How to deal with this lady with possible dementia/Alzheimer's

[Maddymorphosis]

It's a lady I support as a community carer, she's 89 and widowed. There is myself and a few others that go a few times a day.

She lives in a house alone, her daughter lives the other side of the country but visits every few months. She has her niece who lives relatively close by and who has been a tremendous help.

I've noticed a massive decline in her in the last few months, and I no longer believe she is safe to live alone, even with support.

She doesn't even know how to do things like make a drink anymore, cannot use any kitchen equipment, she's lost so much cognitive ability. She says things that make zero sense and seems to be imagining things.

What I'm struggling with too is her aggression which has come on, I know it isn't personal and she's likely frustrated at the fact she is ill and getting worse. However every time I go to her visit she's rude to me, shouts at me, complains and nothing is good enough.

She also thinks an ambulance should be called out immediately for any issue whatsoever, when we explain that they are only for emergencies she blames us for it and says it's our fault.

Today I had had enough and told her I wouldn't tolerate being spoken to like that, that I was trying my best and carrying out my job, and that any issues should be reported to my agency if she's unhappy.

I've reported it to my agency so many times, she is unable to use a telephone anymore so I know she won't be able to contact them without help.

Her niece and daughter have done what they can, I and others have spelled out to the so many times that she has massively declined and appears to be suffering with Alzheimer's/dementia. I report things almost daily but nothing seems to be happening.

I and others are dreading the call. I feel upset for her as she seems to be aware she's unwell and is declining. I don't feel like we can continue to offer the support she needs but I know it's not for me to decide, just struggling and would appreciate any advice.

It's possible that family/ your company have already been in touch with social services. Legally her capacity to make decisions must be properly assessed before any significant change, just because you aren't seeing action right now doesn't mean nothing is happening. As she is entitled to her privacy you would not be told these details.
All you can reasonably do is report what you see and experience to your company and the family and raise your own concerns as you have been.
There's also nothing wrong with firmly drawing boundaries regarding behaviour but if she really does have dementia it's possible they won't stick in her memory.

P.S. When I was a LA social worker one of my mottoes was "the devil is in the detail" so if you can record as much as possible this really helps with risk assessment and care planning.

You can raise a Safeguarding concern direct with the LA but it's usually better done through the agency who'll have more info to present.
The law about mental capacity still applies in this case of course.

That sounds awful op, I don’t know what to say but didn’t want to not respond. Frightening, for her and for you/anyone caring for her.

Also concerning in general terms of how it illustrates how easily any of us could end up in a really vulnerable situation.

Thanks for the replies. She used to be a pleasant and friendly lady but is now rude on every visit to me.
The niece is very helpful but also has high expectations, the list of things we are expected to do on each visit is growing and there is not enough time allocated.
I have reported to the agency so many times now so hopefully something is happening behind the scenes and it is being looked into.

Is she being regularly assessed for uti?

But yes, just record and report every time. Agree you're not likely to be told about other assessments/plans.

Each time I go I am berated for not staying long enough and for not coming at an exact time, I stay for the duration of the visit, I am unable to stay longer as we have to get to other visits.
Each time I am told that I don't care and I'm dashing in and out, etc.
No matter how many times I've tried to explain and reason it isn't retained so I have stopped

She has been on antibiotics for one yes, but it seems to be much more than that now sadly, I will keep the reporting up and hope something eventually comes of it.

I think sometimes families are determined for their loved one to remain in their own home at whatever cost and I can fully understand that

What does your safeguarding training/policy say you should do?

You should be following procedure.

It's very, very hard. In the end I would tell my relative that I had to collect the kids from school as this was a reason to leave that she would always be happy with, but I was family so had more leeway.

The policy is to report concerns which I am doing

It must indeed be stressful and upsetting. But her concept of time could have been seriously affected and as you say it's not being retained. All you can do is maybe redirect her attention. There's no point arguing as you've discovered.

Your agency needs to be crystal clear with the niece how long things take, it's easy to assume if one's not there. If the niece is trying to put pressure on you directly she needs to be politely directed to the agency.
I don't underestimate your stress, families especially if paying privately may be looking at the bills and not the tasks. But it's the agency's job to explain, shouldn't be yours.

