Urgent: Care Home Want To Kick Her Out!

[Pneumothorax]

I'm new so I hope that this is the right place to ask this question.

My grandmother-in-law has a combination of Alzheimer's and vascular dementia. For the past 18 months or so, she has been in a residential care home that describes itself as specialising in dementia care. (She is paying for her care out of her own capital.) Her condition has deteriorated since the home accepted her, but suddenly they are saying that they want her gone "as soon as possible".

Their reasoning for this seems to mainly be that she is reluctant manage her own personal care and becomes distressed if the staff try to bathe or wash her; that she wanders into other people's rooms; and that she will pick food from other residents' plates and sometimes offer her food to others who may be on special diets.

My husband's family and I have never had dealings with care homes before, so we've no idea if it is acceptable for them to ask her to leave on these grounds. Personally, these seem like very small issues that a care home (particularly one specialising in dementia care) should have no problems in dealing with. The care home staff say that she should be in an "EMI" unit, but as far as I can tell, this is just another term for a dementia unit.

We're all very confused and angry about this, but have no idea of what we should be doing! Whom should we be contacting to complain, if indeed we have a justifiable complaint?

Yours, in a state of moderate panic,
Jenny

 

[Grannie G]

Hello Jenny

If the home specialises in dementia care they should be able to manage your grandmother in law`s behaviours.

An EMI Unit is what is now considered an outdated name for a dementia unit [Elderly Mentally Infirm] It looks as if the home is being selective about the people with dementia it is prepared to accept.

All forms of dementia are progressive and the home should have taken this into account from day one.

The only exception really should be if your grandmother in law needs nursing care and there are no registered nurses at the home, or if her behaviour poses a risk to other residents.

Her behaviour might be annoying to other residents and if this is so, the home should seek medical or psychiatric advice.

Perhaps you will consider phoning the Dementia Help Line.

 

[FifiMo]

Hiya and welcome to talking point.

I am sorry that you are having to deal with this and from what you describe I think what this comes down to is that the care home is not staffed to give the lady the kind of attention she is now needing. I will hazard a guess that although they provide services for dementia sufferers that these are limited to people who are perhaps nearer the earlier stages of dementia where they have an ability to largely look after their own personal care and who are also perhaps at a stage where they understand instructions (eg please don't go into that room). If your grandmother's dementia has gone beyond this and requires a different level of care then it could be that they are no longer able to give her the level of attention she needs. Bearing in mind that what is underlying this isi money. They won't be bringing in extra staff for this very reason.

My personal view of this is that if a care home were telling me they couldn't cope - then I wouldn't want my relative continuing to be there. I can understand that you are angry but perhaps a way to look at this is that the care home and being honest with you and if the lady's needs are different now then maybe they are considering her best interests. If the lady is self funding then you don't need to contact anyone - you can go look for another home perhaps a nursing home and ne that can cater for caring for someone with dementia right through to end of life. That way you wouldn't then be faced with moving her again in the future. If you take the stance that the home are trying to be helpful then I would ask to speak to the manager and get their view of what your gradmother's care needs are now. That will allow you to speak to other homes to see if they can meet those needs. Any home that is open to accepting the lady will normally go visit her and do their own assessment.

By way of reassurance, as much as her current home can't cope, the issues that the cite are in fact quite common with people who have dementia. My mother in her care home ticked all those boxes as well and the carers managed her and numerous others with the same issues very well. Her care home however was a nursing home and perhaps had the additional and/or better qualified people to do that. So, I wouldn't worry unduly about not being able to find her somewhere that is more suitable for her.

Hope this helps,

Fiona

 

[Cornishman]

I'm no expert but noting there's some urgency in your message and I happened to read it, here's my initial thoughts:

Personally I'd contact the local authority social services as soon as you can - ie tomorrow.

If she was really "kicked out" (I'm guessing not even the CH would do that, whatever the circumstances), she would in strictly legal and "duty of care" terms instantly become their responsibility. What they'd do after that I don't know of course, but in the first instance I think it worthwhile contacting them if only to seek their advice etc and alert them to what's being suggested.

Hope this helps and hoping everything works out for the best for you and your relative.

