Normal to go back to assessment from NH?

[Peapod]

And so it continues
Dad had the all clear on his hip x-ray, but Mum's just had a call from his nursing home asking her if she'd agree to Dad returning to the EMI assessment ward in hospital for an unspecified time because he's staggering and falling all over the place, is difficult to manage and has been aggressive
What on earth's going on? Anyone experienced this to-ing and fro-ing?

 

[jenniferpa]

Dear Peapod

Nothing's ever normal when it comes to dementia, but from the way you describe him in the other thread, it seems that you father has become too much for the nursing home to handle. If that's the case I suspect the only option is for him to return to assessment. This nursing home is no longer serving his needs (and I have no idea if that's down to the nursing home or not) and it's clear they can't keep him safe. On the other hand I'm not sure if the assessment unit will be able to help him either unless there is something that has changed medically with him. I would want something form the professionals that they feel the unit could help him/stablize him/whatever rather than it being used as a dumping ground by the nursing home. I would ask yourself - has he changed a lot since the last time in the assessment unit? If the answer is no, then it means that the nursing home has bitten off more than it can chew in which case, although he obviously needs to move to somewhere better suited I would be trying to achieve that without the assessment unit again.

I have to say though, and very much sitting on the fence about this, if the nursing home refuses to accept him back because your mother refuses to agree to the assessment unit path, I think there's a good chance that he'll end up there anyway, perhaps as an involuntary patient. I don't know if that's a good thing or a bad thing but on balance you're handing over decision making to others and on the whole, I'm not in favour.

 

[TinaT]

Dear Peapod,

My husband also has LBD and thankfully, seems stable at the moment but I am so sorry to hear of the deterioration in your dad. It must be very distressing for your family to see him suffering in this way.

I wonder if the nursing home feel that his medication needs to be assessed to help his current difficulties. It could also be that his current medication is affecting him badly (some meds can make hallucinations worse). If his medication is reviewed on the assessment ward, it may be that once he is stabilised onto a new regime, he could be transferred back to the home.

Please do keep us in touch with what is happening. I do hope that your dad can be given some measure of peace.

xxTinaT

 

[Trich]

Hi Peapod,
My dad also has LBD and is at the moment in a EMI nursing home. Because of his challenging behaviour I think they are going to ask for him to be moved. There is a meeting on Thursday and we are all very anxious as to the outcome. I don't think that the majority of nursing homes can cope with the complex and unpredictable behaviours that come with dementia. The first one that dad was in said they couldn't have him back after a hospital visit which left him shaky and unsteady as he might fall and hurt one of the other residents. The current home is saying similar things about the challenging behaviour despite having a dedicated demetia unit. I have assumed that it would be down to us to find another more suitable placement though if we fail to do this and are given notice I dread to think what will happen. Could you not start looking around for an alternative home. This would hopefully give you and mum some choice as to where your dad goes. You said in a former post that your dad was not on medication. Has he been prescribed anything? Although I was not in favour of drugs my dad's hallucinations are better since he has had antipsycotic drugs. I don't however agree with all the medication he is given as I feel that these are sometimes used for the 'convenience' of the home.
My thoughts and best wishes go to you and mum.
TrichX

 

[Skye]

Dear Peapod

I agree with Jennifer and Tina, it sounds as if they want to reassess your dad's medication, and try to get him stable again.

If they can do this, it will be much better for you all, and he should be able to return to his NH.

Try not to worry too much, you've been so upset by his hallucinations and aggression, if there is any chance of controlling these, that can only be good.

