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.

This thread is so depressing, the amount of people insinuating that this is appropriate. The reluctance to voice it explicitly on an anonymous forum speaks volumes they do actually know that it's wrong.

That seems very strange. FOUR? I'd have a chat with the nurse in charge to try to work out what's going on. I've not come across that before (both my parents were in NHs, both could be challenging at times)

I didn't say if he doesn't have marks he isn't being restrained.
I also didn't say holding his hand is not restraint.
And no I'm not a care worker.
I'm not going to argue the exact specifics of this situation because we are not there, and as we know, caring for dementia residents requires a very special kind of calming, empathetic, and flexible set of skills that have to be tweaked to each person and their need and responses at that time.

You absolutely made a distinction between forms of restraint in a way that minimised forms of physical restraint.

When you say "dementia residents", I assume you mean "people who have dementia"? This thread is a shining example of why the way you describe people matters.

I have worked in elderly mental healthcare for many years. Needing 4 people is rare. Sometimes 3 people, especially when someone is mobile- so someone holding hands on each side and then someone doing the personal care (I would expect this to be communicated to family it was happening). It is necessary at times to do this level of restraint, but usually it can be reduced over time when trust is gained. That cannot always happen though, especially if the person has frontal lobe damage which can affect behaviour.

It should be clearly documented about personal care and if restraint is used a MCA should be done and the care done in the least restrictive manner (so not a bath every day if the person is really distressed and aggressive unless medically needed, but incontinence care will need to be done in a timely manner).

Ah forget it. It's late here and I'm exhausted and clearly not explaining myself well.
Don't panic, I am vehemently against restraining residents and I am their number 1 advocate where I am.
When I say "hold hands", I mean we hold each others hands, and they are usually happy to continue doing that because I give really good hand rubs and pats and reassuring tone of voice, that works 99% of the time.

My elderly grandmother has dementia (advanced) and I've personally seen 4 people supporting her when changing her/toileting.
To be blunt about it, she's incontinent in both ways and needs changing throughout the day. She has no understanding of why she's being changed and no awareness of if she's dirty or not. She has been known to smear waste not understanding what it is. She's also on a liquid/soft diet as she's forgetten how to chew her food, which obviously doesn't help. It is incredibly upsetting and an awful situation for her to be in.
She is very frail, a significant fall risk unable to stand unaided - but doesn't remember she has no balance/strength in her legs. She regularly tries to stand and then falls, so she is now on round the clock watch even when not being changed. She can not be left alone (and her care home fees as a result are staggering).
When four staff support her for changing trips it is a few to support her body in a safe way, and another two to change her/clean her/dispose of the used materials before she touches them.
She doesn't need this support because she's combative. She needs it because she is very vulnerable, very elderly and very fragile.
I wish dementia on no one. It is horrendous.

There will be 2 actually cleaning him and putting on a replacement pad and the other distracting him, holding hands potentially if he’s putting them in the way and talking to him. My now late ex relative had 3 members of staff for all personal care as a 5ft1 frail woman with surprising strength

This sounds really hard op im sorry. Haing around the home for a few hours so you can see how the care is being delivered.nothing like first hand observation, even if your the other side of the bathroom door.

I fully understood that this was what you meant when I made each of my comments.

I would ask them to describe what everyone is doing. You’re correct having four people there could be contributing to his distress.

I dropped my mum back to her care home after a medical appointment and had my car stopped in the driveway so she didn’t have to walk too far. After I’d taken her inside I went to move the car and a lady with dementia ran out the door as I left. She had a walker but she was quick! Four care workers came running after her and then they had a confrontation right in front of my car. They were surrounding her and someone was trying to turn the walker around and someone else was holding her arm. She was getting agitated and slapping their hands away and they were being more and more insistent. Then another worker arrived, told all the others to go back inside and with a big smile said ‘hi Gladys do you want to go for a walk?’ The lady was instantly happy and they did a lap of the circular driveway and back inside without a peep. Honestly it was a master class and I hope the other staff reflected on what they can do better next time.

Could you not ask them,instead of inviting people to just guess?

If this was the case, then you shouldn't have been allowed to be present to witness the indignity of this. If it is something true and legal it will have had to have been a one off done by nursing care until your grandmother would have had her medication reviewed to allow care to be given without distrssing her to the level stated.

You have said that he could shower himself at hom, but he is now in a care home. In my experience, the change from one place to another can have a huge impact on someone's ability to do something. My dad could make himself tea at home. Once he had moved he would stand and stare at exactly the same kettle and cups, but could no longer use them to make tea.