 

[zena285]

Similar thing happened with my mum last year. She was in a so called specialist dementia unit but they never seemed able to handle her or take care of her properly. Most days my sister and I would pick her up in the morning, bring her home, put her in the bath as they couldn't manage that, feed her because they struggled to get her to eat anything, we even gave her her medication. We mistakenly thought that things would get better with time, how wrong were we.

We went to see mum on a Monday morning, the home didn't say anything was wrong but by four o'clock that afternoon we were informed by SW that home wanted mum moved asap as they said they could no longer handle her, not that they had done much handling up till then. We managed to get them to keep mum for five weeks while we sorted out a new place, but this only happened because she only slept at the home, I used to pick her up after breakfast and we would take her back at bedtime and stay with her until she was asleep, she wasn't any bother on a night time. The CH still took full fees for the five weeks though.

Anyway, to cut the story short, it was the best thing they could have done was to ask for her to be moved as she is now in a lovely home where she is well taken care of, they manage all her care so well and she is so happy and settled.

 

[Not so Rosy]

My Dad has been kicked out of three homes between Christmas and May because he is considered difficult to handle. He is currently in a locked facility within the grounds of a Hospital which is the best place he has ever been in. It is the most wonderfully compassionate place, spotlessly clean, great food, every type of professional you could shake a stick at for Dementia patients and the best accommodation I have ever seen. I was initially mortified when he was sent there but how wrong I was.

He is ready for discharge now and I am completely dreading it. I hope I have picked the most appropriate new Nursing Home for him but time will tell !

 

[wobbly]

my Dad is nin the same situation and was assessed by the cpn as needing emi nursing care for what sounds like the same reason as your relative, he is doubly incontinent but there again was on admission?? They said they couldnt cope so he was assesesed and as they didnt provide nursing care he was going to have to move, they agreed to let him stay whilst we got a place. That was feb and they recently served 30 days notice to SS and haven't told us a thing about it, so not even any decent manners or care for relatives feelings, like someone else says we wouldnt want him stayiing there anyway......we were hoping to move him this week but all the red tape stuff isnt complete...surprise surprise!!

 

[Dazzaman]

Best interests

I have to agree with Fifimo. As disturbing as the possibility of your mother being evicted is, my mother was placed into a 'dementia care' home' and after 18 months or so it started to become apparent the staff there were not trained to manage a person with her degree of dementia and the symptoms she had. As a result, she was subject to neglect and poor care for another year before I could have her moved to a nursing home. Without appearing dramatic, what she went through was truly horrific.

Speak to your mum's social worker asap and don't stop speaking until a solution you're happy with is found.

 

[Jessbow]

Try and get them onside- where do they recommend might meet her needs? Don't be defensive about it. They might know where other folk have gone and where has the best facilities.

Right way= do they have any suggestions as to placements that might meet her needs better
wrong way = So where do you suggest we put her?

Try and stay calm and understand their request ( even if you don't) and they are far less likely to set deadlines and alike. The last thing you want is to get backs up and to have them say ''She has to go Next Friiday'' for instance

 

[Chris-G]

Hiya and welcome to talking point.

I am sorry that you are having to deal with this and from what you describe I think what this comes down to is that the care home is not staffed to give the lady the kind of attention she is now needing. I will hazard a guess that although they provide services for dementia sufferers that these are limited to people who are perhaps nearer the earlier stages of dementia where they have an ability to largely look after their own personal care and who are also perhaps at a stage where they understand instructions (eg please don't go into that room). If your grandmother's dementia has gone beyond this and requires a different level of care then it could be that they are no longer able to give her the level of attention she needs. Bearing in mind that what is underlying this isi money. They won't be bringing in extra staff for this very reason.

My personal view of this is that if a care home were telling me they couldn't cope - then I wouldn't want my relative continuing to be there. I can understand that you are angry but perhaps a way to look at this is that the care home and being honest with you and if the lady's needs are different now then maybe they are considering her best interests. If the lady is self funding then you don't need to contact anyone - you can go look for another home perhaps a nursing home and ne that can cater for caring for someone with dementia right through to end of life. That way you wouldn't then be faced with moving her again in the future. If you take the stance that the home are trying to be helpful then I would ask to speak to the manager and get their view of what your gradmother's care needs are now. That will allow you to speak to other homes to see if they can meet those needs. Any home that is open to accepting the lady will normally go visit her and do their own assessment.

