Frequent falls - care home can't cope

[Candleabra]

Mum has very advanced dementia but is miraculously still mobile. She walks a lot. A lot. Won't stop. Falls every other day and the care home (EMI residental) have put so many measures in place, they've been brilliant. But other than someone accompanying her 24/7 they can't completely prevent the falls. She had a bad fall on Saturday night.

The care home are now starting to say that her needs may be too high. They've escalated the problem with social services. I'm worried she will have to move into a different home. Any experience with this?

[dottydally]

@Candleabra we had something similar with my DGM though it wasn't mainly for falls in her case. She had a few falls but was becoming violent and refusing personal care (she had severe Alzheimer's). She was reassessed immediately as a crisis case and offered a bed on a specialist older people's mental health ward.

We didn't have the funding issue as she was sectioned under the mental health act at that point so it was fully funded but I just wanted to say that the move was the best thing to happen to her. It is unnerving for family - even more so because it was done under the first lockdown, so no visitation at all, but it meant she got the 1:1 care she so desperately needed. The staff were angels - I honestly couldn't ask for anything more. They cared for her with such compassion and kindness.

In her case it also meant (and I mean this nicely) they could be more forceful in terms of things like personal care where the care home couldn't. If she refused to wash/be washed there they couldn't make her. It sounds horrible but it is absolutely in her best interest to be clean if you know what I mean.

Sending hugs to you It's a horrible situation. We ran ourselves ragged trying to do things and I know a PP has suggested taking on a caring role but we wouldn't. It's not because we don't care.. Alzheimer's and dementia is such an unpredictable condition and even if you could manage today, you just have no idea what tomorrow will bring.

[Candleabra]

Hi @CausingChaos2 no POA unfortunately.
That's sounds awful, your poor grandma.
Mum living with me isn't an option, her dementia is too severe and I couldn't cope with caring for her. It's good to hear other options though, as you can get blinkered in your thinking. External input is always so valuable.

[CausingChaos2]

So sorry to hear about your Mum. Do you have power of attorney? We had a similar situation with my DGM falling in a care home with the most awful facial injuries that never fully healed. Unlike your DMs care home, they were defensive and unprofessional.

We removed her and she moved in with my parents, and we recruited two full time live in carers. This was not financially that different to the care home fees. She didn’t have another single fall for the almost 18 months until she passed away. She also didn’t have the regular viruses and UTIs she was getting in the home. Just worth considering if it’s something you’d be interested in.

[Candleabra]

It's a horrible situation alright. Poor mum.
I'll speak to the care home tomorrow. I think they are escalating the issue to social services, but I'll be involved as well.

[Umbridge34]

Its been about 5 years since I worked with the elderly but getting 1:1 funding for falls risk alone was unheard of in the area I worked. There had to be additional needs to qualify (usually challenging and violent behaviour). And unfortunately a private care home cannot absorb the costs of 1:1 staff like an inpatient hospital ward can.

It does sound like the home are making the right call though, she would probably benefit from nursing care, if only because the staffing ratios should be higher making observations easier (in theory). I sympathise OP, seen this situation far too many times

[JiltedJohnsJulie]

Just one more thing, I know it's difficult in lockdown but is her footwear suitable? It might be a simple thing but could, maybe, be contributing to the falls?

[NecklessMumster]

Then social services should take it on re making a decision in your mum's best interests with everyones agreement. At the end of the day it could end up with a move to a nursing home but at least all options shldve been considered. I have got 1 to 1 funding before for a nursing home, I've not had to try for residential.

[handsforfeet]

Has she been reviewed by psych team? Non-pharmacological strategies to manage the behaviour might help, but they'll probably be staff intensive too, at least initially. The walking has a purpose, it's just trying to unlock what the purpose is and see if that can be channeled in another way or done in a safer place.

Is she is a dementia specialist home?

I would try CHC again. However if she doesn't have complex and unpredictable needs other than the falls then it's unlikely to be approved.

