drugs doctors and assesment units!

Discussion in 'ARCHIVE FORUM: Support discussions' started by j.j, Aug 31, 2007.

  1. j.j

    j.j Registered User

    Jan 8, 2007
    91
    hi all, mam been in assesment unit now for eight weeks, was admitted from her residential nh because of overload of drugs doctor prescriubed olanzapine and didnt make it clear about other drugs already bieng given, anyway in the unit they prescribed risperidone which we havn,t been too happy with, the dose had to be dropped because mam was showing signs of the facial movements which can be permanent if not monitered, then her head drooped to her chest and she drooled. now her leg has swollen and is very inflamed wether this is a side effect we do not know but we have now INSISTED mam be taken off risperidone. the doctor said her neck was probably due to the az and not the drug and yet i can already see an improvment! he also said he thought the dual registered home we chose for mam would no longer be able to meet her care needs any longer. I brought mam home yesterday to sit in the garden and enjoy the sun and her grandchildren she thouroughly enjoyed it, joining in all the fun as best she could. I just wish the doctor could see her like this instead of telling us she is ready for esme care, i feel so frustrated since we allowed the proffesionals a say in mams care, getting them to realise we DO know what we are talking about, sorry its been a bit of a rant but the negatives are outweighing the positives for us at the moment, x
     
  2. elaineo2

    elaineo2 Registered User

    Jul 6, 2007
    945
    leigh lancashire
    Hi am so sorry for your plight.Unfortunatley dual banded homes are normally banded for residential and nursing needs.However there are homes that are banded for reidential/nursing EMI,a totally different scenario i am afraid,I do feel your grief about this,but at the end of the day we all want whats best for our loved ones.Do what you feel is right thats all i can say and i work in a care home!joking apart it is a big decision and choose wisely.love elainex
     
  3. Cymbaline

    Cymbaline Registered User

    Aug 23, 2007
    36
    #3 Cymbaline, Aug 31, 2007
    Last edited: Aug 31, 2007
    Hi J.J.

    I hear you loud and clear. My mother is in an assessment unit at the moment as well, mainly because she started getting very agitated and screamed for hours without her medication helping her anymore. To be honest, if I had a choice I'd pull her out of there in the morning but that's not possible at the moment.

    What I've learned in the two weeks since she went in there is that you can't trust the so-called professionals to do the job we want them to do. The medicine they gave my mother in the unit reduced her into a drooling, chairbound wreck. I'm convinced if my father hadn't kicked up an almighty fuss about this last week, that she'd still be in that state. Indeed, when my dad pointed out to the consultant that she hadn't walked in a week (something that alarmed us beyond belief because mum always walked), the consultant stated that she was mobile. Mobile being defined as her being able to move from a bed to a wheelchair with the aid of nursing staff. :mad:

    None of us are particularly happy with the standard of care she's getting. I'm not going to bore you with the details here but I am utterly convinced that the care she's receiving in the unit is substandard and only improved because she's got a family to fight for her. The staff in the unit want a quiet life and don't give a toss about our loved ones. I am so proud of mum mum who, despite having advanced Alzheimer's, seems to hate all the staff in the unit. I hate them too now...all my mother is to them is a piece of meat.

    I wish you all the best with your mother. You know better than any so-called expert what is good for her. I am delighted to read that she had a good day in your garden and I hope you have many more of those. I also wish you luck in standing up to these people. They don't necessarily have your mother's interests at heart so you really need to keep on top of them and ask lots of questions. This my family has learned the hard way.
     
  4. Cate

    Cate Registered User

    Jul 2, 2006
    1,370
    Newport, Gwent
    Hi J.J. and Cymbaline

    I really feel for you both, and I agree with you on the standard of care in a lot of hospitals.

    I experienced the same low standard of care when mum was admitted to hospital following a heart attack. I won’t bore you with the details, suffice to say I couldn’t get her out of there fast enough and back to the NH where they understand her AD, treat her with respect and loads of TLC.

    My only advice would be, ask for constant meetings with the doctors for updates on progress and their care plan. Ask to be consulted on any changes in medication, and particularly dose. Ask questions, what do they hope to achieve by giving X, what’s the minimum dose, how to they plan to monitor before they titrate the dose up. If you see something you don’t like, shout loud and long. Whilst I appreciate getting medication right is not an exact science, but I do think you are right, a dosed up to the eyeballs patient is easier to care for than a challenging one.

