Unsure what to do

[thestens]

My mum has been showing some signs of mental decline for about a year, subtle at first but during the summer we persuaded her to go into a care home while we were on holiday in USA for 4 weeks as she had been having falls and had needed more support from us in her flat (she is 91, she could hardly walk, I am the only daughter) During her stay she developed a UTI (she has suffered chronic UTIs for many years) and confusion. On our return she had declined both mentally and physically and ended up only being at home in her flat for a few days before needing hospitalisation with another UTI and inability to walk at all.
On leaving hospital in November she was only at home for 3 days before she was taken into a rehabilitation care home, as again she couldn't walk so the carers that came in daily couldn't manage her (she is also incontinent).
Since then she has been in the care home. At first she seemed to be making some progress with her mobility but after a few days she seemed to decline again and another UTI was found and yet more antibiotics! Since before Christmas the home has been hampered by winter vomiting disease, so the hairdresser and physios have not been visiting and basically my mum is just in her room all day except for meals. I have been visiting daily and most afternoons she is asleep in bed and most mornings she is asleep in her chair. She is getting more and more sleepy and unable to hold a conversation. Physically, she can't hold a cup or a newspaper now and has to be fed by the staff.She is on antibiotics again for another UTI.
She should be moving to the upstairs (paying) part of the home but this has been put on hold because of the sickness. This was to be a temporary move as my husband and I are moving house at the end of February and she was going to move then to a new care
home near our new house (30 miles from where she is now). She says she likes the staff at this home - they do seem nice but I don't know whether she should be somewhere better - would anywhere else be better? I feel that the lack of stimulation may be partly causing her rapid decline. Any suggestions?

 

[sue38]

Hi and welcome to Talking Point.

Sometimes it's better the devil you know, and if your mum is happy there that's a big plus. Have you spoken to the home about the lack of activities? Would your mum be able to participate or engage with them?

Sadly these winter vomiting bugs can take hold in care homes.

 

[tom0591]

You have a difficult decision to make .
I don't envy you, because it's a 'roundabouts and swings' situation for you.

Generally speaking , it's not a good idea to move someone with dementia if they are happy and comfortable where they are. People with dementia need stability and change can make them stressed and anxious.
But is she happy if she's just left in her room alone and asleep most of the time ?

On the other hand, you think your mum would get batter care and more stimulation somewhere else. Maybe, maybe not.
Only you can judge from what you see of the two Care Homes.

Your mum needs very attentive hygiene care since she is getting recurring UTI's, and
the continued use of antibiotics is not good for her, and neither is the possible exposure to infections that cause vomiting etc. This is very important.

Finally , since your mum is 91, having recurrent infections, losing mobility , and becoming tired, you will want to be able to spend as much time with her as you possibly can.

There is no straightforward ' no-brainer ' answer to your mum's situation, and I hope that you arrive at the solution that is beneficial for your mum.

 

[betsie]

Have you looked at the new home?

If you liked it I would move her. You will be able to visit more frequently and keep an eye on her.

Also, I would not be happy if my dad was in his room all day, this can not be helping her mental state.
All residents in my dads home sit in the lounge (there are 2) and in the summer can go into the garden.
They have activities every day (which my dad mainly watches but at least something is going on) and I am sure this helps.
I also read somewhere that people with recurrent uti's are sometimes put on a preventative low dose antibiotic long term if they have continuous UTI's- my dad has a catheter and is very prone to UTI's but, touch wood, they have been less frequent since he moved into the home.

 

[geordie]

If you are happy with the new care home- I'd go with that on the basis it would would increase your opps to spend time with your mum - that to me is the most important variable in this decision process.
best wishes

 

[thestens]

Thank you for your helpful comments.
The new care homes that we are considering are in the town that we are moving to at the end of next month, which is about 30 miles away from where we are now, so in the short term that would be less convenient for visiting. We have visited both and they look nice enough and make all the right noises, but, as we found out from the one that my mum was in this summer, that doesn't necessarily mean they do it!
The only reason she is still in the current home, really, is to avoid moving her before we move. However, I am concerned about her rapid decline. The part of the home that she is in is run by NHS as a rehab facility, short term. It is not really suitable for her needs now I feel. The lack of activities is because when it is running properly them mornings are supposed to be taken up with physio and I suppose the idea is that they rest in the afternoon? However, due to the winter vomiting bug, no physio has taken place since before Xmas as the physios have been told not to go there! As I said, she is supposed to be moving upstairs, short term, to the paying bit, which might be a bit better (??) but cannot because of bug.
It all seems a bit of a disaster and I feel I need some medical advice on whether my mum would benefit from more stimulation or whether the trauma of a move would out weigh that. Someone is coming to talk to us about the results of her CT brain scan tomorrow (maybe Lewie's bodies or frontal lobe damage caused by a brain haemorrage 10 years ago) so maybe can get some advice then? The staff at the home (nurses) are nice and try to help but seem essentially clueless regarding what is happening to her and seem to just react if I ask them to. Hygiene is an issue - she is getting a shower a week if she is lucky, whereas when she was at home she was showered almost every day.

 

[thestens]

Been to the home mum is in this morning again. Apparently the outbreak of winter vomiting bug is now over and they wanted to move my mum upstairs to the paying bit today!!
Took her up to see the room, which is slightly better that the NHS one she has been in (as it should be for £550 a week) and she has agreed to take it until we move. We have been told that she will be included in "activities" in the afternoons instead of sleeping. We will see if this suits her or not, but I think a bit of stimulation is worth a try. No mention of a care plan today! Will ask tomorrow when I visit with the lady from the memory clinic. Very cynical about the whole thing at the moment - will see what is provided!!