AIBU to put complaint in about carers? Aunt now in hospital with 50% chance.

[PhoebeFluffingtonFyffe]

I started this thread last week

https://www.mumsnet.com/talk/chat/5508722-caring-for-elderly-aunt-who-hides-health-problems-and-wont-speak-up?reply=151320727

There has been a very upsetting development.

I just got home 2.40 am after being at the hospital with my aunt from 9pm when she was taken in whilst I was at work. She has necrotising fasciitis and has just had an operation to take away a hell of a lot of basically rotting flesh. She's had this for over two weeks but we didn't find out what it was until now, thinking it was a pressure sore until Saturday morning.

The day after I posted this I went to intercept the district nurse who was visiting her that morning to make sure she told her about the 'pressure sore'. I arrived when the morning carer was there. Neither my brother nor I have been there at the same time as the carer. I noticed the carer was giving her a strip wash using the same bowl that has been used for washing up. This has been going on since September, every morning. The same flannel used over and over and left on the radiator (which isn't switched on). I only just found this out.

She injects herself in her side with insulin, and if mucky water and scruffy flannels are used then the infection and bacteria could have got into her system through an injection site.

The carer told me that she was concerned about the pressure sore and I said that is why I was there. The district nurse came and I made my aunt show her. She cleaned it, took a swab, took some photos and dressed it saying she would send the swab to the clinic and we would get results by Monday.

Saturday morning my aunt texted my brother saying the dressing had come off, the wound was weeping and it smelled horrible. The carer had already contacted the district nurse. The nurse didn't turn up, my brother cleaned it and put on a new dressing.

He went to her house today. I got a message at work (I'd planned to go to see her on the way home) to say he had called 111 and they had taken her in and he was following. Just before I finished work he messaged to say that the surgeon had said what it was and she was going into theatre that evening. I managed to get there before she did, and we waited around for the outcome. It seemed to have gone as well as possible. Still a long way to go and things can still go very wrong though.

She had a hospital check up two weeks ago and she said she had a swelling on her hip. They just looked at it and measured it. Wouldn't you think they would have raised concerns then?

We are very upset and very furious.

WWYD? The carers have been strip washing and dressing her for months. Nobody has noticed this - I cannot believe it.

I’m very sorry about your aunts operation.

The carers are there in a non medical capacity, who is doing your aunts laundry? Should they be taking the flannel to wash along with clothing and bedding?

how often does the district nurse visit ?

is the frailty team involved?

It all sounds very unjoined up. Elderly people really need good advocates. Who pays for the carers? Might it be worth contacting SS if they do?

She pays for them herself.

Caters are there in a non medical capacity, but if they notice anything like a pressure sore developing or anything health related then it should be logged in the notes, reported to the office and then the client’s point of contact. Even calling the GP or nurses.
As for laundry, if it is in the care plan notes then the cater should be doing this. The sore should’ve been reported as soon as is there was any sign of redness.

There should be a separate bowl used for strip/bed washing, and using 2 flannels. 1 light for face, neck and hands, and 1 dark for the other areas. Flannels to be rinsed and changed every other day at the most, along with fresh towels.

OP: I would make a complaint to the office of the care company that looks after your Aunt and also demand that a more competent carer is put in to care for her. They have failed her.

I hope she recovers well.

I'm a carer of 32 years, and I agree with this. Carers should be observing skin integrity at every visit, and documenting what they see in their daily notes. Anything of concern should be reported to the main office and, if any skin breakdown, reported to the District Nurse team.

Even a small skin breakdown can very quickly deteriorate, so it needs to be taken seriously.

I'm sorry this has happened, and I would definitely raise it - with the agency, and the Local Authority.

The care company sends someone different every time. They do come again but it's not one consistently.

There should be written notes of time, date things done, medication ect

I'm really sorry to hear about your aunt. In my extensive experience of working with carers, only about a quarter of them might have the cognitive ability to know how to prevent avoidable infection and deal with separate flannels. Even the ones who have undergone 'training' won't necessarily follow the guidelines and will do things to cut corners and save themselves extra tasks. Many people just can't pay attention to detail. Some are very good and switched on, but I found that most aren't. Part of the problem is that they're busy and time restricted. People in general don't take infection control that seriously either due to the availability of antibiotics. Back in the day it was something people had to work hard at avoiding hence all the disinfectation and careful cleaning in hospitals.

I hope your aunt is able to recover soon.

