Crisis Point after 9 days in a care home

[Elle3]

My mother's behaviour was nothing like your father's. All the same, she was about to be asked to leave the first non-dementia home we tried, and the second one, a dementia home, in the first few days she was behaving aggressively, waving her stick at people, shouting out, and scuffling with other residents. She had been on no medication - they called in the mental health team and Mum was put on memantine. It had an immediate calming effect and there was no more aggression. Mum seemed depressed so some weeks later, she was put on an anti-depressant. After that, she was much more contented and settled in.

I was terrified that Mum would be asked to leave her second home, so I can imagine what you are feeling. I do hope that a solution is found - either a more suitable home, or some medication that will help.

Very best wishes. xx

Thank you Marcelle123, I have been informed that the GP has refused to visit dad at the home as they feel he has been incorrectly placed, what that has to do with it I've no idea and how they know this I've also know idea as they haven't seen dad for well over a year. His GP surgery do not have a good reputation. However, apparently they have prescribed some medication which they hope will settle him this evening.

I now have to meet the social worker at the home in the morning, as the home is still adamant that he has to leave asap.

 

[Amy in the US]

Elle, I like your description of a dot to dot that is in the wrong order. That really describes my mother as well. There has been no possibility of any sort of rational or normal conversation with her for years.

I'm so sorry you have this worry about his placement to contend with.

 

[Marcelle123]

Thank you Marcelle123, I have been informed that the GP has refused to visit dad at the home as they feel he has been incorrectly placed, what that has to do with it I've no idea and how they know this I've also know idea as they haven't seen dad for well over a year. His GP surgery do not have a good reputation. However, apparently they have prescribed some medication which they hope will settle him this evening.

I now have to meet the social worker at the home in the morning, as the home is still adamant that he has to leave asap.

I hope the medication works, and that you and the social worker can sort something out tomorrow.
Very best wishes. xx

 

[Scriv]

Elle3 - We have been through exactly this. .

The time has come for you to be very assertive and get on to your SW and the Adult Mental Health in your area and demand a full assessment of your father's mental health.Make a fuss.

Tell them quite clearly that this cannot go on and that you cannot have your father pushed from pillar to post and that he needs a full assessment and a professional recommendation as to the medication and care that he needs.

It sounds as if he needs a care home with a proper EMI Nursing Unit, otherwise this will carry on believe me. Care homes often say EMI skilled, but often do not mean the challenging behaviour people.

Hang on in there Elle and get in contact tomorrow and be firm - this is beyond your capabilities now and the poor man needs professional help.

Thinking of you. As said, we've been there.

 

[rockysmts]

I had the same problem. I had homes assure me they were qualified to deal with Alzheimer's and dementia clients. I had one place she was there for 3 hours before I had to come get. Another 1 day. Another 2 days. She was admitted in a behavioral dept of the hospital to have her medications adjusted. She had returned there so many times that the staff knew me well. The social worker was awesome and really advocated for my mom and me. We would have nursing homes send their people to meet her and they would make promises and then faulter on them. She told one home please don't make promises to her that you can't keep bc her daughter now had PTSD from all of this. Thank God for those of us that don't put our families in these places and visit rarely because those are the ones that I worry about. I was my mother's advocate. I did what I could but she still managed to get abused. If I was wealthy I would have a home and people that really care be there for not only Alzheimer's but the forgotten elderly.

 

[Scriv]

rockysmts ..I couldn't agree more. We have often thought of those poor souls who haven't got anyone to battle for them and fight their corner. It was so very hard for us to deal with all this and nigh on impossible at times and it made us ill too ... but we were feisty and articulate and just wouldn't give up. I so feel for those on their own.

 

[love.dad.but..]

Elle...keep Scriv's comments firmly in your mind when you meet the SW at the home tomorrow. Place the burden and responsibility very firmly with the SW and be assertive when mentioning you want your dad to have full assessment etc. Your dad deserves to have the care he needs and you deserve to have him properly assessed and placed where the best care can be given. Good luck

 

[Jazzyjab]

