1. Expert Q&A: Living well as a carer - Thurs 29 August, 3-4pm

    As a carer for a person living with dementia, the needs of the person you care for will often come before your own. You may experience a range of difficult emotions and you may not have the time to do all the things you need to do. Caring can have a big impact on both your mental and physical health, as well as your overall wellbeing.

    Angelo, our Knowledge Officer (Wellbeing) is our expert on this topic. He will be here to answer your questions on Thursday 29 August between 3-4pm.

    You can either post questions >here< or email them to us at talkingpoint@alzheimers.org.uk and we'll answer as many as we can on the day.

Good nursing home turned bad.

Discussion in 'I care for a person with dementia' started by copsham, Jan 18, 2018.

  1. copsham

    copsham Registered User

    Oct 11, 2012
    593
    Oxfordshire
    I am angry, upset and sad. My mother has severe dementia and has been in this nursing home for 5 years. She sleeps most of the day and night getting up for meals. She does not recognise us now. She is thankful to the staff and offers them cups of tea, even though she can't make it. So she is well liked and I am sure has been treated well.

    Until three weeks ago I had always said this is a good service, looking after my mother well. Then there was a CQC inspection, lots of problems were uncovered. These problems had not directly related to my mothers care but mainly to the active, challenging residents.

    As a consequence the nursing home was put on special measures and this has made it worse. The managers from all over the organisation descended, loads of people suspended, and loads of agency staff. The "new regime" were very good at flannel at the relatives meeting but not followed through in practice.

    For the first time in five years I am worried about my mother. When I visited on Monday her toe nails were so over grown they curled over. Until recently she had had a regular podiatrist. A care planning review was held and the only input from the nursing home was an agency nurse, who was very pleasant but had just been there 3 weeks. The meeting was seen as collating information rather than planning how to meet my mothers needs in the coming year.

    I had a call from the unit at 10.30 at night from the manager returning my call. She sounded grossly tired, ill and apologetic. I felt no confidence. I thought it was a call to say mum had passed, being at that time of night I also had a call the next day at 10pm about my mothers bottom being sore, the message should have been given to someone else. It was not my mother! For the first time yesterday she was wearing someone else clothes. The place has gone down hill. CQC will be keeping the place under scutiny as it is on special measures. I am confused. Should I tell them of my increasing concerns. I feel as though I should but I feel I know enough for the place to be closed down given that it is on special measures. This may be is not in everyone interest. I feel sad to have lost so many staff who I had known for 5 years. I hate seeing agency staff who do not know my mother, working with her not realising she is very deaf and has very poor eyesight. I feel angry and sad and do not know what to do with it. I have been very lucky to have a settled time with my mother for 5 years but it has ended so abruptly.
     
  2. love.dad.but..

    love.dad.but.. Registered User

    Jan 16, 2014
    4,380
    Kent
    I would arrange an appointment with the manager regardless of how tired she sounded ! urgently to discuss your concerns and ask for a proper care plan review with a senior permanent member of nursing staff so you can set in writing anything you want in your mums care particular attention paid to. If you are unhappy or unconvinced by the reaction or ability to implement anything reasonable you are asking for I would bring it to CQC attention. Is your mum funded by LA? Are they aware as they should be that the home Is in special measures? If you have a serious concern then I would have thought Adult Safeguarding should be contacted. It is a shame when all has seemingly been fine but if a home has a lot of staff changes in a short time things can change quite quickly if not well managed.
     
  3. copsham

    copsham Registered User

    Oct 11, 2012
    593
    Oxfordshire
    Thank you "love dad but" I did meet with the manager, she was all smooth talking, full of apologies and no substance. A care plan meeting was arranged, cared by the local authority and it was to this meeting she thought it was okay to just send an agency member of staff.

    Last night I was thinking of writing to CQC but I think things have been so fragile there I do not really want the home closed down. I just want it to have good, stable staff!

    Adult Safeguarding are aware as are the local authority. They were asked by the "new management" not to be popping in all the time as they need to concentrate on making improvements. This was accepted! As I write this I think I have got to let CQC know!
    Tthanks for your response sometimes it is good just to be acknowledged and to know I am not over reacting.
     