[Candleabra]

No POA. Have applied for Deputyship but it's taking a long time.

[NecklessMumster]

Tell social services she needs a care act assessment, review, doesn't matter that she is self funding. As a social worker I would review with home to make sure they've tried all options. Do you have power of attorney for health and welfare? You could tell social services you want a capacity assessment/ Best Interests decision

[AnnaSW1]

If you like the home and she's happy there l'd investigate 1:1 care at the home.

[Candleabra]

No unfortunately no walker or any other aids. She was assessed by OCC health two years ago and she couldn't understand how to use them. It's so hard when so many of the solutions require a certain level of cognitive performance. We had the same issue with frequent referrals to the incontinence team when she was still living at home, none if the products were suitable because she couldn't understand what to do (or even know there was a problem).

[Chunkymenrock]

Does she have a walking frame to push as she goes?

[Candleabra]

Despite all this, it is a nice care home, and the staff are lovely. I just worry that a move would tip her over the edge. She's only just started to eat again. She's very frail.

[Candleabra]

I think the needs review is instigated by social services, is that right?

[Candleabra]

I agree about the CHC. I've read everything I can find, all the criteria, and I do not know why she's being rejected. It is terribly difficult to get CHC funding for dementia patients though. And the difficult process is even worse under covid. The social worker said unless you're at end of life, and require short term funding, you have no chance.

[JiltedJohnsJulie]

It does sound as though a move to a home with Nursing might be a good idea.

I'm aware that our DMIL will probably need a move in the future, but for now this one suits us all.

Not sure how you would go about getting a review of her needs though.

[Ritasueandbobtoo9]

It sounds like she needs CHC funding for additional support.

[CosmicComfort]

Sounds like she needs nursing care so a nursing home.

It’s seems completely alien to me as in the NHS, the need comes first and we just have to meet it. Obviously we turn to bank and agency staff a lot but agencies are available to care homes as well.

I hope things work out for your mum, must be very worrying💐

[Candleabra]

I'm not sure they're being obstructive. They just keep saying they haven't got the staff. They're worried about mum too. They're residential.

I agree that a review of her needs would be a good thing. I think they've got too used to her behaviour and so are maybe a bit blind to all the risks. Given the volume of incidents it is only a matter of time before she has a catastrophic fall.

[CosmicComfort]

If she is self funded then yes, I am guessing the funding would need to come out of her estate but the care home should be able to organize extra staffing.

It’s seems ridiculous that they are being so obstructive, are they a nursing home or a residential home? I would have thought it wasn’t uncommon for elderly people with advanced dementia to need constant observation. If they are being that resistive, a move may be the best thing for your mum and a review of her needs may be indicated.

I work on a functional older peoples mental health ward and we fairly regularly have 1:1 observations, I know it’s even more common in dementia wards.

[Candleabra]

She's self funded. CHC had been thrown out twice (but assessed using fast track covid rules, so no paperwork or transparency).
The home say they don't have the staff to provide 1-2-1 care. Is this something we could pay for?

[JiltedJohnsJulie]

No advice sorry Candle but just wanted to say that if they do have to move her, I'm sure it won't be completely awful.

I feel that we might just be a bit behind you however.

DMIL has vascular dementia, delirium and won't stay still either. I feel the fall stage won't be long.

[CosmicComfort]

How is she funded? Maybe I am being naive but if she needs 24/7 1:1 support, she needs it and it needs to be funded. If she is that restless and wandersome I am not sure what setting would be able to keep her safe without constant observations.

I am a nurse and am aware in hospital is different but we would just put someone on 1:1 if they were falling regularly and frequently. We are responsible for their welfare and have to put all measures in place to prevent falls.

[Candleabra]

She falls in the day time. A lot of the falls are unwitnessed. She just walks around the home for hours so I think the falls are tiredness, she is quite unstable. She will not sit still. They've put pressure mats, bed sensors etc in place.