Expectations of a home

[Nick]

Hi,
My mum finally went into a nursing home just coming up to a month ago. The carers are kind and helpful but I have a number of real concerns. Her mobility was bad before she went in but is now almost non existent; she has had 3 bad falls in the last week, all at night time, one of which nobody at the home seemed to know anything about; she has had no induction type examination from a doctor; many clothes have gone missing; she is not eating well - the food is always cold; she is refusing medication but the impact of this seems to be played down by the staff; there are no indications that she is getting exercise or fresh air; she is often inappropriately dressed in summer clothes. Whether this is a sympton or a cause I don't know but the place always seems understaffed.

Mum is unable to make herself understood so it is so difficult to know whether she feels well, in pain, settled, happy or traumatised.

I am raising these concerns with the home manager but don't know if my expectations are just too high. Is every home catering for residents with dementia pretty much the same? What is it reasonable to expect?

Any experience out there to help me with handling this would be much appreciated

Nick

 

[Brucie]

Hi Nick
it is very difficult at first, isn't it? Not knowing what we should expect.

From my experience with Jan, which will undoubtedly be different from yours, I learned the following:

a new GP was assigned to her on entering the home, which was too far away from our own home for her existing GP to be used. The new GP reports straight to the consultant, so it works well.

It takes quite a while for new residents to settle into a care home. It is all so strange, including the carers, the food, the change, the need to adjust to medication, etc.

Often they eat really slowly, so there is no choice but that the food gets cold. For health reasons they can't re-heat it. If they won't eat the food they may be offered Ensure or some other special liquid meal.

Clothes do go missing as they tend to be washed together for all - does the home label all clothes for each resident? Jan's does.

Staff can't exercise anyone that refuses to be exercised.

I'd have an informal chat with the manager, and ask what her expectations and plans are for your Mum; what the care regime is, what the food menus are [you can advise on anything she may not like], etc. Ask if there is anything you can do to help - ie show you are sympathetic and concerned.... and are watching [don't appear to be Big Brother though].

Does she have a room to herself? What are her sleep patterns etc.

It took Jan at least 6 months to properly settle into her home, though she was I am sure in worse condition that your Mum.

Take it slowly, keep a watching brief, visit at different times of day, including meal times - help her with lunch to understand how well she copes, etc.

 

[allylee]

Hi Nick, I have two experiences of care homes , one very similar to yours. I chose a home for my nan four yrs ago, I looked round , chatted to the staff etc, and felt fairly satisfied. After a couple of months , I had many of the same concerns as you, and as a qualified nurse of 20 yrs , became very worried about the standards of care, or lack of them.I spoke to the home manager on several occasions, and basically was fobbed off that everything was ok.
After witnessing the manhandling of an old lady by two "carers" who were trying to get her to the loo, I took my concers to social services. THey were fantastic and did a unannounced inspection.
Following their report, I chose to move my nan to another home, which turned out to be the opposite. She spent her last couple of yrs there being truly cared for and treated with dignity. mY mum now has AD, and itll be the same place that will take her when I can no longer cope caring for her at home.
Every home has a social services or healthcare commission report, which should be freely available for you to read.
Do raise your concerns to the manager, do be a pain in the bum , it may be enough to spur them into action !
All the best Ally xx

 

[Sandy]

Hi Nick,

Can't add much to the sound advice given already, but if you do want to look up the home's inspection report, you should be able to do it online here:

http://www.csci.org.uk/inspection_reports/default.htm

Take care,

Sandy

 

[Jude]

Dear Nick,

Do get all of your worries checked out asap. If you want to do spot checks, then a good time of day is 9.30am when you can really see what's going on in the home. If the Home is on the ball, then they will welcome you at this time, if not, you need to wonder why..... 3 falls in a week does not sound good to me.

Jude

 

[Nick]

Thanks

Thanks everyone. Really helpful. The place is very open - we can, and do, visit at any time but the people in charge are often too busy to talk properly - and after all, I travel 2 hrs to visit mum, not to have meetings with the staff. But I am arranging for an informal discussion with the home manager and have written a letter in advance so they know what we're concerned about. I hope we can get this sorted without escalating through formal channels. Thanks again for your support and advice.

 

[mominthemiddle]

Nick,

My father was in two homes recently, one a nursing home and the other an assisted living home, both in the US. Both required a detailed physician's examination and report for admission, and both had safeguards in place to alert them of nighttime wandering or falls (they included a motion-detector camera in his room, a bed alarm that rang when he got out of bed, and an alarmed pad on the floor beside the bed).

I think your other concerns are all legitimate, and I would have the same concerns--nutritious meals, appropriately dress for the weather, fresh air and exercise, and proper medication management are all very important. I think it's a great idea to express your concerns with the administrators and even plan a surprise visit to the home, so you can observe the home when they are not expecting a visitor.

In case your talk doesn't create the changes you hope, we found it helpful to get recommendations on good homes from people who had placed a loved one, from social workers, and from other professionals involved in dementia care. We found that the good homes were repeatedly recommended by many people independently.

Hope this helps and your mum's situation improves.

Mominthemiddle

 

[Nick]

Information sheet

Thanks Nada. Yes, I'd seen the sheet. It's helpful in articulating our concerns to the home. We're also reviewing the csci report (which we knew was poor but we'd been led to believe the main issues had been addressed since).

Some movement - after writing to the home, a meeting has been arranged for next week. In the meantime, there have been additional causes for dissatisfaction and concern but at least we're trying to nip it in the bud and they are aware of our expectations before going down the official complaints route.

Thanks again to everyone for their ideas.

Sad fact is there is precious little choice in mum's area.
Nick