  4. SnowWhite

    SnowWhite Registered User

    Nov 18, 2016
    699
    Firstly I think you should tell the home NOT to ring you late at night unless its an emergency. You have enough worry without that.

    I would definitely go to the CQC. Its definitely not right that your Mum seems unkempt and wearing other residents clothes.
     
  5. copsham

    copsham Registered User

    Oct 11, 2012
    593
    Oxfordshire
    Thank you for the answers received. It is helpful to offload and receive constructive suggestions. I can't believe the position I am in. My mother had such good care for 5 years now under the new regime worse than ever.

    I would appreciate advice on deciding whether to move my mother from her nursing home or not. I am really upset ... but I will try to be factual.
    • She was settled and happy in her nursing home with dementia (type not diagnosed) getting very slowly worse over 5 years, can be mobile but stays in bed a lot.
    • CQC visited in Dec 2017 nursing home put in special measures,
    • Half the staff suspended including all of those who were kind and caring to my mother, replaced by agency staff
    • Since then my mother has gone down hill. She looks unhappy, groans very quietly when she is uncomfortable. it is just horrible to see this.
    • Since special measures I have noticed toe nails curling over not cut, blood test taken in error from her instead of resident with the same first name, groaning with constipation as nothing had been done about it, not given her antihistamine so itching severely, many other practical issues
    • Now lots of finger print bruises and a largish bruise on one side of her leg. I was told she had done the bruise on the bedrail. I protested that she should not have a bedrail, I asked do you mean the bed frame? the conversation could not go forward due to language barrier.
    • I have met with the manager and she told me "don't worry. It will take time" This made me mad as my mother may not have time. She was very bureaucratic and might improve the paperwork but no person skills.
    • I have spoken to the managers manager. She is the first person that sounded solid and a "can do" person but one person cannot improve a home full of agency nurses..
    • I spoke to CQC inspector before my mother had her bruising
    • I rang Adult Safeguarding gave them details and sent a photo of the bruises on Monday. They are taking it seriously and investigating . They have informed CQC.
    So that is the back drop to should our mother be moved to a new home? I think moving would finish her off (but then so might staying). Another home could be like this one, good for a time then change. My mother may be totally disorientated by a move.

    I do not know what to think .... please help me good forum people!
     
  6. VOA

    VOA New member

    Feb 15, 2018
    7
    My heart goes out to you, it is so difficult to know what to do for the best but the situation sounds very worrying.

    Perhaps it would be helpful to gauge how disrupted your mother might be by a move to a new home by requesting a move to a different bedroom within the home she's in now.

    If you feel requesting such a move would raise suspicion you are planning to take her out of the home then maybe using the excuse of the room being too noisy/too quiet/too sunny/too dark or similar?

    As you say the carers have changed anyway so it sounds like there's little familiarity left at present so maybe a move won't be as unsettling as you fear.

    You certainly don't sound like you are overreacting at all. Best of luck with whatever you decide.
     
  7. love.dad.but..

    love.dad.but.. Registered User

    Jan 16, 2014
    4,380
    Kent
    Ok..these are my thoughts. Move her because:

    A move may accelerate her decline but poor care may also do that.
    There are no guarantees as you have already found out that after good care..large staff turnover which is fairly common in some homes ....can change good care to poor...however you say a lot of the good staff have gone.....and therefore your mum is already dealing with a lot of staff she didn't know and agency staff who may not be allocated to your mums home for more than a few shifts so a new home would not be that much of a leap.
    The dementia is going to decline anyway.
    The home saying it will take time may be so...but your mum's care should not be improved in time...it should be improved now.
    Bruises can happen easily with frail skin but I too would be concerned as it adds to the whole picture of poor care...meds not given..incorrect bloods taken...constipation no addressed
    Unless the 'can do' manager is drafted into the home to oversee the 'doesn't seem up to it' manager staff will continue to bumble along.

