Not eating or drinking

Discussion in 'ARCHIVE FORUM: Support discussions' started by elaineo2, Sep 8, 2007.

  1. elaineo2

    elaineo2 Registered User

    Jul 6, 2007
    945
    leigh lancashire
    Hi everyone,this is a question i am asking because of a resident in the home i work in.The family is reluctant to admit az/dementia and we are awaiting another assessment from the memory clinic.This problem we are encountering at the moment is they will not eat.When encouraged to eat they say they have eaten when the food is still in front of them.Has anyone got any ideas on how we can get this person to eat.today they have eaten nothing and we are not allowed to feed them as we are a residential home.Any suggestions are welcome as i am very concerned about the resident.love and thanks elainex
     
  2. Grannie G

    Grannie G Volunteer Moderator

    Apr 3, 2006
    69,863
    Kent
    Hello Elaine,

    I didn`t realize you are not allowed to feed residents in a residential home.

    I can only suggest you ask the family in, to feed. Even if they don`t admit to Alzheimers, they must admit to refusal to eat.
     
  3. elaineo2

    elaineo2 Registered User

    Jul 6, 2007
    945
    leigh lancashire
    Thanks GrannieG,the family have been in to try to feed their parent,unfortunatley is didn't work.the family say there has been more eaten than actually has.We obviously monitor and document food and fluid intake but when they make excuses that their parent has got a swallowing problem,not Az or dementia,it makes things more difficult.The daughter has now said that their parent has an ulcer.How she knows is beyond me.The G.P has not got any concerns about the swallowing and he puts it down to the dementia and not being able to recognise and understand food.We in the residential setting cannot be seen to feed anyone as this is seen as force feeding and therefore abuse.what can we do until this person is appropriatley placed?love elainex
     
  4. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,438
    Elaine a couple of things that you've probably tried but if not...

    Very small portions: my mother was totally put off if confronted with a plate full of food: she wouldn't eat any of it.

    Dessert first: yes I know it goes against everything we've been taught, but calories are calories in this situation.

    Will the resident drink? Those meal replacement drinks (whose name escapes me) might help.

    If it is the dementia causing the swallowing problem (or even if it isn't) can you not push for a speech therapist to see her? Those are the specialists in this field: perhaps if the family are convinced it is a swallowing problem (and of course demntia can cause swallowing problems) the speech therapist is the person they should be pushing to evaluate her.
     
  5. elaineo2

    elaineo2 Registered User

    Jul 6, 2007
    945
    leigh lancashire
    Hi jenniferpa,we have tried everything imaginable.there is no evidence of a swallowing problem on the medical side.The G.P is reluctant to refer to a speech therapist until the CPN has done another visit.The resident will eat one type of cereal,breakfast time doesn't present a problem its lunch,tea,supper.We have tried just giving the cereal,but can you imagine the bowel movements!too much fibre!therfore creating the situation of dehydration. a no win situation for the time being.thanks elainex
     
  6. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,438
    Interesting that she will eat a type of cereal. I would have thought if she had forgotten how to eat she would have forgotten how to eat anything. To be honest, I don't really agree with the doctors stance about this: clearly she needs to be evaluated for the dementia, but she'll still have to have the eating issue evaluated and that's the speech therapist's job. Why not have both referrals in train at the same time? You would think the GP was paying for the speech therapist out of his own pocket. Sorry but it gets my goat when they put things off like this: it takes so long to get referrals, I see little point in waiting. My mother died waiting to see a dermatologist, and while an earlier visit would have made no difference to her death, it might have made her last few days more comfortable.

    Best wishes
     
  7. elaineo2

    elaineo2 Registered User

    Jul 6, 2007
    945
    leigh lancashire
    I quite agree jennifer,its a pity that the G.Ps are the only ones who can do the referrals.We work with this problem day in and day out be it speech therapists,dieticians,physiotherapists,cpn's.Its a crying shame that the ones who look after them can't go direct to the professional.In the meantime the resident begins to deteriorate.I do know that when my dad has to have care I WILL be the one making the calls and gets things moving.In this sad day and age we live in its a pity that "its not what you know.Its who you know".I am fortunate enough to know the contacts through my work,but what about those who don't know who to contact?I could go on all night about this!love elainex
     
  8. alfjess

    alfjess Registered User

    Jul 10, 2006
    1,213
    south lanarkshire
    Hi Elaine

    I am suprised that in a residential home you are not allowed to feed the clients.

    In my parents home (residential) carers are feeding the clients.

    Although, it was admitted to me that not many needed to be fed, Mum and Dad had been moved to a different table, nearer the people who needed help.

    Mum can manage to eat very well on her own, but Dad needs to be reminded to use the fork/spoon, to pick up the food and put it in his mouth, but others need to be fed.

