Nursing home - possible concern

[Memom]

I have no experience of nursing homes and maybe I expect too much.

MIL has very advanced Alzheimer's, is still mobile, shuffles along, but has no ability to do anything for herself. Doesn't know what food is if a plate is put in front of her but will eat the lot if fed. Otherwise puts it in shoes or pockets or basically anywhere other than eat it.

She is in a secure area of the home with 13 other people. There is sometimes two staff, more often one. The residents have no activities other than TV. Staff are nice but not enough of them.

Residents wander around in and out of each others rooms, move furniture around, take each others things. That kind of thing. MIL's glasses and slippers have been taken and not found.

The staffing levels concern me, all residents are high need, hence secure section of home. None communicate. Is this normal? Is this what nursing homes for people with such needs are like?

Reviews are good. CQC report is good. I feel it's lacking. MIL is always in dirty clothes. Not clothes made dirty that day. Very few showers/washes in the months she has been there. Rest of family think this is perfectly normal and it doesn't matter because she isn't bothered.

Anyone with experience of such nursing homes able to tell me if I expect too much?

People coming in and out of each others' rooms sounds familiar, but this was more my FIL's experience when he was in residential dementia home. After a stroke, he spent his last three months of life in the nursing wing but everyone there was bedbound; they did get checked every fifteen minutes or so and all the doors were propped open (apart from when doing personal care). In theory there was an activities assistant but no one really was able to engage so yes, it was just TV blasting at full volume.

The dirty clothes don't sound good and don't match my FIL's experience, although he was frequently wearing other people's clothes despite everything being labelled. Shower was probably once a week if I remember correctly but there was assistance with a quick bed-based wash on a daily basis as he was doubly incontinent. So on the personal hygiene front your expectations definitely sound reasonable. Sorry to hear your MIL is not getting her needs met.

The level of activity can vary but my DM is in a council ran care home and staffing levels are significantly higher than what you mention. They have activities every day, a monthly lunch club, catholic residents are taken to mass, church service in home once a month, and today they had an elvis impersonator in singing. Residents who have a partner are being treated to a valentines afternoon tea together this week too. My DM can be very stubborn about showering but they are brilliant at coaxing her. I’d definitely raise concerns.

Sorry to hihack your post but my mother is law sounds very similar - advanced Alzheimer’s and just moved into a home. Today the home said she might not be able to stay as she keeps on opening the fire doors. But surely if they are a home that cater for people with Alzheimer’s then that is part of it, and they need to make sure she can’t? It’s not safe! DH is going to tomorrow to talk to them.

In your situation I would be concerned about the dirty clothes - this is not proper care! But maybe I’m naive about the whole sad situation.

The home my DM was in had a ratio of roughly 1 staff member to 5 residents in its main area - I don't know anything about the nursing wing. There were at least two residents with dementia who regularly tried to go outside and would wander around the ground floor. The staff would interact with them and take them for walks or involve them in the kitchen.

DM's clothes would be dirty by the time she had had lunch - she had no movement in her hands or arms and would dribble a lot but she was always clean when we went in the morning. She was always dressed in matching clothes and one carer in particular would style her hair. Until the last week when she was in bed all the time she looked beautiful. In the last week she had a fresh nightdress every day and the day before she died she had had her hair washed - we commented on the fact that even though we all knew she was dying she was treated as a person with dignity.

There was an activities lady who would play games, hold karaoke sessions and do manicures. She would also organise special theme days such as Chinese New Year or a day at the races. And for those who weren't able to be a part of the main social area she would visit them in their rooms and if they weren't able to respond she would sit and chat and massage their hands for a while.

However if you arrived at the sort of time we usually did you would have seen the sitting room with chairs around the edge with the tv full blast and you might be searching for 10/15 minutes to find a member of staff.

What I'm trying to say is that there was a lot provided for the residents and they were entertained and involved but if you visited at the wrong time of day you would never know!

It is hard. Many alzheimer's patients aren't interested in engaging with anything and are fine with TV on in the background. And get very aggressive at the suggestion of a shower.

Ratios is also hard. My mum's care home looks like there are a couple of staff and 15 patients but actually there are two staff in the lounge with 10 and a couple of others doing in room care. And a nurse on duty.

The one that would worry me is dirty clothes if you are sure that it isn't just spilt food from that day. But even then it could be a resident wanting to wear the same clothes. We were horrified when we turned up and my dad was in his room wearing a vest and pj bottoms. So we tried to dress him and he was having none of it. The manager came in and said they had decided it wasn't worth stressing him about and that they had just turned the heating up instead.

In summary it's hard. But the one way of knowing is if the manager is happy to chat about your these things with you. If no then definitely be concerned.