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.

Directly contact Adult Social Care. Say that you have reported it via the agency but you thought they might find it helpful to have the person who saw things so you can give more detail and answer any questions.

Not only will this hopefully help but it will also flag to ASC if the agency aren't reporting as they should. Sadly as agencies get paid by client it's not unknown for them to pass on details that could lose them business (as she would go in a home). Chances are that your agency is fine but just on case....

I can’t stress enough how much older people’s behaviour and cognitive function can be affected by UTIs. She may have been on antibiotics, but if she’s not able to get herself a drink, it’s possible that she has developed another one. It essential that she gets enough to drink to ward off repeated infections.

My mum worked for someone similar. She tried everything to get her help. She spoke to the neighbours who spoke to her family. She contacted the GP who said they would call her (she couldn't answer the phone) they wouldn't come out or do anything. She ended up dead as she slipped and banged her head. Unfortunately people often don't want their relatives to go into care because they then won't get their inheritance so they visit as little as possible and bury their head in the sand.

I agree with some of the other posters that this is a case you could raise with the safeguarding team if no one takes action soon. It could be that the agency haven't contacted social services or it could be that social services are so overwhelmed with cases she isn't top priority. I would highlight how she is at risk from self neglect and be very specific with what she can't do for herself, and definitely highlight that she can't call for help.

Thanks for all the replies.
She has had dangerous incidents in her house in recent months, which have all been reported

She is always provided with a drink at each of the 4 visits, I suspect she's able to pour herself something but I know she's unable to use any form of kitchen appliances anymore no coffee etc

I will definitely raise it with adult social care, would I be likely to get in trouble with my agency if I reported it myself and not through them ?

Also had another family say they won't be putting their elderly father into a care home as they don't want to pay for it with his money...

You can still ring social services, if a referral has been made, no harm done.

Have you had dementia training? Never argue, deflect, distract.
Report to social services directly. Log everything in your daily notes. Log that youve spoken to X in the office regarding concerns.

With regards to the list the niece leaves for you, make sure you have done everything you need to do to keep your client safe, but you are not a housekeeper.

@Maddymorphosis

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

I lived next door to an old man - his daughter (who lived hundreds of miles away) contacted me and asked me to go every evening with a home cooked meal for a small payment. All she said was that he had "a bad memory". In fact, he clearly had severe dementia: He was alone in the house, didn't know where he was or who he was, sometimes thought he was in hospital or a hotel. He used to cry for his wife who had been dead for a decade. it was soul destroying.

I tried to get across to his daughter that he was very unhappy, afraid and in danger on his own (leaving electric rings on, ringing the police all the time because he thought he had burgled someone's house etc)

Honestly, I now think people with dementia are better off in a care home than being in their own house alone. Many people can share the load of taking care of them and they are not left alone for hours.

I reached a point where I said "no more" to caring for this man as I was enabling his daughter's fantasy of her Dad being ''happy in his own home''. It was nonsense. He had no idea where he was from moment to moment. I think the daughter just didn't want to pay the care home fees!

As for your situation, no, I most certainly would not deal with that unpleasantness and aggression, no matter the cause. I would refuse to have her as a client.

Yes you will get in trouble with your agency. Quite rightly so as well unless you doing a whistleblow about neglect by agency or family?

This isn't whistleblowing of a neglect, this is a lady who needs to see OPMH and it is for her family - or for agency managers - depending on capacity and consent to report to GP and to persuade GP to refer her to OPMH. Those latter referrals / assessments take time and GPS balance it with consent and rights. So please feedback incidences as that is evidence that helps build up fuller picture so that MDT professionals can understand what is happening for this last.

Unless adults health and care are funding, they aren't involved. If they are funding, agency MANAGERS should have already referred for urgent early review (reassessment) in which case Social worker will ask GP refers to OMPH

I ask you - Do you have little trust in your care agency managers that you think they don't know what they are doing?

Rather than talk to people on internet - please make an appointment and go chat to your agency senior or managers and ask about the plan they are following.

@Maddymorphosis
My reply below was in response to your question "I will definitely raise it with adult social care, would I be likely to get in trouble with my agency if I reported it myself and not through them ?"

This has got to be done thorough your agency managers not random carers ringing direct unless you have no confidence in your agency the you are effectively whistleblowing . You won't have full picture at all nor know what consents are in place or what already has been done, which is why there are processes in place.

The comments you say family members made, did you report those to your managers? . Make sure you have reported everything

She used to be a pleasant and friendly lady but is now rude on every visit to me. Have you had much training around dementia? As this is very common especially with vascular dementia.

Are the company a good company to work for? Do you feel confident they will act on your reports?

You need to detail what harm she is at risk of (if she is). Her being rude isn't a safeguarding concern. Her not complying with care and not receiving adequate personal care, for example, is.

It is really hard to get GPs, social workers and CPNs to come out to see service users. We had a lady in a previous care home who was choking despite being on textured diet and fluids and nobody would help us. We sadly had to give notice to the local authority in the end. We were a residential care home so no nurses. She was assessed for nursing but we were told she didn't meet the criteria (in other words, they didn't want to pay). When we served notice she got transferred to, you guessed it, a nursing home! The social care system has been so neglected for so long that so many people are suffering.