Dads dementia predicament

[Andy B]

Hello everyone, new to this so please bare with me. My name is Andy and I have a father who has been living at home with dementia for a couple of years. We have had a care package in place, he has been getting 2 visits a day from a care provider plus family members calling in. My dad has been swearing a lot for about 6 months, every sentence seems to start with or end with the * word. He is also defensive physically, any sudden movements around him he will grab hold of your arm and normally tell you to **** leave him alone or ask what the * are you doing.
I must stress at this point that in no way is my dad aggressive, he has never started anything but does react.
He goes to daycare twice a week and the staff there and his carers, people who know him and what he is like, all love him as he can be very witty and is likeable.
Now to my problem.
In the New Year he had a fall at home and injured himself quite badly. He is still in hospital now although his physical injuries are mending. While he has been in hospital we as a family have agreed that he can no longer be left alone at home so needs full time care. The Social services team have agreed and carried out an assessment on him. They have classified dad as EMI nursing, we think this is due to his perceived aggression. They have given us a couple of choices for residential care home giving emi nursing, which we have been to look at, both giving me the impression of internship and restriction. I don’t feel he deserves to be classified as aggressive all he wants to do is sit, drink tea and eat biscuits, he doesn’t like to be fussed over.
Do we have the right to question the hospitals social services findings and have him re-assessed. We are running out of time.
Sorry this is so long

 

[Grannie G]

Hello @Andy B Welcome to Dementia Talking Point.

I used to care for an elderly neighbour, an ex guardsman and a gentleman. As dementia set in he shocked me by using what I could only call barrack room language. When he was in residential care the care home staff said it was quite usual for this to happen even in the most gentle people.

I would ask for a re-assessment for your dad regarding his perceived aggressive behaviour simply because I wouldn`t want him labelled as aggressive. However , please do not be distressed by the idea of an EMI unit. The restriction, the secure entrances and exits are there for your dad`s safety and I'm sure even in an EMI unit he will be free to sit in peace with his tea and biscuits.

 

[Louise7]

Welcome to the forum. It sounds as if an EMI placement would be best for your father, based on what you have posted. He is physically defensive, grabbing those who go near him, and social services will be primarily basing their assessment on his behaviour whilst in hospital, with input from the medical team. If you are unsure about the basis for the EMI recommendation the social worker should be able to explain the reasons for this.

The type of behaviour that your father is displaying will require staff who are knowledgeable and experienced in such behaviour and the problem with a 'standard' dementia care home is that most can't handle any type of difficult behaviour. The staff in an EMI unit will be used to such behaviour and will know various techniques that can make things better for your father and also keep both him and the staff safe. If your father is not able to pay for his own care and is reliant on the local authority to pay this then unfortunately the choice of homes is likely to be limited. However although the homes you have looked at have given you the feeling of internship and restriction the family would have input into his care plan so could let the staff know that he doesn't like to be fussed over and likes tea & biscuits in peace. The care plans will be tailored to the individual so not all residents will necessarily have the same type of restrictions imposed on them as others. Your father will also be subject to regular assessment to make sure that the EMI unit is a suitable environment for him. It sounds like the home suggested covers both residential care and EMI nursing. If that is the case is there the potential for your father to remain in the home but be moved out of the EMI nursing unit if necessary? My Mum's home has various different units - some are for challenging behaviour and others are not - so people are moved between the two if necessary. I hope that your father isn't kept in hospital for too long as it is not a good environment for those with dementia.

 

[Andy B]

Hello @Andy B Welcome to Dementia Talking Point.

I used to care for an elderly neighbour, an ex guardsman and a gentleman. As dementia set in he shocked me by using what I could only call barrack room language. When he was in residential care the care home staff said it was quite usual for this to happen even in the most gentle people.

I would ask for a re-assessment for your dad regarding his perceived aggressive behaviour simply because I wouldn`t want him labelled as aggressive. However , please do not be distressed by the idea of an EMI unit. The restriction, the secure entrances and exits are there for your dad`s safety and I'm sure even in an EMI unit he will be free to sit in peace with his tea and biscuits.