Hi just signed into this resource - my mother in law has altzheimers and we had a very challenging year with her last year - various infections, nearly burned the house down, getting lost in her own cul de sac, living in the house with others and queueing for the bathroom etc. There are social workers who are there to help and effectively take responsibility for some of this, service providers who are supposed to do things like key safes, grab rails etc and then health care professionals - none of these talk to each other ad the family is left to pick up the pieces. We got quite hard quite quickly and after being hoodwinked into putting her inopt respite care for 3 weeks - tag a cost of 200 quid a night, they allowed her to come home promising all sorts, and nothing was delivered. The next crisis led to a 14 week stay in hospital - 9 of which were unnecessary - but even during this time nothing concrete was done, WE dealt with the house clear out (recycling and rubbish is a major problem) and renovation of the bathroom. Frankly, the whole thing nearly broke up my marriage until we both started playing hard ball and saying - you decided she can be at home (against our wishes), you say she can can live at home - so you damn well deal with it. Care package in place (she won’t actually accept any help) and it was a bumpy start but things have settled down and they are getting on with it. YOu can;t cope with your dad and you need to stay mentally and physically healthy to do what you can for him. They (an appropriate care home and social services) are there to keep him safe and have that responsibility so the ball is in their court. So they may not be able to cope (so why did they take him?) so they and SS need to find an appropriate place for him, sounds like he’s settled in well so will likely settle in somewhere else too. ON the upside, she is just about coping and rather than going into a home within 2 weeks, she is still at home 6 months later - miserable as sin and largely house bound, but she would prefer to be at home at this point so there you go. Good luck..x

 

[Malalie]

Elle, I have been reading your posts and you did really well in actually moving your Dad into a care home, and I was so pleased that it all seemed to be turning out successfully until the 'escape' It seems such a small thing for a care home that supposedly has experience with dementia to be unable to cope with (I do understand the proximity of the canal must be a great worry for them - and you)

You have identified that Dad doesn't just want to go back home, or even return back to his "childhood home where he was healthy and safe" - just this silly thing about "having to get the money"

Have a look at this YouTube thing by Teepa Snow.

Behaviour by a lady that was incredibly trying for both staff and other residents - it would drive anyone insane. Her need was identified, and hopefully something was done within the home to satisfy it. Her need was something that she used to do all the time when she was younger, and it sounds like your Dad's need is similar.

Could you maybe do a bit of brainstorming between you and the home and the social worker to see if there's something that could satisfy his need for collecting his money?

(First brainstorming idea from me: Little brown pay packets with his name on and a few fivers in (fake if necessary) in the Office, and any sign of trouble or every morning, the carers , or you, say "Have you been over to collect your money yet Dave?" Point him in the right direction and repeat..........)

Does that sound silly or not practical - I don't know? It seems that it is just a lame excuse to evict Dad from a home that he is reasonably settled into for such a small thing.

I hope all goes well - stand up for your Dad XXX

 

[DollyBird16]

Oh @elle, sorry to read. I’m gutted this has happened. I can only imagine how you feel.
I’m thinking out loud on how to make a better situation, sorry if it’s a list.

Maybe the home is just not for Dad and there is a better one.. disappointing that they won’t put a little more effort in.

Perhaps a further chat with the manager and social, re medication options.

Love the idea of staff escorting him to the office through another door.
Any chance of his home asking him to do jobs (watering plants, digging the garden, collecting cups and so on) and then to the office to collect his wages.
Love lies, could the bank now be doing cash deliveries, save him the journey, local branch has closed, Home is now a bank too, they have them in Supermarkets.
Staff getting him ready for the day saying something like ‘Are you ready for work today’ You asking, how was work? I know every PWD is different the work thing is something I use with my Mum, she goes to work at the day centre to help with the old people! I guess it gives her a sense of purpose.
Oh Elle, it’s such a shame.
Hope your meeting goes well and you are able to reach a good decision for you and your Dad. X

 

[Elle3]

Thank you everyone for your support and your fantastic advice, in particular @Scriv for making me think assertively and @Malalie for the video clip on how to see their behaviour differently.

This is how it went today, sorry it's lengthy.

I'm pleased to say that the Social worker is definitely on our side and is looking out for dads best interests. The meeting at the care home this morning, with the Manager and Social worker went as well as could be expected and we are all thinking about what is best for dad and how to keep him safe and secure and the SW said the last thing she wants is for dad to get passed from home to home.

The care home gave dad half a Lorazepam tablet last night about 5pm in order to relax him and help him sleep which seemed to work, although they said he was up twice in the night and was slightly incontinent. They said as dad is not used to taking medication they would rather avoid increasing the dosage and if anything both the Care Home Manager and Social worker agreed that medication is not the answer for dad, which is good to know.

