I'm sorry I haven't read this thread through before now. I'd like to make a few comments which spring from having been in the situation where I very strongly did not wish my mother to be moved from her current care setting. I won't go the whole hog and do the 'Devil's Advocate bit,' but some of the points that Elaine raises about the family might perhaps at some stage or another have been spoken about our situation as a family so perhaps what I say might shed a little light on their motivation.
Please bear with me as some of my comments may sound as if I am siding with the relatives. I'm not, but I don't think they are necessarily entirely the ogres they might seem to be in every respect. The fact that the family do seem to come in very frequently speaks , to me, in their favour. I'm sorry if that sounds naive, but I have longed for my own siblings to take more interest in my parent's care and the fact that they seem to be quite active says quite a lot. Visiting is tiring emotionally and physically but they haven't given up and walked away. They want to be near her.
As regards the feeding of the resident, I would have been very upset, and often was, if I thought that carers in a residential home were not helping frailer residents to eat if they needed help. I would not have expected them to force feed anyone, but I certainly would have expected staff to offer food on a fork or other suitable utensil, cut up food, find a diet that was appropriate for the resident etc and take time to keep offering other types of food if they didn't succeed at first. When my mother began to have feeding difficulties, I asked for a dietician to assess her diet, and the input she has made has been invaluable, recommending supplements such as Ensure, Calogen, Build Up and Maxijul, checking with me and my mother what food she likes, and how it needs to be offered, i.e as regular, soft or pureed.
She has recommended the setting which is most likely to benefit my mother, i.e quiet company rather than the larger room where there are higher noise levels. She has recommended the addition of cream to food, and she has asked the manager to keep food and fluid charts. Some residents liked to eat in their rooms, and I asked for flexibility on this at times.
My guess is that the family are very scared of the diagnosis of dementia. I believe that they love their relative , because, as I have said, the visiting is a stressful and time consuming business and I don't think that if they lacked feeling for her they would bother. I think they would walk away. I think the dementia diagnosis scares them and whilst there must be examples around the country of specialist dementia units that offer excellent care, in my search for a home for my mother, I only found one home, many miles from her usual residential area, where I would have been happy to see my mother settle. My view about EMI registered homes, from having seen a fair number, is not good. I'm not saying good ones don't exist. I've just very rarely seen any.
So I can understand why they might not wish to transfer their relative from the point of view that the alternative homes, registered as EMI might seem very forbidding. ( They did when I was looking around). However there is another obvious reason. Any change in care setting is traumatic. The fact that elderly people have to be shifted from one home to another at a stage in their life when they might reasonably expect tranquillity and stability, is a very sad truth, that still needs to be corrected nationally somehow.
Of course it is not in your power, Elaine to change the system, and you don't feel you can meet this residents needs anyway, but from the family's point of view, you are trying to eject her from her home, where they were hoping she would be settled. Underneath it all, believe it or not, I think they are happy with your home. They can see that there is something very good about it, and what they would like to do is prevent their relative from going through trauma and upset in an unknown home where they can't keep as regular an eye on their relative.
I don't think there is any monetary issue in this story. If there was, they would be looking for reasons to move her into a nursing home where some element of her care would likelier than not be deemed eligible for NHS funding. The fact that she has leukaemia is actually more likely to warrant nursing care and subsidy , so why would they, if they were mercenary, hide the leukaemia and not push for NHS funding?
Perhaps, as with the dementia, they are in denial about the leukaemia too. Not because they don't want to see their relative properly treated but because they simply haven't been able to get support or advice about the implications, or maybe they have had some advice but not been able to take it in or deal with the emotions that major illness evokes. They have got two horrendous diagnoses looming at them and they simply don't know how to cope. The last thing they want is for their relative to be thrown out of the care home because that will feel as if the carpet is being pulled from under everybody's feet. I know they seem to be acting stupidly and unpleasantly, but I genuinely think they think they are doing what is in their relative's best interests.
As for the admission to hospital by 999. Well I guess that does have to happen but that exercise is also fraught with worry. Hospitals are notoriously poor at recognising the needs of people with dementia, and often an admission can be avoided if a GP will come and check a patient over in the home, or arrange for DN's to visit. One of the upsetting things about the 999 process was that the home did not ring us to say they were doing it, they just did it. We would not have objected but we would have like to have known so that we could get up to A and E to help my mother through the process, even if it was in the middle of the night.
It sounds to me as if things have escalated into a really dreadful breakdown of trust between the family and the home and I would expect the manager to be taking the reins and talking to the family. I would expect her or him to be supporting you and taking responsibility for what is a very upsetting scenario. I do not think it is the family's responsibility to give a complete medical history on admission. That is up to the professionals. My guess is that the family might have thought someone else had done it, or that they were hoping against hope that it was not as serious as they feared and might go into remission or be curable.
There is no legislating for stupidity, but there are professionals who should have checked information and made sure that everyone knew the full diagnosis.
The manager needs to step in with all the diplomacy she/he can muster and discuss all the concerns as openly as possible and without retreating into defensiveness. Personally I think the manager should have taken responsibility for this much earlier and not let you take all the flack and upset. The home, at the end of the day, has the right to say that they cannot cope with the resident, but a clever manager will try to deliver this message firmly but with the least possible further upset to the resident, calmly and with consideration for the difficulty that the relatives will have in finding a home that they are happy with. Hard though this is going to be, the home has to display some trust in the relatives too, because there is nothing to be gained by anyone in forcing the relatives to accept the decision in an atmosphere of acrimony.
I hope I haven't trodden on any toes. I can just see a defence for the stupid family. I may be entirely wrong, but this is how things strike me.
Love and best wishes to you, Elaine, Deborah x