Should I raise an adult safeguarding concern? Carers giving dad Weetabix 3 times a day 😫

[Bake]

My dad was in hospital in November. He had delirium while in hospital and hasn't returned to normal since he was discharged. He has carers coming 3 times a day.

Initially they were fantastic, raising concerns with the GP, calling us to say when he wouldn't get up or refused to eat or have medication. In the last week I feel like they've been neglecting him. My sister has brought over meals twice in the last week, I was over at the weekend and none of the meals have been touched. The carers are supposed to be providing him with food and ensuring he takes his medication. They’ve either been feeding him weetabix 3 times a day or not feeding him at all. 😫
My sister called the care company this morning to express concern about him being given weetabix 3 times a day. We have a camera in his living room as we have been concerned about him falling and can see he was given a bowl for dinner yesterday which I assume was weetabix, carer was there for less than 15 minutes, a bowl this morning, a bowl and yogurt for lunch and whatever was given to him on a plate this evening was less than 5 minutes after the carer arrived, so can't have been a ready meal. There is no soup in his flat, only thing that could be in the bowl is Weetabix. The battery had died so we have no footage for most of last week.

My dad can't remember if the carer has been there and can't tell us what he's been fed. It was such a relief to have the carers there as it's impossible for us to be there all the time, but now I'm angry that he's being neglected.

Does anyone have any advice? Should I raise a safeguarding concern with the care company and adult social care team?

Is it reasonable to ask them to take a photo of what he's given for each meal and then a photo of what is left that they end up binning? They empty his bin so it's impossible for us to tell what he's eating. His weight is down to 7 stone and he's literally skin and bone. It feels like they are starving him.

No concept of time. He's sleeping lots and nearly always is in bed when carer arrives so wouldn't be surprised if he thought it was morning each time. Cereal is in cupboard and he doesn't go in kitchen with the carer so I don't think he sees it. But could have an association of Weetabix and carer.

I think a note in the kitchen for carers suggesting what he's offered for each meal would be useful.

Thanks all. I'll start with asking to see notes and raising concerns rather than jumping straight to a complaint.

It breaks my heart that he doesn't seem to be getting what he needs 💔. Trying to work out if I could do the evening visit but I have young kids and a job and I just can't see how I could.

Will sleep on it and write an email tomorrow morning.

If he's no concept of time then he really does need to be eating his meals I agree, something I used to do for my dementia clients would be leaving chocolate or nuts or sausage rolls around.

Things that he would like, even old favourite sweets he used to like, but it must be open and ready to eat, ie a sausage roll left on a plate in the hallway, or a bowl of sweets beside his bed, no packets to think about opening, only picking up and eating when(if) he goes for a wander around the house.

It may prompt him to grab a fistful of something when no one else is around. High calorie drinks too, ask the GP for some.

Hope you get to the bottom of it all OP. It's a tough place to be for you.

Thanks he used to go through lots of chocolate before he was sick, will get my sister to bring some over tomorrow. And sausage rolls too.

What food is in the house for carers to provide?

Somebody needs to stock the freezer with meals to microwave, make sure there are soups eggs, cheese, bread, porridge etc.

Can his gp or nurse refer him to the community dietician, he might like build up milky or fruit drinks, there are also calorie powders that can be added to food and drinks. Would he like chocolate milkshakes

Fridge and freezer have ready meals. There is bread, ham, cheese butter for sandwiches plus cornish pasties, sausage rolls, yogurts and trifles.

One thing to discuss with care manager would be a meal plan for the week, and then careers ticking off what he’s had so you know what’s being eaten so you can keep an eye when you pop in and know what to shop for.

If concerned on weight then look for high calorie options. Healthy living isn’t particularly a priority - full fat milk, any favourites like crisps, smoothies, pastries, cake etc.

Do you think the carers are asking "What would you like to eat?" and he only ever answers "Weetabix". Do you imagine they never tried to get him to eat something else in the larder?

I worked as a carer when I was at university and I will always remember one lovely elderly man- his son used to insist he should eat fish pie for lunch and used to buy it incessantly for him and put it in his fridge but he hated fish pie. If he didnt eat the fish pie the son would have a right go at us but his dad used to tell us that he didnt bloody like fish pie and wanted to eat snacks instead for lunch like bites of cheese, cold meats, olives, bread, humus etc

We communicated this to the son but he refused to listen and just kept telling us to force the fish pie on him. In the end it became really unhealthy and we had to have a review with the son where we supported the dad to express his opinion that he didnt like fish pie and please stop buying it. The son was shocked because he said his dad had "always" previously liked it, not recognising that tastes and appetite change as one ages.

My point is-I think you need to gather more information before storming in with a safeguarding. Have you actually observed or asked what your dad what he would like to eat daily? have you made him the meals you are buying him and does he actually eat them and enjoy them in front of you? if not, maybe he doesn't actually like them. Sometimes we assume someone likes a food because they have done in the past but maybe they no longer like it.

Of course, the carers could equally be lazy and rubbish but you won't know that until you look into this. There are times when I come home from work and eat cereal just because I fancy it, I would be furious if someone told me off for it and tried to force a ready meal on me instead, you know?

So there’s no diagnosis of dementia. Have you seen his care plan? Does it state what his condition is?

Does he have capacity to decide what he wants to eat? If not, is this recorded in his care plan?

has he given permission for you to access his care notes?

Do you have POA for him?