    Does such distinction and rules exist, where a carer cannot help or give food to a resident?

    Seems crazy to me. The residents are there for care.

    Alfjess
     
  9. elaineo2

    elaineo2 Registered User

    Jul 6, 2007
    945
    leigh lancashire
    Hi aljess,i understand what you are saying,but by removing people with eating problems is segregation,outling to other residents that they have a problem.Dignity and respect is through the window.I am sorry but that is something the home i work in will never do.Every route will be followed to identify the problem with the resident.It is clear that the problem is dementia,they insist they have eaten when the food is still on thier plate.This person needs to be suitably placed to recieve the one to one care they need.love elainex
     
  10. Helena

    Helena Registered User

    May 24, 2006
    715
    My Mother refused to eat or drink much of her time in hospital but clearly that was because she had simply had enough

    she did not realy know where she was or who we were 50% of the time but somehow she knew if she refused food and drink then it would be her way out Hospitals arent allowed to feed patients either
     
  11. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,438
    Elaine perhaps I'm misreading what you are saying, so if so forgive me. But are you really saying that in your residential home you as a carer are not allowed to put some food on a spoon and offer it to a resident? What if they had severe arthritis, or srtoke dmage, and were no longer able to physically hold a spoon? I understand that in the case of this resident it is clear your residential home is not the most appropriate placement for her, but I can think of a lot of situations where people don't require nursing care, are in fact quite independent, but simply can't manupulate utensils. Also, and I'm not doubting you have been told this, but it is NOT assault to feed a patient in this manner: force feeding yes, and under some circumstances insertion of a tube for enteral feeding without consent, both of those would come under the category of assult, but loading a utensil and offering it, no, there is no assult there. There would be, of course, if you had to prise the mouth open, and perhaps this is what you are referring to.

    I assume that you have tried with different utensils (you say she eats cereal, so in her case a spoon). Sometimes people forget how to use forks and so won't try. Something else I've thought of: if she is actively refusing to eat, then it's anorexia and she shoudl be referred to a pyschiatrist. I mean a CPN would cover that I suppose, but it does sound as if everything has been put on hold waiting for this elusive individual, and in the meantime, this woman is starving herself.
     
  12. elaineo2

    elaineo2 Registered User

    Jul 6, 2007
    945
    leigh lancashire
    Hi Jenniferpa,It is an impossible situation.We have tried everything.A previous post suggested that perhaps they were full after eating a little.The resident won't even attempt to eat,other than breakfast.And we cannot feed the resident because they refuse to eat it.It isn't that they are not able to feed themselves,they just choose not to eat.We have tried sitting with them and as said previously,placing the cutlery in their hands and instructing what to do with it.to no avail i am afraid.they simply say that they have eaten what is in front of them.We have tried finger foods,blending food,little food but often.its a no go i am afraid.As for the cpn?unless this person is a threat to others they are way down on the visit list.What about being a threat to yourself?does that not count?thanks elainex
     
  13. Margaret W

    Margaret W Registered User

    Apr 28, 2007
    3,725
    North Derbyshire
    What a caring carer you seem to be

    Hi Elaine,

    I just wanted to say what a real professional you sound in your job. Hope there are lots like you out there. I can't advise, I have no knowledge or experience of any kind of this, except that my mother in law (who died 3 years ago aged 90) simply had no appetite for the last 5 years of her life. Strangely, she didn't lose weight, and didn't seem to suffer as a result at all. After a lifetime of a good appetite, it just went. She had home care, and the carers would prepare her meals, and she'd just leave them untouched or chuck them in the bin.

    I've no need to tell you that its important to get fluids into them, the high calorie drinks are a good idea. I'm also a person who "goes off" food at times of stress, and am going through some at the moment, and I haven't eaten properly for a fortnight, but today I enjoyed a totally unhealthy place of sausage and mash. Last night we cooked fillet steak and I couldn't face it! Yoghourts are refreshing I find.

    Anyway, my love, you can only do your best, and it seems you are doing it.

    Funny that her family don't seem to agree. That must be hard for you to accept.

    And no, the medics don't rush to your side when you need them, do they?

    We need a whole re-think of dealing with the elderly in this country. We are going to be one of them sooner than we think.

    Keep going, you are clearly doing a great job in the circumstances.

    Love

    Margaret
     
  14. elaineo2

    elaineo2 Registered User

    Jul 6, 2007
    945
    leigh lancashire
    thanks Margaret.the family do not want to accept their parent has some form of AZ/dementia,which is blatently causing the not eating scenario,Why is i that i loose sleep over these things?no offence to anyone with loved ones with the bloody awful disease,but does denying theres a problem actually help anyone?I can accept it with dad.probably because i see and work with it daily.don't w want the best care though?i am a bit upset writing this,because i know my time will come to make these decisions.and i will,through TP and my own experienxes.thanks to all of you for being there.love elainex
     
  15. Skye

    Skye Registered User

    Aug 29, 2006
    17,000
    SW Scotland
    Dear Elaine, I can see how upsetting this is for you, and I admire you so much for caring for your patients so much.

