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.

Ive worked with dementia and at no time have we needed four staff to do personal care with a resident. If dad is uncooperative, having four members of staff trying to carry out personal care would only add to his distress, causing him to become unmanageable. I would speak to the manager and ask them why they needed to do this and how they did it. Is this out of character for your dad, he might be more challenging if hes in any pain or frightened.The staff may need more training in dementia as restraint is not a practice used in any care homes! A little compassion and patience is sometimes all that is needed but if this is a regular occurrence, you may need to look for another placement as this home may not be meeting dads needs.

This seems like a very kind, compassionate and helpful post, from someone who knows what they are talking about!

It seems like two things could be happening:

A) dad's levels of distress and inability to cooperate have escalated suddenly and drastically - someone needs to look at why.
B) the care is inappropriate for his needs. Sadly this does sometimes happen.

Either way, as a loving daughter it is entirely right that you are asking the question!

Unfortunately dementia can get worse very quickly especially if the person has been moved to a new home. He may be in a different state of mind now than a month ago. So sorry.

You should ask the staff to explain the protocol and what they are all doing at the time to ease your concerns.

It might be something such as a person each side who shouldn't ever need to restrain, but are there as a safety measure to prevent your dad striking out towards the person/s attending to his care should he get confused.

Maybe he's violent, sexually inappropriate, very overweight and difficult to keep clean etc.

Who knows but carers don't hang around in toilets dealing with someones faecal matter for the fun of it.

My MIL had the whole care home thinking she was being murdered with her screaming and violent outbursts everytime they had to shower her after one of her poonami incidents that no amount of pads could contain. (Untreated cancer was playing havock on her insides).

Everyone understands that he is ill amd isn’t doing on purpose.

If he was left covered in poo you’d have something to say about that.

If they deem 4 staff necessary for theirs and his safety then so be it. If you don’t like it, speak to them, listen to their reasoning, explain yours and see what the options are.

I think the first PP has it. Distraction. And extra people to remove things stained with body fluids (poo!) so it doesn't go everywhere.

In dementia, the person may not understand what's going on. This gets worse when they move to a different situation, like from home to care home. So agitation can get worse for a while, until they settle.

It could be that this is why he's more upset than at home. He's in an environment he can't make sense of, due to his brain not working as well as it used to. It's possible that, once he is more settled, he can receive personal care with fewer carers.

It's important to have enough people present to distract, to prevent injury to the carers and patient, if the person is very agitated. Not doing personal care can lead to skin problems and infections so it's really important that they try to do it.

I have a lot of experience of this both professionally and with several relatives and understand how difficult this is for everyone.

🌺

As I have repeatedly said I am not saying they are doing it for fun I just don’t understand what exactly they are doing and am concerned this is making it worse.

my Dad is slim thanks. Not that being overweight should be an excuse for manhandling someone.

really people with dementia are completely dehumanised as is apparent from this thread. I think I will ask mumsnet to remove its

Go in and have a chat. Ask why they are using 4 members of staff. He should have a behaviour support plan written up if he is displaying behaviour. If it's to the extent that they are physically restraining him this must be written up in his behaviour support plan and risk assessed. Ask what training the staff receive- it will be accredited training.

Do you have power of attorney for health and welfare?

its more for the staffs safety your just looking from your dads point of view
the strength and agitated person is unbelievable even though you say he’s slim
a normal change would take 2

I think your first port of call is to speak to the staff/manager about your concerns and to explain. It may not be how you are picturing.

For example, when I have worked in a situation where four people were involved in supporting a personal care task for an individual: One member of staff was encouraging, reassuring and talking to the client. Another member of staff was doing the personal care task as quickly and smoothly as possible. And two further staff members were there for safety reasons and were to act invisible and not distract the individual. We would slip in, stand in our positions at the side of the individual while the task was being done, and slip back out again.

A good care setting should be able to explain and reassure to you how they are supporting your dad and maintaining his dignity as much as possible at the same time.

If you are not happy with their response you could then take it further.

Yes this. I would ask to meet with the manager and explain your concerns so they can explain to you exactly what the 4 carers are doing. You can also explain that you feel that the more 'hands off' the better in terms of how he would react.

The difficulty is that he may become aggressive or combative with the staff and they will have to decide in his best interests to clean him up so he doesn't get skin damage and infections from being left soiled. He may be more agitated when you are not there simply because he feels more calm when you or your mum are there as you are familiar faces.

Hope you can get some clarity from the care home soon.