By way of reassurance, as much as her current home can't cope, the issues that the cite are in fact quite common with people who have dementia. My mother in her care home ticked all those boxes as well and the carers managed her and numerous others with the same issues very well. Her care home however was a nursing home and perhaps had the additional and/or better qualified people to do that. So, I wouldn't worry unduly about not being able to find her somewhere that is more suitable for her.

Hope this helps,

Fiona

Hi Fiona, I agree.

However, It does seem a bit disingenuous to accept a self funding resident that can only get worse mentally and then "kick them out" when the disease progresses.

Should dementia patients be encouraged to spend their cash in what is in effect temporary accommodation without being strongly cautioned of their need to move out in the later stages?

I would argue that anyone advertising some specialty in this regard is fibbing at the very least.

The home also benefits financially from not having the expense of dealing with the more severely afflicted as they progress.

If they cannot cope with the later stages of dementia then are they dementia specialists at all?

For hypothetical example, a hospital casualty unit that only dealt with slightly broken legs would be pretty useless unless everyone knew in advance that it was the case.
Advertising that it specialised in broken limbs would obviously be a wrong thing to do from the outset.

 

[Wirralson]

Hi Fiona, I agree.

However, It does seem a bit disingenuous to accept a self funding resident that can only get worse mentally and then "kick them out" when the disease progresses.

Should dementia patients be encouraged to spend their cash in what is in effect temporary accommodation without being strongly cautioned of their need to move out in the later stages?

I would argue that anyone advertising some specialty in this regard is fibbing at the very least.

The home also benefits financially from not having the expense of dealing with the more severely afflicted as they progress.

If they cannot cope with the later stages of dementia then are they dementia specialists at all?

For hypothetical example, a hospital casualty unit that only dealt with slightly broken legs would be pretty useless unless everyone knew in advance that it was the case.
Advertising that it specialised in broken limbs would obviously be a wrong thing to do from the outset.

Your last point is not a valid comparison, I'm afraid. The home has a duty of care towards its staff and residents. If a given resident's condition enters a phase that the home cannot contain and so discharge its duty of care, it has a duty to seek alternative arrangements for that resident. Part of that would involve informing relatives and/or social services and working with them to achieve an alternative placement. That is what is happening here. Some of the more challenging behaviours dementia can cause can fall the scope of even what used to be called an EMI nursing home. There was one home near where my mother was in care that specialised in such demanding cases, although it cost considerably more.

Dementia is a condition that has a wide range of symptoms which change over time, so it is entirely possible for a home to take a patient/resident who has one set of symptoms only for that condition to move beyond a given home's ability to cope. That doesn't mean they're lying when they claim to handle dementia - it's just that some manifestations are more specialised. To use your orthopaedic example, while most NHS Acute Trusts can deal with broken limbs, some forms may be so specialised that they might need to be referred to the Royal National Orthopaedic Hospital. It doesn't mean that the Acute Trust fractures clinic is lying - just that some cases may require more specialised intervention.


W

 

[Chris-G]

Your last point is not a valid comparison, I'm afraid. The home has a duty of care towards its staff and residents. If a given resident's condition enters a phase that the home cannot contain and so discharge its duty of care, it has a duty to seek alternative arrangements for that resident. Part of that would involve informing relatives and/or social services and working with them to achieve an alternative placement. That is what is happening here. Some of the more challenging behaviours dementia can cause can fall the scope of even what used to be called an EMI nursing home. There was one home near where my mother was in care that specialised in such demanding cases, although it cost considerably more.

Dementia is a condition that has a wide range of symptoms which change over time, so it is entirely possible for a home to take a patient/resident who has one set of symptoms only for that condition to move beyond a given home's ability to cope. That doesn't mean they're lying when they claim to handle dementia - it's just that some manifestations are more specialised. To use your orthopaedic example, while most NHS Acute Trusts can deal with broken limbs, some forms may be so specialised that they might need to be referred to the Royal National Orthopaedic Hospital. It doesn't mean that the Acute Trust fractures clinic is lying - just that some cases may require more specialised intervention.


W

Hi Wirralson, I accept what you say.

As this is not the first time I have seen such a problem, it would seem that there are indeed care facilities that regularly cannot or will not deal with increased care needs.

That should disallow them from making the claim or having it implied, that they can or will. That is all that I am saying.