You say four people might be restraining him, which is an upsetting thought, but if he is flailing both arms, trying to push them away, then one person could be holding a hand each.

You say he is fully mobile and can stand, so the third person might be in front of him, to stop him from running forwards or from kicking out. That leaves one person to help him to wipe or wash.

It is entirely normal for someone who is frightened and confused to lash out or kick out or to try and push their way past to get away. It used to take me up to three hours to wash and dress my mum, who was not large, but would not sit or help me to help her. I knew she didn't want help with washing and dressing, but she also didn't want broken skin, soiled underwear, BO or to walk around half dressed. In the care home they did change her more quickly with 2 or 3 of them - they just didn't have 3 hours each morning for one patient.

You don't say how long he has been there. It may settle as he gets more used to it. Or if he finds a career he responds to well.

Hang on in there.

I don't really understand why you think waiting for someone to be too tired to put up a fight is better than keeping then calm by holding their hand?

to the people saying just ask the care home, yes but I have no experience of having a parent in a care home so I was merely asking mumsnet is this the norm/ what is others experiences. I thought that is what this forum was for. The care home I’m sure are likely to say it’s fine/necessary as he is so difficult.

to the person who asked if I’d seem him - yes multiple times. My mum is also there 4/5 times a week. We do know how difficult he is at times we have been caring for him without any involvement from anyone else up until very recently. My mum has changed him a few times at the home and he has accepted that. Appreciate she is his wife though so slightly different.

Because one gains consent and one is by physical force

And it's about what is legal and within the permissible guidelines set by the regulator

And also 1 method is by 1-2 carers and the other is by FOUR

Honestly I'm bowing out because I'm getting so enraged by the shit poor care standards and abuse justified on this thread.

Op best of luck. Have an open and honest discussion with them so a transparent and apparent solution can be found. Despite my ire on this thread, these things can usually solved simply and easily with a meeting or two with managers.

Thank you @OldCrohn for your input.

just makes you realise there is such a stigma around dementia - second class citizens really.

I feel some of the responses are just quite lacking in empathy - me and my mum are only trying to do right by my Dad and make sure he is looked after properly.

If it's not appropriate for someone to do it on you with a broken arm, it's not appropriate for them to do it on your dad x

Care homes won't be overstaffing through choice in my experience. We had one relative who needed this level of support. 2 people to manage the personal care, plus 2 to swap in and out when the relative got agitated with one of the original two.

Having said that there is usually a clear protocol and written evidence of what support is needed. If you are concerned about his wellbeing I would discuss with your local safeguarding team and ask for a DoLS referral. There are strict legal frameworks around this, and the presumption should always be one of minimal intervention.

Edited to add: unfortunately loved ones often deteriorate when they move into care. Whatever is happening it sounds like he needs a proper review by social care and also maybe his GP and an older people's MH team to see if there are any other options. In our relatives case they have a policy of leaving them to quieten down and returning later, which doesn't stop the issue entirely but often means they can manage personal care with less distress.

Good luck it is hard

Hi OP, so sorry about some of these responses - you are of course going to worry if something is going on with your beloved dad that you don't understand.

My dad has dementia too, and mom and I cared for him at home for 10 years until he passed in January. I too felt very protective of him, as he was unable to advocate for himself in any way. We accessed outside care at the very end - and he had some hospital stays - and it was by no means true that the care he receievd from others was always flawless and ideally suited to his needs.

You are quite right to be vigilant and curious about this.

Is your father continent? How was toileting managed at home? I'd be very worried if a man who, until recently, could handle most aspects of toileting and other self care largely independently, suddenly needed this amount of intervention. I'd be asking questions too.

Also, I'd try to arrange to be there when it happens. Or maybe your mom should, to help preserve your dad's dignity?

Good luck, hope you get to the bottom of it.

They will not be using 4 members of staff if it wasn’t necessary. We have a lady at my place who is extremely agitated and aggressive.. It’s no joke just to get a night dress on her and she’s super quick with her hands . For us she’s be assessed for medications to sedate her as it’s just to much and everyone herself included is getting injured.

The care home should explain to you why "its fine" and show you the risk assessment. None of us on here can tell you whether or not its an acceptable or needful way to care for a particular person. I do understand that it can be an intimidating thought to approach the care home in this way but if they are a good one they will understand and be happy to discuss it. Is a social worker still involved? Might you find it easier to approach them?