Dad getting aggressive in care home

[Remmy123]

My dad is 77 he was an alcoholic and lost mobility so kept falling over .. spent months in and out of hospital, had carers that came but it wasn't enough he had terrible bed sores, feaces on carpet etc drinking all day

Hospital sent him to a council funded care home. He was in bed for months recovering (still none the wiser as to why he now can't walk) i thought he had dementia but he has put weight on and memory has improved so much so I don't think he has.

we got him an electric wheelchair and he thinks he can now do what he wants and go out alone.

he gets v rude and aggressive to the staff they have now banned him from leaving his room so he is now stuck in his room. He can't go to the lounge or restaurant downstairs.

he kd like this because he feels like he is being treated like a baby and has lost his freedom. It's not all the time as staff say he is really funny and lovely and so he volunteers.

i took him to the lounge yesterday and everyone had dementia and not with it at all and only my dad and one women had mental capacity.

my dad can't live alone and he can't live with me but he is calling me 6 times a day saying he is suicidal that he can't stay there. That they won't let him downstairs. Why can't he go out etc

I feel drained from this I am having a call with the manager as they can't leave him in his room

I'm worried this is it now fior tears and years until he dies stuck there with no freedom but he can't live alone!

not sure what I can do to make life more bearable and can only visit on de a week

thanks

They still have to put him somewhere that will meet his care needs, though, and one of his care needs is going to be access to community and socialising, because that's one of everyone's care needs. I guess it is possible that he has been assessed as being a risk of harm to others but they shouldn't be barring him from socialising with other residents if he really has just been a bit rude to staff. I think you need to understand better what the actual problem is that they say can only be solved by him not being allowed to socialise.

I would consider looking for an advocate for him, OP - try speaking to Age UK or another charity that might be able to help you understand what he's entitled to. It's a home, not a prison, and barring him from the communal areas might mean that they aren't managing him properly one way or the other.

Speak to your father's social worker. You won't have the amount of choice that you would if he was self funding, but Social Services still have to find a care home which meets his needs. So it would be worth making the argument that this care home does not.

If the SW agrees, they would need to find him an alternative placement. However it could be a fair distance away, and there would still be an aspect of confinement.

Yep this.

My aunt was in essentially this same situation, she has dementia and had become aggressive with staff and other residents, their assessment was that they had to safeguard staff & residents so she had to remain in her room or that floor.

Her daughter went back to Social Services and they were able to find her a different home which had more staff, more space and staff specifically trained to handle these situations. My aunt has been in the new home for 2+ years now and is happy there however the home is further away which was the trade off.

It does sound as if he’s in the wrong care home, if he and one other resident are the only ones who don’t have dementia. Do the home not organise activities for residents, sing-songs, card games, film nights etc? They should.

I do really sympathise with you about the endless phone calls though. I went through the same thing with my father. It’s so depressing for you. But if he is mentally fit there is no reason why you can’t ask him not to phone you more than, say, twice a day. You might have to harden your heart and just not always answer, or switch your phone off, and if he complains tell him you are busy etc. I know you’d feel guilty but you are entitled to your life too.

...............can I reiterate he has NEVER been drunk in the care home

Well of course he hasn't.

They won't give him alcohol!

Absolutely you are right. They are depriving him of his liberty which there are significant processes to be adhered to regarding this i.e. DOLS, and rightly so otherwise you are illegally depriving someone of their liberty. Providing he has capacity he has the right to make an unwise decision i.e. go to the pub and get drunk if he wants, unwise but he has the right (like 1000s of other people you will see in town centres on a Saturday night!)...

You need a meeting with the manager to understand what the care plan is, and a meeting with the SW to understand your options. Yh aso need an appointment with the Memory Assessment Service (or whatever it's called in your area). He may have a Korsakoff dementia if he's been using ++ alcohol.
Realistically though no care home will allow him out to the pub. Either by means of a DoLS or by agreement. It's just not safe or far for the other staff or residents.
The key is getting a diagnosis, he can then be managed as someone without capacity and dementia related aggression, or as a beligerant old gent, the pathways are very different.

