Many care homes are very depressing environments

[Meandsusiehadsomuchfun]

I know not all homes are like this but many are. What is also alarming in the home I've been in is that many residents in the advanced stages of dementia are only in their early/mid 70s, which is no age at all really.

There are obviously funding issues which means most carers are not well paid at all, and staff numbers are low. It can cause people to be overworked, stressed and to start resenting the job.
A lot of residents with dementia no longer have any autonomy over their lives, and it's sad to see. I understand some of it is necessary as otherwise they can forget to eat and drink, forget to wash themselves.

But I see homes telling night staff to start getting people up at 5am so there are enough residents up for the day staff, a lot of care staff neglecting oral hygiene and residents being put in someone else's clothes because their own have gone missing.

Put into a chair and left there all day apart from toileting, told to sit down, wait a minute, stop shouting. Put into bed at 7pm and again the next day. I haven't seen any entertainments in some of the homes despite management claiming there are always things going on.
I know some homes are really nice and allow residents a lot more choice, and of course with dementia it's difficult as you do need to encourage residents to do certain things.

It's just sad to know these people are in the end stages of their life and would probably be horrified if they could see themselves now. It doesn't feel dignified for them. Care work will likely always be underpaid and under funded though and I don't see things changing.

Some elderly people go to bed early, my DF used to be in bed by 8pm. Plus sitting on a bum all day is not good, so getting in bed and off it is good.
Again, my DF spent most of the day watching TV at home, he didn’t want to be busy, and it got to the point where he didn’t want to go out either. It’s easy to criticise homes, but think about what the person would be doing if they were at home. And care has always been a low wage job, that’s not new.

Yes, and they can’t recruit staff so they are always running at minimum staffing levels. It’s a skilled job which needs effective and creative leadership. It’s depressing and I despair of ever ending up in one. Unless you have a lot of money and can afford to pay thousands of pounds a week for a half decent one.

I see where you are coming from as we are currently dealing with a family member in this situation. The level of care required at end of life for this person with the conditions has is extraordinarily high. The staying in chairs for her and to be fair it is not all the time but it is for the vast majority of the day is to counter extremely high falls risks but also a very short walk means she is extremely exhausted. The home she is in does have entertainment though so on that regard it is better than most and the staff levels are the highest we have seen but the issues you raise still exist because often older people in care require an extraordinarily high level of care.

There is a definite correlation between your observations and a tendency to treat people with extremely poor quality of life in acute settings which is contentious and my family member have chosen extraordinary measures to support this (refusal of DNR for example) for her but the quality of life she has left is so poor and it simply would not be possible for family members to meet her care needs which happened up until she went into the care home. I don’t think this drive to have people live longer lives is always a good thing because there are no easy answers to the issues you raise.

Care work will likely always be underpaid and under funded though and I don't see things changing

To many people don't want to pay for decent care.

Years ago I was a social worker and we used to be pleased if we got someone a place in one of our local authority care homes which were often better than the private ones, unless a very expensive private one. There were often staff and managers there who had been doing it all their lives and knew what they were doing. The pay and conditions were probably comparatively better than they are now. All gone now because local authorities can’t afford to run them any more.

I did bank shifts in a few care homes when I was training to be a nurse. They are all as you describe. I'm yet to find one I would be happy for a relative of mine to live in.

Difficult though. My DB's last home was bare of furniture as some of the men, and it was mostly men would throw stuff about sometimes. So not a cosy place. Also windows restricted how much they would open as some tried to escape. A garden they could go into any time they chose but they never chose to.
They did organise get togethers in the big lounge for cake and coffee (or was it bingo) but I wasn't there on that day. Some of the carers were very kind and some residents would be very attached (sometimes literally) to them.

Unless you had enough fit staff to walk the residents about regularly eg 4 times a day which is unlikely, the residents become unfit so walking about is risky for them.

Not sure there is an answer. Though I would have liked to have seen everyone taken out in the garden every day it was fine for half an hour. But that is alot of work for the staff.

I agree they are depressing places but I'm not sure what would change that. By its very nature being very old and very ill is depressing. Many dementia patients have no sense of time or ability to decide on anything. it makes no difference to them what time they get up or go to bed and the staff intensity needed to do these things means it does need to be spread out. Helping residents have autonomy and make choices properly needs far higher staffing ratios than can be afforded.