It seems that the reason the GP said he was incorrectly placed was because of what the care home Manager told them. In all honesty I still believe if dad just accepted where he is and stopped trying to escape this would be the right home for him and they agreed.

The Social worker has requested an urgent assessment of dad by the Mental Health team and that should be done within 72 hours, they are going to get his bloods checked and try to test to see if he's got a urine infection and they are applying for an urgent DOLS.

The Manager said most of the problems with dad trying to get out of the building seem to occur from 12pm onwards into the afternoon and then he calms again around 6pm and accepts getting ready and going to bed around 9pm. She feels for the afternoon, dad requires one to one attention and as they do not have the staff to do this, they will have to get an agency nurse in to do this as long as I agree to the additional cost, which is around £15/hr, I of course had to agree. This will continue until I can find him another care home. If he was to stay at this home and required full time one to one, then his fees would double, which would be awfully expensive to keep him there. They did mention the NHS continuing care scheme could help with this if dad requires it long term.

The Social worker then stepped in about the agency nurse and said that she would require a daily report of the actual hours and what this person has to do, as I shouldn't have to pay for more hours than required. She said she would be asking for this if the council had to pay, so expects the same and she will monitor it for me, which is good to know.

We also discussed dad's compulsion to try and get out and wanting to get money. We have come up with a strategy to try and distract and occupy dad by giving him jobs to do in the home, ie sweeping up, gardening, doing a bit of washing up etc, anything to try and stop him being bored and wanting to leave. The Manager is going to do a job sheet for him and when he's completed the jobs they will pay him for the work, ie. he will go to the office and they will give him a pay packet with some money in it, (they have also ordered some fake cash to see if that works). I have also given dad his wallet back with just £20 in £5 notes in it just in case this has been a bit of a trigger for him wanting to get money, due to having none. So I've said if dad offers to pay for his lunch they should accept the money and later they can give him the money back as his wages, so the money continues to be circulated. Also if it gets lost or goes missing it's only £20.

After the meeting I went and sat with dad for a while, he wasn't happy today, but neither was he walking around trying to get out. He actually seemed a bit more talkative and with-it. However, he did tell me he now wants to go home, no mention of the bank, just home. He said he's fed up and bored, there's nothing to do. So we talked about the work he can do in the home and he can get paid for doing it. One minute he seemed quite positive about this, next he said they couldn't make him do anything. Also today one minute he was convinced he was still in the army and then the next still a bricklayer. When I said I had to go he seemed fine and willingly said bye.

I have also visited two EMI nursing homes today, they were just OK, I don't know if it's just me, but some care homes just seem so cold, clinical and lifeless. Also, now that I'm having to think about dad's safety and keeping him secure, my questions have certainly had to be different and I've had to be more aware of their security, ie cameras, alarms, sensors, locks etc. Both homes I viewed did not convince me they would be any better equipped than the home he is currently in, especially if dad is determined to escape. One home is on a busy main road and they have a very small garden with a wooden fence, which to be honest I could imagine dad trying to break down or try using the bench which was against it to try and climb over. I also was not convinced by the people who showed me around that they would be able to handle dad as he is now, one carer seemed quite bemused by what I was saying and asking, especially when I tell them he is 81.

The problem is there are not that many EMI nursing homes either near to me or within my dads LA, especially with vacancies and I seem to be rapidly running out of options, which isn't good.

 

[Amy in the US]

Elle, thank you very much for the update. I have been wondering how your meeting went today. Don't worry, your post isn't too long at all! I write masses about nothing at all, so you just write whatever you want/need to get out and don't worry about it one bit, please. We are happy to listen, I promise.

I am thrilled to hear the SW is not only on your team, but also clearly caring and on top of things. That is a big plus and a relief (given some of the stories I've heard).

I also think it's positive that the care home are willing to work with you, because of course not having to move your dad would be better for so many reasons.

I think all the strategies are good ones and will cross my fingers that they work!!!

Wishing you all the best.

 

[Beate]

Please give yourself a large pat on the back. You are doing tremendously well fighting your Dad's corner, and hopefully he will calm down and be allowed to stay where he is. It really is all about seeing the patient as a person and trying a tailored approach. Btw, if you have time, I would hugely recommend reading "And Still The Music Plays" by Graham Stokes, who's a psychologist called into care homes to deal with "difficult" patients. The individual solutions he found in each case are inspiring.

