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Mum - worsening condition and likely notice from care home

Discussion in 'I care for a person with dementia' started by SKD, Mar 15, 2019.

  1. SKD

    SKD Registered User

    So after a rocky start Mum appeared to settle in her care home but about a month ago her symptoms and behaviour began to worsen. She is extremely agitated and, I believe in a state of great anxiety, leading to her acting aggressively. The home is not coping well with this and do not have the staff for 1:1 care. Yesterday her condition was so bad that an ambulance was called and I feared she would be hospitalised before I could arrive. This didn't happen and she appears to have slept last night and will be visited by GP sometime today. The home are talking about serving notice on her - they have said she requires EMI nursing care and also talked about a referral for CHC funding (which I understand is very hard to obtain). I am currently waiting for a report on the GP visit but am wondering what my action should be in this situation? Mum is self funding at the moment and has a property currently on the market which will fund several years of care. She did have a social worker review at the end of last year which concluded that she should not be moved but her condition has certainly deteriorated since Christmas. So I could contact the social worker again. There seem to be a lot of things swirling round among all this. Have arrived at work today with bag packed in case I have to do the train journey up north this evening.
     
  2. canary

    canary Registered User

    Feb 25, 2014
    8,653
    Female
    South coast
    Yes, I would contact the Social Worker as things have changed.

    I dont have any experience of CHC, but it seems to me that aggression is one of the things that can swing it for people with dementia, so it would be worthwhile investigating this.
     
  3. Beate

    Beate Registered User

    May 21, 2014
    11,309
    Female
    London
    Th problem is that a care home has the right to give notice to anyone if they feel they can no longer look after them. Whether a social worker says she should not be moved is unfortunately completely irrelevant. Lots of care homes only take dementia patients up to a certain level, and if they start to get aggressive, they get rid of them. This means, whichever way you feel about it, this home is not the right place for your mother. A notice can come quickly and not give you much time, so don't wait for the SW. Your mother is self-funding so start to contact other homes and explain her behaviour. Don't sugar coat - you need to know that they will be able to deal with her challenging behaviour. EMI is an old-fashioned term that stands for Elderly Mentally Infirm. It's not used that much anymore but you will need to look into nursing homes that specialise in dementia or at least have a dementia nursing wing.

    As far as I know, everyone going into a nursing home is being checked for Funded Nursing Care eligibility anyway, which is done via the same form as for CHC. In my OH's case it was done automatically, I didn't have to request it.
     
  4. MaNaAk

    MaNaAk Registered User

    Jun 19, 2016
    1,003
    Essex
    Dad was recently put on memantine because of aggression but sometime ago the nurse told that this was the next step anyway. She also told me that when dad becomes aggressive the home will call her and she will come and prescribe this medicine also you might also like to bear in mind that at a recent prescription review I found that dad was on some medication that was originally taken out of his prescription. This has now been removed and his blood pressure has now returned to normal this medicine would also have affected his Alzheimers so it is worth checking his medication..

    Good luck

    MaNaAk
     
  5. Fattywatty

    Fattywatty Registered User

    Jun 13, 2016
    51
    Hi there, you’re in the same situation I have have just gone through. Mum moved into her care home October last year and following a really good settling in period she gradually became extremely anxious and aggressive which has ultimately led to a recent move. She is also self funding and through the past few weeks I have had no involvement with a social worker, in fact one has never been mentioned or offered. The decision has been made between the care home and the mental health team.

    The home she was in originally is supposed to be EMI, but is very small with only a small number of staff, the residents there are all fairly mild tempered and my mum just disrupted the whole house and they just couldn’t manage her. They also almost got to the point of calling either an ambulance or the on call mental health, but as I am in the area they called me instead! When I mentioned this at a best interest meeting everyone agreed that she would never have needed to be sectioned, even though that’s not the impression I got from the staff who were dealing with her at the time!! I have since realised that certain categories of sectioning do qualify for CHC funding, so maybe that has something to do with the reluctance to section!

