan 25, 2023
218
0
Hi. Mum was moved to a different nursing home by the ICB about a month ago. Mum has end stage Alzheimer's and is bed-ridden. She's unable to communicate her needs.

Both of mum's legs have been contracted for about 18 months. The contractures developed during the months following hip replacement surgery in 2021, after which she was unable to comply with OT & Physio input due to her lack of cognition. Mum's distress at being hoisted resulted in her becoming bedbound.

The contractures mean that both of mum's legs are bent at the knee and are flopped across to her right hand side, with her left leg resting on top of her right - skin on skin. Mum always lies on her back with her hips/pelvis twisted to her right. She's repositioned 4 hourly, but carers are unable to change her position by much due to the contractures. In recent months, mum developed moisture lesions between her legs, which were successfully treated. Quite rightly, the care home requested another referral to OT with a view to seeking their advice on positioning/equipment to prevent skin breakdown. Unfortunately, OT declined to assist as mum had been diagnosed as EOL - that's a disgrace, but another story. Consequently, the care home used pillows, cushions and folded towels to alleviate pressure. They also used extra pillows under mum's upper arms (shoulder to elbow) to provide further pressure relief. Mum was, and still is, laying on an Airflow mattress.

Since being in her new care home, I've noticed that there are no extra pillows placed anywhere around mum and her contracted legs are once again stuck together, skin on skin. I raised the issue with the nurse, bringing her attention to the moisture lesions which had previously occurred. The nurse responded by stating that mum's skin is checked regularly and that the skin between her legs looks healthy. I asked if a pillow could be placed between mum's legs to help prevent moisture lesions (or worse) developing again and she said that she might have a cushion somewhere! I was rather dismayed by her response.

I'm not a nurse, but I do understand the concept of preventative measures to avoid the development of pressure ulcers, of which mum is at high risk. I will contact the ICB, as the contract for mum's care is between them and the care home.

I wonder if anyone reading my post has experience of dealing with contractures, frailty and pressure ulcers, and how the situation was dealt with by caregivers and healthcare professionals?
 

nitram

Registered User
Apr 6, 2011
30,497
0
Bury
All I can suggest is that once tissue damage is evident try to get a referral to a TV (tissue viability) nurse.
 

try again

Registered User
Jun 21, 2018
1,308
0
No real help here but your mum sounds in a similar position to mine.

I have been asked with finding her another home as the current care home, even though they promised they could care to most levels, are worried that they can't meet her needs

Can I ask how your mum managed with the move at this stage?

I am dithering over which home to accept. It's so hard to judge the standard of nursing care.
 

luggy

Registered User
Jan 25, 2023
218
0
No real help here but your mum sounds in a similar position to mine.

I have been asked with finding her another home as the current care home, even though they promised they could care to most levels, are worried that they can't meet her needs

Can I ask how your mum managed with the move at this stage?

I am dithering over which home to accept. It's so hard to judge the standard of nursing care.
Hi @try again my mum is at end stage Alzheimer's, so the move itself doesn't seem to have adversely affected her at all. She has no sense of place, so I don't think that she realises that she's somewhere diferent - although who knows what's going on in her mind?

I am sorry that you're having the stress of moving your mum. It's not easy to work out whether or not the nursing care standards are up to scratch from a visit and chatting to staff, as they'll always put a glossy spin on things. In my experience, you only really find out once your relative is under their care. Everyone has a different experience too, and it's how your relative, with their unique needs, is cared for that really matters.

For what it's worth, I've found that the prevalence of agency staff, especially nurses, is a good yardstick, tending to indicate that the home are having trouble recruiting. This can often result in a lack of continuity of care and staff not really having a grasp of your relatives needs. Checking the home's latest CQC inspection report is a good starting point - although I would advise looking up the previous reports too. The ICB were responsible for moving my mum as she is currently funded by the NHS and mum's new nursing home has been rated 'Good' by the CQC. However, I've since discovered that their previous rating was 'Inadequate' with the home being placed in special measures, and the 2 before that were 'Requires Improvement'. Consequently, mum's home is still under the scrutiny of the CQC and after just one month of mum being a resident, I've spotted several issues which I'm sure the CQC would frown upon.

Wishing you luck and hoping that you find somewhere suitable for your mum x
 
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