Thanks

so I have a meeting with the manager Saturday and will ask questions advised on here.

it could be Korsakoff dementia from the drinking - he was drinking around 4-5 cans of cider a day and not eating. Then his legs kept giving way, during this time I never saw him really. Used to end up in hospital a lot. Next thing he is in a care home.

Legs giving way and becoming doubly incontinent suddenly in a person without drinking or memory issues would be viewed as an acute medical emergency such as potential cauda equina.. I know it's unlikely but I guess the drs at the hospital ruled out causes like that??
I remember a late colleague was referred to a neurologist when she got the symptoms of MND.. she actually died a few months before the appointment was due and that was 20 years ago, it's still as difficult to see a neurologist it seems.
I hope the neurologist can give your dad some answers though.

The not walking can also be due to dementia as I remember one of the first signs of my Nans vascular dementia was that she fell and suddenly was unable to walk properly. She had to go to rehab.

Echoing pp in that the staff at the care home should be transferring your dad into his electric chair (unless he's refusing to let them follow manual handling guidelines and wanting them to actually lift him instead of using a hoist for example; or being actually aggressive to staff at the point of transfer).
If either of these examples are the case then they should be documenting this & making you aware. But actually refusing to transfer him as a way of 'restraining' a man who has capacity is not right. If they don't feel the home is the right place for him, they should speak to his social worker.

Thanks - he wants them to transfer him into his wheelchair the other night my dad was calling me very distressed saying saying they won't let him out of his bed. Carers saying that he can't go in wheelchair so I asked that he be out in his bedroom chair whilst we sort any issues out. He doesn't want to be on bed all day long.

im not sure they tested him for anything in hospital as nothing on his notes. He had a very bery bad bed sore.

I think he had been left bottom of the pile

not sure we can choose an alternative care home because he hasn't got any finances at all .. didn't have own property etc

I suggest you get a professional to assess DF’s mental capacity - as a pp has said, he might have Korsakoff’s syndrome?

If he doesn’t have capacity, then he comes under DOLS. A best interest assessor from social services should visit him, every so often to get his views - including whether he likes the care home or not. He should then also have an RPR (representative) appointed - either a family member or friend. If nobody wants to do it, he should have a paid RPR such as an IMCA (iirc Independent Mental Capacity Advocate). If he tells them, he doesn’t like it in the care home and he is not being subjected to the least restrictive options (ie confinement to his bedroom and the floor), then they should see if he is eligible for legal aid in the Court of Protection for S21a action.

The Court of Protection exists to protect vulnerable people without capacity. DF would come under the Official Solicitor although a firm of solicitors and a barrister would be appointed to act for him, on legal aid, if he qualifies. The Court could direct DF’s local authority to produce a list of alternative providers that could meet DF’s needs; and to commission a psychiatrist’s assessment of DF (and any other professional assessment, it thinks necessary).

DF’s solicitor would have to go get DF’s wishes and feelings to present to the Court as evidence, including his views on any other care homes.

You and the care home would be asked if you want to be joined as parties to the action, so you could express your views. Neither of you have to. It is supposed to be a collaborative process.

The Court would look at the restrictive practices DF is being subjected to, and issue court orders to the care home about what they should be letting him do, including community access, in his best interests.

If the Court decided DF’s best interests lay in him moving to another care home, they’d issue a court order, saying so. The Court really is seeking to act in DF’s best interest - it’s not just going through the motions.

If DF has mental capacity, if I were you, I’d seek a review of DF’s care plan by the care home, the social worker, DF and you (if DF agrees).

IMO, care staff should be used to rudeness and aggression, if they look after people with dementia or other neurological conditions - there should be a behaviour support plan? If they claim they can’t cope with it, then Social Services should be looking for somewhere else, that can. DF should have a Social Services assessment for care and support and care plan; and any care home should be able to meet the assessed needs.

