Care home sent her back

[WickerShit]

Mum (78) has Alzheimer's, diagnosed 2018, being cared for at home by my 85 year old step-father. Things have been really awful for a long time.

She is very very bad now crying and distressed a lot of the time, hallucinating, not washing or changing her clothes.

We have been pushing and pushing for them to get help (carers etc) and SF wouldn't have it said Mum would not accept any help from anyone but family. There's a lot more to the history of the last few years as you can imagine.

This month things came to a head with paramedics being called/hospital visits finally people seemed to start to sit up and listen and after a very bumpy ride very emotional and stressful she was found a place in a home which we moved her into. She went in Thurs lunchtime. By 7 pm they had called us and said they couldn't cope and we'd have to take her home. She was verbally and physically aggressive and throwing drinks / food at the walls.

Back home she is now calmer than that but back to crying and moaning and wandering round unable to settle. And still in the same clothes, hadn't washed for weeks,

When they called SF yesterday afternoon and asked how things are he said 'fine' . Someone called us yesterday and said if he continues to say 'fine' the authorities will move on and no more help will be offered.

Me and my step-sister have PoA. Just wondering what the next step is. So sad as I really thought on Thursday we'd finally moved on to the next albeit upsetting phase but no back to the nightmare again.

I think what people are saying is you should have stood firm and said “we cannot cope and will not accept her back”, then you’re leaving the problem of finding somewhere suitable to them.

Sometimes “behaving nicely” doesn’t cut it when trying to get support for your loved ones.

…. Just seen your edit. So they’d have taken her to A&E, who would have had the problem. It would have been messy, but as relatives you have the disadvantage that you can be pressured into doing things that no work situation would do.

Hi and thank you so much for your response (and thank you everyone else) much appreciated.

So if in the home you described a resident arrived and displayed the level of aggressive behaviour I describe the home would be able to cope and would keep her until she settled? She is not frail, quite strong and very angry when separated from SD.

I need to know what kind of place I am looking for when I go back to the team. I'm scared they will say nowhere will cope with her.

She needs a nursing home, with qualified nurses on shift 24/7. They will easily manage her behaviour and needs. Assisted living is for people with lower needs. You should invoke the LPoA and ask kindly that dads opinion is disregarded if he isn't being honest.
Is she eligible for FNC / CHC?

@MereDintofPandiculation Hi - as I said further up they said they were going to send her to A and E . Not sure what would have happened then. They definitely were not keeping her that was made clear.

An assisted living residence is not a dementia care home.

Even within dementia care homes, skills differ so what one home may think is horrendous, another deals with barely thinking about it.

And I've been to older people's mental health units where people are sectioned - no restraints, purpose built for the needs of people with dementia and actually not that different to a care home.

You need to think about the person's needs, rather than what looks attractive to you. When FIL had dementia he was happy as long as he could walk round in a circle and look at the cars in the car park. Anything else such as gardens and nice lounges was wasted on him.

This! Go and visit some and find one that's right for your mum.

If SS. are paying, then she can only access a nursing home if there's a nursing assessment saying that is what she needs. Speak to her social worker

@Puddingpieplum Is she eligible for FNC / CHC?

Currently the only funding we have is for a local-authority 6 week assessment which is what was supposed to be happening at this home. Now we need to apply for the highest level of funding I guess - I will speak to the team about how to do this asap

Yes, sorry, I didn’t see your update before I posted.

A&E would have found somewhere suitable.

As long as you’re doing the negotiation, they know they can pressurise you to taking on something they wouldn’t ask of anyone else.

Thanks. This response has really hit home with us. What we have been looking for is something that makes us happy, less guilty about leaving her.

It's much harder to think about what will make her happy. Because currently nothing does. Nothing at all.

@WickerShit it sounds like she can't be managed in a residential bed so will need nursing. You need a FNC assessment. This is key to everything, it's not in her interest to have another failed placement. Has the SW not identified nursing needs?

@MereDintofPandiculation

Thank you. To clarify previous to this placement they had suggested somewhere else. My SS visited it and says it was horrible, dark, smelt of urine, several flights up - generally didn't feel great. In SS words 'I'm not sending her there'. So we refused that one. So I think from our perspective we were scared that if we left it with them she'd be put in somewhere horrendous.

