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Home can "no longer meet her needs"

Discussion in 'Middle - later stages of dementia' started by esmerelda, Nov 15, 2015.

  1. esmerelda

    esmerelda Registered User

    Jul 1, 2014
    8
    Stratford upon Avon
    Sorry, this is me trying to get ready for today's visit.

    Mum's 90 and her progression is such that her care home with dementia speciality have said that they can no longer meet her needs. You see she falls a lot (about 3 times a month), she has lost the ability to communicate and doesn't always understand why what's said to her is important. She's learnt that when she stands, she falls and is scared of standing (I think). She has arthritis in one knee which has not been treated or considered but was identified by the hospital as a possible cause of the falls. The GP says that she wouldn't get any help at the Falls Clinic because she wouldn't understand or communicate. The care home think she's too high risk - every time she falls they have a form to fill in that asks whether she's been referred to the falls clinic and they have to say no. On her last fall she broke her last pair of glasses - more are on order - but she can't really see too well at the moment. She threw away her hearing aids but wasn't wearing them anyway and apparently because we paid for those they won't refer her to a hearing clinic.

    She doesn't comply with personal care any more, she won't dress, is already taking anti-depressants. They've taken chairs (all but one) and tables out of her room because they are a "risk". She can't put the television on and anyway they've put her chair where she couldn't see it. There's no radio. She won't move out of the room so she sits in isolation in her own world with her "dog" and her "family" and her "children".
    I know they'll try to get her to take more drugs soon to deal with the hallucinations and take that world away from her.

    I've been told she needs an EMI unit - by the CH manager. That term is no longer in use - you can't search for an EMI unit, there's little about them here. Now they are all care home with dementia speciality - like **** they are. We're self-funding (an application for CHC has just been made, but we know what a lottery that is).

    I'm dreading each visit - last time I watched 2 well-intentioned carers try to get her to stand up, without support so that they could clean her.

    I dont' know what should happen next. Moving her? I have to take her in my car to a new place? The CH manager still hasn't signed off a new care plan for her since her last decline- discussed 10 days ago (post fall declines are regular, small bounce back, getting smaller).

    Any advice please?
    W
     
  2. nitram

    nitram Registered User

    Apr 6, 2011
    19,035
    Male
    North Manchester
    "I've been told she needs an EMI unit - by the CH manager. That term is no longer in use - you can't search for an EMI unit, there's little about them here."

    EMI is no longer an 'official' term but it is still in common use as a >>>Google search<<< shows.

    Even if self funding the LA should be able to provide you with a list of homes that they consider fit the old EMI description.

    I agree with your inference that if the hallucinations are not causing her distress there is no need for medication to reduce them.
     
  3. esmerelda

    esmerelda Registered User

    Jul 1, 2014
    8
    Stratford upon Avon
    Thank you for your reply. The visit was better than I expected and Mum has bounced back a little. I've had a PM as well that's been helpful - thank you, I'm apparently not allowed to respond as I haven't posted enough.

    Mum came into my county to the CH and there's been no involvement of Social Services here - on Monday I'm going to get in touch with them and start the assessment process again as one CH has advised me that we should do this - they wouldn't take her, by the way, but I suspect that they are at the lower end of "care home with dementia".

    W
     
  4. fizzie

    fizzie Registered User

    Jul 20, 2011
    2,739
    If she keeps having falls then it is partly because the care home is not meeting her basic needs. I think you need to speak to social services urgently - their safeguarding team - too many falls means that the home is not safeguarding her adequately. In my view she should be referred and a note on the referral put in that she requires specialist help as she has dementia - the ball is then in their court to provide a service of some kind and hopefully onward referrals. Often when people fall they lose their confidence completely and it sometimes takes a few weeks to get it back - we used to 'walk' my mum 3 times every day, just a short distance with one of us either side of her until she believed she could do it. Does your mum have any walking aids? Are they not using even a standing hoist when they try to attend to personal care? Perhaps she is refusing to 'comply' because she is terrified that if she stands (required for some personal care) that she will fall so it is safer to refuse and sit tight!!!


