How often should you visit the care home at first?

[Michael E]

This is a question about fairly advanced AD... Disorientated, depressive, unable to dress, undress, requiring helping with feeding and of course talking AD but not incontinent and an apparent awareness of the people close... I suspect the answer varies with the stage of AD the person is at...

When somebody is put into a care home they will probably be there for the rest of their lives... They will have to become institutionalised and make the place their 'home'. They will have to find companionship or even some sort of friendship with their fellow 'residents'......

(Perhaps one of the good things about AD is that they quickly 'forget'...)

When somebody goes into a care home - albeit unwillingly - how often should you visit?

Is it better in the first few weeks to not visit at all? Allow them to accept the new 'home' and hopefully have forgotten the old? Once 'settled' then the visits make a 'highlight' for the resident but are quickly forgotten...


or

Visit daily, with the advantage of letting them not feel, for a brief period, abandoned but perhaps extending the 'settling in period by constantly reminding them of you?

 

[Grannie G]

Hi Michael,

I can only go from my own experiences when my mother was in a home.

When she first went, she wasn`t incontinent [but was messy], fed herself, dressed herself, [often unsuitably], and had language. She was very confused and disorientated, and was considered at risk, living alone in her own home. She had been attending day care Monday-Friday. She had lost all social skills.

At first she was unsettled but became institutionalised quickly, and never made friends, nor gave or received any form of companionship from other residents.

As long as she recognized me, I visited every day. just to let her know she hadn`t been `dumped`, but the visits were short during the week as I worked full time, and a bit longer at weekends.

When she stopped recognizing me, I continued to visit at least once weekly. I visited more to keep the home on its` toes than anything, as the home she was in left a lot to be desired. I would check on my mother, and check her room and her clothes, to make sure everything was in order. I made sure I went at random times.

Once she was transfered to an excellent home, I literally just showed my face to show the home she hadn`t been forgotten. By this time my mother was unaware whether I was there or not.

It sounds cold and calculated, as I read this, but I`m afraid that was the best I could do.

 

[Cate]

Hi Michael

This is a tough one, and I can only speak from my own experience of a mum not in the advanced stages.

I was advised by the staff not to visit for the first couple of weeks, so that mum would make friends amongst the staff and other residents, and not sit by the door waiting for me to arrive. It worked, although I have to say, not a whole lot of conversation goes on between the residents, but then I guess this is a small world they live in. My natural instinct was to visit all day every day, but I realised this was probably my need and not hers. For a long time now, 5 minutes after I have left, she hasnt seen me for 5 years. I am also confused with her long deceased sister.

Mum has settled well, and instead of me being totally fraught by the day to day crisis that we were going through when mum still lived in her own home, I can now enjoy my visits and time with her, and she looks forward to my visits.

I think it is totally up to the individual how you handle this one, in any event, its not going to be easy. I went through all sorts of emotions from feeling a total failure, and to be honest, at some level, relief that mum was now safe and this wasnt totally my responsibility.

Best wishes,
Love
Cate

 

[Natashalou]

Depends on circumstances...and not just the person in the home. When my mother was admitted I visited daily, and this was a big mistake. She refused to communicate or interat with anyone and whenI arrived would launch into long lists of things she wanted me to deal with...nearly always she could have spoken to a member of staff and had the matter resolved quickly.

After a couple of weeks, I had to go back to work and "downgraded" to about three to four visits a week. This caused and enormous furore with her demading the staff of the home keep phoning me up to find out "what had happened" and also her being very rude and even abusive when I did visit her.

But that is my mother...and this is really only something of an extention of how she has always behaved. She thinks I have a "clear duty" ..(her pre az statement) to always put her first because she is my mother.

Pointing out im now a mother myself fell on deaf ears!

With hindsite, I wish I had, from the outset, arranged and stuck to just one visit a week. things are a little better now..she still produces lists but she will also speak to the staff. She hasnt really made any friends, but then she has never had friends anyway. She has been more polite since I actually walked out of a visit a couple of weeks ago...

however, Im sure there are very nice old people where visiting them is a pleasure for both sides...my mother just isnt one of them!

 

[hawaii50]

Hi Michael
You probably have read my posts that mum just went into a home on Thursday. I chose to visit on Friday and Saturday but just for 45 minutes each time - today I wont go because my brother is going. She seems content with a short visit as her attention span is short and 45 minutes probably feels like all day for her!! I have learned quickly however not to say when I leave that I am going home in case she says she wants to come to. I just say that I am going now because I have some things to be getting on with. That seems to work.

