Day care - and dieting!

Discussion in 'I care for a person with dementia' started by Ann Mac, Jun 26, 2015.

  1. Ann Mac

    Ann Mac Registered User

    Oct 17, 2013
    3,699
    I wonder if anyone has any suggestions, please :)

    Since last November, shortly after she started at a new day care facility, Mil has gone from 11 stone 4lbs, to 12 stone 12 lbs. Its a lot of weight for her to carry, as she is only a smidge over 5 feet tall, its having a bad impact on her health and causing her some distress. At her last health review, for COPD and diabetes, whilst the diabetes was stable, I was told that her breathing was being compromised by the excess weight - and I can see for myself its getting worse. She's also having a lot more trouble with pain from her arthritic knees, and again, the weight gain is a definite contributory factor. The breathlessness and pain are causing her a lot of upset, but she can never remember that when she is offered any sort of 'treat' - and if reminded, her appetite takes prededence over any weight gain consideration, anyway. At home, I've cut out puddings and snacks, cut portion size, replace carbs with veg/salad wherever I can, and obviously am keeping fat and sugar content to the bare minimum.

    Another factor is that as she gets heavier, the more I have to do for her in terms of personal care, and as I have some back problems, its having an impact on me - even pushing her in her wheelchair has become really hard work.

    But how do I get day care on board with helping with this issue? At her review at the care home where day care is held, I said I was worried about her weight, and was assured they would kep an eye on her eating there. After her health review, when the concerns about the COPD were raised by the nurse, I spoke to them again. Yet still I know, from odd remarks the staff have made, that as she walks through the door in the morning she is being given a 'second' breakfast of butter laden toast, and that she is still being provided with biscuits on demand. She recently had a weeks respite at the sister home to where she goes for day care - and gained 4.5lbs in that one short week :( A few weeks ago I went to collect her at 5pm, and found her tucking into a plate of fishcakes and chips - even though she has her evening meal at home with us, and they know this - it was just before 5pm, so the excuse that everyone else is eating really doesn't hold, does it? No one else was eating that I could see. I dropped her off after a hospital appointment (usually she gets a mini bus in) and she didn't even have her coat off before a plate of toast was put down in front of her. Last night I went to collect her and she was tucking into a plate of biscuits. We've found, on several occasions, empty family size packets of sweets and chocolates in her pockets and handbag - she had either been given them as 'raffle prizes, or has helped herself to 'treats' belonging to staff or residents - the calorific value of the family size bag of 'giant chocolate buttons' that she had scoffed a few weeks ago was over 1000 calories. Add that 1000 calories to the additional toast and biscuits throughout the day, plus her regular meals, and its no wonder she is gaining, despite all my efforts.

    Last night, for the first time, I got really cross with the senior staff who was at day care - I told them I was fed up, that they weren't being fair to Mil, that they were damaging her health. The staff looked a bit taken aback (I have a really good relationship with them, and in all other area's, I think their care of Mil is great) but again, they agreed that they would be 'more careful' - but I felt like they were just making 'soothing noises' as past events have shown that they can't/won't actually do as I ask.

    Mil will ask for biscuits/toast/cake/food in general when she gets agitated - its like she has the munchies - and as the staff have told me that she is tending to get more agitated when she is there now, as her illness progresses, I suspect that biscuits/treats are being used to distract or pacify her. I do understand how hard it is to say 'No' when she asks - but I have to do it at home! And a cup of tea by itself can also work (sometimes) as a distraction for her.

    Its horrible seeing her distress when she can't get her breath, or to see her in tears because the pain in her knees makes her dread climbing the stairs to get to the loo - we are looking at putting in a stair lift for her, ut surely it would be better for her if she could lose the weight ad manage the stairs by herself, for just a bit longer? I'm sure she could if she lost some weight. So, any suggestions about how to get day care on board will be very gratefully recieved.
     
  2. CeliaW

    CeliaW Registered User

    Jan 29, 2009
    5,653
    Hampshire
    Tell them the consultant has said you have to keep a food diary so that it is possible to look at where MiL is having foods that could be cut and so ensure she at least gains no more and ideally loses some.

    Maybe print up a page per week that you give them and collect on last day of week - dated and with columns such as drinks/ lunch/ other....

    Difficult one but they have a duty of care towards your MiL whilst she is in their care and this is obviously not in her best interests - even if you can understand them giving in and why!

    Good luck x

    PS - you could always say after your conversation yesterday you discussed with OH about the problem and he reminded you of the Consultants comment regarding weight gain.
     