    Best wishes

    Cate
     
  5. suptowngirl

    suptowngirl Registered User

    Sep 19, 2005
    39
    Staffordshire
    #5 suptowngirl, Sep 2, 2007
    Last edited: Sep 2, 2007
    Hi JJ, My mum went into an assessment unit in April. When she went in she was confused and already on medication but we could have a conversation with her. We were led to believe the professionals would sort things and put her on the correct medication. We believe she was being abused in there and we obviously kicked up a fuss. Mum lost the ability to talk normally as they made a mistake with her Ebixa. They also continued to give her co;codramol on top of her usual medication and this just knocked her out, she was just slumped in a chair and left until we got there. It seemed better for the staff ( mainly agency ) if the patients were out of it.
    We kicked up a fuss and went to the top, this was our mum and it was torture watching her go down fast. They hurried things along after this and mum was moved to a lovely care home, however she got up wandering one night and wrecked the kitchen and tried to climb out of the window ( no staff about ) she fell and broke her hip.
    She was in hospital for 6 weeks and refused to walk after surgery.

    She is now in a nursing home and is being fed and cared for but she just sits in an armchair on wheels.She doesn't know us when we visit, I think she knows our faces but she doesn't know we are her children.
    She lies in bed in the same position as she sits in the chair as her legs have stuck in that position. She has to be fed and has to have her food pureed and her drinks thickened..
    It's left us feeling so guilty thinking that if we hadn't let her go into that dreadful assessment unit she might just not be as bad as she is now.

    Keep a check on things in that unit and don't be afraid to speak out. It is after all your loved one in there.
    Take Care and I wish you well with your mum.
    Suptowngirl
     
  6. TinaT

    TinaT Registered User

    Sep 27, 2006
    7,095
    Bolton
    Hospital assessment units

    Of course we have every right to complain if we see our loved ones 'going downhill' in the assessment unit. Of course we have the right to ask about medication, to make appointments to see the Consultant, and to keep a concerned, loving eye on the situation our loved ones are suffering. It is a most heartbreaking situation to leave someone you love so much to the mercy of others

    The other side of the coin is that the people working in the assessment unit are probably doing their best within the constraints of the organisation they work in. Staff phone in sick, agency staff either don't arrive or when they do arrive are more of a hindrance than a help. The staff have a job to do, they mop up the sick, wipe up the wee on the floor, keep patients clean and fed, etc., in fact do so many jobs day in and day out that are unpleasant and unpallatable to most of us. It is a job which only 'special' people can do well. I am quite convinced that there are decent, hardworking staff, just as there are lazy and uncaring staff.

    I have been heartbroken when visiting my husband to see his decline, to see him not in his own clothes, to see him sat staring vacantly into space, or endlessly pacing up and down, up and down and many other distressing things. Some of my worries are trivial, some of them very important. I have been angry and frustrated by the slowness with which my complaints are dealt with. I have been angry when I have felt my worries have been stonewalled or not dealt with quickly enough to satisfy me.

    But I also recognise that the staff are not my enemy. This terrible disease is my enemy and I try to treat staff as allies in my struggle against this thing that has wrecked my husband's and my life together.

    After all, where else can my poor, poor husband go? I cannot cope at home. no matter how much I yearn to do this. We don't live in a perfect world. All we can do is strive to continue to do the very best we can, given the circumstances which govern our lives.

    xx TinaT
     
  7. Brucie

    Brucie Registered User

    Jan 31, 2004
    12,413
    near London
    Hi TinaT

    such a good, practical and sensible post about a nightmare we all recognise all too well.

    Thanks :)

    Such a shame we must all come together for such a sad reason.:(
     
  8. janjan

    janjan Registered User

    Jan 27, 2006
    229
    Birmingham
    Dad was on a drug late last year that wasn't helping the fact that he was still able to walk, but because he had LB dementia the drug he was on didn't help him, so to cut a long story short i caused a few problems at his n,home when his consultant said he had to come of the drug. But because he was still walking i to felt he was better of it than falling over and getting broken bones as well. He was taken off it and given a lighter drug, and for a few months he as been OK with it. Dad was always no trouble to them there , but over the last couple of months has become violent , so for safety of himself and others has been put on a stronger sedative.
    Where do you draw the line i ask myself between him being able to walk and be slightly aware of his surroundings, getting upset and agitated so that he is not at any type of peace.
    It broke my heart to see him the other day , totally spaced out he looked, when i asked him who am i today he still called me my moms name, even though over the last few months i thought he had forgotten that i was connected to him.
    He was more relaxed than i had seen him for the last 2 months, but i was still gutted to think that i had lost a bit more of dad because he had to be so drugged to be of no harm to himself or others.
    Is it better for him to be at more peace ?, but i feel so gutted that he has to be so drugged to be like that.
    I pray to god his time is soon near and he can be at a natural peace. :(
     