A skilled activities coordinator can do alot to cheer up a place but these are incredibly hard to recruit. My mum's care home has been trying for a while and not managed. Staff are doing their best but there is still less activities.

I worked as a domestic in a care home and they are depressing places. It definitely felt like people were trying their best but there was about 6 -10 residents per carer so they were busy. Some It takes ages to get people washed and dressed every morning they’d also strip / remake the bed if there were continence issues. Starting at five they could all be ready for eight.

We were always very careful with clothes so people weren’t in random clothes. Some of the smaller items ( bras, black socks, those tight type socks) were hard as couldn’t label well.

We had a physio work with everyone who could once a week and they had exercise plans, there was about wellness lady who’d bring in a therapy dog and have a chat with the residents one on one and regular entertainment.

More than half the residents were non verbal and immobile though and that’s a depressing situation to be in. It sort of permeates the place despite best efforts of staff.

There can be huge differences between one care home and another.

Ive worked in some amazing care homes that were really enriching.
I know that there are some really depressing ones though.

I am sure there are depressing care homes. My mother was very lucky with hers, she was in there for many years (dementia). No one was told to stay in their chair unless there was a good reason i.e. needed to wait for a carer to help them safely mobilise. Their philosophy was that although mobilising can cause falls, the residents must have as much freedom of choice as possible.

In the early days my mother would wander around the entire building, and the staff would also take the able residents on trips to the park (obviously that all stopped with Covid). But her mobility deteriorated and for the last couple of years she spent her life hoisted from bed to wheelchair to lounge chair. She was however always dressed in her own clothes!

It is a very challenging environment precisely because of the type of residents but the carers were all lovely and many had been there for years. The residents were well cared for and as content as their illness allowed. If I develop dementia that care home is where I would want to go.

God this is depressing. I need to look at care homes as both my parents have dementia, although currently at home with carers but it feels inevitable that they will end up in a home, if they survive long enough.

Having worked as a carer for the elderly and disabled for many years, I would never let a relative I loved go into a home if there was any way to prevent it.

It never mattered how lovely the care home looked, or some staff were.

Inevitably the managers would put on a performance for any inspections, getting staff to do things they'd never do usually. Residents would get treated like humans when inspectors or their families were there, then like mute cattle at best when everyone left.

They repeatedly hired unsuitable staff who were uncaring and often rough with residents. This would be brushed under the carpet when reported, and any really cruel staff just moved on to another service.

The worst was the constant covering up of anything going wrong, gas lighting residents and cajoling them into giving different accounts.

Why have they refused DNR?

My mum was in a nursing home temporarily for rehabilitation after a fall, in her run-down Midlands city. My heart sank when I walked through the door the first time. However, although there were few "facilities" and it was an unprepossessing building (at the cheaper end for long term residents), the care was fantastic. The place was clean, the care/nursing/domestic/maintenance staff were so hard working and kind, in often very difficult circumstances. I was so impressed.

Years gone by I worked in a fair few homes both council run and ‘posh’ private and what your describing is true for I’d say 95% of homes.
ive learnt many things in my time but I stand by saying never fully trust what a Care home manager is telling you, they spend half their time covering their arses and jazzing up what actually goes on.
Daily entertainment is poor at best but made to look good for photos, food isn’t great apart from lunch, everything is like a military operation and residents don’t get a say in what time they go to bed/ get up/ have food/ shower.
some staff are great but they usually burn out and leave hoping another home will be different or end up making themselves Ill but the majority are working there because they have to and it shows.
I don’t know what the solution is but I really hope I don’t end up in one

But what is the alternative?

Live in carers for those that can afford (and where carers are available)? My aunt has dementia and this is working for now but only because her adult son (no wife or kids) also lives with her and her adult daughter (divorced and children left home) travels 150 miles to visit every other weekend. It wouldn't be enough otherwise and she would be in a home. And of course its expensive.

How achievable is the above for many in reality?

There is a bit of a nostalgic view of how elderly were cared for by their families before care homes - the reality is women transitioned from caring for children to caring for parents/in laws. And then faced poverty in their own old age (one of the biggest groups living in poverty currently is women who took long periods off paid work for caring responsibilities). Is that what we want to return to?

