Expectations of care in a dementia care home

[wormthatturned]

I'm looking for advice from anyone with experience working or having a relative in residential care, please.
Dad has just been transferred to a care home after a short hospital stay. Previously cared for by my mum at home. He's got quite severe dementia with very limited communication ability and needs help with almost everything. He was very physically able until his hospital stay, now stumbling a bit but mobile.
I visited him in the home for the first time and was a bit shocked to find him dressed in a thin jumper (no vest or shirt), that the staff seemed to expect me to call them if he needed help with the toilet, presented him with a written menu to choose lunch (not a chance!!), didn't check on him in the 6 hours I was there. I knew it wouldn't be the same as his care at home but is this normal?
Now I'm worrying that if a family member isn't there, he's not going to be cared for.

I can’t talk to normal but that is in no way acceptable. Was the placement arranged by social services? If it was I’d suggest contacting them and saying you have safeguarding concerns - your Dad is being neglected, his nutritional needs are not being met, his dignity (poor standard of dressing compared to how he would chose to dress) is being undermined and you don’t have faith n their care plan around his toiletting or the care staff’s ability to meet his communication needs.

In my authority home care is hard to access but care homes are full of vacancies and a move would be easy

Have you had a chance to speak to the manager about his usual care and abilities.
They may not know enough about your dad yet (usual dress).

Thanks for your reply. You have exactly identified my concerns so I will raise this with the social worker using your words - much more coherent than my gut feelings!

And I'll talk to the manager. He is a new admission, but he's not able to communicate his needs

Have they spoke to you and your family about making a support plan for him? This should go through his usual wants, needs preferences. It was done with the family and social care input when needed where I worked. They would talk through his preferred routines, food likes and dislikes, activities etc
We would check people at least hourly unless family visiting said they would attend to their needs while visiting. Tbh until we knew them we still would just in case

OP I would also recommend you request to join the private Facebook group “Safeguarding futures health & social care support” - really great advice there and run by two people who specialise in legal & care matters for the elderly.

@Nearlytheretrees, my mum completed detailed paperwork about his usual routines etc. but she was actively discouraged from being there when he was admitted. I felt uncomfortable about that, given his communication difficulties, but we've never done this before and it's all very upsetting anyway

This is nothing like the care that my MIL gets. She is treated with the utmost care. They dress her beautifully and appropriately, in things that go together and suit her, even though she's only a physical shell now.

I suppose it might be that they only bright the down menu because you were there to ready it to him. Likewisewith the toileting and checking, as you were there, they didn't disturb you and left you to let them know if he needed anything.

But yes, they should have talked through every detail of good care with you, all his needs and his preferences etc. So it isn't sounding good.

My MIL's care is in a local authority care home by the way. The staff are warm, loving and attentive. So any care home should be able to meet these standards.

I feel like the new kid at school - just don't understand what I've got to do, ask, explain. I'm so sad to see dad like this. Whilst his overall decline has been over a few years, the sudden deterioration in the last few weeks has been truly shocking!

You may find the transfer of information from the hospital very poor. It’s also the weekend with the manager probably working M-F.
Don’t be afraid to speak to the staff esp the manager come Monday.

I have worked in care homes for residents with dementia (previously, I don't now).

I would say he was left for that length of time purely because you were with him. I've never seen a menu in a care home, but again, I would think he was given that as you were there & able to read it and ask him what he would like. Or choose for him if he is unable to remember what he likes to eat.

When you say you had to ask someone to help him use the toilet - again, that is a very normal thing for a relative to ask. It doesn't necessarily mean that nobody would have been watching him or offering help had you not been there.

The clothing is actually what I'm more worried about TBH. Not only has somebody thought it appropriate to not offer him a vest let alone a shirt, but nobody in seniority has noticed. In the "good" homes I've been in any Carer bringing a partially dressed resident down to breakfast would be immediately sent back to the room to fetch the missing items! The poorer homes would have been too short staffed to notice.

Your experience of care mirrors my experience. We ended up removing DM back home with a care package. Dreading her going into a care home again.

Covid seems to mean that the quality of care has gone downhill. Residents don't eat or socialise together. Mum became quite ill and er dementia much worse.

Mid-September we were able to go for long walks together (he was fit and could outwalk us all!), we'd sit and have a cup of tea together and have a nonsense 'conversation' with him using the few remaining words and phrases left in his vocabulary. He was sweeping the garden at home - it was spotless, no leaf escaped! It kept him busy and he was happy and had a purpose. A few weeks later and he's a vacant, stumbling, incoherent mess - and on his own in a strange place where they don't seem to understand him. So sad!

@CoffeeRunner I wondered if it was because I was there - but has had the effect of leaving me very anxious about when I'm not. I'm going to have to talk to the manager tomorrow.

You need to raise with the manager and with social work and don't accept anything you are not happy with. Have you seen their inspection report? This should be online.

@AdelindSchade , they're outstanding, apparently!

He should have a detailed care plan and they should be able to demonstrate to you that they are following it.

[quote wormthatturned]@AdelindSchade , they're outstanding, apparently![/quote]
Well things can change right enough.

Firstly, was the reason he was admitted alone to do with Covid? My mum went into care in March and I have not been inside the home at all. We can book 3 1-hour visits per week and these take place in the garden or in a summer house, masks preferred. Also she had to isolate for 10 days when she was first admitted. Were there no Covid rules in place at all? I'm surprised at the 6 hour visit and also that he is not isolating. The fact that you were there would be the reason he wasn't checked I would think. From what I can make out, care homes are woefully understaffed but once you had gone they would have gone into their normal routine. My mum has a document that lists all her needs, meds, diet, specific preferences etc that I have a copy of. Worth asking for to see if anything that is missing?

@CoronaPeroni, don't panic, I work in healthcare so I report 2x weekly LFTs, also home asks for LFT on arrival - my nose is sore!!

@CoronaPeroni and they wouldn't transfer dad until multiple negative PCR test in hospital. Given his compliance, I'm surprised he's not still on an acute ward 🙄

It's hard to know but you are right to be aware and monitor closely. On a good day they would get my dad to choose from two colours of polo shirts with a patience I'd have struggled to replicate. If he was having a bad day he would put a vest on happily but absolutely refuse a polo shirt so they turned up his heating instead.

And when we were there they presumed if help was needed we would alert them. But that was only after we had been regular visitors for a few months and knew staff and routines.

And actually in 6 hours would have come in to offer tea etc.

Definitely have a chat with the manager and ask what their expectations of what should have happened would be.

One of the other things I used to do which was maybe a bit passive aggressive was to look through his care records and make sure it was obvious someone had checked by leaving them on a different date.

@helpfulperson ooh, good advice, thanks

Speaking from experience I think most likely the staff thought they would give you some privacy during your visit and I'm sure if you weren't there they would have been in to do their checks but assumed that because you were there you would alert them. I think the menu was probably more for your benefit so you could go through the options with him.

I would speak to the manager or senior member of staff about the way he was dressed. There might be a reason for it, perhaps he declined to put anything else on if he is confused?

I think give them a chance before jumping to conclusions they are still getting to know you and your dad.