Pressure from consultant to transfer mum from care home to psych ward

Discussion in 'I care for a person with dementia' started by Ash148, Jan 6, 2015.

  1. Ash148

    Ash148 Registered User

    Jan 1, 2014
    276
    Dublin, Ireland
    Mum's consultant wants to transfer her from her lovely care home to a psych ward. She says that mum's medical needs are too complex for her to manage in care home setting, but the proposed hospital is a standalone psychiatric hospital with no other medical facilities on-site.

    Her stated concerns are:

    Weight loss; mum lost a lot of weight last year actually starting during a previous stay in the same psychiatric hospital but this has stabilised over the last couple of months. Family often go to care home at meal times to help mum eat and this is encouraged whereas psych hospital does not allow visiting at meal times.

    Pain: mum had serious side effects from Risperidone in Nov and Dec, and although Risperidone has been stopped for Gabapentin in the last three weeks! Still has residual back pain from stooped neck. She also has osteoporosis which may be contributing to pain. Her GPS prescribed a Butrans transdermal patch 5mg last Friday and this can be increased to 10mg in a couple of weeks if mum is still in pain.

    Restlessness: mum has been a "walker" for months, constantly on the go. This escalated late last year and she now also has "restless legs" which I think was triggered by the risperidone. She never sits done and sleeps little and as she is a falls risk (gait ok but cornering and steering dodgy) she really needs someone to walk with her. Family are willing to self fund additional one to one for her (in Ireland there doesn't seem to be any State funding for this) and I don't understand why the restlessness of itself requires psych admission.

    I and my siblings, who are all very engaged with mum's care, are now divided. I want to resist the proposed move and don't rate the consultant at all. I'm looking to get a second opinion and only want mum to be subjected to another move if it's essential (she's in her third care home and has had two previous hospitalisations last year when she was far more agitated and difficult to manage than she now is). If care home can no longer manage mum, I would like to get long term leave of absence from work to look after her.

    Two siblings think we have to follow consultant's recommendation; the other is more sceptical of the consultant and agrees with me that mum should stay where she is, although doesn't feel as strongly as I do.

    We have reached a rather confrontational stage and I have told siblings that I will resist mum being "sectioned" into psych hospital. I don't think there are sufficient grounds for it and believe I would succeed in getting her released but of course don't want to damage family relationships by going this route (although may already have by saying tat I am prepared to).

    Has anyone been in circumstances like these? Any thoughts or advice would be very welcome.
     
  2. Witzend

    Witzend Registered User

    Aug 29, 2007
    4,287
    SW London
    Has the care home said they can't cope? That would be the critical question, I would have thought.

    Restless wandering is pretty common in dementia. My mother's care home (specialist dementia) looks on it as entirely 'normal' even if it goes on half the night, every night. If someone is wobbly of course there is the risk of falls - my mother has fallen several times during her wanderings - but nobody has ever suggested one to one, the cost of which around here would be prohibitive.
     
  3. canary

    canary Registered User

    Feb 25, 2014
    9,663
    Female
    South coast
    My thoughts are along the same lines as witzends. All the while I was reading your post I was thinking "yes, but what does the care home say?" If they can cope with her I see no reason for the move.

    Like witzend, my mum is also in a specialist dementia care home and wanders about all times night and day and no-one blinks an eye-lid. She also falls a lot, in fact, she has fallen when I was standing right next to her :eek:. So even if you get someone with her one to one it may not prevent the problem.
     
  4. Ash148

    Ash148 Registered User

    Jan 1, 2014
    276
    Dublin, Ireland
    Nursing home has this afternoon said they can't cope unless we pay for 24/7 one to one!
     
  5. Ash148

    Ash148 Registered User

    Jan 1, 2014
    276
    Dublin, Ireland
    Nursing home has now given a 24 hour ultimatum to us!!!
     
  6. love.dad.but..

    love.dad.but.. Registered User

    Jan 16, 2014
    4,364
    Kent
    Oh dear that's very worrying for you. I don't have experience as you describe but Dad has always been restless and walks during the night and some during daytime. He isn't aggressive or abusive but gets worried about personal care...taking bloods...blood pressure....even being weighed. He gets frightened and refuses strongly. He is in a specialist dementia nursing home who have a very can do attitude to dad and others. He was turned down by 2 other dementia care homes because they saw his walking and wanting to go home as challenging behaviour which it isn't it's just classic moderate dementia presentation they just wanted to cherry pick those that needed less attention. Our Alz Soc support worker having worked on acute mental health wards told us under no circumstances was our Dad in need of acute care specialist homes should be able to cope as it is not unusual behaviour.Dad has had a couple of falls as is sometimes wobbly but wants to move independently around the home uses his sticks. I don't know about the care/nursing home system or categories in Ireland but from having looked at 17 here in Kent some that say they are dementia from what I saw I was sceptical about. Could there be another specialist dementia nursing home more experienced with residents like your mum that would suit her needs better? Fad is and always will be completely self funding and social services weren't involved so we had choice to an extent. Mental health team didn't get involved other than diagnosis.
    I wish you well in your search for a solution for your mum and compromise with your siblings.
     