Have the carers asked you for specific bowls and flannels and towels?
We would have asked family to make sure there was/provide a specific bowl, light and dark flannels and light and dark towels.
Who is doing the laundry?
You need to escalate this to the care agency

Very sadly true. Pretty much anyone can get a job in the care sector, which drives standards down.

She had a hospital check up two weeks ago and she said she had a swelling on her hip. They just looked at it and measured it. Wouldn't you think they would have raised concerns then?

Definitely pursue the care company for details of record keeping etc but it does seem odd that the hospital didn't raise the issue?

It does sound very messy and I’m so sorry about your aunt.

I don’t think either the carers, the district nurse or the hospital have really managed the basics; I do also think that your aunt is clearly extremely vulnerable with multiple risks which could mean things going wrong at any time.

One of the most difficult things I found about having my mum in a care setting was the lack of proactive communication - but in my very brief experience of actually doing care work with others I would say that neither the agency, the family nor the other services ever communicated with me either, beyond some basic training videos. You basically guess what is acceptable and what isn’t. To us it’s completely obvious that the carers should have spoken up and said ‘hey I’m not sure that this is hygienic, could there be disposable wipes or at least multiple flannels? How do I put in a hot wash and is it ok to do that with just a few flannels? How should I dry them?’ But nobody around you will lift a finger to suggest you do that, believe me.

@PhoebeFluffingtonFyffe the same bowl as used for washing up?!? No wonder she has infections! Was there no other bowl?

Thank you everyone for responses. Some really useful info I've shared with my brother. I've been at hospital most of the last two days so not been on here but am in work for part of the day today. My brother is speaking with social services right now. I went to her GP's surgery yesterday to explain what happened and to ensure all the different agencies she's seeing (medical, not the care company) are talking to each other.

Those asking about the laundry - my brother did it and washed/tumbled towels and flannels separately, but he only took what was left in the laundry basket so it went on trust.

She had an operation Sunday night to remove most if not all of the dying or dead tissue or infection (she is in theatre today for a check to see if there is anything left behind) and was under complete sedation yesterday. She is wired up to so many monitors and bottles it spun my head. They had to go down as far as the bone to remove all the flesh. If she gets through this (50/50) she will require skin grafts.

I went to her house yesterday to retrieve the care folder. There is no care plan in the folder at all and absolutely no entries about anything. As our aunt couldn't see, she couldn't tell us what the carers were recording. I will be trying to find out where this information is recorded today.

I checked their website and the last report from CQC was 2018 - that is 8 years ago now. It states they were reviewed in the summer of 2023 but the report is not available. The photographs of staff on the webpage bear no resemblance to the carers who have come out. They all seem caring and friendly but how actually qualified they are is another matter.

@PhoebeFluffingtonFyffe no care plan? Presumably that's a vital concern and possibly illegal? Would be in Scotland, I think?

I'm not saying there isn't one, just that it wasn't in the folder. We don't know what she discussed with them, because it was done with a district nurse, not us. And our Aunt can't remember. I contacted the care home by email just now asking what and how visits are recorded and where my brother and I can view them.

It should be available to anyone, like you, who wants to see it, I would have thought?

I hope so. I have asked to see it.

If your aunt does survive, I would lean strongly towards a nursing home. She sounds just too vulnerable for home care to me.

There will be a care plan, but it will only be available to you if your aunt has given them permission to do that.

Basic notes and record keeping should be done for every single visit, so I would be asking the care agency to provide details of that. Again, they will only share it with you if your aunt agreed they could talk to you.

It sounds like the agency have let her down very badly. I would be making sure all your interactions with them now are in Writing so you have a clear record of everything they say.

No, if someone has capacity they have to have signed to say they agree for any documents about them to be shared.

Didn't know that. My mother didn't have capacity and we had POA and the care plan was there in her house for us to see. It was completed each day by carers.

This is what happens when family leave all the care to strangers , our home care is quite frankly awful in this country , unqualified , uncaring people wandering in and out of people's homes doing bare minimum. Never ever assume carers are doing a good job because 99% of the time they are most definitely not

@Terrribletwos you were able to see the care plan because she did not have capacity and you had POA. If the OP's aunt has capacity and/or there is no POA or agreement with the aunt, the OP would not have access.

My mother had care at home for some time and then moved to a care home, and her care was very good. At home there was a big folder with her care plan and visit notes, at the care home it was all on computer.

Hi Phoebe
We do record digitally on every visit scheduled according to the client's plan. We also allow access to family to be able to see the care notes.
Kind Regards

This is what came back this morning.