Grannie G, thanks for taking the time to read my post.
We will be asking for a reassessment because we feel he is not aggressive and don’t want him to be labelled as such. The hospital social team have not held any meetings with us or made contact with dads care providers, I just think they have jumped to a wrong conclusion based on his stay in hospital. I think we are in for a frustrating few weeks

 

[Wildflowerlady]

Hi @Andy B

As a child and right into my adult years I never once heard my dad swear he simply didn't however since his dementia became obvious Iv'e heard some really ripe language from him if I say Oh dad he denies he swore so I don't mention anymore .
Dad has shown verbal aggression towards his carers and myself but hasn't yet shown anything physical other than a raised arm although it can be a bit scary as he will glare as well.
I know that carers do report in his Care Book any incidents and sister has had 3 calls in the last 4-5 months regarding dads temper and what may happen ( withdrawal of care ) but as yet no further action has been taken. I have no experience of residential care or respite because as yet dad has not gone down that route but I feel it may not be long before he does.
Have just remembered dad has grabbed a walking stick which he doesn't even use and threatened carer with it but she told him she would have to report him if he used it on her. Dads coffee table has taken a few kicks too as is usually the closest thing to him.

 

[Lorraine D]

Hi Andy, My mum has alzheimers , she was also in hospital for a back injury . while she was there she got very confused, didn't even know what country she was in, getting upset with myself and siblings. However when she got home and into her own environment she improved greatly.
You could ask them to re-assess your Dad once he is in more familiar surroundings.

 

[Andy B]

Welcome to the forum. It sounds as if an EMI placement would be best for your father, based on what you have posted. He is physically defensive, grabbing those who go near him, and social services will be primarily basing their assessment on his behaviour whilst in hospital, with input from the medical team. If you are unsure about the basis for the EMI recommendation the social worker should be able to explain the reasons for this.

The type of behaviour that your father is displaying will require staff who are knowledgeable and experienced in such behaviour and the problem with a 'standard' dementia care home is that most can't handle any type of difficult behaviour. The staff in an EMI unit will be used to such behaviour and will know various techniques that can make things better for your father and also keep both him and the staff safe. If your father is not able to pay for his own care and is reliant on the local authority to pay this then unfortunately the choice of homes is likely to be limited. However although the homes you have looked at have given you the feeling of internship and restriction the family would have input into his care plan so could let the staff know that he doesn't like to be fussed over and likes tea & biscuits in peace. The care plans will be tailored to the individual so not all residents will necessarily have the same type of restrictions imposed on them as others. Your father will also be subject to regular assessment to make sure that the EMI unit is a suitable environment for him. It sounds like the home suggested covers both residential care and EMI nursing. If that is the case is there the potential for your father to remain in the home but be moved out of the EMI nursing unit if necessary? My Mum's home has various different units - some are for challenging behaviour and others are not - so people are moved between the two if necessary. I hope that your father isn't kept in hospital for too long as it is not a good environment for those with dementia.

Louise7, I suppose it could have been the standard of the emi homes we looked at, the first one made me feel very uneasy about putting my dad into that environment. I agree with you on the hospital environment not being suitable. My dad has always hated needles, he has been getting plenty of them over the last few weeks and has no hesitation in telling the nurses where to go (Putting it politely), I think this has added to the perceived aggressive call they have made on him.
I do understand that the social team have a safety responsibility to my dad, other patients and staff but feel they have jumped to a quick decision. Once he is out of hospital it is good to know that assessments are carried out continuously as I am sure when the care home staff get to know him he could be moved into a different environment

 

[Andy B]

Hi Andy, My mum has alzheimers , she was also in hospital for a back injury . while she was there she got very confused, didn't even know what country she was in, getting upset with myself and siblings. However when she got home and into her own environment she improved greatly.
You could ask them to re-assess your Dad once he is in more familiar surroundings.

Lorraine, agree with what you have said. Dad needs to be out of hospital, he won’t be going back to his house though so just need to get him into the right place and I am sure he will get back to some sort of normality. He is very confused and scared at the moment

 

[Louise7]

The hospital social team have not held any meetings with us or made contact with dads care providers, I just think they have jumped to a wrong conclusion based on his stay in hospital. I think we are in for a frustrating few weeks

Mum has had a couple of hospital stays and from experience we have found that they seem to just want to get people out as quickly as possible without bothering with thorough assessments with regards to health & care needs. During her last admission we didn't hear from the hospital social worker for 2 months despite requesting a meeting on several occasions. Hopefully you will be able to arrange a 'best interests' meeting with the social worker and medical staff to discuss in detail the type of care that your father needs.