  9. j.j

    j.j Registered User

    Jan 8, 2007
    91
    hi just to update on mam, the risperidone is now out of mams system and we are pleased to say her neck is so much better.not perfect but more upright. and the drooling has stopped. she is much more her old self with some witty one liners! the downside is her agitation is also back at times, she races up the hospital corridoor back and forward for hours, because of this they think she will not be able to go back to the nh but need esme care, does anyone have any experience of esme care, i just presumed esme was when sufferers were in the last stages of az,
    thank you j.j
     
  10. Grannie G

    Grannie G Volunteer Moderator

    Apr 3, 2006
    69,884
    Kent
    Dear j.j.

    I think esme care is the old term for EMI care, but I might be wrong. The unit my mother was first in was referred to as both esme and EMI.

    It just means combination locks on external doors, so residents can`t run out, and a higher staff ratio.
     
  11. blue sea

    blue sea Registered User

    Aug 24, 2005
    270
    England
    #11 blue sea, Sep 13, 2007
    Last edited: Sep 13, 2007
    Hi jj
    Assuming esme is the same as EMI (Elderly , Mentally Infirm), as Sylvia suggests, the other main difference, as I understand it, is that there has to be a RMN (Registered Mental Nurse ) on duty as all times. EMI homes units are not necessarily for people in the last stages of AZ, though a nursing EMI will care for these too. The essential point is that they offer secure and more specialized care for people with a whole range of dementia and other mental health problems. They are usually the only option for people whose illness causes them to be very agitated, constantly moving etc as ordinary residential homes cannot meet their security and safety needs. EMI units, in my experience, vary hugely in the quality of care. They are often in rather short supply and you may have to look outside your immediate locality. It is worth visiting several as well as looking at inspection reports. On an initial visits they can seem rather frightening places as, by the nature of them, the residents may be behaving rather oddly. A good EMI unit will let the residents behave as they need to, gently stopping or modifying behaviour where it is infringing on others or is likely to become unsafe. The best ones are where the staff get to know the residents and work with them individually and with the relatives to support their care needs. Talk to the staff, the carers as well as the nurses, as it is the carers who actually do most of the day to day caring, ask them about the routines of the home, how they cope with residents who are agitated. Through conversation, and observing how they ineract with the residents while you are there, you will get a feel for the sort of home it is. I would try to make 2 or 3 visits, at different times of the day, to any homes you are seriously considering. A nurse from the home will need to assess your mum to decide whether the home willl be suitable for her, so it is a two way process. By the way, EMI homes should not accept people whose illness is causing extreme aggression or violence. There are more specialized units with much higher staffing ratios run as part of the national health service for such patients. You should be reassured, therefore, that if your mum does need to be in an EMI home, it will be a safe environment for her.

    This will be a very difficult time for you. Don't let anyone rush you into a decision. It is very difficult to assess needs when the person has been on a variety of medication - it does take time for things to settle. Also every move causes a period of instability, so you want to be as sure as possible that decisions are being made after careful consideration and after your mum's condition is stabilised. If I can be of any more help, I am happy to respond to a PM. My father was in an EMI home for several years, as well as going through various assessment units and many different attempts at medication as a result of the problems his agitation caused.
    Blue sea
     
  12. Margaret W

    Margaret W Registered User

    Apr 28, 2007
    3,725
    North Derbyshire
    #12 Margaret W, Sep 14, 2007
    Last edited by a moderator: Sep 14, 2007
    Thanks for explaining esme and EMI care, I didn't know what you were talking about.

    By contrast, my mum spent 6 weeks in a Hospital Psychiatric Unit, in Derbyshire and her care, and as far as I can make out the care of every other patient in there, was supberb, I'd have liked her to have stayed there forever.

    There were some very sick patients in there, including a couple who were inclined to violence and they were dealt with calmly and professionally. There was one patient who was such that he was not allowed to mix with the others, he was confined to a bedroom, with constant attendance, for which extra staff were drafted in. There were 12 patients and 4 staff minimum at all times, including a Sister, two nurses and an auxilliary (probably the wrong term now). In additional the Occupational Therapist team (2 of them) were there at least 3 days a week, as well as a team of volunteers. As well as housekeepers, who all spent time talking to residents. The staff did tell me that their unit was unique in the country, and I hope everywhere gets one of the same standard before long.

    Love to all

    margaret

    [edited by Bruce to omit precise identification of medical facility]
     

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