With people moving away for work, having children later, working longer etc, its not realistic anymore. Neither would I personally want my child to give up their income, life etc to care for me.

So the alternative is paid care. The big problem is it isn't valued as a career choice and is massively underpaid, under resourced and under trained.

DM is in a care home and TBH it's fine. She has a good sized room, which is kept clean. No major issues with laundry. I make sure her clothes are labelled plus I make a lot of her tops so they are unique.

DM is now in the nursing care section. There is a qualified nurse on duty 24/7. On the whole staff are friendly and competent.

It is a purpose built home. When choosing somewhere for DM I avoided the converted edwardian vicarage type homes as often the fabric of the building isn't suitable: narrow corridors and dodgy plumbing.

DM's place is bright, sunny, clean. The food is institutional as you would expect when catering for so many people with so varied tastes.

Cost is £1400/week (Midlands).

@Decisionsdecisions1 But what is the alternative?

I agree. If my DM wasn't in a care home she would have to live with me plus carers. DM can no longer walk. She requires a two person transfer plus equipment between bed/chair/wheelchair. The whole of the ground floor of my home would be taken up by hospital style bed plus storage for MoLift, electric stander and hoist.

Back in the 'good old days' an elderly and infirm person would at some point take to their bed. They would then be carried off by pneumonia which used to be known as 'The widow's friend'.

Of course the caring responsibilities would fall to the women of the household.

It sounds bleak, but my grandad didn't know who he was in his final few years. He hit his wife for the first time, didn't know his own kids, made sexually suggestive comments towards us grandchildren (he thought he was a young man and not related to us) and was doubly incontinent.
For patients like him - who would rather die than live like this - as long as they aren't suffering actual abuse, does it matter?

For patients like him - who would rather die than live like this - as long as they aren't suffering actual abuse, does it matter?

Yes it does. That he isn't who he used to be, or is divorced from his lifetime of previous social understanding, is no reason to further punish him by allowing the lowering of his quality of life, when it doesn't have to be that way.

The majority of people in his position can be given mainly good experiences in the 'now' regardless. These aren't related to who they where necessarily, just where they are at now, and what soothes, connects, both with bits of the past, and the present, and makes life more pleasant, less anxiety inducing, and into a 'good day.'
I've spent a lot of time providing meaningful living to people who where 'no longer themselves' and 'very far gone.' Very few cannot be helped to have overall quality of life no matter how scattered and fractured their minds are, but it mainly requires a lot of one to one work, and then training busy care staff to use the tools developed for them as best they can in between, and mainly we don't value them (or the care staff) enough to pay even NMW for it, or anything beyond 'housing' them..

I've also been a resident in a care home as a disabled person, when I couldn't get into a proper rehab unit and there was no where else to put me post operation.
I found myself treated as if I was subject to a DOL's order, visitors turned away, including the hospital OT, and kept in bed with my wheelchair confiscated, refused (simple) vegetarian food, even a non shared towel, with no good reason other than it was 'easier' for the running of the place.
Some of what goes on in the name of cost cutting and 'do they really matter' is unbelievably cruel and parsimonious, and often entirely unnecessary.

Incontinence, double or not, does not preclude the capacity to have psychological needs, e.g. for safety, and for positive sensory stimulation.

I work in adult social care, and people with dementia can still be happy, provided there are sufficient staff present who care about achieving that.

People shouldn't be left to sit in armchairs without social or cognitive stimulation, and it matters. As for carelessness regarding oral care, it drives me mad. It's neglect.

It does amaze me the number of families who refuse to allow DNR certificates when their frail elderly relatives go into hospital or nursing homes with severe dementia.
Despite what we see on tv resuscitation is not often successful out the hospital setting.
When the care home suggested DMIL needed hospital admission we were upfront and said yes to DNR which surprised the young doctor on duty as most families had insisted the the elderly person by kept alive no matter what.

Have you reported all of these things you have seen? Most of them not the norm in most homes at all.

I think nursing homes are a last resort myself, having worked in one. The one I worked in was profit making though, so they were always trying to cut corners.