There are of course exceptions, even to continuing to provide care in an "EMI" or "DE" environment.

Even self admission to a mental care facility can be trumped by sectioning because of the increased needs.

What appears wrong is that some homes that provide care for the generally elderly infirm, are willing to take (often self funding), Alzheimer's patients without it being made apparent to the patient or their families that they may have to move on because of their disease state.

That is not just an opinion, it is backed by disappointed posts on several websites in that regard.

All the best CG.

 

[Wirralson]

Hi Wirralson, I accept what you say.

As this is not the first time I have seen such a problem, it would seem that there are indeed care facilities that regularly cannot or will not deal with increased care needs.

That should disallow them from making the claim or having it implied, that they can or will. That is all that I am saying.

There are of course exceptions, even to continuing to provide care in an "EMI" or "DE" environment.

Even self admission to a mental care facility can be trumped by sectioning because of the increased needs.

What appears wrong is that some homes that provide care for the generally elderly infirm, are willing to take (often self funding), Alzheimer's patients without it being made apparent to the patient or their families that they may have to move on because of their disease state.

That is not just an opinion, it is backed by disappointed posts on several websites in that regard.

All the best CG.

No, there are few if any homes make such a claim. In practice, what happens is applicants seeking a place for a resident assume their relative can stay in that home indefinitely. When my father and I were seeking a home for my mother I expressly asked about this point and was, correctly, advised in every case that there was always a caveat about what happened if the needs of the resident changed to an extent that the home could not cope.

And what you say is just an opinion, although no less valid because of that. The fact that others are disappointed doesn't alter the legal duties of the home to its residents' visitors and staff.

w

 

[Chris-G]

No, there are few if any homes make such a claim. In practice, what happens is applicants seeking a place for a resident assume their relative can stay in that home indefinitely. When my father and I were seeking a home for my mother I expressly asked about this point and was, correctly, advised in every case that there was always a caveat about what happened if the needs of the resident changed to an extent that the home could not cope.

And what you say is just an opinion, although no less valid because of that. The fact that others are disappointed doesn't alter the legal duties of the home to its residents' visitors and staff.

w

Agreed.... My mum currently has a very large and disturbed gent in her home. However, even though he has been dragged off several women including my mum, (grazed eye last time), by several staff and visitors at a time. When challenged, the care home manager knows nothing about it.

Once again and I do hate to seem argumentative. We had to ask the question "what will happen if her (mum's) condition worsens of several homes. Not once (4 homes), was it intimated that a move might be required at some stage. Although one did state that they would not take her even though they had a closed alzheimer's environment as well as space for less incapacitated people. We assumed that they moved their own residents through and so anticipated the need to avoid filling the closed space.

 

[Wirralson]

Once again and I do hate to seem argumentative.

Surely not!

Serious point: raise the grazed eye incident formally with CQC and as a SOVA issue. And if the home is a part of a group, raise it in writing with Head Office. We did with my mum's chain (as did other residents' relatives), and, strangely a change of manager ensued.....

Homes can and do refuse residents for any reason or none. Provided this isn't in breach of a "protected characteristic" under the Equality Act (or none of the exemptions apply) then there isn't much anyone can do.

 

[Chris-G]

Surely not!

Serious point: raise the grazed eye incident formally with CQC and as a SOVA issue. And if the home is a part of a group, raise it in writing with Head Office. We did with my mum's chain (as did other residents' relatives), and, strangely a change of manager ensued.....

Homes can and do refuse residents for any reason or none. Provided this isn't in breach of a "protected characteristic" under the Equality Act (or none of the exemptions apply) then there isn't much anyone can do.

Hi Wirralson,

Only by discussion and expression of points of view and then ultimately clarification, will consensus or understanding be reached.

I take your point that SOVA and the CQC aspects are relevant. But it is a little difficult when the manager refuses to play the game from the outset. It is reported elsewhere on the site that previous attempts to get the LA adult care team to investigate safeguarding of my mother was botched.

However, since the Care Home manager was informed by my father of the above mentioned incident, there have been several further incidents that have seen slight injury and much distress to other residents within this DE Nursing environment.

Only two days ago my father had to drag the resident off my mum and another resident that he was simultaneously dragging about the lounge. Twenty two residents in the large open plan lounge and no staff observing!