    Luckily I wasn’t served official notice but was told to find somewhere else and managed to find somewhere very quickly after being told. She has now moved to a home which provides EMI and nursing on different levels so hopefully as she progresses I shouldn’t have to move her again. It’s been an awful few weeks and I’m still coming to terms with everything, she only been there 3 days but seems to be doing well so far. Funny really, she had started to calm down by the time I moved her, just hoping that this move doesn’t set her back again. I would definitely start looking for somewhere to hopefully give you more choices, as I’m sure you’re aware spaces are sometimes hard to find. Good luck with everything, it’s so bloody hard isn’t it? (((((((Hugs)))))))
     
  6. Elle3

    Elle3 Registered User

    Jun 30, 2016
    506
    I was in a similar situation last year with my dad, the first care home he went into said just after 2 weeks they could not cope with dad and said they had reached crisis point and wanted dad to be moved. Even though dad was self funding we still had a SW, so she quickly became involved and became the mediator between myself and the home. She organised the Mental Health team to come and do an assessment of dad and he was put on some medication to try to calm his behaviour and I had to agree until dad could be moved, to paying for a one to one agency nurse to be appointed for 8 hours a day to be with dad until I could find him a new more suitable care home.

    It took me approximately 3 weeks to find a more suitable Dementia+ care home which dealt with residents with challenging behaviour, the staff ratio was much better and the unit only had a maximum of 18 rooms. The difference in care homes and how much more specialised the staff were with dealing with Dementia patients was immediately obvious. After my experience with the first care home, I became much better at judging the care homes I viewed and I also knew more about how my dad would react to being in care, this enable me to be totally open and tell them how he was and ask how they would deal with it.

    I too was told that dad could potentially qualify for CHC funding based on his challenging behaviour and lack of cognition and communication skills. The SW agreed that after dad had settled into the new care home for 4 weeks she would do the initial assessment. This proved positive and she put him forward for the full assessment. The CHC assessment team came out to do the assessment and they also agreed and dad was awarded full funding, this was back in June last year and they came out again in October to do their 3 month review and they still said he qualified. It helps if you have a care home with experience of CHC funding and are willing to keep good detailed records, ie an ABC chart.

    You also may find if you have to place your mum in a more specialised Dementia care home, it may be more expensive, the care home my dad went into was almost double the cost of the first care home and would have been more expensive if the SW hadn't helped us and got the care home to agree to accept us on the LA rate. I'm just saying this as sometimes SW's can be very helpful, my dad's proved invaluable.

    Good luck.
    Elle x
     
  7. SKD

    SKD Registered User

    Well - events ended up overtaking me. A week ago the care home sent Mum to hospital after an evening of extreme agitation and aggression which led to me dashing up north and spending a week with her. Mum was so frightened and lashing out at everyone - even me - for the first few days. Various tests have some to the conclusion that there is no infection or physical cause so we are looking at a downturn in her dementia and a more to nursing care. She is now on one of the DME (Department of Medicine for the Elderly) wards with support from Mental Health Unit and is slowly recuperating - but so many skills seem to have gone and she clearly feels her bed is the safest place to be. She is now on Rispirodone so is sleeping a lot. The ward is bright and cheerful and appears to have a good staff team. I have started the search for a nursing home and am waiting for the referral to the MCCAT team managing discharge. Spent Saturday morning emptying Mum's care home room which was hard.
     
  8. Rolypoly

    Rolypoly Registered User

    Jan 15, 2018
    2,302
    Sorry to hear about your situation. My mum went straight into a nursing home as we soon realised that residential homes either couldn’t or didn’t want to cope with her as she was or if she/ behaviour got worse. Mind you some nursing homes only wanted well behaved dementia residents. At first mum was very agitated and aggressive but this has lessened as she has settled. Mind you she still wallops the carers on a regular basis! Mum is in a dementia nursing home so they know how to handle difficult and challenging behaviour which brings its own sense of relief and peace of mind.

    CHC was applied for automatically. Mum got the funded nursing element but not full CHC as she only had one severe, not the two severe required.

    Good luck with the NH search.
     
  9. SKD

    SKD Registered User

    Thanks @Rolypoly - I spent some time at the end of the week looking at dementia nursing homes - there were one or two possibles. Sadly the one I think would be best for Mum is the least convenient for me but I can probably live with that. I think my Mum is will still be walloping the carers!
     

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