My mum still has some social skills albeit not making much sense and she talks away to the care assistants and a few of the residents. She thinks she is there on holiday and I was going to stop encouraging that thought until my niece who works as a senior carer in this home said not to worry about it as many residents who have been in there for more than 5 years still happily believe they are on holiday. So I am trying to view it as a permanent vacation!! My mum seems to be enjoying the care and attention of all the staff and having a variety of things to comment on (in her own way!) - lets face it at home all she saw each day was me and my husband with the occasional visit from others. Nothing too exciting happened - and she was bored as she is incapable of entertaining herself and lost interest in TV, newspapers etc.

So I think a whole new life has opened up for her in the care home and I am back to being able to enjoy the short time I have with her instead of feeling overwhelmingly responsible and trapped for every minute of every day and night. I think she has also been set free from me following her around making sure she is safe and probably feels more independent - as she now has her own self contained room and can roam around the larger area of the home quite safely without feeling "spied" upon!!!

I dont go back to my other home in Hawaii for another six months so will continue to make regular short visits each week but wont go every day - she doesn't always know who I am any longer but responds to me because someone is paying attention to her!! I guess I am probably just another care person to her looking out for her best interest.

Hope you sort out a visiting plan that suits you and your loved one Michael,

Elspeth

 

[Canadian Joanne]

Hi Michael,
I did visit my mother every day for weeks. I gradually cut back and now I visit usually two evenings a week and once on weekends. The number of my visits vary with what's going on in my life.

I agree with Cate, the every day visits were more for my benefit than hers, I suspect. But I needed to go. It is individual, and that's how it should be handled. What is too much for one is not nearly enough for another. Yes, I have encouraged one woman I know at the home to cut down her visits. But she was going in feeding her husband lunch and dinner. She was looking completely exhausted and needed to ese back. Now she has done so and is looking so much better.

Joanne

 

[Kayla]

I visit my Mum a couple of times a week and try to vary the time and day if I can. Mum has settled now and likes the staff. She varies a lot from visit to visit and is often quite bright and can hold a reasonable conversation.
I don't think she remembers when I've been to see her, but she always smiles when I go into her room. Sometimes she thinks I'm her sister. An hour is about as long as she can concentrate for and sometimes she is tired after only half an hour.
I think the staff appreciate relatives visiting, so they can pass on information or ask questions and it is possible to sort any problems out straight away.
Kayla

 

[Brucie]

I think it depends on the relationship - man and wife, parent and child, grandparent and grandchild - and for all of these, whether the relationship is/was close or distant.

When my wife Jan went into her home I visited at least once a day for the first two years.

After 6 years I am down to every other day, and feel really badly about not going often enough, although I have had no recognition from Jan [no obvious recognition] for the past two years.

The staff welcomed my visiting, Jan seemed to welcome it, and I could not have done anything else.

No suggestion was ever made about letting her settle in alone other than for the first hour she was moved there, and in a care home of her type, there ARE no conversations between residents.

The staff at Jan's home are grateful for the interest shown by the spouses and there are three key relationships involved here - the one to be maintained between man [carer] and wife [resident], the one between the wife [resident] and the staff, and the relationship between the husband [carer] and the staff.

With a parent, I'd guess the situation might be different.

Having said all that, each case is an individual case and must be judged on the needs of all parties.

In my opinion.

 

[CraigC]

Hi Michael,

Having just moved dad to a new home, I can speak from first hand experience. But as Bruce says, the first thing to make clear is every single situation is different.

For the first week or two I will try and visit every day to make sure dad settles OK and if he needs any assistance or the staff have any specific questions. Indeed they are getting to know dad as an individual and don't need too much advice from me, but I'm just the type who likes to keep an eye on things for my own peace of mind. I also think it is nice to get to know the staff so they feel comfortable discussing anything with me.

The home, or indeed any home that mum or dad have been in have always encouraged visiting as much as I feel comfortable, particulary in the early weeks. Generally they just prefer not to be bothered at meal times, which is very understandable. In dad's case my presence doesn't affect his settling in. I may see him every day but the recognition is very limited now. He seems very tired these days.

