Why would four staff be needed for personal care in dementia?

[IDontLikeMondays88]

Dad has late stage dementia. We are being told he is so agitated when receiving personal care ie toileting that he is needing 4 members of staff attending to him to do this.

can anyone explain why 4 staff members would be necessary? I just don’t get it unless they are restraining him which I assume they shouldn’t be doing.

from my point of view I just am thinking well no wonder he is agitated with there are 4 of them at him.

A number of possibilities.

people with dementia can regress and may not understand that the staff are trying to clean them up. They simply know that other adults are trying to touch their private parts and there is a strong taboo against that which is usually taught very early and very strongly.

some people with dementia were abused as children and can regress to those memories.

both can mean that the person becomes violent when carers try to clean them up however there is a responsibility not to leave them bluntly sitting in their own shit.

distraction is generally the way to go but this requires a lot of staff.

Yeah I think he is embarrassed by the whole thing but not sure 4 carers being at him will make him less embarrassed.

just don’t really understand what 4 of them would be doing.

Imagine trying to change the nappy on a three year old who is adult sized.

you can talk to them while you are doing it. That takes their attention away from what is actually happening.

the four staff are probably at least one there to talk to him and distract him verbally, one or two to change him and the fourth to maybe make physical contact by holding his hand or similar.

How big is your father? It could well be a safery issue if he is becoming agitated and aggressive ie hitting, pinching etc maybe its sk two can hold has hands/redirect his hands so he doesnt hurt staff?

4 does seem a lot though.

Can you go snd see for yourself how agitated he gets

The rule in sen school I work is less staff as its more dignified for the child. Generally we manage with 1 member of staff physically there and always another member of staff in earshot/close by for safeguarding of child and adult.

Dementia is such a cruel disease and can be incredibly hard.

Do you know what they wre doing to support his anxiety, to look at why he is so agitated.

Also I can say feom experience it can be quite tricky with men and hairy scrotum etc to ensure cleanliness ie with a messy poo. Are they needing to showr gim or use a bidet type device. Lots of options for ensuring cleanliness in a dignified way but it is not always of jobs. I worked in a residential home for the elderly.

You dont say if you father is continent, just needing support to go toilet or if he has issues snd needs pads etc

I would be inclined to try snd support yourself and see what is going on. Are you able to visit in person regularly do you know what they mean by agitated? Details of the behsviour woukd help.

But you are right to be concerned sadly not all care facilities proivide the best care, staff are often poorly trained and paid.

I used to work in elderly care, and believe me if someone is resisting it's quite frightening for them AND the care staff. Those numbers are purely for everyone's safety including your Dads, and isn't done lightly. I looked after a very frail 8 stone man with very advanced dementia who was nearly 6 foot tall and believe me, when he went for you, it hurt. His one to one care had to go to 3 of us.

I worked in a care home a long time ago. We'd need two carers for a straighforward poo.

Some residents - and I was a student who had no training so I didn't get used for this - would get very agitated even outside of change times and I heard of one lady who would try and smear poo on the walls which is obviously really unpleasant for everyone. But generally, the more the resident moves the more difficult it is to clean up efficiently and quickly.

I dont think the care home would be overstaffing on this - if it's really bothering you then speak to them to try and understand what's happening, but be aware the details are probably quite grim.

Ask them, nobody here can explain what happens during those periods of time but if you talk to the care home they will be able to detail the specifics. He isn’t agitated due to having 4 carers present though, he has that level of care due to his needs, one of which is due to being reluctant and agitated.

Our relative (with dementia) did go through a very aggressive period. Before dementia hit they were a mild mannered pleasant person
It did take three or four to shower them during that time because they tried to escape, and did break away and escape once.
For a while they were medicated, and it stopped. The staff need to keep the residents as fresh and as possible. There isn't really any alternative, if they refuse to bath or shower.

So I think he would like to be able to eg wipe his bum himself but can no longer do this. So I get why he is agitated and that he is very agitated but what I am not getting is why it is 4 staff and not 2 for example.

4 staff is surely just distressing him even more.

He lived at home until recently and was very agitated there at times too but did still shower and was clean etc. he wanted to go for a shower it was part of his morning routine.

Now being told he is often refusing to shower and that to wipe his bum is taking 4 people.

Depends a lot on his mobility and agitation.

Two to help him stand, one to manage his hands if he's trying to hit people, one for his bottom.

My dad had Alzheimer’s. He needed 3 people to restrain him once. 4 does not seem excessive

If you're concerned OP, I would ask to see his positive behaviour support plan. If there are issues or concerns regarding distressed behaviour resulting in a need for four staff, I'd expect there to be a PBSP in place. Additionally, I'd expect them to be able to explain how they've assessed that four staff isn't the cause of (or contributing to) his distress. It may well be that they have done all of this and they can evidence that four staff are necessary, but I'd want to be clear that they aren't going in mob-handed for expediency

And if they are restraining him, I'd want to see the protocol for that alongside the PBSP that they use to identify escalations in his distressed behaviour and interventions they can use

@cadburyegg as far as I’m aware they are not allowed to restrain patients

I can assure you they're not doing it for fun. I work in healthcare (nursing) and it can be extremely challenging with some EMI patients.

I would ask to see his care plan, the number of carers should be written in that

My dad was violent in the later stages of his Alzheimer’s and before he went into a home, he got lost and then was arrested for assaulting a police officer. Restraining patients is sometimes necessary I can assure you.

He is mobile btw he doesn’t need help to stand

i get that it is difficult and they aren’t doing it for fun. He lived at home until very recently we saw first hand how difficult he could be.

however he still showered every day at home willingly and there wasn’t 4 people wiping up. So I do wonder if the approach being taken isn’t helping.

Because he’s probably physically violent.

You really do need to ask the home, OP, but they will only be doing this because it is necessary for the safety of your parent and the staff, and to ensure that he is cleaned properly.

My DF was unable to stand by the time he went into the nursing home - very advanced Alzheimer’s - and there were and still are times when it takes more than 2 staff to attend to him as in his agitation he would lash out and bite.

@cadburyegg I know! I have been dealing with my dad!!! I am not completely naive.

however to restrain him there should be a protocol set out which as far as I’m aware there isn’t.

I'd actually disagree with the assumption that staff aren't doing it for fun. I've been involved in adult protection investigations into inappropriate restraint and I can tell you that some people do it for convenience, some people do it out of laziness, some people do it because they've not been afforded the time or training to implement earlier intervention for escalating behaviour, and some enjoy the power. You only have to look at the decisions of governing bodies to issue warnings or rescind registrations to see the evidence.

Looking at some of the language on this thread, it's easy to see how people who exhibit distressed behaviour which challenges staff are dehumanised in the eyes of staff and just seen as a "violent EMI patient" who's not an actual human with fear and distress rooted in a lack of understanding and perceived threat.

OP, I hope you manage to get some reassurance.

Thank you @WorstPaceScenario i have actually just been thinking how awful some of the responses are here. He is ill, he isn’t deliberately being difficult.

Nobody said it was deliberate, but it’s just the fact of it. Him not meaning it doesn’t mean the staff can compromise on their safety