It is also on record that the manager seeks to avoid bad "Behaviour" recording (for CHC purposes), as it reflects badly on (her limited abilities?), the home and in any case she was "told (by CHC assessors), that the NHS takes no account of behaviour in CHC assessments anymore."

I think that much like my FIL's home, they have recently discovered the premium to be gained in assisting the denial of CHC funding for residents that might well be able to pay the much higher self funding rate. I can think of no other reason for the change of attitude from the nursing home's staff when they are called upon to support claimants during CHC assessments.

For example a nurse that works 2 days/nights a week in another part of the home, that has no real or regular contact with her, represented the home in my mother's last assessment.
She was a waste of oxygen during the assessment. She couldn't/wouldn't even contradict incorrect recording of the care needs by the assessor. We had to do that, to her shrugs and disinterest. We were even admonished by the assessor for asking her what the care records actually said so that we would not seem to be exaggerating matters. She had to go and get the records. Then we were denied the right to ask her questions germane to the assessment.

Previously, when the higher NHS CHC rate was preferable to the low council rate, the manager played that role. She actually fought for my mum with the care records to hand.

All the best CG.

 

[Wirralson]

Hi Wirralson,

Only by discussion and expression of points of view and then ultimately clarification, will consensus or understanding be reached.

I take your point that SOVA and the CQC aspects are relevant. But it is a little difficult when the manager refuses to play the game from the outset. It is reported elsewhere on the site that previous attempts to get the LA adult care team to investigate safeguarding of my mother was botched.

However, since the Care Home manager was informed by my father of the above mentioned incident, there have been several further incidents that have seen slight injury and much distress to other residents within this DE Nursing environment.

Only two days ago my father had to drag the resident off my mum and another resident that he was simultaneously dragging about the lounge. Twenty two residents in the large open plan lounge and no staff observing!

It is also on record that the manager seeks to avoid bad "Behaviour" recording (for CHC purposes), as it reflects badly on (her limited abilities?), the home and in any case she was "told (by CHC assessors), that the NHS takes no account of behaviour in CHC assessments anymore."

I think that much like my FIL's home, they have recently discovered the premium to be gained in assisting the denial of CHC funding for residents that might well be able to pay the much higher self funding rate. I can think of no other reason for the change of attitude from the nursing home's staff when they are called upon to support claimants during CHC assessments.

For example a nurse that works 2 days/nights a week in another part of the home, that has no real or regular contact with her, represented the home in my mother's last assessment.
She was a waste of oxygen during the assessment. She couldn't/wouldn't even contradict incorrect recording of the care needs by the assessor. We had to do that, to her shrugs and disinterest. We were even admonished by the assessor for asking her what the care records actually said so that we would not seem to be exaggerating matters. She had to go and get the records. Then we were denied the right to ask her questions germane to the assessment.

Previously, when the higher NHS CHC rate was preferable to the low council rate, the manager played that role. She actually fought for my mum with the care records to hand.

All the best CG.

As I have posted elsewhere, I don't think the CHC funding argument you use above is quite right. AFAIK the NHS is (still) stuck with more or less whatever the home is charging - LA's are obliged not to pay more than the expected to pay rate in most circumstances. So CHC funding is still preferable from the Care Home's point of view - they get the guaranteed reliability of publicly funded payments but at their own rate. So there is no mileage either way for the home in assisting or refusing CHC funding. I suspect it is more that the care home management company has noted the amount of time and resources involved (and the potential liability for statements that are not covered by their insurers) and told the management of the home(s) to rein it in. There's also a "chilling effect" of the forthcoming changes in charging, which may have the effect of making LAs pay more and removing the disincentive to take LA funded residents a little. All of which makes it harder to combat the disinterest of the care home staff in assisting you.

btw, the NHS has nothing to do with preparing CQC assessments, since the CQC isn't part of the NHS - it is independent and actually licences NHS establishements among other things. What the NHS thinks about residents' behaviour is irrelevant - indeed in most cases it will have no involvement except via primary care or community psych teams or if the resident is on a placement under s17 of MHA83. The CQC doesn't take account of behaviour in its assessments except in the general sense of assessing whether or not a home is managing challenging behavioural needs. If push comes to shove, public protection units or their equivalent in the local police force can (and do) investigate such things.

W