@WickerShit I must reassure you on our experience on a secure ward for someone with dementia. My parent was sectioned and taken for assessment and then observation and then treatment. My parent had their own room and toilet, and were able to lock their door when they wanted to. My parent stayed for nearly a full year and in that time, they improved considerably - they now live in a care home under a DOLs (deprivation of liberty safeguard) and they are happier and more social, balanced than they have been for years. They are still explosive occasionally, but the home are looking into mood stabilisers rather than knocking them out with high strength medicine. I am very clear indeed that this was the best thing that could have happened for them (and they didn't want to leave the hospital in the end). If you're anywhere near South London, I'm happy to share more by pm.

You need to get in touch with adult social care, possibly a memory team, and explain everything that you have said here

At the end of the day, with a health and welfare poa you are able to advocate for the best treatment for your mother. She deserves better than this.

Previously she has not been assessed for nursing needs as up till now she has not demonstrated such violent behaviours. Her social care assessment came back as complex needs which I assume is not the same thing. This FNC (?) assessment is something which needs to happen asap. We are in full crisis mode at the moment and trying to make sense of everything

Thank you so much this is very reassuring and I fully hope this will cast we will send up with.

I am going to print out this thread and discuss with our caseworkers

Thank you to everyone for all your help and thoughts - I'm going to write up some notes now and we will discuss with SD and the team. Fingers crossed we can get somewhere.

The care home selected was not right for her, they could not deal with challenging behaviour and they had to keep both staff and other residents safe.

The care home manager usually does an assessment beforehand, meeting the person and their relative(s) to ask about behaviours and ensure they can meet her needs.

Dementia care homes differ widely in what types of behaviours they will accept, there will be a dementia care home which will be able to deal with your mum, as a previous poster said they have a higher staff to resident ratio and additional training in challenging behaviour.

@WickerShit the criteria for sectioning includes if your mum is a danger to herself or others; a section 2 would hold her for assessment for up to 28 days. A subsequent section 3 could hold her for up to 6 months. After a section 3 she would become eligible for section 117 aftercare which might help in getting her a suitable placement.

Not sure if it's relevant but might help you see what the right path is especially if she is aggressive or violent

A&e sounds bad but could be the only option to get the help she needs, they will have access to facilities that you can't self refer to easily. It sounds like she needs full nursing not assisted living, and 1:1 - from hospital it's easier to access chc money I found. If you are looking in the midlands, I can recommend one place

Ps I've had experience of a relative being sectioned too, was pretty bad, but to long ago tj ge that relevant because councils have mostly sold off their facilities, the more recent case was a secure private nursing home fully funded by chc

So when my dad became like this in his nursing home he was prescribed medication initially by the local GP that the nurse could give when needed that helped calm him. I can't remember what it was but it was low doses. When that wasn't working he saw a psychiatrist who prescribed something regular. At one point there was talk of a secure until for assessment but they managed to balance his medications. Eventually it was pretty strong meds but it was always for his needs not the convenience of the home.

The point is there is lots a good carehome can do in partnership with social work and NHS.

I'd also add 'smells of urine' is not necessarily a great way to assess a care home.

I used to know all the care homes in my county v well. One in particular looked v glossy, had a great brochure and sounded posh but we were always making safeguarding referrals about it.

The one that was tatty and yes, often did smell of urine, had amazingly caring staff.

Ultimately it is the staff that make a care home.

When I was looking for a care home for my Mum, I asked each home I considered for examples of what types of behaviour they would not be able to cope with ie for what reasons why they might as Mum to leave. This helped me find a suitable place for her. I also wanted to know how they dealt with challenging behaviour, in particular what additional support or medical pathways did they have access to.

A lot will depend on long term funding for the fees. If your Mum will be self funded for more than three or four years then you might find that Social Services will not get involved with sorting out a care home other than providing you with a list of homes. However, if your Mum has limited funds, then they do need to be involved otherwise you might find a suitable placement that is much more expensive that SS will fund, in which case when your Mums money drops below approx £23k, she will have to be moved to a cheaper home.

I had no support from SS for Mum but as I refused to allow her to be discharged from hospital after a fall as the home care package was no longer enough to keep her safe, the hospital Social Worker became involved and helped me find a good care home - they wanted the hospital bed!

She needs a lorazepam PRN prescription.

A secure unit may just mean the entrance door is secure and this will be risk assessed and fire risk assessed. Anything else would be classed as restraint