Elderly care issue?

[ThatsNotMyCherry]

Hi
My gran lives in assisted care home and my mum does a lot of stuff for her (laundry, cooking etc) while I help out with admin.
My gran has recently fallen a few times but luckily had no serious injuries. She goes to the bathroom twice at night. Every time she calls the night carer they take 1-1.5 hours to come. By this point she’s really struggling so often just gets up herself with great difficulty and then the falls happen. She has told us if she calls the carer a second time at night she’s always in a very bad mood with her so sometimes she doesn’t bother. We have begged her to wear incontinence pants but she refuses and insists on using the toilet. We have asked if she wants to us to mention the delays and attitude of the carer to management and she says no because she’s worried the carer will be more difficult. She doesn’t use up all the time that she pays for but clearly has a need for help in the early hours of the morning. We have approached the carer politely about it and she said she has other people to attend to so it takes her an hour or more.
We can’t see any way around this. Do we just let this carry on and hope that she doesn’t have a fall where she’s seriously injured?

Can she get a commode next to her bed?

Sorry you are going through this. I'm a bit confused about what an assisted care home is? Are you in the UK? Surely a care home has multiple carers all night to assist residents when needed? Also, doesn't the care home provide her with food, laundry etc? Are you referring to sheltered accommodation where your nan has her own apartment and only a single, overnight carer for multiple apartments?

Would a commode in her actual bedroom help prevent her having to walk to the bathroom during the night in the dark? I assume she has been checked for a UTI or other illness causing her a need to get up twice at night and fall? Could she stop fluids earlier in the evening, so less likely to need the loo during the night?

If her care needs have increased, then she needs a re-assessment and a facility with higher levels of care might be needed. I wouldnt be happy with the attitude of the 'carer' either!

One other point I'd make is that when you call a carer in a home (of whatever sort) they do take ages to come, but "ages" is about 10 minutes. It obviously seems way longer when you are desperate to go to the loo. Is she really waiting as long as she perceives it to be, is there any way of timing the waits to see if they really are that long, so it can be taken up with the care home management?

We had exactly this issue with my mum (she had bowel cancer and lived alone). We got a commode by her bed but then she would get herself on the commode and couldn’t get herself off again so would spend hours sitting there at night stuck between the bed and commode or stuck on it. It was awful. I lived a way away and have a disabled child and couldn’t just drop everything to get there.

It sounds like the level of care is not enough. I think you are going to have to go above her wishes and speak to someone, it’s not safe otherwise. It may be that she needs extra carers to pop in more regularly or a nursing home instead of assisted living- my mum ended up being admitted to a high needs nursing home after an assessment through nhs continuing healthcare.

Thanks all. She has a commode and again we have asked her to use that but she will still go to the toilet. Her stubbornness is an issue but we just haven’t been able to ever change that her whole life. Her major difficulty is with getting out of the bed, once she’s managed that she feels ok so she walks to the toilet although obviously that walk adds to the risk of falls. There are two night carers in the building (only one is female and she isn’t comfortable with the man being in the toilet with her). I think delays of 10-20 mins which is what happens during the daytime would be manageable but over an hour gets too much. My mum has put a camera in her lounge to monitor her during the day and a couple of times when she’s been up at the time she knows my gran wakes up she’s heard when she’s called for the carer and when the carer has arrived and it has been over an hour. We aren’t sure she would qualify for full nursing care either :(

Complain to the management. Six other patients or not, it should NEVER take an hour to respond to a call. That is so far from acceptable, your poor gran!

Might it be worth looking into those beds that you can use a button to raise the head? it might make it easier for her to get out. My dad struggled to get out of bed as well in the last few months of his life and these beds did the trick something beautiful.

Is she is a residential home? Or an a flat which has carers in the building? Like extra care housing? In my area the staff at extra care housing are only on call for emergencies during the night. If a resident calls constantly for assistance in the night, it is usually suggested they will usually be told their needs can no longer be managed in that setting. Does she have any cognitive difficulties??

Ooops excuse my double sentence

She has the hospital bed. Her parkinsons causes her mobility issues. She’s often very stiff so even with the special bed it’s difficult for her to get up :(

It’s a self contained flat with carers in the building. I don’t think calling for assistance to be taken to the toilet during the night is seen is out of scope of the services they provide as no one has ever said anything. My mum did say to the manager a few months back when her falls started that as previously discussed my gran is paying for more care then she uses but now she will probably need a bit more assistance especially at night when she needs the toilet and he said that’s fine.