  7. Moonflower

    Moonflower Registered User

    Mar 28, 2012
    775
    I'm sorry, you must feel very pressured
    If the care home are saying they can't cope and the consultant wants a move to a psychiatric facility might the best way forward be to agree to the move? That gives you a breathing space to find somewhere more suitable, or for medication to be adjusted to maybe make her behaviour more manageable?

    24 hour one to one would be terribly expensive, and not something you could do alone even with leave from work

    Restlessness is common and shouldn't alone be a reason for a move, but maybe the consultant wants to monitor and adjust medication?
     
  8. Ash148

    Ash148 Registered User

    Jan 1, 2014
    276
    Dublin, Ireland
    Just spoke to doctor in the psych hospital. He doesn't hold out much hope for medication changing restlessness; as has been said it is typical dementia behaviour. However, he thinks we may as well try. I explained concern re visiting and he was not aware that visiting hours were restricted on the ward to which mum would be admitted!!!!!

    He thinks this is wrong and will talk to the nursing staff and see if they will agree to more flexible visiting.

    Nursing home says she must go for a min of 8 weeks and it will only take her back if she is settled.

    The ward she is on is designed for dementia and they actually have a few far more challenging patients as far as I can see. It's a lovely place and the carers are wonderful, and as she has has so many moves and is deteriorating so fast (but still has what my brother calls her Duracell batteries) that we really don't want another disruptive move.

    Also, the community psychiatrist is saying that she doesn't see mum going back to the nursing home after hospital.

    There are so few specialist dementia facilities here but I guess we need to start looking for alternative options.
     
  9. Ash148

    Ash148 Registered User

    Jan 1, 2014
    276
    Dublin, Ireland
    I should have said that my siblings are sceptical of my ability to care for mum at home and to be honest I have my own fears in this regard.

    How can a nursing home require such a big decision to be made at 24 hours notice? We have told them that it's too complicated to do in that timeframe. They're afraid that the hospital bed available now will be taken by another patient if we don't agree to hospital immediately.
     
  10. Ash148

    Ash148 Registered User

    Jan 1, 2014
    276
    Dublin, Ireland
    So it's happened: nursing home has given an ultimatum and my siblings have succumbed: mum will be sectioned and detained in a psychiatric hospital indefinitely all because she paces, isn't sleeping and eats erratically. I have lost all faith and have opted out of a family conference this evening: I cannot bear to speak to my siblings and cannot be a party to this injustice.
     
  11. love.dad.but..

    love.dad.but.. Registered User

    Jan 16, 2014
    4,364
    Kent
    Am so sorry that must feel unbearable....as your mum is safe and being looked after while she is assessed...take a bit of time to recharge your batteries all this stress must be very upsetting...then think about if you feel you could engage in the process again having researched whether there is a suitable alternative nursing home you can opt for when things have calmed down a bit. It is so difficult when siblings can't agree on a course of action. If your mum had awareness she would be so proud of you fighting her corner.
     
  12. Ash148

    Ash148 Registered User

    Jan 1, 2014
    276
    Dublin, Ireland
    Thank you so much love.dad.but. My heart is broken tonight. I would have taken leave of absence from work to prevent this happening but my siblings would not accept this: too many i's and t's left undotted and uncrossed. They seem to be holding out for a medical miracle that will make mum calm and happy; I've done the research and based on the many medication options that have already been tried, mum's pre dementia personality and extensive discussions with the doctor who manages the secure unit in the psychiatric hospital, I don't think this is going to happen. It's such an unkind environment and I am afraid they will simply sedate her to stop her pacing at night; she will be safe but she is safe where she is. So sad my siblings don't trust me to provide a better option than this: it was a serious proposal on my part, but they won't treat it seriously. I know it would be hard and would be apprehensive about doing it, but better than the alternative.

    Thank you again for your empathy.
     
  13. susy

    susy Registered User

    Jul 29, 2013
    806
    North East
    Sometimes things happen that we really don't like for a reason, but that reason doesn't show itself to is til much later. Maybe that is what is happening here. Also, to take on your mum when a care home can't cope I feel would be honourable but exhausting. Although you would be giving everything for your mum it would take it's toll on you massively. Be kind to yourself and forgive yourself for not doing this for her right now. I know your family have taken this out of your hands but it doesn't stop those guilt feelings does it!! I do hope that you can find a way through this and can make up with your family. Ultimately, it is dementia that has stolen your mum, nothing and no one else has.
    Much love xxx
     
  14. Ash148

    Ash148 Registered User

    Jan 1, 2014
    276
    Dublin, Ireland
    Susy, thank you for your kind words. Right now, I don't see how I can ever forgive my siblings. although I know they think they're doing the right thing for mum. Plus, I'm not sure whether they'll ever try to forgive me for fighting this. Poor mum, to be on the move again, she's like the baby with no room at the inn.
     

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