 

[Juliematch]

Hi Andy . I have been going through the same with my dad .The only difference was he was already in a care home for the last year. He has become aggressive due to his delusions and confabulations but not all the time and the home has decided that they can no longer meet his needs. Dads been in hospital since New Year’s Day and ready for discharge since the 6th of January . We had a nightmare in a and e ( he attacked a nurse because he thought she was attacking him, 2 porters to hold him down) and I to was worried he would have a label of aggression.I now realise it’s not a label but a heads up to carers to tread carefully.He was such a quiet and gentle man before dementia. Dad has a place in an EMI home which he is being assessed for on Monday. They will have all the expertise to cope with his behaviour even if it’s only occasionally he’s angry. Residents have to be kept safe so there are bound to be restrictions but most homes are like this .You will get a say into his care and they include you in decision making.I wish I had looked at carehomes with EMI attached when I first started looking at homes but we are all learning as we go along.I hope all goes well with your dads move and that you can relax knowing your dad is in safe hands.

 

[Andy B]

Hi Andy . I have been going through the same with my dad .The only difference was he was already in a care home for the last year. He has become aggressive due to his delusions and confabulations but not all the time and the home has decided that they can no longer meet his needs. Dads been in hospital since New Year’s Day and ready for discharge since the 6th of January . We had a nightmare in a and e ( he attacked a nurse because he thought she was attacking him, 2 porters to hold him down) and I to was worried he would have a label of aggression.I now realise it’s not a label but a heads up to carers to tread carefully.He was such a quiet and gentle man before dementia. Dad has a place in an EMI home which he is being assessed for on Monday. They will have all the expertise to cope with his behaviour even if it’s only occasionally he’s angry. Residents have to be kept safe so there are bound to be restrictions but most homes are like this .You will get a say into his care and they include you in decision making.I wish I had looked at carehomes with EMI attached when I first started looking at homes but we are all learning as we go along.I hope all goes well with your dads move and that you can relax knowing your dad is in safe hands.

Thanks Julie, sorry to hear about your dad, anyone going through the same situation must feel the same stress levels but at the end of the day all we want is for our parents to be in a good environment where we know they are being looked after in a compassionate manner

 

[Andy B]

Mum has had a couple of hospital stays and from experience we have found that they seem to just want to get people out as quickly as possible without bothering with thorough assessments with regards to health & care needs. During her last admission we didn't hear from the hospital social worker for 2 months despite requesting a meeting on several occasions. Hopefully you will be able to arrange a 'best interests' meeting with the social worker and medical staff to discuss in detail the type of care that your father needs.

Louise, you can certainly see the strain everyone is under in the hospital.

 

[Jessbow]

Sorry, grabbing/Physically definsive and swearing IS aggressive- he sounds as though he'd be best places in an EMI home.. He goesnt need to be an aggressor- reactive/defensive aggression is enough to warrent this.

 

[Beate]

If you get him reclassified as not aggressive, and the first care home turns him out because they can't handle his grabbing and swearing, you won't have gained anything. Also, the care home will assess him first anyway, so why not give a few EMI homes a chance to do so? I really don't see what you're achieving with your "how dare you say my Dad is aggressive" stance. Any placement must be in his best interest and able to deal with him on his worst day.

 

[Rosettastone57]

I think you need to stick with the EMI home. The staff are more experienced in dealing with aggression, which it is, even if it's defensive. If he goes into a care home that is not used to this type of behaviour, he will be asked to move somewhere more appropriate which means more disruption

 

[Louise7]

The Social services team have agreed and carried out an assessment on him. They have classified dad as EMI nursing, we think this is due to his perceived aggression.

Bear in mind that being assessed as needing an EMI nursing home isn't the same thing as being 'classified' as aggressive, that's just your perception. The term EMI tends not to get used as regularly now as it did in the past, and an EMI nursing home is one where staff will be specifically experienced in dealing with residents who have dementia, including challenging behaviour. Try to think of it as your father - who has some challenging behaviour - needing nursing care in an environment where staff are knowledgeable about dementia. My Mum's in a nursing home which deals with those with dementia, some of whom are aggressive, so I suppose it could be described as an EMI home but she isn't aggressive and neither are many of the other residents. You need to make sure that your father is placed somewhere which meets his needs - try not to focus on emotive terms such as 'classified as' or 'labelled as'.