What does excellent dementia care look like?

Have you had him checked for a UTI?

Dementia can come on very suddenly, sadly, but a UTI has many of the same symptoms, so it's worth checking. If it is dementia the GP will be able to prescribe medication to slow the progression (it doesn't always work) and something to take to help the anxiety dementia can cause.

The way staff talk to relatives is very different to the way they speak to a resident i.e the way they told you your dad was being "rude and threatening". They won't have sid that to him. They would understand there is no point as it wouldn't make sense to him. The training we are given advises us to distract and try to bring them back to today by asking about things earlier in the day or talking about something they were looking forward to later i.e "Come on, let's your get trousers back on. We can't have you walking about in your pants. Did you go to the morning room this morning?/I heard you had a bacon sarnie for breakfast this morning, I'm jealous/Oh, look it's 3pm didn't you LaBelle was visiting soon?" etc.

If residents do threaten staff we might say "That's not nice" or "You can't speak to people like that" etc but we would then dive right into another conversation to attempt to distract from the behaviour rather than wallow on the bad, iyswim? My go to was always "Let's go for a cuppa and a biccy and you can finish telling me about X," while gently leading them away from whatever triggered the behaviour. But as violet pointed out, this doesn't always work. Sometimes the best thing we can do is give the resident space.

There is a specialist care home near me that ensures that all staff wear Pyjamas when on night shifts so that patients waking at night realise that it is night time. This makes a huge difference to night time care apparently.
If you are in England look at the CQC rating for each establishment. I wouldn’t want to be anywhere that wasn’t rated as Very Good.
look at how clean and tidy the patients look as this will be a good indicator of actual staff ratios.

i totally understand what you mean.
I have a close relative with advanced dementia. Paying over £1000 a week for them to be there.
Relative defecated in their room at night- there was no ensuite in the room and he wouldn’t remember to go out to find the loo. Care staff were almost annoyed saying they wrote a sign to the loo. He can’t read anymore let alone work that out!
Relative can’t cut food. Won’t eat unless heavily prompted and really almost needs feeding. Staff haven’t been cutting food or ensuring it’s eaten. Got to dehydrated he had to go to hospital and has lost so much weight.
We get the same annoyed tones when speaking to some staff- like he is being deliberately rude or annoying etc. I just don’t get it honestly.

Not sure what you've found offensive about Frequency's message?? Have you picked her up wrong maybe?

I didn't mean to offend by the hackles up remark - I just meant both families and carers can be guilty of it during a conversation and it hampers communication. Please try and not focus too much on the words used. Theres not often any other way to explain someones behaviour being rude and threatening. What is important is the way it is said - "your father is rude and threatening" is completely unacceptable whereas "you father was exhibiting some threatening behaviour and using rude language which isn't like him...etc" has a totally different tone. Again it doesn't say a thing about him or his character as a person.....its all just a manifestation of his disease, which they will know.

With him being alone in his room - there could a number of reasons why. Sometimes residents request to be left alone. Sometimes our presence is aggrevating them further, so we will give them space and check regularly on them quietly (more often than not this is the case). Your father may have been unsettled as he was feeling tired and lay down on his bed himself. The main goal is to help pass ths period of distress and being alone can sometimes help that. In my home everything is assessed minute by minute and quite a few of our residents respond best to having some time alone as any conversation or noise or agitation deepens their distress. Others respond better to a hug and a hand hold and a chat about the olden days. Maybe thats what suited your father best that day. You say he was still distressed when you arrived - unfortunately with dementia sometimes the only thing that works is the passing of time. Maybe have a chat with the nurses and ask what his mood is like overall - whether he has more good days than bad etc. The staff see him 24/7 and will have a better overall idea of how he is than you visiting at a bad time. It could have been a total coinicidence and he could have had a great few days before that. Its hard for you to assess with only a snapsnot.

Oh La Belle, I could have written a very similar thing.

I have had to stand back and think, yes he's in this state because he's trying to take his trousers off to go to the toilet but his brain can't tell him to call a career or press an alarm to get two carers to help him on to the commode.

Sadly in our case even though he is in a beautiful care home they are short staffed. They can't be in every persons room at once, and there's a mixture of needs and so on.

I have to tell myself that. Or it would make everything so much worse.

And I know that the bad care homes are so much worse.

It's horrible and the hardest thing I've faced in my life. We don't have long with him now.

They shouldn't in your case be confrontational with him though. I found if we complained that it was sometimes flipped by one member of staff to say he'd done something. It was also totally out of character.

How long has he been there? It does get easier and you'll get to know the staff better and find your favourite ones which will help you cope.

