Care home sent her back

Hi, you need to ask for a continuing health care assessment urgently. This would fund care at home or in a nursing home. You would ask the mental health workers that are involved with her to arrange this. Beacon are excellent advocates and give 90 mins free advice https://beaconchc.co.uk/how-we-can-help/free-information-and-advice-on-nhs-continuing-healthcare/?gclid=CjwKCAiA8NKtBhBtEiwAq5aX2MV_mWGTGscMabepR8l5oxKy6N4Lr8JLvKJ9CPpe-pmuCr7SH4jz2xoCH9oQAvD_BwE

Hopefully your Admiral nurse can help with sorting out medication.

Pain in older people is very common, especially if you know they have arthritis. Or any history of manual jobs or significant accidents. And people with dementia will often say 'no' if you ask them if they are in pain.

I have seen so many dementia patients get calmer and less distressed when their pain is treated.

That’s not necessarily going to be helpful. Lorazepam is often contraindicated in dementia care. She needs an assessment by the PLN with regards to appropriate treatment.

She's a failed discharge. She was discharged into the wrong setting; who ever assessed her has not highlighted her needs correctly/was given false information by family.

Idea one is that she stays with you for 3 months, and then your sister for another 3 months. Giving your father respite. When you suggest she returns to him, he might question whether that's in his best interest and can declare her homeless.

Another idea is If she becomes violent or risk of leaving her own home at night etc, the police will only get involved if she's outside her property. (They just return her back otherwise).

Your mum doesn't want strangers in the house so you may have to give up your current lifestyle to accommodate. Alternatively, push the assessors to doing their paid job correctly.

Another thing to do would be to speak to her gp for a review- are her medications optimised?

OP@WickerShit please make sure your mum has had a full physical check up by a medic….there are lots of physical causes of increased distress..UTIs, chest infection, constipation, dehydration can all be frequent issues and I have seen a lot of elderly people with dementia whose physical care has been sub par and the aggression put down to worsening of dementia ,rather than a treatable cause.

Is your step father prepared to continue caring for your mum at home? If he says he is, you may find that social services try to maintain that, unless there are serious safeguarding concerns. From what you have said about mums behaviour in the care home, the staff will absolutely not have been able to meet her needs. EMI nursing care would be more appropriate. Sending her to A and E would not be beneficial to her, if it can be avoided. She would remain in hospital for a long period of time whilst they gather all the evidence they require, various nursing homes assess her and there is usually a waiting list. It could even mean a placement out of area. Meanwhile, mum is in a hospital bed for months, with all the risks that entails. I would speak to her social worker in the first instance.

My friend is dealing with this situation with her father. He is fit and well, but dementia is quite bad, he cannot be left alone. He went into a dementia care home whilst friend was on holiday. A couple of days in they got a call to say she had to collect him as he was violent to another resident. It turns out a male resident kept going in his room and despite asking him to go, he kept going in, so friends Dad pushed him over. He now seems to have being violent on his file as when another care home was approached to take him full time, apparently there is no spaces available.

My lovely dad was briefly in a care home before passing away. It was a lovely care home built in a, circular way so the residents could walk freely supervised if nerve. It had a pleasant lounge that they could use. Rooms were definitely NOT locked and restraints were absolutely NOT used. You just need to find the right care home.

I would make a list of her care needs
.
Can she shop, cook, clean, make tea. Has she lost weight
Can she wash, change clothes, keep herself clean, does she use the toilet
Does she have any wounds, skin conditions, medical issues
Can she walk independently and safely
Is she at risk of falling, does she wander
Is she at risk of self neglect or risk like leaving gas on, refusal by sd to get the care she needs
Can she manage finances
These are questions ss and a carehome should ask. Have you got a copy of her assessments, what do they mean by complex needs, are they nursing needs or behaviour needs. Does she have any insight into her anxiety, hallucinations , aggression and pacing around
Does she have nursing needs that only a qualified nurse can give, if so you get fnc.
With funding, has she had a financial assessment, would she need to pay for care, do they claim attendance and carers allowance.
Has she had a formal capacity assessment, does she have capacity to move to a carehome.

If she doesn't have capacity and needs a carehome, emi unit, hospital or home carers will there be a best interest/nearest relative meeting and who will arrange this and make the decisions .

Quite often the homes that look the most appealing are the ones that are spending less money on staff. All the behaviour you describe is fairly common in a person with dementia, who becomes disoriented and distressed. For lots of homes, it's routine and they have ways to manage. (Not sedation, usually. That comes with its own set of risks)

I have seen care homes turn people away like this one did, but usually the person is sent back to hospital until a suitable place is available. Going back home to be cared for by an elderly spouse, round the clock, is not ideal.