The thing about Korsakoffs is it can sometimes improve when people are not drinking, making ‘capacity’ difficult to assess. He may have capacity at the moment but lose it if he were to start drinking. Tricky situation OP I do feel for you. Below is an example of advocacy in the north of England. Obviously I don’t know where you are but just an example. You can see they work with people on dols.

cloverleaf-advocacy.co.uk/advocacy

Other organisations is the field of advocacy for vulnerable adults are Voiceability and Pohrer. DF’s local authority probably has a contract with an organisation to provide IMCAs for its care home residents, with no family or friends to act for them.

No, sorry spelling mistake - Pohwer

I can’t solve your problems but you need to take the phone out of his room or, if it’s a mobile, take it home with you.

If he has capacity and it’s his mobile, that would be theft or maybe a form of abuse, possibly financial or psychological? People in care homes have a raft of rights and protections.

Yes quite. The care home have a duty of care to their staff as well.

He should have had a DOLs. But perhaps worth mentioning that my dad never had one when in a home with dementia, it was always on the to do list but never happened, in over a year.

The material effect was nothing, as he definitely had dementia and me, DBro and DM all had POA and all agreed he should be there.

So if he does have dementia and that is what is far enough advanced to cause his aggression, then the DOLs would be granted if he ever got assessed.

If he doesn’t have dementia and his aggression is conscious and voluntary - then the staff do have to protect other residents- who seem broadly to have dementia from what you have said.

It is a tough position and he needs the assessment to see if he is in the right place.

he called me dozens of times last night as now he thinks someone has got it in for him downstairs in the home now he is paranoid!

That sounds a lot like dementia.

For peace for a while can you block and unblock his number as you see fit, or mute it for his calls or similar.

Just because up to now he hasn't been drunk in the home, doesn't mean the staff aren't worried about if he does come back drunk, the safety of the staff. You wont keep many staff if they start getting abused on a regular basis,.
Dont they have some duty of care to make sure your dad doesn't get plastered? So if no one is available to take him out, you (not you, them or social services) need to organise a trip out or someone to take him out.

I’m not a doctor, but I doubt he has dementia.
It sounds like the care team don’t have enough spare staff capacity to take him where he wants to go. They have worked out the best way to manage him in his room as else wise he needs 1:1 care as can’t be trusted to behave well left to his own devices.
I remember a chap at DM’s care home who had his own electric scooter and oxygen tank who insisted on chain smoking at the front door. The staff found him extremely challenging to manage. There was a compromise arrangement negotiated but he was hugely resentful of the staff, and clock watched his windows of opportunity.. Then lockdown came and I never saw him again.
OP, I would block his calls except for a convenient time once a day.
Your SW will be the best person to broker a deal and find some middle ground.

I hadn't realised i had further responses - thanks all!

so update is my dad is still calling me multiple times about the same thing,but still no diognosis, the care home emailed me this the other day:

I would like to inform you about your father's behaviour he is swearing and being abusive to staff. He is additionally trying to transfer himself without the staffs assistance which I have spoken to him abut this morning as I do not want him to fall.

that was it I mean what am I supposed to say? He does apologise to staff profusely afterwards he can't remeber any of it.

I did write back and ask how do they handle aggressive dementia / Alzheimer patients and to apply the same - not sure what I am supposed to do!

Just write back 'thank you for informing me'

I like doing that to people who send me dumb stuff. Polite but frustrating.

I mean honestly it's not as though you are responsible for his behaviour or can do anything about it.

@ThePure exactly - I feel like his mother when I get these emails, quite honestly I have enough to contend with with my own kids!

I was thinking if this might be the case too.
Very difficult situation for you, OP.

I do feel for you.

I used to work in a home where one of the residents became very aggressive towards staff and occasionally other residents. It wasn’t fair on the other residents because they have a right to live in a calm, comfortable environment and not be continually stressed by unpredictable eruptions of verbal / physical abuse towards staff, other residents or indeed themselves.

You can't “fix” your father’s behavioural issues. Could he be transferred to another care home which can cope with residents who have challenging behaviour?
best wishes xx