So my answer would be us much as you are comfortable with and as much as is practical. To be honest, if dad had more recognition I'd still be inclined to visit often just to make him feel that he is not alone. But again, that is just dad's case and what I feel comfortable with. From a personal point of view I cannot work out whether seeing dad more makes me feel more guilty or less guilty about him being in care, I'm still trying to work that one out

Good luck and kind regards
Craig

 

[Brucie]

Hi Craig

I've got all fingers crossed for you all [makes typing this feel a bit weird ].

Generally they just prefer not to be bothered at meal times

just to show how things vary; in Jan's case [and that of many of her fellow residents] she is incapable of feeding herself - the staff at Jan's home welcome family who will help in feeding their loved one at meal times.

It takes some pressure off the staff, and mealtimes can be a form of communion for the people concerned.

Again, case by case......

 

[connie]

Oh such a personal thing.

It must depend on so many things. Person staying in home, Relationship to person, (Lionel is like my right arm to me)
Ability to communicate and integrate with staff. Care home rules and regs.........

The list is endless, no right or wrong.

When Lionel went for respite in the past I used NOT to visit, my time to recharge the batteries.
When he went into care permanently, well that was where he was living, so I visited every day.

 

[Nell]

To be brutally honest, I find the visiting of my Mum quite arduous. I feel ashamed to admit this because there are so many others doing it SO much harder than me, in every way. In Mum's case, the problem is that no matter how often you visit, or for how long, she wants you to stay longer.

I have been visiting about 4 times a week, usually for 3-5 hours at a time, and my sisters (and sometimes my brother!) visit once a week for similar time periods.

Despite company on most days of the week, for much of each day, she (Mum) still wants us to stay longer. She is especially pressing on me - perhaps because I'm the major carer.

Mum is still pretty "with it" altho' like all AD people she can be quite off the wall at times. Her general health is good. I do not see her declining very rapidly. Therefore I think she could well be with us for another 10 years (or more!). (She is 85.) Altho' I'm delighted not to be losing her, I just cannot cope with these long sessions, 4 times a week on top of my daily life. I am married, with adult children, and I work part time.

I have started to cut my visits back to twice a week. I've tried visiting for just 1/2 hour to an hour but Mum spends the WHOLE visit bewailing that I'm not "properly" visiting, so short visits are a waste of time.

As others have said, this is partly a personality thing. Mum has always been a "Me first" sort of person - very little regard for the needs of others. (I could go on and on, but I won't!! )

None of this helps you in your situation, Michael, but I think it points out (yet again! ) that each situation is different. I hope you can find a way to visit on a semi-frequent basis that allows you not to feel guilty, but to still re-discover a life of your own. Thinking of you.

 

[CraigC]

Hi again Michael,

I think Nell picks up on another very important point - juggling care and visiting with your own life. Taking time out to visit loved ones can be a strain on your immediate family on both an emotional and practical level. Perhaps I was a bit quick to say "whatever makes you feel comfortable". I'd feel more comfortable seeing both mum and dad every day and for longer, but it just isn't practical. Throw a full time job and family into the equation and you are just not going to be able to keep everyone happy. So it is a difficult judgement call; and as people keep saying to me you just can't beat yourself up about it. So perhaps the 'practical' bit is most important as what use is a carer if they make themselves ill or mess up their own immediate family relationship.

And Bruce, I'll mention going in at mealtimes as I know they can be a bit stretched at this time. I was just told that family members in the dining room can be a little distracting for the other residents - I've seen them in action it is a very difficult time. However, it wouldn't be difficult to take dad off and feed him elsewhere. For now, I'm going to leave the staff to feeding as it will help them to work out dads need - but thanks for reminding that ever case is different.

Michael, may I thank you for bringing up this question at such a pertinent time. It is making me reassess my situation and who knows, I may even try to practice what I preach.

Happy juggling
Craig

 

[Brucie]

Hi Craig

I should always state that the home where Jan lives is for those with more advanced conditions of dementia.

The residents are really not too aware of anything going on around them, unless you actually touch them and make them aware of your presence.

That may make things easier in some ways, though more difficult for the family......

 

[Adrian M]

Michael,

I am faced soon with the same dilema; My Mum will be going into a home next week for the first time... (read my thread Decisions for the whole story..)

I wish that you had had a "Visit as often as you feel able in the long term to establish a routine / expectations" option on the poll, as this this how I am planning to work it out (if guilt doesn't eat me up in the meantime...)

The main reason I am moving Mum into a home is that she can't cope emotionally with being on her own anymore and is over run with lonliness when her carers are not there (which has become less and less over the last few months).

