managing distressed behaviours in a care home”

[EdithScotland]

Hi there

I am looking for urgent advice if at all possible. I don’t know what to do for the best.

my mum has vascular dementia. At home she was very lonely and we just couldn’t meet her emotional needs. The pandemic made this 100 times worse ? she begged us every day to find her somewhere new to live with company. We put it off for as long as possible because of the coronavirus cases in care homes. However, in July we found a placement for her. On the day, however, she became very distressed and had to be sectioned and taken to hospital. She was shouting and swearing and hit my sister and I - she didn’t hit anyone else, but slapped our hands. She spent time in hospital, just to stabilise her after the experience. She was discharged to a care home but didn’t settle. Every day was a bit of a battle. Mainly asking when she could go home, shouting and swearing, taking everything out of her room, trying to influence other people too. At that time mums hospital social worker was not sure a care home was required long term which meant we didn’t know what was happening and couldn’t have discussions with mum. The care home asked for her to be readmitted to hospital where she stayed for 3 months. This time she has a psychological assessment using the Newcastle Model, her meds reviewed by psychiatry, an OT assessment and the social worker completed his assessment too. All were in agreement about longer term nursing care. Mum was fairly settled in hospital after the first week or so.

My mum has been in her new care home for 10 days time and today they have said that she cannot stay and needs to be moved tomorrow. On day 4 they wanted her to leave despite being fully prepared for her to be unsettled. She is currently the only resident there due to it being a new home, therefore there are 3 staff members on at every shift who can support my mum. We have many concerns about how the situation has been managed and some concerns over the care mum has had and some of this is now being investigated. The view of mums team is that she is safe and her needs are being met by the home - yet they say her behaviours are too difficult to manage. She shouts, swears and throws everything when she is distressed. As the week has progressed this behaviour has improved as we hoped it would and she has had more settled periods, which again, we thought she would. But the home have said today that more residents are coming in and they cannot have mum there any longer as they have to think of the bigger picture. We were desperate for this to work because it’s in mums home town and the area is very familiar to her.

However we have a situation where mum has to move tomorrow - back to hospital probably, yet she does not need hospital care. She has had all of the assessments she needs to get. We feel she needs somewhere that will commit to supporting her through the transition period.

We are in Scotland and hoped other people could offer advice?

in desperation earlier I emailed mums clinical team and asked their view on her returning home with care but in my heart I know this isn’t really the best option. But I can’t bear for her to return to hospital as it was the pits. It was awful and the thought of more time there makes devastates me.

no

 

[MartinWL]

I would not worry too much about where the care home is as long as you're able to visit. It does not sound as if she will be popping out to the local shops. There are care homes that have the skills to deal with challenging behaviour. If I were you I would be looking for a suitable place that specialises in the more difficult dementia patients.

 

[canary]

I agree with Martin, she needs a specialist EMI care/nursing home that deals with challenging behaviour. They are, unfortunately, few and far between, but its definitely what she needs and dont worry about where it is, as she probably wouldnt recognise anywhere anyway. Just so long as you can get there to visit.

Dont even think about trying to take her home. Care agencies would refuse to take her on. It would be a recipe for disaster.

 

[Sarasa]

I'd agree about moving your mother somewhere where her needs can be met, and where you can easily visit, and not to worry about it being somewhere she is familiar with,
My mum also has vascular dementia and also can be extremely volatile. The home have managed her behaviour and gradually over the last eighteen months she has settled. It sounds like the home she is in, just don't have the experience to deal with her sort of behaviour, and are more keen on getting people who they can manage easily there rather than people like your mum.
I moved mum from south-east to south-west London, so she is just down the road from me, rather the area she'd lived in for the previous twenty years. In the first few months she was there I would take her out for coffee or by bus to our local big shopping centre. Mum either thought she was where she lived before, so wanted to go to the chemist over the road, or she was in the town where she grew up in the 1930s and wanted to go and see the sea. She couldn't work out at all where she actually was.
I hope the care team find a more suitable place for your mum so she doesn't have to go back to hospital. Certainly going home would be a disaster and probably end her back in hospital anyway.

 

[lemonbalm]

Hello @EdithScotland . I am sorry to read your post. My mum, who has vascular dementia, sometimes shouts, throws things, shouts and screams, tries to stab other residents with forks - and scratches the staff. She is self funding and it took me a long and desperate time to find a care home which was prepared to take her when the previous one was unable to cope. I did this with no support. Surely Social Services should be able to find a care home which is able and willing to take your mum and be confident that they can provide the care she needs. You do mention that your mum was fairly settled in the hospital after the first two weeks, so perhaps returning there would be acceptable whilst a solution is being sought? Not ideal, I know, to keep moving your poor mum.

I should add that the staff at mum's care home are genuinely fond of her and regular medication reviews have been very beneficial. Good luck. This is very hard to deal with.

 

[Jessbow]

I'd get back onto the discharge team at the hospital now- basically its a failled discharge and they need to sort an alternative, sooner rather than later.