Elderly Mother in Care Home with Extreme Anxiety

[Yew23]

Is anyone able to advise on this situation please?

My mother is 87 and has a history of anxiety particularly health anxiety. During the Covid lockdown her doctor remotely prescribed Sertraline. She took this for a couple of weeks and then stopped suddenly, which triggered a psychotic breakdown resulting in her being sectioned for three months. She recovered from this and resumed independent living with one carer visit a day. She has taken anti-psychotic and anxiety medication since this episode.

She was doing relatively okay but when I went to stay with her last November she was in a terrible state. Turned out she had a UTI. From that point on she became super anxious with a particular fear of going to bed in case she dies in her sleep. I got back in touch with Adult Mental Health Elderly Care. They tweaked her medication but from that point on she could not be left by herself because of extreme anxiety. My brother and I both live four hours away and were not able to stay with her on a long term basis. So, with her agreement she went into a care home on a self-funded basis at the end of December.

She seemed okay there up until Easter but unfortunately her extreme anxiety particularly about going to bed has resurfaced. It obsesses her from about lunchtime onwards. She is literally a quivering wreck. The home has been 'managing' this by giving her a sedative before bed. However, she is regularly waking in the early hours thinking it's time to get up and getting very anxious. I have pushed for the home to involve the Intensive Care Liaison Service, which attends to mental health cases within care home settings. An appointment has been set for mid June, which I'll attend with her.

Although the staff at the home are kind she's pretty isolated; a combination of her declining to join in activities, and them being understaffed and not fully understanding the intensity of her anxiety. My intention is to move her to a local care home near me when my husband and I move house but that is at least three months away.

My question is whether a standard care home is the right place for her, or whether there are other specialist homes that are geared to dealing with people such as her? If so, what would be the process for getting her into such a facility?

Is there anything else I could be doing at this stage? I've met with the Care Home Manager twice to express my concerns that her anxiety is not being appropriately managed but nothing has really changed.

I am in the same situation as you. I haven't heard of the intensive care liaison service. My DM is under the mental health team from the hospital. She is also on sertraline and anti phychotic meds. She a little better but still get anxious at times. She has good and bad days at the moment but I hate seeing her unhappy. Before this she was very happy at the home. This started after having a UTI and a couple of TIAs. She does have a history of metal health problems and has also been sectioned for 3 months a few years ago

It sounds like she needs to be in a nursing home where there is a registered nurse who can administer a wider range of drugs, including 'as necessary' strong drugs.

My DM care home has a registered nurse they just can't hand out any medication they like it still has to be approved by a Dr or hospital by prescription.

Iloveeverycat sorry it's the Intensive Community Liaison Service not Care. Maybe it's a regional thing?

Sorry to hear you're going through similar with your mum. Mine needs constant reassurance and I really mean constant. So upsetting for her and for my brother and me.

Is she was sectioned for 3 months was some of the time under a section 3?

If so she should be eligible for funded section 117 aftercare. I agree that a review by a mental health team for older people or care home liaison service would be recommended, and a move to a nursing home where the qualified staff can administer the prn (as required, not routinely given) medication when indicated.

Thank you for replying Muchtoomuchtodo. She was detained initially under a Section 2 for 28 days for assessment and then transferred onto a Section 3.
Does it matter how long ago she was sectioned?

I think a move to a nursing home sounds better for her condition, which is not being appropriately managed currently.

Sorry, I didn't explain clearly. Yes, everything still has to be prescribed by a registered prescriber whether that is Dr, Hospital, District Nurse etc but there are drugs that once prescribed can only be administered by a nurse and instructions that require a nurses decision making skills can be left. With my Dad he was prescribed an anti-psychotic and the nurse was able to amend these dose within the scope of Psychiatrics instructions. Had he been in a care home he would have been admitted to the local Psychiatric Hospital,

I just wondered if she is able to verbalise what her anxiety is about? Is it that she’ll suffer as she dies, is it worry about what comes after death or intense sadness at leaving you all? There might be some ways to address it alongside meds and appropriate levels of support?

I used to work in a hospice and the following stories stick in my mind about patients who were scared. I remember working with a chap who’d served in WW2 and I think had done things he shouldn’t, he had a faith and was petrified of meeting God. A chaplain helped - not fully resolved at all but gave him some peace. Another patient was terrified she’d feel like she was suffocating during dying and again the nursing staff were able to reassure her about what to expect and how they could help if she did feel like that . Another patient was just so sad to be leaving her family but chatting with her about them and helping her write some cards for after she had died helped a bit.

i realise it isn’t simple and she will need meds and 1:1 support but I just wondered if these aspects had been explored alongside?

Many thanks for your insightful reply PandyMoanyMum. I genuinely don't know what her anxiety about dying in her sleep really stems from. Sadly she's too anxious for us to broach it with her. Her father died very suddenly when she was five and she has frequently said she thinks that's why she's so anxious.

I’m pretty sure that if you’ve ever been detained under section 3, you’re eligible for section 117 aftercare.

Have a read here www.mind.org.uk/information-support/legal-rights/leaving-hospital/section-117-aftercare/

That's really helpful Muchtoomuchtodo. Thank you.