I have a very full time job (65+ hours every week) and a family of my own ( with a wonderful wife and three young children) to cope with too, so I have to find a balance for everyone.

My parent's in law perhaps gave me the best advice (that they had been given whilst looking after their parents), remember you have a life too - your parents would not want to see you ravaged by guilt to the extent that it began to hurt you...

I wish you luck, and hope you can find balance too.

Adrian.

 

[CraigC]

65+ hours every week

I dunno, part timers

thanks adrian, you reminded me of another key point. Routine. Most of the angst that I get about visiting and juggling care is people not knowing where they stand. A lot to be said for a routine. My partner prefers to know when I'll be away visiting rather than constant suprises.

Adrian, best of luck with the move next week. Such difficult times and hard decissions for you.

Kind Regards
Craig

 

[Michael E]

Thanks all who have contributed to the tread and the poll... hope there are more replies...

I think the thing I left out was the relationship - in some ways it may be easier with a parent type relationship than with a spouse-lover type but neither are simple.

During the past weeks I have been visiting various homes throughout France that specialise in AD and similar. The best so far was of the opinion that that it took up to 3 months to 'acclimatise' a 'resident' to the new environment and that during the early weeks it was not necessarily efficacious to visit too much or at all in the beginning... This was from a very caring, specially built with a little outdoor theatre and a full time 'animator' together with a 2-1 staff ratio. (the ratio is of course 24/7 day and night so...) The sociologist treated the patients with care and understanding and respect. - interestingly for a lot of posters on this site she said "look, we are human and sometimes we fail" residents wander in and out of each-others rooms sometimes and take clothes and other items. We try to control this and a resident can lock their door if they want - are able - but the alternative is to lock everything and we are not comfortable with that.. If you see your loved one's things being worn by somebody else do tell us and we will sort it out but it can happen." Very occasionally one of the patients becomes violent - sometimes they hit out - we do control the situation but it is impossible to guard every body 24/7 totally.." She also stated that the induction period can possibly be as hard or harder for the person putting the patient into the home as for the patient.
They have 'group' meetings for the families of patients every month at which you are invited to comment - make suggestions - complaints etc. If you do not attend then you are sent the minutes of the meeting by post.

Another home - equally modern and I think pretty caring, felt that daily or at least frequent visits were important to help make the patient not feel abandoned. They however did lock all the doors to the bedrooms all day. The staff ratio was much lower, and all the 'residents' were assembled in one large room together for the day... No 'animator/entertainer' and the manageress did not stop to speak to a single patient during the visit.... None the less she came across as compassionate although I was 'amused' when she got out the 'death book' to tell me the average monthly - quarterly mortality rate - how frequently places become available.

Been to lots more and am heading for Northern France this week to visit 2 more and then to the Dordogne to visit the last one... It matters not a jot where I live in France - has to be France as I could never afford a UK home - so will sell up and move nearer to where ever Monique ends up... I am a great believer in 'fate' - did you ever read the 'Dice Man'?

So that's what my post was about - my feeling so far is it is really hard decision - in my case logistics might influence it but ..... its real scary knowing if one is going to be able to live with it all......... I mean the conscience.

Michael

 

[mocha]

Visiting

Hi Michael,
Ron has been in his Nursing Home for 6 months now[how time flies] and is now unable to feed himself.
Along with another wife who has become a good friend we visit every other day so we can feed them both in Ron's room. All rooms are on one floor and his is within sight of the dining room. They have their main meal at teatime so I usually go about 3-00 to 7-00 pm.
I think the staff appreciate us giving a hand and they both seem to eat better in a quiet atmosphere.

It costs me £11 in taxis each time so I can't afford to go more often.
Ever since he first went in permenantly I have gone 3 times a week sometimes 4.

Hope you find a lovely home for your wife as it is such a wrench to give up the fulltime caring but I think I feel it more than him.

Good Luck for the future, you deserve it

Love Aileen

 

[Grannie G]

Dear Michael,

That you have ;

conducted this poll,
saught the opinions of others,
visited and will visit several homes ,
are prepared to move house to be near Monique, should the `best` home be out of area,

says you should not be scared, and neither should you have anything on your conscience.

You are doing absolutely everything possible to provide the best for Monique.

I hope you are successful.

 

[Margarita]

1st home sound honest open , I know your visiting more home , so just want to wish you Good luck in finding the right home for Monique xx