Yes I agree it should be their job. Every time I report anything verbally I'm told 'leave it with me and I'll look into it', and that's it.
Redirecting her attention could be a good idea

Even if she isn't diagnosed you might find some useful guidance via the Alzheimer's association?

Hi OP. I work for the ambulance service and just wanted to say you sound like you do care about this patient which means a lot and I understand your frustration. If you do end up calling for an ambulance or 111 at any time, they can also raise a safeguarding issue. 111 may be a good shout anyway as they can deal with queries like this, and maybe a kick up the bum from an outside organisation would encourage your agency to deal with it promptly.

Sorry to keep posting on but another thing to remember is that people can be supported in their own homes by making changes to the environment short of moving into care. It's not necessarily a matter of either/ or. Plus a move in itself can be very distressing and can in fact increase risk in some respects. I've seen it happen.

Adult social services, she will require an assessment.

This isn't safeguarding (it's frustrating when people randomly shout SG for everything which..) is an increase in care needs or health deterioration

OP is doing the correct thing by reporting deterioration and changes in her memory and behaviour
Care logs should show time you arrive and leave anyway
Your agency policy should be to record incidents when caters are verbally or physically abused- it sounds related to progression of her dementia

If she is privately funded your agency should be discussing with family about their contacting GP to request memory assessment / medical screen
The GP can then refer to local older persons mental health team for support including her behaviours

If she is local authority funded, your agency managers should be contacting adults health and care to request review and they will likely pursue the above with family

Referral to memory clinic for a diagnosis. Find out who her GP is and badger them. It's really hard getting a diagnosis currently.

In my experience with dementia you only get the attention of the statutory agencies when there is a safeguarding issue. If she is safe then possibly she can continue to stay at home with support. How many visits does she get each day?

Document each time she raises a concern for you- to be honest being a bit rude whilst unpleasant isn’t affecting her safety. Leaving the gas on, wandering out at night or giving her bank details is. She needs an assessment of needs by SS to determine a plan of care which will inevitably take some time and also her needs will rapidly change (typically).

It’s nice to know you care so much.

If she is thus bad she should be assesssed to move into a nursing home that deals with dementia-my MIL behaved exactly the same way and we had multiple carers plus ourselves and SIL go in.She set fire to the microwave-we had to hide car keys etc- turn gas off- whilst waiting to find somewhere for her to live.
Keep on reporting and say you feel she is unsafe-tbh the family should be doing more to find appropriate accommodation for her now.All you can do is repeat and say you are deeply concerned for her welfare.

Is it possible that she owns her own home and the relatives are trying to keep her there as long as possible.I know it sounds mercenary but it's quite common.
I deal with many people like this although not as a carer, it's more in a monitoring vulnerable adults role.
All you can do is keep reporting to the agency, perhaps they'll have to withdraw their services if she continues to deteriorate in order to force the hand of social services.
The relatives often won't pay any attention to it until they're forced to.

@invisiblereally
Self neglect is a safeguarding matter though. We can't know without being there whether it's at that stage. The LA make that decision, not people on the internet.
Agree that other paths on the face of it are a better bet.

You can make a Safeguarding referral to Social Services yourself. You could ask your agency what they have done/if they’ve made a referral, and tell them that if they haven’t then you will make one yourself. Just google Safeguarding for her area and a number will come up.

Good advice above - give specific occasions where she has shown you that she is at risk of harm. Unsafe in the kitchen (risk of fire/burns/knives etc), imagining things (give an example of one that might result in her doing something dodgy).

As above, unfortunately her being unreasonable/rude etc aren’t putting her or you at harm.

It sounds like your agency is the problem here, they should be flagging her deterioration back to social services if funded by them and the family if not, as it sadly sounds like her condition has deteriorated and care needs have changed. Keep reporting, ensure it is noted on her care records and in the meantime, carry on trying to avoid explaining and reasoning with her. It won't be understood or retained by the sound of it and may upset and confuse her more. Redirecting her attention is a good idea.

Has she had a recent assessment of her cognitive function by a CPN/psychogeriatrician? Also, have you had any training in caring for people living with dementia, because (and I mean this really gently) you seem to be taking this more personally than is usual for people working in these situations. Ultimately, this is not your responsibility, although I accept it may feel as though it is.