An example of how you can relatively easily neee four:

1. On distraction and engagement duty - chat and redirection.
2. On hand holding / hand redirection duty. Not necessarily restraint, but similar to what you do with a young child with hands wandering unhelpfully. You take the hand and redirect it.
3. On actually cleaning up duty. Probably on knees.
4. As the supply person for the cleaning person, so passing clean wipes, taking dirty ones etc.

@IDontLikeMondays88 hopefully you will read this before it gets taken down but I suggest contacting the Admiral Nursing helpline and taking a look at the Dementia Forum (Alzheimers Society, I think). You will find lots of people in similar boats, and able to advise if you aren't happy with suggestions here.

Edited to add link: https://forum.alzheimers.org.uk/

I don’t know if someone else has mentioned the terminology here, but it might be better to use the term safe holding as opposed to restraint. I’ve been in situations where I’ve had to provide personal care to a patient and that took three of us - two to interlock arms on either side (gently) with the patient, and one to clean. That was for a very small, very frail, lady who also had to be masked as she was prone to spitting. It’s not restraint in the sense of someone pinning them down, more holding them in such a way as to ensure they’re not hurting themselves or others.

2 for manual handling. One for distraction and one in case he hits out/tries to get his hands in poo etc or needs to pass things to the 2 doing the handling

It would be better if you asked to speak to the Home manager to explain this and ask for a copy of the care plan and risk assessment rather than people on Mumsnet who don’t know the situation. People with dementia can be occassionally very resistive to help with personal care. If someone is hitting out with arms, legs and trying to head butt or bite, three staff may hold the person and one person do the care, explaining and reassurance. Restraint (holding) is allowed, as long as it is the least restrictive way of meeting the need, care planned and carried out by staff who are trained. It should also be legally authorised under the Deprivation of Liberty Safeguards which provides external scrutiny. It’s distressing to people to be looked after by three or four staff and very expensive to look after people with four carers and is never the first resort, and you are right to ask the Home if opportunities arise or if they can create opportunities for fewer staff.

I've worked in dementia care and usually we've only had 4 people when the 4th has been the nurse checking dressings or skin integrity etc, on a resident who needed 2 for manual handling and the 3rd person for clean up etc, but I have known it, for the safety of the person and the care staff. It was while showering and two were either side as a 'buffer' diverting attention away (we used chocolate - his favourite!) while one washed and the other passed soap, shampoo etc so everything could be done as quickly as possible - for the persons sake, it distressed them, but was necessary, and the quicker it was done, the less distress caused. The carers either side were the only ones who spoke, to lessen the overwhelm of several people talking at once, and as pp says we linked arms and were effectively there to take the brunt of the physical response, being pushed against at closed quarters rather than punched full force, so while they were shoving at one carer the other one is offering a chocolate to distract. Someone throwing limbs about also becomes unsteady, so you were also there to support balance and prevent them falling. All this was documented and discussed with family and GP and mental health practitioner, because ultimately it was that, sedation or no personal hygiene administered. It was the least problematic method.

I think you need to know the roles these 4 carers are taking, 4 would potentially be overwhelming and intimidating but may be necessary for everyone's safety.

Unfortunately while as a carer I totally understand that the violence is not the person's fault, that doesn't lessen any resulting injury, nor does it hurt less. I've had my fingers broken from being twisted, more bruising than I could ever count and have scars on my arms where I stood between two residents, one trying to attack the other - this is the reality of dementia, and I still have problems with my fingers now, because of the mechanism of injury. So consideration does need to be made towards the safety of the staff too.

Unfortunately the condition often worsens quickly, especially with changes of home etc.

It’s very sad for all of you, speak to the managers but remember the staff are doing a very hard job for minimum wage

I’m surprised they have four staff available

Restraining someone with medication is just as bad as restraining them physically!

I have never worked in a dementia home setting and it was a while ago but you have to restrain patients sometimes for your own and also their safety. Nobody wants to have to do it and it’s a last resort but necessary.

When people have Adrenalin running through their bodies even the smallest people can gain what is a huge amount of strength. People who have cognitive issues especially when they really don’t have any level of understanding are often very scared. You can reassure and try eveythjng but sometimes they just sadly cannot understand.

Morally we have to ask ourselves about treatments meted out to people who cannot consent.

MIL went into hospital for 2 weeks and FIL was left at home on his own, the deterioration was frightening. FIL went from showering daily to resisting any suggestion of taking care of personal hygiene.
Later, when he went into a care home he went further downhill. Like you dad, he hated going to the toilet with staff and become very agitated, he is now bed bound and largely immobile so it has become easily for the staff.
People with dementia don't cope well with a change to routine.
Speak to the staff for reassurance.

They are going to need a large toilet room to fit 5 people (4carers + your dad) in