    She needs stimulation - so the chair needs to be moved away from the TV so that she can see it and a carer needs to be responsible for making sure that she has it on with subtitles when she is in her room if she wants it. or can you take in a small radio and make sure that they keep it on as background. However she also needs to be with others - are they not taking her to the main lounge for an activity period at least once a day? Are they not encouraging her to eat at least one meal outside of her room?

    Who told you that she can't have a referral to the hearing clinic? I know many people who have both private and NHS aids. They can't refuse you a referral - you are within your rights to ask for an assessment, if they won't refer you I suggest you phone the hearing clinic and refer her yourself. I would question how she managed to throw away her hearing aids - does noone in the home take any responsibility? If she 'put them to one side' and they threw them away then they need to pay for replacement. They must be used to dementia residents who live in their own worlds and need support to make sure that things like that don't happen. If she wasn't wearing aids was that because the home were not helping her to put them in each morning - I despair at the number of times I see hearing aids sitting on tables!!!! Tables can't hear!

    If she had her hearing aids and her glasses she would stand a better chance of being able to participate at some level in the 'real' world, she must be so isolated.

    She will probably be best off in another home where at least they try to make her comfortable and give her quality of life. I would phone the safeguarding team at social services on monday (falls, hearing aids, glasses, isolation, personal care etc), and tell them what you have told us and ask for their help - tell them you need to be able to look at some suitable homes with a view to a quick move as you feel that your 'vulnerable' mother is in 'danger' and is not being properly cared for.

    I hope this helps. Good luck, keep posting.
     
  5. 2jays

    2jays Registered User

    Jun 4, 2010
    11,604
    West Midlands
    My experience with hearing aids was a battle I finally decided not to fight anymore, as it occurred to me that as mum kept taking them out, she was finding the "enhanced" noise annoying so took them out.

    1J - no dementia - often takes his hearing aides out when the family are here because of the distortion of "noise" when more than 2 people are talking. So it made sense not to inflict hearing aides on mum


    Sent from my iPhone using Talking Point
     
  6. fizzie

    fizzie Registered User

    Jul 20, 2011
    2,739
    Yes some people do find it difficult it depends on their hearing loss. However if it is the home not giving her the support she needs to wear them then that is a whole different matter.
     
  7. esmerelda

    esmerelda Registered User

    Jul 1, 2014
    8
    Stratford upon Avon
    Thank you for your reply. I think this is a real case of being stuck in the middle. On advice here I contacted Social Services on the following Monday. I was told that unless Mum qualifies for CHC then they could not help - it is up to us (me) to resolve things. We are "self-funding" as Mum has now sold her house to pay for care.

    Out of the blue on Tuesday a physio arrived at the ch from something called integrated care services (follow-up from hospitalization from fall?) - did an assessment and declared that there was probably no point but she'd bring a Zimmer frame for Mum to try (did recognise severe arthritis and change of gait - did not consider balance or basic strength and mobility a problem - really? there's so little muscle left). She also said that there was no point in an exercise programme as she wouldn't be able to understand instructions. The GP had agreed the day before to refer her to a falls rehab clinic who, I think would provide the same service as the physio who has visited. He did not refer her to a diagnostic falls clinic but a rehab clinic. She fell again this morning: rushing to the toilet.

    So, another question. How can I get advice on the care and support that Mum needs? Do I need to lobby for referral to the diagnostic falls clinic? is there an alternative to social services? The CH don't think she needs nursing care - no wounds to dress, no diabetes, etc. but do think she needs more support. They are listed as dementia/nursing, will dementia/nursing, used to be EMI provide different care?

    Yesterday Mum said she just wanted to die. This is not the first time she's either said this or asked me to kill her. No move between CH will make her/things better for her. All she wants to do is "go home" - she can't do anything else.
     

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