    Could she be profoundly depressed? She may have decided she no longer wants to live like this.

    I had that experience with my mum, who had a stroke aged 91. She was a very determined and independent lady, and decided after the stroke that she was not going to live like that. She refused to eat, though she could, and pulled out her naso-gastric tube every time it was inserted.

    I tried and tried to convince her that if she would only try to build up her strength, she would be able to walk again, but to no avail. She hated being dependent, and was not going to tolerate it.

    I don't know if this is a similar situation to your patient, or how old she is, but if she's relatively young and able, I'd see if anti-depressants could help.

    Sorry if I'm way off-beam.

    Love,
     
  16. Lonestray

    Lonestray Registered User

    Aug 3, 2006
    236
    Hereford
    Elaine, You said it, one to one care is what's required. With the best will in the world many loved ones placed in a NH give up on living. I'm not saying all, but I can't express the awful fear I have of ever ending up in care. It's for sure my wife gave up, in spite of my daily visits of eight and nine hours. She would look cross
    at me when I arrived in the mornings, and I'd explain I've been to sleep and wash.
    She was under six stone, had pressure sores, oral thrush etc. In the first few weeks after I took her home, she was still on a downward slide and had to be rushed to hospital. It was not surprising to me that she wouldn't eat. They'd had her on a drip and oxygen mask. When I asked to feed her a yogurt, I was told she wouldn't eat. I coaxed to eat it and when the nurse was surprised I asked "If I took a strange young child away from it's Mother, would it eat for me in a strange house?" Informed at the hospital there was nothing they could do for her, I insisted on taking her home, to what I then expected, to die.
    A Rapid Response Team of nurses attended her for a week. At the lowest point I was advised by her GP not to sit holding her hand over night, as she was likely to pass away when I went to the toilet or for a drink. Days later he advised I shouldn't try to force feed her, which I ignored to the upset of our daughter.
    Yes, it took hours of patience to have her eat and drink to get her weight up to what it is today eight and a half stone. Meals which took two and a half hours now take half an hour. I've learned what and how to feed and give her drinks.
    Though she lost her speech more that four years ago we now understand each other as good as ever. It's a two way street to love and be loved, to want and be wanted, to feel each others hurt and reassure each other.
    We are so very lucky that I'm able to care for my Jean alone. Both in our seventies and in two weeks time 52yrs married, what more could anyone ask for?
    While I've got her, life's well worth living, without her I see little purpose to life.
    Elaine, you will have seen many with little to live for. Your a one off, sad to say I met too few of your kind in that line of work. I once asked a member of the staff at the NH: "If, or should you become like the people here, how would you like to come here?" "No way!" Padraig
     
  17. Hi Elaine,

    What drugs do they have your mother on? Any changes in meds? Any 'anti-psychotics'?

    I have never heard of never helping someone eat whether they be in a home or anywhere. If the home has mean and inhumane rules like this - start looking for another home.

    Jennifer
     
  18. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,438
    Jennifer,

    I'm afraid you mistunderstand: this is not Elaines's mother we're talking about: this is a resident in the home where Elaine works.
     
  19. allylee

    allylee Registered User

    Feb 28, 2005
    180
    west mids
    I find aspects of this post very disturbing.

    In over 25 years in the health service I have never heard of a policy where residents are denied assistance with feeding.

    In fact with several appalling cases in the press of the elderley suffering malnutition and dehydration in our care homes and hospitals the Care Standards Commission are extremely hot on it.

    Elaine there is a distinct difference between force feeding someone and helping them to meet their nutrtional needs.
    Im amazed that the managers/seniors in the home are not aware of this and as loss of appetite is a common factor in old age its worrying that there are not systems in place to address this.

    Ally xx
     
  20. elaineo2

    elaineo2 Registered User

    Jul 6, 2007
    945
    leigh lancashire
    Hi Skye,thanks for your post.There is no evidence of depression whatsoever.The resident is kind,obliging(apart from the eating issue),jolly,and very very pleasant.There is nothing at all to suggest depression.The family came in today to feed them lunch.In the end i had to ask them to leave the table.Because their parent point blank refused to open their mouth whilst they fed them,they started to get irate and spoke to them in a way that i felt was uncalled for and was not nice in front of other residents having thier sunday lunch.I (in a nice way,considering i was angry) explained to the family that their behaviour was not acceptable and to try to force someone to eat is seen as abuse in the care profession.Their reply is not something i can put on this site.Suffice it to say I am the bad guy AGAIN!Whats on my work agenda tomorrow? i dread th think!;) love elainex
     

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