Write up your notes from this thread, and email sw'er now so there's a paper trail. Why wait? Ask for all the things you want, list them eg: her nursing needs, FNC, review of medication eg lorazepam. Put in a few key words so that the sw knows you mean business and are not to be messed with. Ask for an urgent review, with a view for her to be placed asap. And ask for a phone call asap, eg Monday or Tuesday to discuss. Don't let them off the hook, keep pressurising them, keep the deadlines tight. Fight hard, but polite.

I'd be selective in what you print out! You need Social Services on your side, whatever you may think of them in private.

What we have been looking for is something that makes us happy, less guilty about leaving her. Focus on the fact that she now needs more care than you can provide. What helped me re my father is that the nursing home was able to get him to take his medications on time, and feed him properly, which was something I hadn't been able to do, so I didn't feel guilty. The key thing in a nursing home I believe is the staff rather than the facilities, by which I mean a home with dedicated staff and a good hands-on manager but poor facilities is better than a home with great facilities but disenchanted staff, high turnover, and no personal relationship with residents.

Come and join us on this thread, OP. You'll find plenty of people in your situation, and lots of support.

https://www.mumsnet.com/talk/elderly_parents/4967638-so-bloody-exhausted-waiting-for-someone-to-die-2

A secure unit may just mean the entrance door is secure and this will be risk assessed and fire risk assessed. Anything else would be classed as restraint

She needs a lorazepam PRN prescription.

When I was looking for a care home for my Mum, I asked each home I considered for examples of what types of behaviour they would not be able to cope with ie for what reasons why they might as Mum to leave. This helped me find a suitable place for her. I also wanted to know how they dealt with challenging behaviour, in particular what additional support or medical pathways did they have access to.

A lot will depend on long term funding for the fees. If your Mum will be self funded for more than three or four years then you might find that Social Services will not get involved with sorting out a care home other than providing you with a list of homes. However, if your Mum has limited funds, then they do need to be involved otherwise you might find a suitable placement that is much more expensive that SS will fund, in which case when your Mums money drops below approx £23k, she will have to be moved to a cheaper home.

I had no support from SS for Mum but as I refused to allow her to be discharged from hospital after a fall as the home care package was no longer enough to keep her safe, the hospital Social Worker became involved and helped me find a good care home - they wanted the hospital bed!

I'd also add 'smells of urine' is not necessarily a great way to assess a care home.

I used to know all the care homes in my county v well. One in particular looked v glossy, had a great brochure and sounded posh but we were always making safeguarding referrals about it.

The one that was tatty and yes, often did smell of urine, had amazingly caring staff.

Ultimately it is the staff that make a care home.

So when my dad became like this in his nursing home he was prescribed medication initially by the local GP that the nurse could give when needed that helped calm him. I can't remember what it was but it was low doses. When that wasn't working he saw a psychiatrist who prescribed something regular. At one point there was talk of a secure until for assessment but they managed to balance his medications. Eventually it was pretty strong meds but it was always for his needs not the convenience of the home.

The point is there is lots a good carehome can do in partnership with social work and NHS.

Ps I've had experience of a relative being sectioned too, was pretty bad, but to long ago tj ge that relevant because councils have mostly sold off their facilities, the more recent case was a secure private nursing home fully funded by chc

A&e sounds bad but could be the only option to get the help she needs, they will have access to facilities that you can't self refer to easily. It sounds like she needs full nursing not assisted living, and 1:1 - from hospital it's easier to access chc money I found. If you are looking in the midlands, I can recommend one place

@WickerShit the criteria for sectioning includes if your mum is a danger to herself or others; a section 2 would hold her for assessment for up to 28 days. A subsequent section 3 could hold her for up to 6 months. After a section 3 she would become eligible for section 117 aftercare which might help in getting her a suitable placement.

Not sure if it's relevant but might help you see what the right path is especially if she is aggressive or violent

The care home selected was not right for her, they could not deal with challenging behaviour and they had to keep both staff and other residents safe.

The care home manager usually does an assessment beforehand, meeting the person and their relative(s) to ask about behaviours and ensure they can meet her needs.

Dementia care homes differ widely in what types of behaviours they will accept, there will be a dementia care home which will be able to deal with your mum, as a previous poster said they have a higher staff to resident ratio and additional training in challenging behaviour.