 

[love.dad.but..]

Well done Elle...I am glad you had a positive meeting and you sound a lot more hopeful....part of anyone's battle for their loved one in difficult circumstances is getting the SW and care home to have the determined will to try to make a difference...your dad if he knew how hard you are trying would be so very proud of you. I felt I fought dad's corner on all important issues and the peace of mind that gives you after end of life is immeasurable. Fingers crossed for your dad and you as the days pass.

 

[Scriv]

Well done Elle!!! That sounds very positive.It is really great that you are getting an urgent Mental Health Assessment and have your Social Worker on your side and are trying out different strategies.Thanks for updating us.. I for one have been thinking about you all day.

My advice re thinking and acting assertively came because when we were in the same situation as yourself, someone with experience of all this took us aside and fired us up similarly...and it worked. I feel glad that I am now giving something back by passing that on to someone else in this awful battle.

Take care and good luck... and keep in contact. xx

 

[love.dad.but..]

Please give yourself a large pat on the back. You are doing tremendously well fighting your Dad's corner, and hopefully he will calm down and be allowed to stay where he is. It really is all about seeing the patient as a person and trying a tailored approach. Btw, if you have time, I would hugely recommend reading "And Still The Music Plays" by Graham Stokes, who's a psychologist called into care homes to deal with "difficult" patients. The individual solutions he found in each case are inspiring.

This book sounds really interesting...I don't need it for me now as Dad has gone and really hope it won't be needed by anyone else I know but I am going to order it as it will be intetesting to look back retrospectively...thanks Beate. Good luck Elle.

 

[love.dad.but..]

Well done Elle!!! That sounds very positive.It is really great that you are getting an urgent Mental Health Assessment and have your Social Worker on your side and are trying out different strategies.Thanks for updating us.. I for one have been thinking about you all day.

My advice re thinking and acting assertively came because when we were in the same situation as yourself, someone with experience of all this took us aside and fired us up similarly...and it worked. I feel glad that I am now giving something back by passing that on to someone else in this awful battle.

Take care and good luck... and keep in contact. xx

Well done Scriv

 

[Elle3]

Elle, thank you very much for the update. I have been wondering how your meeting went today. Don't worry, your post isn't too long at all! I write masses about nothing at all, so you just write whatever you want/need to get out and don't worry about it one bit, please. We are happy to listen, I promise.

I am thrilled to hear the SW is not only on your team, but also clearly caring and on top of things. That is a big plus and a relief (given some of the stories I've heard).

I also think it's positive that the care home are willing to work with you, because of course not having to move your dad would be better for so many reasons.

I think all the strategies are good ones and will cross my fingers that they work!!!

Wishing you all the best.

Thank you Amy, I do feel a bit better today, I just want my dad to be happy and safe, if only he could understand that.

Elle x

 

[Elle3]

Please give yourself a large pat on the back. You are doing tremendously well fighting your Dad's corner, and hopefully he will calm down and be allowed to stay where he is. It really is all about seeing the patient as a person and trying a tailored approach. Btw, if you have time, I would hugely recommend reading "And Still The Music Plays" by Graham Stokes, who's a psychologist called into care homes to deal with "difficult" patients. The individual solutions he found in each case are inspiring.

Thank you Beate, I think I need a rather large glass of wine tonight. Thank you for the book recommendation I've just seen I can get it on Kindle so I will definitely buy it and take a look.

Elle x

 

[lilaclady]

I was in a very similar position to you, my mum had been in a care home for 1 week when she was asked to leave - they had assured me that they could cope with dementia and all the related problems but she pulled other residents from their beds at night - we think because she no longer distinguished between night and day and wanted them to get up and be with her, unfortunately she injured another resident and the manager felt they didn't have the staff to cope.
This was over the Christmas period and getting hold of a social worker was tricky but we managed to find one and she was really good, mum had lost capacity so our power of attorney came into use and we refused to let mum go back home. The social worker said the home had to let her stay until a suitable place was found but like you we were charged £15 per hour from 10pm to 7am to ensure mum didn't hurt any other residents. A doctor from the mental health team came and prescribed risperidone which seemed to calm mum a bit, eventually she did settle at night. She stayed another 3 months before we found a home that agreed to take mum but we did and she is settled now and if not happy not unhappy if that makes sense.
It sounds like you have a good social worker - stick to your guns and good luck !