I suppose we could try to get her a place in a nursing home but I think we will have a fight on our hands to get that as it was difficult enough to get her into this place .

She’s doesn’t have any cognitive issues really. Seems to sometimes hallucinate at night that there’s something on her ceiling but other then that she’s ok mentally.

Would she tolerate a Kylie sheet on her bed, are you having to change her sheets every day or are you more worried about falls?

Are the night staff sleeping staff or awake?

Not really had to change many sheets yet, it’s more about the falls.

It sounds like she's in a supported / assisted living flat rather than a care home (separate living room, you guys cooking and washing for her) and that her care needs now exceed that of the facility. I am surprised that the management haven't had a discussion with you about it.
If she needs regular nighttime assistance to go to the toilet then her needs have tipped towards proper residential care where they have more carers on hand.
The problem can be that this is a difficult step for many in terms of cost (more carers = more costs) and more often pride - it's hard to accept that you are getting older and loosing independence so to agree to these changes (even if suggestions are well intentioned ) can feel like a defeat.
This isn't the same as nursing care which is a level higher in input and even more expensive.
We had to recently move GGranny and she was not happy but her needs meant there was no choice. She still has a lovely room, luckily in another wing of the same building, but she still hates it, but I think that's a lot to do with hating being old and the limitations that brings rather than the actual accommodations and care.

They are awake staff. My gran thinks because of her attitude that the carer takes her time on purpose. Don’t know how much truth there is in that though.

If it was difficult to get a place then you need to start looking at the next step now because unfortunately the places come up infrequently (existing residents go to nursing care or die) so that you are not in the impossible position where she has no choice but to move but then there are no places.

Yes there is also the issue of moving. She only moved in here 18 months ago from sheltered housing and she found the move very stressful. She said to my mum the other day that she can’t go through another move but maybe we need to look into it.

@wonkylegs is residential care where you have your own room but no living room, kitchen and potentially shared bathroom?

I think you need to go and have a talk with the manager about what is considered appropriate level of assistance as this is a bit unclear. Waiting over an hour after an assistance call is not safe, what if it was something serious? At the same time if the carer is not really employed to help people to the toilet several times a night then this care facility may not be right for your Grandma.

Ah yes, my dad had Parkinsons too. I'm sorry, it's fucking brutal to watch. He was in a care home with care workers like your gran had for a while and the last fall he had there broke his hip. The anaesthesia they had to put him under with in order to replace the hip advanced his Parkinsons dementia a terrifying amount all in one fell swoop.

Don't let this slide. if your gran falls badly enough to need that kind of treatment she could get so much worse very quickly! It's not okay. Complain complain.

My dad's final residential care home was wonderful. He had his own room and a wet room bathroom which was huge. He could also spend his days in the communal living room (we took his favourite chair in for him to have) and he just ate cake the whole time :) I'd advise a move, I know your gran was stressed last time but stress is better than a broken hip. Honestly I am horrified that this care worker is letting her lie there for over an hour at night each time!

@Damntheman yes that’s precisely the worry. A broken hip will just make things so difficult.

We did look at a care home near us at the time that she was moving from sheltered accommodation because she needed more care but it was really horrible and depressing. Hopefully there’s something else better that’s close to us.

She needs to see her GP for a Falls Assessment for starters.

Then it sounds like she needs a reassessment of her care needs and a care home rather than assisted living. My understanding is that assisted living facilities are for largely independent people who need someone to hand in case of emergency, as well as help with mobilising outside the home, medication management, socialising and meals.

If your gran is needing assistance to the toilet twice a night every night that probably comes under the remit of care rather than assistance.

It doesn’t excuse them taking so long to come though, your poor gran.

I think that it is appalling that the care workers can take over an hour to get to your gran's room. Yes she needs the toilet, but they don't know this, what if she is really ill and calling because she needs help?

To be honest I don't blame your gran for not wanting to use Kylie pants or a commode. This will probably be her last bit of dignity and Independence. I would hate to be told to wee in my pants!

Put in a complaint to the manager as this is unacceptable.

Is she council funded or is she funding herself? As pp said, if you know the carer usually takes an hour to get to her talk to management about whether this is considered an acceptable wait by the service. Whether it is or not it’s a safeguarding issue - she is at risk of harm as things are. But if she refuses to wear a just-in-case pad and she has full capacity then there comes a point where there is little anyone can do.

Council funded. I’m guessing that due to funding cuts we will probably have a fight on our hands to get her moved if that’s the route we decide to take