    Good that Adult Safeguarding are taking your concerns seriously as they should and only you can decide but for me...I wouldn't want to hope the care may get better in the next week...month...few months...your mum deserves good care now and for whatever time is left. A move is as you are in anguish about is never taken lightly and as last resort but from your posts you have highlighted your serious concerns and you should not have to have a constant worry of hoping the home can improve
     
  8. Shedrech

    Shedrech Volunteer Moderator

    Dec 15, 2012
    7,740
    Yorkshire
    hello @copsham
    I'd be looking to move my parent if this were happening.
    I find this very odd - my bolding
    dad's care home went through a bit of a blip, but the staff were the ones who made sure it made no difference to my dad, and that impressed me, so I didn't look into a move - one was so proud recently that the latest LA inspection gave them good across the board
    is a move possible? - are you in touch with another care home? - given what you describe there may be quite a few families wondering what action to take
     
  9. love.dad.but..

    love.dad.but.. Registered User

    Jan 16, 2014
    4,380
    Kent
    I had to go out but wanted to add even with CQC and adult safeguarding monitoring seriously the home their procedures are still not properly checked and applied...taking blood from the wrong resident would concern me
     
  10. copsham

    copsham Registered User

    Oct 11, 2012
    593
    Oxfordshire
    Thank you all for your comments. It is helpful just to know others out there understand the dilemma. What I find hard is that I cannot rush - go from the frying pan in to the fire so to speak. She is probably nearing the end of her life and I just need to know she is comfortable...... watch this space!!
     
  11. SnowWhite

    SnowWhite Registered User

    Nov 18, 2016
    699
    I would move her. My Mum had a couple of months of reasonable care at her previous care home but once they got me to sign a contract and set up a standing order it went downhill drastically. You would not believe how it changed. They cut back on meal sizes, stopped offering us coffees when we visited, started bossing Mum about, wouldnt listen to any complaints or queries we had, tried to get us to visit less and treated Mum like a child.

    She is now at a lovely place (3 months now) and it is vastly superior. The staff are all kind and caring, I can speak to them anytime, I have access to Mums care notes, its lovely and warm (other one was chilly) and they treat her with respect.
     
  12. ChristinaG

    ChristinaG Registered User

    Feb 21, 2017
    92
    My mum is in a dementia home and going downhill. There have been serious issues which I don't hesitate to raise but other relatives do not, even though they are not happy (they say there are worse homes) but i don't think this helps anyone. I have made myself unpopular with the Manager because I have raised my concerns and she doesn't speak to me. They do lose clothes, including her special medical stockings but my biggest fear is that they will lose her dentures for good as they keep mislaying either the top or bottom set for several weeks often with no explanation as to where they have been. It doesn't help that residents have free acess to each others rooms and there are long periods of non-supervision. The lack of teeth affects her greatly and she has trouble eating. The manager doesn't think dentures are important and i have this in writing from her. She's knows i have tried to get more dentures for her and failed even though i am willing to pay over £1,000 or more - mum can't co operate. There are still very good staff there in sen and not so senior positions who have supported but it is very worrying when things are going wrong so I do sympathise. I guess moving to another home is always an option but that is such an upheaval what happens if it is worse? I am doing my best to try and ensure the important things such as heating, safety, personal care, food and liquids are right in the home where she lives. I don't know why they get clothes mixed up when they are named and I have seen other residents in her clothes and with her now few possessions but at least they can be replaced unlike teeth which is life changing. I will continue to raise any serious concerns about her care - out of love as well as duty. In my view Homes are getting away with poor care because relatives dont raise concerns as they are too worried about repercussions - the other problem is that many vulnerable people don't have anyone to care about them so we need to look out for them too. We need a government led group of interested/knowledgeable parties to provide advice and advocacy for us carers, our loved ones and those who have no one. Our elderly and very vulnerable are getting a very poor deal. I don't think the CQC look too deeply at things like poor personal care and missing teeth which affect quality of life on a daily basis. I did write to my local Health watch to suggest a government led group but have not yet received any response
     
  13. love.dad.but..

    love.dad.but.. Registered User

    Jan 16, 2014
    4,380
    Kent
    I understand hesitancy in moving a relative from a home providing poor care it would be last resort and has to be for good reason with an alternative researched well but I am surprised at a pessimistic feeling of another home could be worse...it could also be a lot better. I always spoke up for dad at his NH and discussed concerns and equally if things were going well if I felt the need ....and generally had a good relationship with most of the staff...only needed to take a couple of serious issues to the Manager in the 3 years Dad was there. Yes...staff came and went and changes happened but I would never have hesitated in raising anything that needed resolution for dad....if I had received a negative or defensive reaction from the manager to the 2 serious issues...it would have told me a lot about the way the home was led and not the home for my dad...or Me! Unfortunately there are some poor homes but there are also some very good ones as well.
     
