Is it normal for a care home to do this?

[SinisterBumFacedCat]

My DM has been in her care home for 6 months, she has young onset Alzheimer’s and is about 5 years into it. She has been unsettled lately and is screaming at mealtimes. I have been liasing between the home and mental health services and their expectations are very different (care home wants more anti psychotic medication, MH team wants staff to engage more with Mum as she thinks she is bored). Care home have threatened to take her to hospital (which would be even more unsettling for her and frankly pointless based on experience with section DF years ago.)

I went in today to take her out for a walk. As I was getting her ready a carer came in and offered to help clean her teeth. The carer then told I need to visit Mum more often otherwise she will go on to one to one care (which is more expensive).

I didn’t say anything at the time but I came away feeling awful. Is it normal for carers to say this? I thought they didn’t usually tell relatives to visit more.

For context I visit DM twice a week for 1-1.5 hours a time. I always bring cakes/flowers/magazines. I started doing 3 visits a week but as I am emotionally exhausted afterwards it pretty much knocks me out for the rest of the day, so I decided to drop down to 2. She has 2 brothers, 1 visits every fortnight, the other never visits her. She is not miles away, so there is no journey time involved. I come away from visits with an overwhelming sadness and now guilt on top. What would you do if a carer said this? I don’t think it was appropriate however I am reluctant to mention it because I don’t want it to impact upon Mums quality of care.

That’s a mean, manipulative thing to say.

Is she hinting that the care home staff would have an easier time of it if you were there more often, keeping your Mum distracted? Hoping that the comment about costing you more money would entice you to visit more?

You’re already visiting a lot. It takes a huge toll, seeing a loved one in a care home and watching them decline. You need to take care of your own needs too.

I would ask for a discussion with the manager for two reasons

• because what the carer said was inappropriate, but also
• because it sounds as if your mum's needs are increasing, and if she is self funding then additional care will have an impact on costs so needs to be discussed as soon as possible.

You also need to hear first hand from the care home - it's all very well for the mental health team to say the home has to engage with her more but that may not be possible for them to do without making changes. And while medication may sound like an easy option for the home they might have a good reason for suggesting it based on their experience.

Thanks I did think it was a bit off. I just wasn’t sure because I haven’t encountered this before. My DF has been in a care home for many years now and his carers have never said this to me, although as he is geographically further away I actually don’t see him enough. I think they were hinting at cost implications. It’s already so expensive. She could be on a luxury cruise having champagne every night and still have change left over for the same cost, I sometimes imagine that’s what she’s doing.
The home do have access to tranquilliser medication for Mum if they need it. MH team are reluctant to increase her regular medication because of stroke risk. I realise this is ridiculous when Mum has basically a terminal illness but they are bound by safeguarding rules.

My DH has severe dementia and has a one to one carer 24 hours a day. I visit every day without fail for about two hours and the care home staff are wonderful.

It is not normal to threaten with one to one care. If it's needed, then it's needed and it's not dependent on whether the resident has regular visitors. My DH can be violent, agitated, aggressive and doesn't sleep longer than an hour or two (even at night). I am there every single day and it makes no difference to his need for highly intensive care.

So sorry to read this, you must be incredibly strong to visit every day. My Dad went through a long stage of aggression, I know that it’s tough to see.

Does the home have any activities? My MiL actually improved a little when she went into a home, as they had morning and afternoon activities. She didn't really remember doing them, but we saw photos and she definitely seemed to enjoy them.

They have activities every day, the problem is Mum is still pretty mobile (not really a problem!) but she can get up and leave the activity room and because she is not a fall risk no one goes after her. A lot the time I arrive when activities are happening and Mum is in her room asleep. And it’s always the same faces doing the activities.

Is she in a residential or nursing home?

The way the carer approached it is awful, but there have probably been conversations she's heard where 1 to 1 has been discussed. If the home can't meet her needs with their normal staffing levels they'll either need to seek 1 to 1 funding or serve notice, that's just the reality of it.

It sounds like the MH team don't fully understand that the placement is breaking down, can you liaise with them further?

Echoing what everyone else has said. This was not an appropriate comment from the carer. You visiting more often is never going to be a substitute for 1-2-1 care.

tbh the home wanting more meds is a bit of a red flag for me too

it sounds like they don’t want or aren’t able to handle her

def talk to the care home manager. Get a feel for their attitude . If it’s all about how hard it for them or how unreasonable you/your Mum are, then I would at least consider looking for a different home for her where they can commit to more engagement.

it made a massive difference to my Mum when she changed care homes. I was furious at the time with her first home after they did the whole “we can’t meet her needs dance”. But she went from lashing out at staff (including physically) to being happy, content and a real favourite with staff.

DM's been in a residential home for just over a year (diagnosed last summer with mixed vascular and Alzheimer's, controlled at the moment with medication) and I've never been told to come in more.
In fact, the senior I spoke to on DM's first night there said she didn't want to see me there every day, I have a life too. Of course she wasn't telling me to stay away or anything. She immediately put my mind at rest.
I was dreading it - my DM was a formidable woman with a very sharp mind ... until she wasn't 😔but she has thrived since going in there. She's kept active, has new friends - one in particular is her particular partner in crime - they're like naughty school children 😁