To me it looks like the carers, did the right thing in assisting your Father back to his room. Otherwise it could of been a safeguarding. How would you of felt if you walked in and your father was undressed in front of staff and other residents?
Im certain they will have been doing regular checks on your father while he was in his room, safe. Its a shame he was distressed on his own. Sounds like you walked in at the right time to comfort your dad, when he was getting upset.
They should not be using words like rude or threatening. They should use words like confussed, distressed, vocal ect... Like you said you father is confused with the dementia & has always been a peaceful man.
Wouldnt it be lovely if we could have 1-2-1 care for all residents in care/nursing homes/hospitals etc...
Your Dad is so lucky having you watching out for him. Not everybody has family or friends for visits.

I think you are being unfair to the care home dementia massively changes a person and you defend him refer to him as he was not how he is now

It's very possible that he was not distressed when he was advised to go to his room if he wanted to sit without his trousers on. Mood changes can be terrifyingly swift with dementia.

Very few carers would deliberately leave a resident they knew were distressed. Unfortunately, the majority of homes do not have sufficient staffing levels to give residents the attention they deserve.

Where I worked it was not possible to do pop-ins on residents who were struggling as frequently as they were needed. We would sit with a resident who was distressed for as long as we possibly could, even eating into our own breaks but there are other residents to attend to and generally a rota/schedule to follow.

I've left a residnt perfectly happy and lucid and eating their meal only to find them wandering the corridor and crying 5 minutes later.

Book a meeting to discuss your concerns with a manager/senior carer but from what I can see based on what you've written the care staff haven't done anything wrong other than used language you didn't like (which will not have been the same type of language they used with your dad, I promise).

It is upsetting to see your loved ones in distress but sadly that is what dementia does to a person. Even with 24/7 one to one care you can't always avoid the distress and torment that dementia can bring. It's a cruel and horrible disease.

I agree with a PP who said to ask local carers which home they would use. Carers do hear on the grapevine which homes are good and which are bad.

My mother was in a care home where all the residents had dementia and I thought the staff were good with her, very patient, while yes, sometimes having to consider the other residents and not having them upset or scared (or wounded to be honest) if she was being difficult.

I'm sure the care staff are doing their best, but it's really hard dealing with someone who is angry and paranoid, and they might be inexperienced or not well managed. if you might have the option to move him, I think it'd be visiting a few different nursing/care homes, talking to the staff and just seeing what the general 'vibe' – for want of a better word – is like. I know a few people whose elderly relative spent time in two more more care homes before they found one where they seemed to settle.

You might find 100% dementia care homes better - or you might come to the conclusion that actually the place he's in is ok. But at least you'll have something to compare it to.

Deerhurst in Bristol is a fantastic care home that caters for dementia patients. I can also name 2 in the same area that I would actively avoid!

@Frequency glf you have left if you think that was acceptable care and an acceptable way to talk to a relative about their very unwell confused and frightened parent. We need less carers like you.

I think the other issue is that regardless of whether they are specialist or not, some staff will be better than others, some will be more careful in how they describe incidents than others. Describing him as being rude or threatening also doesn't necessarily mean she didn't understand. By all means, keep a close eye, not all care staff are caring and not all care homes do a good job. My own son was abused by a carer. However, you need to look at the overall picture and be measured. Monitor it and talk to other staff. If you think there is an overall lack of care and respect then complain or move him, but be aware it is tricky finding the right place. My grandfather was in a specialist dementia placement, it was pretty dreadful tbh.

I also totally second the resident to staff ratio being a problem. Its not always possible to have one to one care for a full day, but we do as far as practicably possible. Particularly if someone is having a really bad episode. No one is ever left to struggle through something hard, be it in their minds or not. It feels real to them so we will treat it so.

Its very possible that the particular member of staff maybe needs to appreciate some families will be highly strung and sensitive when hearing about their loved ones behaviour. To be fair, challenging behaviour is so small a deal to care staff that we don't really focus on it, so its easy to forget that, to families, it can be the worst thing in the world. Also, it can be quite hard for us to be approached by family members questioning a particular way we have cared for their loved one as many people have so little understanding of the day to day of people with dementia that it can create friction. The staff member may have been slightly on the defensive. If I were you I'd catch her and have a nicer conversation about your father with all hackles down. Explain how it made you feel and that you didn't want to take it the wrong way. Personally I always appreciate when families explain their worries and it always starts a good relationship with staff. It also helps us care for your loved one even more as we can then work around any issues you have and you then feel comfortable coming to us about anything. We also appreciate the opportunity to get to know what your loved one was like in life so its a win win. Is your father fairly new in the care home?

Unfortunately not 😔I feel for you, it's an absolute minefield trying to find somewhere. We found that via a recommendation from a home carer who worked with someone we knew - she had worked in a few homes and knew people who did, and said that was the best one she could recommend. So I'd definitely suggest trying to find any local carers you know/who work with people you know and asking them, as they often have a good ear to the ground for these things!