Reporting a fall in a Care Home - AIBU?

[cowatthegate]

Short background is DM (54) is about 6-8 weeks away from death (Brain Tumour ) and lives in a Care Home.
She had a stay in hospital 2 weeks ago where she had a fall (previously very mobile and no issues) , which they informed me about straightaway by phone although it was in the night.
I rang her this morn and she said she had a fall yesterday eve at the Home (she is back there now) and pressed her alarm pendant and they came and helped her up , back to bed etc and now she is in a lot of pain and can't really move.
AIBU to think they should've called to inform me as her daughter ? She is struggling a lot with memory and sounded distressed at what had happened.

Although in this case it would be fairly straightforward to decipher if someone understands the question

"Do you want us to call your daughter and let her know you feel?"
"No I dont want her panicing and dropping everything, tell her next time she comes in" = pretty straight forward, dont call!

I have loads of experience of hospitals and nursing homes.
40 years worth.

Capacity is assumed unless there's evidence to the contrary.

Mental capacity assessments are decision-specific. They take me on average 2-2.5 hours to complete and document. They don't get done for every decision. Given that capacity is assumed, it's also unlikely a care setting would call a relative of a capacitated adult in the evening to report a fall that at the time seemed to result in no injury. They'd just tell them next time they visited. If there was injury requiring immediate medical attention I'd expect family to be notified.

Pancakemolly speaketh sense.

Or Pancakeinmabelly. I'm not sure where I got Molly from!

I am first port of call (and only number listed actually anyway). I have POA for everything and am next of kin. She is pretty unsettled by the fall , I can tell in her voice and I'm being hassled at every opportunity by her parents to visit and cheer her up (when I have 2 tiny kids to look after so not on unlimited free time!!).

She is lucid at times but utterly confused at other times. It's quite distressing. I feel exhausted by it all. They are now checking every 30 mins on her.

She is definitely keen to not cause any trouble to anyone so will just agree to everything , and say she is fine when she blatantly isn't but the staff nurse in charge assured me that "he has lots of degrees and knows when someone means no when they say yes".

People are allowed to decide to not have a fuss made of them even if theyre not "fine"

Thats the thing.

Even if shes not fine shes allowed to say she is if she doesnt want fuss and relatives rushing in etc.

If they assess her as being at risk of say a hip fracture then its not in her best interests to leave her be.

But if she's checked over and found to be physically fine, it IS her choice to say "no Im fine I done want everyone calling and coming in" even if shes feeling shaken or bruised.

Shes not the only one who doesnt like the cavalry rushing in when shaken. Im like that. Prefer to gather myself then tell people after when the dust has settled.

People without capacity to make other decisions still have the right to say "Im fine dont fuss, Ill tell them later" too, so long as they understand the immediate question.

But again Pancake - there is an extremely fine line between understanding the question and appearing to, responding appropriately, but actually needing the exact opposite answer to happen in order to be safe.

Sadly, I also have experience of so called ‘carers’ deliberately asking leading questions, or questions they knew my relative would always respond to in a certain way for fear of being a problem. They effectively covered their own backs over many incidents by saying ‘he said X’ when he didn’t actually have a clue what X meant in reality. It is irresponsible to expect someone who is significantly brain damaged (as this is what a brain tumour does, damages the brain) to be fully aware of what they are saying and the significance of this.

Cowatthegate - have you had any support from The Brain Tumour Charity? They are very good. Also, Macmillan can help whether the tumour is malignant or benign.

No nobody except Maggie's Wallace who I have accessed myself and the local hospice.
@Sprinklestar it's malignant.

I've asked her if she wants me to go in and see her this eve but she said she is very tired now and thinks getting more sleep will stop her having falls. I have only just managed to get the staff to assist her with washing etc. Previously she was dressing and washing alone in a locked bathroom.

But again Pancake - there is an extremely fine line between understanding the question and appearing to, responding appropriately, but actually needing the exact opposite answer to happen in order to be safe.

Thats not the point, people are allowed to make "bad" choices or choices you wouldnt make yourself.

"Because I dont want a fuss" is valid. Its valid even if theyre not "fine". Even if you think they need you there, theyre allowed to say no, theyre fine, they dont want any fuss.

Its the opposite of "covering your own ass" to do this, as this thread demonstrates if youre asked not to call you know you will have to deal with an angry relative later down the line.
More often than not the patient is very clear that they dont want their relatives to worry, they always fuss and they just want to rest for now. But then tell the relatives that they didnt want to bother US to save their feelings. Thats fine we dont "tell" on them and take the hit, its not about us after all.

But to say we do it to make life easier for us really couldnt be further from the truth. Would be FAR easier to just write them off as "not knowing what theyre talking about" and placate their relatives instead. But trust me you DONT want your relative in a place like that!

(whether we call the relatives or the patient tells them themselves when/if they want to isnt actually a safety issue anyway.)

Look, from the staffs point of view it is so much easier when the patient agrees to the call. Usual response "oh no, okay thank you for letting me know" (shortened version)

Than it is to give the individual what little dignity and control they can have over the situation and wait to bear the brunt if theres a fall out from the relative.

The ass-covering option here is the former.

cowatthegate - it sounds to me as though your DM’s needs have changed since she went into the home. Can I ask - is it a nursing home or a care home? Does she require any nursing care? Is she in an old people’s home?

FWIW my DF was in an old people’s home as locally, there was nothing else available. He was only just over 60. In all honesty, the staff were ill equipped to deal with his needs. There was also little appreciation of just how rapidly his brain was becoming less and less able. By way of example, quite suddenly, he stopped being able to control one arm. I arrived at the home to find the fingers of one hand badly bruised, nails ripped off - an absolute mess. The arm he couldn’t control had been left to dangle and his hand had got caught in the wheelchair spokes as he was taken to dinner. He wasn’t able to tell the carer pushing him he was in pain, though one look at his face would have revealed this, and she didn’t notice until it was too late.

When asked re a dressing/cleaning his wounds etc, he just said he was ok, demonstrating quite clearly that he had no awareness of the severity of the injuries. Luckily I was able to ensure he was treated properly and also that a sling was used for this arm going forward.

I would say that it’s imperative someone within the home management team knows to expect rapid changes in cognitive ability, mobility and so on. Just because your DM is able to do something today, doesn’t mean she will be able to do so tomorrow.

Please feel free to PM me cow if I can help you any more.

@Sprinklestar she's in a Care home which specialises in dementia (99%) and palliative (just her!). I don't feel confident about the care given to her but have no other options.

That’s so hard cow. I think many people find themselves in the same position. Is there the option of transfer to a hospice closer to the end? We were told this was the case and then that it wasn’t a wise idea to move DF. I felt that the local hospice was a lot more caring, to be honest.

Know that you are doing your best in truly exceptional circumstances. No one can really understand what it’s like until they’ve been there.

They will consider it but obviously spaces are at a premium in the hospice.