So FIL was in hospital with delirium following a fall. He had not been eating / drinking well beforehand. He was eventually discharged with three care visits per day. He was ‘informally’ diagnosed with early dementia, but it will take a year to get an assessment. The care plan includes various things that are ‘meant’ to happen but if FIL doesn’t want to eg get dressed, the carers can’t force him. If he’d rather sponge wash than shower, or not wash at all, they can’t force him. If he told them that he wanted breakfast cereal three times a day - despite SIL filling the fridge with food and meals to reheat - that’s what they would give him. And SIL has no right to see his notes because he has capacity and has not given his consent for this - despite the ‘early dementia’ diagnosis given by the ward doctor and despite her being next of kin and having POA.

To be fair, cornish pasties, sausage rolls and trifles are not exactly nutritious either, weetabix is possibly more healthy because its fortified with vitamins as most cereals are

His nutritionist has provided a list of high fat foods to help him put on weight and it's all the things you'd traditionally be told to avoid as part of a healthy diet. 🙄

Yes but the point is- if he doesn't want to eat them then he isnt going to and noone can force him. Its really hard but sometimes eating something is better than eating nothing

Who said he doesn't want to eat them?

You said it’s very possible he’s asking carers for weetabix, he is in bed most of the time and associates weetabix with the carers so that’s why if it were me, I would visit him and offer him a different food to see what happens. If he refuses it and asks for weetabix instead then you will know that this is the issue rather than the carers neglecting him. The more information you have the better.

He eats what he is given. He does not currently have the mental capacity to express what he wants and if he is asking for weetabix every time it is probably either because he's just woken up or because that is the only thing he can think of in answer to that question.

My sister was over this morning and he ate what she gave him. His neighbour brought over chicken soup which he ate too.

I sent an email to the care company outlining my concerns, not had a response or acknowledgement yet.

Please bear in mind that this may be all he is willing to eat. They can't force feed him.

Just have a chat with the care agency and ask them what the situation is. Explain that you would like him to have the proper meals you are supplying, and they will then be able to tell you why they are not feeding these to him.

I am afraid that carers have loads of people on their rounds and never have time to do things as they might wish.

I think you should just have a chat with them and see what is going on. It need not be accusatory in tone.

The person I care for (EPICF) got into this kind of cycle. They didn't have the ability to think what food was available and carers would just leave the easiest option.

I also beg to differ that people always get to choose what they eat. We used to leave a weeks worth of ready meals that EPICF liked. But carers wouldn't do any kind of date rotation so they would use the ones with the longest date first and then the ones with short dates would go to waste. As adults we are all familiar with the "you have to have cauliflower cheese for dinner tonight because it's going out of date" nights (in fact I had one tonight, except it was bean chilli I made over the weekend that needed used up. I really fancied chowmein from the takeaway but I sucked it up).

Once the weeks supply of meals were exhausted due to waste EPICF used to get really random food, no one would even msg me about it (I only know due to comments in the care log found later). They never used anything from the freezer, or used the good quality long life stuff I'd bought in (the merchant gourmet bean chilli and thai green curry are quite nice and I eat them myself at times). Only the fairly vile long live meals that I'd bought in desperation. Stuff in the freezer never got touched (despite being microwavable from frozen). And asking them to assemble anything more than a ready meal e.g microwave McSweens Haggis slices, pre-prepared mash and one of those preprepared bags of brocoli was too much (despite the fact the cummulative microwive time was 1 minute more than a refrigerated ready meal).

And even if there was fruit/ salad in the fridge it never made it onto a plate.

I also used to get really frustrated at some of the food hygiene issues - failure to mark when packs of ham/ pate etc were opened so the carer coming in on a future day wouldn't know. Sometimes stuff went in the bin. Sometimes EPICF got unwell. I'd put a sharpie and labels in a clear box on top of the fridge and a notice on the door asking that this be done. I was also meticulous about doing it myself when I was around. They also wouldn't seal up the packets of cold meat/ cheese despite cling film/ zip lock sandwich bags being provided and signposted so all the stuff dried out.

Anway EPICF is revelling in the care home food. I had to buy bigger pants! And gets two courses at least at each meal and plenty of fruit/ veg. It is lovely to see how much they enjoy good food.

Sorry I missed this yesterday. He said recently to my brother not to get him any more cottage pies, which has previously been a favourite. My brother said what did he want and he wasn't sure, so he asked what was his favourite and he said cottage pie 🙃

I have calmed down and grateful for the advice not to go all guns blazing before getting more info. I've sent and email with my concerns for now.

However the carers do seem to be doing very little, where previously they'd been great so I wonder if it's a new person. I watched on Monday evening and she gave him a cup about 3 minutes after she arrived and then a plate a minute after that. We can't see what is on the plate but my sister wonders if it's just a slice of cheese. Then she say down for next 25 minutes before clearing away his dishes.

If the notes are electronic, then they should be able to allow you access via your mobile, pretty much as soon as they are written.
For this you need to have POA health and welfare or dad has to consent to you having access

A few things to keep in mind:

• engaging with the client is emphasised as important. So sitting and trying to chat is considered part of the care activities.
• with food for elderly / frail / underweight the main emphasis is on interest in eating and going with whatever they want to help with that. Not Whats sensible / nutritionally balanced for people leading normal lives.

So if weetabix is what he’ll eat, Thats success. If just wants cheese and no bread, That’s what they should offer first.

Theres also sometimes concern about giving wrong things, which is where meal plan with some generic alternatives can be helpful.

I'm a home carer.
We are required to document what was offered and how much was eaten.
Our records are electronic, some people have paper copies too

OP you could get some of those protein supplement drinks (Ensure or Altraplen) and ask the carers to give him one or two a day.

That way you know he’s getting some nutrients, even if he doesn’t want to eat much.

I remember in the last few months of his life, my dad stopped wanting to eat and it was very distressing to watch.
I could literally sit with him for 2 hours trying to feed him, and all he would eat was a spoon or two of yoghurt. We were told that losing interest in food is part of dementia.