  3. LYN T

    LYN T Registered User

    Aug 30, 2012
    6,967
    Brixham Devon
    Ann, I've just posted on your other thread, but I think that Celia has given a good suggestion here. My OH had asthma and COPD which was totally in control when he was well; he was always naturally slim and exercised everyday. However, as his AD advanced the COPD got worse-it's horrible to see how energy levels go down and the breathing gets affected. I think you have every right to mention the biscuits/toast (plus the rest) -this kind of 'comfort' eating is not doing anyone any good.

    Love

    Lyn T XX
     
  4. Cat27

    Cat27 Volunteer Moderator

    Feb 27, 2015
    9,765
    Merseyside
    Would the GP write a letter.
    They should be more helpful. They must cater for diabetics & food allergies etc so should appreciate your concerns.
     
  5. RedLou

    RedLou Registered User

    Jul 30, 2014
    1,161
    Ann - it is worth--

    a] putting it all in writing to the head of the DC? Harder to ignore or 'forget' if you've put your concerns in a firm but polite and reasoned letter.

    b] suggesting alternatives they can use for distraction, such as the cup of tea? Also, why does it always have to be carbohydrates they offer? Why couldn't they offer a small portion of sliced fruit, for example?
     
  6. 1954

    1954 Registered User

    Jan 3, 2013
    3,836
    Sidcup
    Could you not give her breakfast before she goes to day centre? My MIL gets a second breakfast of toast and butter at day centre because 'she likes to socialise' with those on her table! We realise that whatever we say they'll still give it so don't give brekkie now. Also we never give her second meal in the evening, we give her a snack. May not work for you but just a thought.............
     
  7. Kjn

    Kjn Registered User

    Jul 27, 2013
    5,835
    We have same trouble with dads clubs he goes too, it's all biscuits and cakes , then they also make cakes. He is diabetic and it's so hard as he doesn't understand he shouldn't be having them either.
     
  8. Spamar

    Spamar Registered User

    Oct 5, 2013
    6,838
    Suffolk
    1954, I know Ann's mil has breakfast before daycare.
    I'm not sure what it is about daycare and food. OH is naturally thin, no problems. But once when he was on antibiotics that had to be taken on an empty stomach, I came in to pick him up and there he was, eating coffee and cake! No pm ABs, therefore and there was no excuse cos I told them and they had the packet with instructions!
     
  9. 1954

    1954 Registered User

    Jan 3, 2013
    3,836
    Sidcup
    I do agree it is irritating. Thankfully MILhas not got diabetes nor breathing problems so I have it easy
     
  10. susy

    susy Registered User

    Jul 29, 2013
    806
    North East
    If she gets the munchies when agitated can they not give her something healthy instead? Such as chopped up fruit?
     
  11. 1954

    1954 Registered User

    Jan 3, 2013
    3,836
    Sidcup
    Oh but it doesn't taste the same.....My MIL would ALWAYS find sweets over fruit!
     
  12. SpringsEternal

    SpringsEternal Registered User

    Jun 26, 2015
    5
    Hi
    Is there not a care plan in place? if so ask for a review around diet needs including do's and dont's.
    I am waiting on a GP appointment at the moment to see if my mum has dementia so at this moment do not have much in the way of first hand experience with what you are going through but I have worked with people with autism and had to find ways of dealing with outbursts of anger at being told they must wait until set meal times and can not just eat whatever they want when they want due to health issues.
    Using food as a way of calming someone down should not just be seen as a way of making life easier for the staff if it is effecting the persons health surely?.

    Wishing you luck !
     
  13. angelface

    angelface Registered User

    Oct 8, 2011
    1,086
    london
    Could you tell the day care staff that mum is at risk of diabetes if her diet does not change?

    After all, it is probably true! Would the GP give you something similar in writing to help you out?
     
  14. angelface

    angelface Registered User

    Oct 8, 2011
    1,086
    london
    The other problem I came across with day care was that they were behind the times with 'healthy eating'. So the idea of fruit does not figure in their thinking. Also it costs money and affects their budget.

    You really should not have to, but could you give them more suitable snacks for MIL?
     
