Frustrated at how people in care homes are denied basic freedoms

[Nananananana]

Work in various homes as agency staff. A lady has just asked me if I can get her up at 10am instead of 8:15.. reported this back to the permanent staff and they said, no, she has to get up now. Tell her she needs to get up now.
Why?
Or they have to be put to bed at 7am.
I understand that some have morning medication etc. But this can be given whilst they're in bed still if needed, just woken up for it/something to eat then back to sleep if they want.
I've seen this across different homes, it probably happens in many.
Feels like they're in a prison sometimes, why should they be denied basic freedoms?
They pay thousands to live here.

I don't agree "she should have been there" there's lots of legitimate reasons for her not being there and a family member doing care as a one off (e.g. hospital appointment, day trip, family wedding). But they absolutely should have let the agency know. Ideally the day before but certainly on the day.

And the carer has "no reply" policies to follow. What is the client was a risk to themselves of wandering off? Middle of winter in just her nighty. Carer had no way of knowing she was safe.

I’ve recently started visiting an elderly ex-neighbour in a care home. It does have the feel of a prison.

When she walked me to the door she looked very upset and said “oh, they don’t let us out”, had to get a member of staff to let me out and then the staff member gave her a withering look and rolled her eyes at being asked to unlock the door.

"I understand that some have morning medication etc. But this can be given whilst they're in bed still if needed, just woken up for it/something to eat then back to sleep if they want."

If ten residents request to stay in bed under those circumstances, then it becomes unworkable. Do we deny those needing assisted feeding the same rights? Under what legalisation would that be legal? It's the medication and supervision that's the issue. There's routines in hospital, were people are got up out of bed to change sheets and it's a really early start on most hospital wards. I've only ever worked in homes that started putting to bed at 8 and residents could choose to stay up until 9.
Although with the shortage of care staff I do think that we need to rethink the shifts and perhaps we could have more flexibility.

Staying at home won't save you from having constraints put on your schedule if you get to the point of needing care - unless you can afford a trio of private full time carers that is. You may wish to decide on a day to day basis when to get up and go to bed but if you need someone to come round and help then you'll need a set routine and hope someone's available. If you want to be put to bed at 11pm then good luck finding someone.

In all honesty unless you've worked in care you would not under stand the pressure we as carers are under. We have routine for a reason. If we were to allow one person to get up an hour later that would mean we would have to push other care calls earlier/later which clients/residents may not want either. I agree it would be lovely if we could allow them to choose but unfortunately we don't have the staff capacity to allow for that I've worked in homes and the community and would love nothing more than to give every person exactly what they want but we are under such strict time allocations it's impossible.

I agree, these homes are too regimented. It's bad enough getting old without having to spend the days that are left to you in a place where you effectively lose most of your independence.

People should be treated according to their needs. Those people with dementia, obviously, need close supervision, and a routine, but someone who is fully cognitive should be free to make decisions over such basic freedoms as what time to get up, go to bed and eat.

It's high time that care home staff were decently paid and trained. It should be a career that people choose, not just a job when there's nothing else. I haven't looked into it, but as far as I know, you can get a job in a care home without any training.

this\it doesn't happen where my adult child is.

Yes I’ve also seen this and it was not on the secure dementia wing either. In fact there were security coded doors all over the place.

I’ve visited a client who had moved into one when her husband did. They were not allowed to be in the same home and she had to wait until a member of staff was available to take her the hour journey between them. She didn’t see her husband for months on end.

I’m pretty hard baked but I got back into my car in tears for her on more than one occasion.

These days it is a system based on delivering basic care and supervision of individuals who need help and or supervision, at the lowest cost and squeezing the highest profit out of it.

To do that requires a level of efficiency extremes and measures that create lowered choice for those on the receiving end. (and those paid to work within it)

The same is true of council funded carers. But mine don't get paid if the caree says they won't/can't be there. They still get paid if they attend and can't get entry.

@user143677433, what made you not say to her that there was no need for the facial expressions?
I think that many people don't have experience of the level of care, the amount of medication and supervision (locked doors) that is needed for those who are in the position of needing residential care. Although I do think every care home should have secure gardens and flowers etc. We have set meal times throughout our lives, nursery, school, work etc set the time. Those who are now elderly lived to more rigorous time frames. If you know elderly people who live in their own home, many tend to like their routines.

@singingbirds the thing is, I don’t think it used to be like that. I used to visit a lot of residents in a care home when I was a teenager (30-35 years ago) and it seemed very different. Residents being asked what time would they like their tea, what time did they want help for bed etc, did they need someone to help them out to the shop etc.

I suppose it’s possible it was a much more expensive home, but I don’t believe so.

I hate to say, but I think the driver for change has been profit.

It happens in hospitals too, it’s a form of institutional abuse.

I did an agency HCA shift once when I was a student nurse, I was the only one on shift, with a single agency nurse (who had all her meds and IV’s to do), and 15 patients on the ward (it had empty beds). I had 15 patients to get up and out of bed and washed, thankfully some of them were independent, but others weren’t. But one lady there had terminal cancer, but not yet end of life, her son and husband were in her side room with her and I asked if she wanted any help to get washed. She really, really wanted a proper full bubble bath, but could no longer get herself in and out of her bath at home. I knew we had this massive fancy proper tub in the ward bathroom, which has a seat to lower people in and out of it, and I could help her have this longed-for bath. I promised her that whatever happened with the day we’d get her in that tub for a soak.

Around 1pm everyone else was up and washed, they were eating their lunch and things were quite settled. Another HCA came on shift who could keep an eye on everyone so I took this lady to the bathroom for her bath. Just after I’d got her settled in her bubbles and left her with her book, the hospital site manager came on the ward and demanded to know why we were still doing “washes” at this time of day. I tried to explain we’d been short staffed and this lady was having the last bubble bath she might ever get but the site manager didn’t care.