Let us know what happens,

Love,

 

[Peapod]

Thanks all - Jennifer you've confirmed what my suspicious mind was thinking! Dad isn't actually on any special dementia medication as he has a slight heart defect, and with his LBD being so severe, any drug can be pretty dangerous to him.
I can't quite believe that the NH would find him so difficult; he's only been there a couple of weeks, it's specifically for EMI residents and as far as we can gather Dad has never actually struck any members of staff, just been verbally aggressive and uncooperative (struggling etc.)
UPDATE - My mother has JUST heard from the NH that their senior nurse thinks Dad's 'aggression' is due to his falls (can't walk well but thinks he can) and not so much a 'behavioural issue' So he's staying put for now.
What really worries us is what may happen if the NH 'kicks him out'? We're in rural Pembrokeshire and there is no other EMI NH within travelling distance (Mum and I don't drive)
Nightmare!

 

[TinaT]

I chatted with several wives whilst Ken was on his assessment ward. They all related a similar experience to the one you are in the throes of. When the EMI units refused to keep their husbands for the same reasons you are being told, then the men were transferred back to the assessment ward at the hospital. And sadly, that is where many of them have stayed for a very long time.

I think that some EMI units/Specialist Dementia Units do not have sufficient nursing staff or the training/experience to properly take care of the very ill, difficult to manage patients. I feel so angry that they are allowed to call themselves 'specialist' when they are not able to take care of a very sick man such as your father. It is a disgrace to our society!

I hope and pray that if your dad does go back onto the assessment ward, he can be helped. I know that it took 9 months in the assessment unit before my Ken became stable enough to go on to the Nursing Home.

My thoughts are with you at this very hard time

xxTinaT

 

[Trich]

Hi Peapod,
Glad to hear that dad is staying put for the time being. This is strangely like the situation at my dad's EMI nursing home. When he has an outburst the head nurse tell's us he will probably have to be moved and then we are told by the manager "no he can stay". I am hoping that this Thursday's meeting has the same outcome. I wonder if they ever stop to think of the stress their remarks cause. No wonder we are all so strung out!
TrichX

 

[Peapod]

Thank you so much for your input Tina and Trich....I think it's becoming quite clear that Dad's NH is running scared. To think that they call themselves 'a home for life'!
You're so right that this is a disgrace; do the powers that be think that dementia sufferers sit around quietly drinking tea and playing scrabble in their wheelchairs?
If Dad does go back to the assessment ward, then it'll be our choice (hopefully); actually the staff there are wonderful and the place is as good as you could wish for.
Will keep you updated as this is an issue which could affect anyone here.
Take care all of you XXX

 

[Margaret W]

Wot? You will all tell me I am naive, but mum is in a general home but I expect some day soon she will have to go to a specialist unit - are you telling me that some of them aren't up to the job? Surely a specialist EMI unit can cope with anything? Silly me. Off course people needing specialist units have challenging behaviour - if they didn't have they would be in general homes like my mum. Somebody tell me I have misunderstood.

Margaret

 

[TinaT]

Dear Margaret,

Not all dementia sufferers follow the same path. The disease in some sufferers takes a course which means that they have to have 24 hour, 1 to 1 supervision for most of the time. They also have, at times, to be confined to a room in which they cannot hurt themselves or others. They have to have very strong, immediate medication. They have to have specialist doctors at hand and very specialist nurses. They are a very grave danger both to themselves, to others and to any property surrounding them. They are not usually frail, elderly people but mobile, strong and often early onset dementia sufferers. There is no medication or treatment which can change the course of their disease.

These are extreme cases (but ones which I have myself witnessed). We also have sufferers who display such symptoms but who can be stabalised and greatly helped by medication, correct handling etc., and need to be placed on assessment wards so that this can be achieved.

In my experience EMI nursing homes/Specialist units are only capable of coping with residents who can show aggressive behaviour at times but whose agression can be managed by their staff. As far as I know, their staffing levels are not designed to cope with prolonged, extreme behaviour difficulties.

Perhaps my perspective is off balance because of my experiences but I am concerned that such sufferers are left to live out the rest of their lives in a sterile, hospital ward because there is no where else to put them.

We have come a long way since the lunatic asylums and barbaric practices of old, but the problem of how to allow such people to live out the rest of their lives in some form of comfort troubles me greatly.

xxTinaT