  14. SnowWhite

    SnowWhite Registered User

    Nov 18, 2016
    699
    That is totally childish behaviour on the part of the Manager not speaking to you. Both the owner and the Manager at Mums old care home used to go and hide when they saw my car come into the car park! I was always polite and really didnt raise anything unless it was absolutely necessary but they hated anybody questioning anything they did. Most of the other families had long since given up trying to discuss their concerns and as a lot of them were funded they were scared to say anything.
     
  15. notsogooddtr

    notsogooddtr Registered User

    Jul 2, 2011
    806
    I think you are in a stronger position when funded,the LA have a lot of power,more than the individual
     
  16. SnowWhite

    SnowWhite Registered User

    Nov 18, 2016
    699
    Actually youre right there!
     
  17. copsham

    copsham Registered User

    Oct 11, 2012
    593
    Oxfordshire
    I was faced with the real dilemma about moving my mother or not as described above, when last week she fell and broke her hip. She was admitted to hospital and got so much brighter. She was chatting and demanding, such a pleasure to see. Single rooms are okay if you can read or if you can follow something on the television but it must be like a prison cell for someone who can't. There she was in a ward of four women, unable to relate to them but so much more bright, I think from the stimulation. She had the hip replacement and walked a few steps the next day. All of this made the decision that we would move her when she is ready for discharge. It will be no loss to her.

    My dilemma now is they are suggesting that she has a pace maker fitted. Her last GP was of the mind let's just keep her as comfortable as we can when a pace maker was suggested before. I think quality of life rather than quantity of life is important for her now. Any thoughts re a pace maker, will it be irritating to her? she readily pulls her canula out! Is it major or minor surgery? what benefits? disadvantages to someone who cannot understand what is happening?

    The one good thing is that mother still loves her cup of tea!!

    Thank you everyone on the forum. It is a relief to share and ask at times like this.
     
  18. doodle1

    doodle1 Registered User

    May 11, 2012
    241
    Ok mum has a pacemaker and she had it replaced a year ago at the age of 92. Same procedure as if it's a brand new one. No general anaesthetic needed .its a local with sedation. I didn't want mum in hospital overnight so we had the bloods done a week early ,got to the ward for 830 am having had nil by mouth overnight. I stayed with mum all the time right up to there doors and even asked if I could go in . The consultant was brilliant ,came out and spoke to me and said if necessary would top mum up with more sedation. We were home by 5 and mum had forgotten about the op by the morning. You need to be quite forceful as in MUM has DEMENTIA don't mess me around but this was all NHS and could not speak more highly of them .hope this helps x
     
  19. doodle1

    doodle1 Registered User

    May 11, 2012
    241
    Ps reread your post stitches invisible small plaster.
     
  20. love.dad.but..

    love.dad.but.. Registered User

    Jan 16, 2014
    4,380
    Kent
    I am glad you have come to a decision about the home...having a time away albeit in hospital sometimes allows a bit of space to see things a little clearer and sorry to hear she has broken her hip but it seems as though she has coped well with the op and recovery. don't have experience of pacemakers and dementia but because my dad could not tolerate any interventions ...procedures...canulas...bloods taken...he was so frightened and pulled everything out and so had to hold him if something was absolutely necessary I wonder whether your mum would be able to cope with the procedure unless with full anaesephetic and afterwards would leave the area alone. Dad had an operation under general because it was life threstening and that risk and getting him hopefully painfree was a risk worth taking but after that all interventions were only considered on that basis and balance of quality of life. This included a decision at end of life
     

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