She didn’t discourage me, some things, including last ever bubble baths are more important than rigid time schedules and routines, and I will happily die on that hill.

Not all care homes are like this.

DFIL had dementia but was mobile and could dress himself. He used to get up at dawn and potter round the garden in good weather in the summer. And then he went to bed at 6pm. All accommodated by the staff.

I guess the problem lies with staff having to get non mobile residents up, washed and dressed within a certain timescale. There must be an issue with staffing levels.

I remember seeing on tv care home staff treating residents like family playing games cooking with them doing their hair reading to them ect. Time doesn't allow for that anymore and it's so sad. We have strict rules and procedures in place now that means we have to have a certain number of activities done in a certain amount of time. I don't agree with it at all. It's shocking but because there is such low levels of staff we can't spend the time with each individual it's such a shame

I agree @Nananananana

My 83 year old mum was diagnosed 6 years ago with alzheimers. We cared for her in her own home until it got too much.

Them we had carers. That didn't work. Mum always liked a little lie in, 10am would have been perfect, slice of toast, wash, dress and she's have been ready for her day.

But the carers schedule didn't allow for that, they'd be there at 8.45, made her toast or porridge and let it sit on table whilst they washed and dressed her then her breakfast was cold. And all the time mum would be saying let me sleep etc.. she was so distressed.

But also thanks to carers we realised she'd let herself out of the house as they rang to see if she was with family. SW had a meeting and we agreed to a card home. Mum had no capacity to decide and it was the hardest thing we ever did in our lives.

In her first care home she loved getting out a drive with us in the car, we'd take her to our houses for tea or out for a picnic etc. Since cocid she has fallen and is in a nursing home and it's so different. She wouldn't be able to go out now, she's wheelchair dependent and on a walking frame.

They put her to bed at 8pm and she's up at 8am now.

Totally agree, but also see it from the other side as a former worker there. Staffing levels are always low and if you are trying to get 30 frail residents dressed and breakfasted and medications given in a reasonable time, without it running into lunchtime, getting up needs to be all done at once. There are also rooms to tidy and beds to make, toileting and multiple other work to do like talking to and interacting with residents,

I have seen your suggestion done in a residential home, where the people involved were far more self caring and could dress with minimal care and and had simple breakfasts.

I totally disagreed with getting elderly people up early (6 am) and left to sleep in chairs, and put my foot down and stopped this practice.

I disagree.

My mil was a danger to herself and others and DoL was essential. My dad is just a danger to himself. It isn't possible for either to have the freedom that they may desire.

I was about 5 meters away, it was my first time visiting so I didn’t know if it might be a ironic/teasing/joking dynamic between them, and I didn’t want to jump in “to the rescue” of someone who may have wanted to address it herself. That would have been putting her in the role of victim. However, if I were to encounter it a second time I certainly would say something.

Not all places are like this. I work for a nationwide care provider (residentials, supported living and domicile art care) and we work in a very person centred way. The clients needs come first. Yes sometimes it’s hard to marry that up with the availability of staff but mostly we manage it.
I am so tired of all care providers being tarred with the same brush. For our staff we pay travel time, we pay over and above expenses.
For our clients we go over and above and don’t implement DoLs or MCA lightly.
We are a not for profit organisation. And we care. We genuinely care about our clients and we do what is best for them.
Saying that - it can be frustrating when a carer has taken 2 buses or walked 3 miles to a client only to find out the client has gone out for the day. It’s not a problem - it is great people are getting out and about again but please just let us know because we could have redirected that carer elsewhere.

*domiciliary

💐

She didn’t discourage me, some things, including last ever bubble baths are more important than rigid time schedules and routines, and I will happily die on that hill.

@ZealAndArdour That made me cry. That was a lovely and hugely important thing that you did 💖

My grandmother is in a care home that has a varied approach to schedules. Her area is aimed at low-needs residents. At most, someone might need help getting up and getting to breakfast due to mobility issues. There aren't many who do and if they call and have to wait 10 minutes for someone to be free, they don't complain. They have a buffet breakfast in the morning that's available from 7-10, lunch and dinner are served in a 2 hour time slot. Everyone gets up when they want to, joins in with activities if they want, can go for a walk around or a day out. It's a bit like a budget hotel though costs thousands per year.

The high needs area upstairs is much more rigid. They have a lot of people with advanced dementia or complex medical issues so care is planned in advance to a rigid schedule. If they didn't, they could easily miss a resident. One of the biggest risks is pressure sores, if a resident is left for an hour longer because a few others have gone off schedule the consequences could be awful. The worst pressure sores can go down to the bone and prevention is easier than treating after they've started.

She did the right thing didn’t she? If your mum needs a carer and she’s not there then surely the carer would rightly be concerned?

@Snuffy28 you can start with no experience but are trained while doing the job. You've got the chance to do NVQs and various certificates. There's senior care staff and people who carry the shift. As well as the Nurse in charge. As a new starter you'd be put on 2-1 residents with experienced staff. A lot of student nurses work in care homes while studying.

Some Care homes are 65 beds, many of the residents will need help to eat etc, there will be a few stroke etc patients who decide to stay in their rooms. How could you run the kitchen to feed on personal demand? bearing in mind that the CQC want to see menus and fluid charts and all nutrition has to be adequate (which is often a job in itself) and documented. Residents aren't just put to bed and left. There's pad changes, fluids and turnings/OBs to be done on some. As well as emotional support. The night staff also clean the lounge etc. It's great that there is flexibility for lower care needs residents, but we need more care homes so we can place people appropriately. Routine is needed for those who have higher care needs.