  15. Ann Mac

    Ann Mac Registered User

    Oct 17, 2013
    3,699
    Thanks everyone, really appreciate you taking the time to reply :)

    Celia, the food diary idea is a good one, and I wonder if I could combine that (sort of) with Cat's idea about a letter from the GP - there is an in-practice dietician that I could request a referral to, and I wonder if a 'diary' plus instructions from that source might work? And I think - if that doesn't work - then following it up with Red's suggestion of a letter might have to be the way :(

    Lynn, I can't say that Mil was ever 'naturally slim' or that she exercised regularly - she has always had a very sweet tooth, but until dementia she stayed around a size 16 - in the early stages, she did get to be terrible about gorging on sweet stuff and went up to about a size 22! As she lost the ability to cook and get out to the shops herself, the weight then dropped off her, and when she moved here, she was back to a 16 - she initially lost a little more, until she settled at 11st 4lbs, for well over a year. It is horrible the way the breathlessness from the COPD saps her strength - I also find that if she gets breathless, she tends to panic, which makes it worse, too :(

    I have suggested just the cuppa, and I have suggested fruit, too Red - and I wouldn't have any problem at all with supplying the fruit, Angelface. I suspect Mil won't settle for that, when she see's others having the cake and biscuit, though.

    A lot of the residents/day care attendee's have the opposite problem to Mil - many are on the underweight side, which I know is a horrible issue that a lot of carers also face with their loved ones, as not eating seems to be a common issue - for that reason I've been told that the food offered there is 'calorie heavy' - again, I understand it, but why not practice portion control? I do it here - easy enough to cut the potatoes down by half and pile on the cabbage, caullie or salad instead. That way, it doesn't look like she is having anything too different from anyone else - as kjn says, Mil wouldn't understand or accept that.

    1954, Mil wakes - and Mil is always 'starving' - her food not being on the table as soon as she sits for breakfast would be guaranteed to start her off really agitated. She also has meds that must be taken with or after food in the morning, and as they come in a blister pack with her evening meds, it would be a pain to have to sort out and send in her tablets to be taken with breakfast at day care - I suspect that I would forget occasionally, too. So I can't skip brekkie for her here at home - what I've done instead is halve what she was having before - so a very small bowl of porridge and just 1 piece of lightly buttered wholemeal toast - and boy, has she given me some grief over that! Because that's another issue - as I know she is getting 'too much' there, I've been trying to compensate here at home, so I am always the 'bad guy' saying an absolute no to puddings and cakes, no to extra toast, no to any little treat - and as far as she is concerned, saying no to what she considers a decent breakfast too!

    Mil has diabetes already, Angelface - at her last review, that hadn't been made worse at all - though as the nurse said, excess weight will cause her problems eventually, perhaps quite severe ones.


    SpringsEternal - the issue about her over eating was raised by me at her last day care review, and instructions on watching her diet sould have gone in the care plan then - they are just not being followed, from what I have seen and what's been said to me.

    I think I'll try for a GP appointment early next week and see if I can get a rushed referral to the dietician and engage his or her help - Mil struggled to dry the back of her neck and the back of her legs this morning, she she simply can't move as well with all the weight. I know that eventually, I may well end up having to do all these things for her - but surely keeping her as independant as possible for as long as possible, counts for something?

    Thanks everyone :) x
     
  16. SpringsEternal

    SpringsEternal Registered User

    Jun 26, 2015
    5
    Well I am well aware of most if not all types of care now being " person centered" and if the people giving her care are not all singing off the same hymn sheet then this can cause more distress and issues.

    Care plans are there for a reason and if they are not being followed , putting a persons health at risk and it has been addressed many times I would take a more formal approach and complain to someone higher.

    I am pretty sure if the issue was that of a person becoming violent because people approached from behind for instance then the day care center staff would not put themselves in harms way by approaching from behind so I find it awful that they would put others in danger just for an easier time of it.
     
  17. angelface

    angelface Registered User

    Oct 8, 2011
    1,086
    london
    Oops,sorry,penny only just dropped about the diabetes.

    Sorry to be negative about care plans,but I did find with my aunts in care,that the plan was written down, then ignored.

    My aunts care homes did not seem to have carers who were bright enough to follow the plans. Hope MILs daycare is better than this.
     
  18. cragmaid

    cragmaid Registered User

    Oct 18, 2010
    7,963
    North East England
    How about sending her with a packed lunch...like we do for my granddaughter at nursery. In her case , it's because she won't eat the lunches provided. But it should be easy enough to personalise the contents and put it in writing that MIL is not allowed.....backed up by her GP and Dietician.... to eat anything more. That chocolate is forbidden....not that she can have a treat, but FORBIDDEN !!!!!!!!! yes put it in shouty capitals:D:D:D and that she is not to have extra bread/toast/biscuits regardless of how much MIL begs as her diabetes and weight are now out of control.

    :D
     
  19. canary

    canary Registered User

    Feb 25, 2014
    9,302
    Female
    South coast
    I have a sneaky feeling she would eat that AND the lunch provided
     
  20. cragmaid

    cragmaid Registered User

    Oct 18, 2010
    7,963
    North East England
    :d:d:d:d:d:d:d
     

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