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.

I see.

But he won't always be in the same state of mind, OP. That one nurse may be able to care for him on her own, but at other times he may be more difficult to handle.

By all means question the situation, and get some answers, but you seem keen to blame the care staff and their competence. Rather than considering that dementia is an ever-changing condition, and that your father was alreay agitated at times before he left his own home.

The trouble is it can be very challenging to discuss this type of things with families. Some just don’t want to know others can be combative about it.

It doesn’t surprise me at all that sometimes he is ok and others he isn’t. That is incredibly common in dementia patients. Often there seems little rhyme or reason as to why one minute they are happy and content and the next they are incredibly combative and distressed. It’s a terribly cruel illness.

For sure discuss it with the home. Find out about what’s happening. What is happening should be being documented thoroughly. Care plans are constantly evolving and sometimes are a little behind reality as sometimes it takes a bit of trial and error to find out what works.

I have worked in dementia care for 40 plus years. Three care staff are absolutely neccessary with some patients, but, theres a big difference between 3 and 4 in this scenario. Four is overkill. Extremely overwhelming and scary for the patient, 5 bodies in an often fairly small space, 5 voices, 4 different ways of doing things. It smacks of restraint to me, not to mention that there would undoubtedly be others in need while 4 staff are in a room at the same time. Two staff to physically support, distract, try to calm and soothe, hold patients hands to keep them out of the way. One to wash.

How am I keen to blame the care staff? I asked if anyone else has had this experience. So I don’t agree I am keen to blame the care staff.

Thanks for this perspective @BettyButterBum

why are 4 all speaking? if each one of the 4 has a different job, why are there 4 different ways of doing things if they are all doing something different?

After far too much experience of dementia, I don’t think embarrassment is often a cause of dementia sufferers kicking off.

They wouldn't have 4 staff there unless it was necessary,I'd just leave it to them to deal with it. Sorry your dad is going through this.

OP I do sympathise with your circumstances and I accept that not every home or healthcare setting is a good one. But you do seem to be more prepared to acknowledge posters agreeing with you than the vast majority who are telling you that this is normal.

FWIW I’m really very sorry for your poor Dad, and for you all. It can be a horrible way for someone to end their days.

Actually I don’t think anyone has said 4 carers is normal. Some have said 3 might be needed in extreme circumstances.

There are also a lot of posters who clearly don’t have any direct experience of caring with someone with dementia or people saying oh people with dementia can be aggressive/aggitated/difficult as if I don’t know that and haven’t been helping to care for my dad until very recently. So I’m not really thinking those posters are bringing much value I am more interested what people who are actually carers / work in care homes etc have to say.

no one has replied saying oh 4 carers is absolutely standard we do that all the time which is interesting in itself. That’s all I was trying to get a feel for. As I’ve said I have never been through this experience before so don’t know what is normal and what is not. It’s quite difficult you get very little support and really have to navigate everything yourself it’s been incredibly stressful.

I won’t be leaving them to it as some has suggested I will speak up for my dad (if required - not just to be difficult) and support him like he has always supported me. But each to their own.

Well, I am speaking as someone who has been a carer and as someone whose parent definitely needed multiple people changing them and they are a tiny person. Ultimately you do have to let them get on with changing people how they see fit.

Any good care setting will be happy to explain what they do and why, and they should be explaining how they do what is best for your dad, including his dignity.

They should also be understanding that it is hard for relatives and that relatives will have questions concerning their loved ones.

If you wanted, you could ask to see his care plan and how the approaches they use have been decided and risk assessed.

Of course, unfortunately bad care and poorly run settings do exist. You might feel they don't answer your questions with your dads best interests at the centre, or that they are defensive or unclear in their explanations to you, or if they can't explain exactly what they do and why. This could indicate that the setting is not providing your dad with good care.

I hope you are able to get some clarity soon.

@IDontLikeMondays88 I worked in social care for 10 years. Some but not many residents required 3 carers for personal care. For the very extreme cases of stress and distress a low dose of Lorazepam was administered 30 minutes prior to assisting with personal care. This usually meant only 2 carers were needed. I agree that 4 carers is over the top.

@IDontLikeMondays88Id go and witness what’s happening before you can judge. It seems a bit mean to complain. Would you prefer to keep caring for your dad? If not, I would check out what he’s really like and see how they are managing.

I have not complained though! I have asked mumsnet if this is the norm before saying anything.

OP it’s easy to see you very much love your dad , you describe him as late stage dementia but say up until recently he could manage his own personal care .. That does not sound like late stage dementia to me .. Late stage is very redundant of being able to do anything for themselves or be able to have the capability to feel embarrassment.. Can you tell us what sort of dementia he has ? That may help us advise .. Speak to the care home manager ask what is going on and why they think it’s safer he has 4 staff to manage him .. If you are not happy move him .

Because they physically fight them off. My gran had no idea that she needed personal care by a certain point so of course to her when they came to do it they were just strangers forcing her to remove her clothes. Even if they explained she’d forget part way through. Terrifying for her! So she fought and hit and bit and screamed. They often had 2 people to her - a 6st frail woman. If she was a man and the carers women I can see they’d need more people to assist.

He’s not at home anymore and dementia is a progressive disease… he is getting worse. He will get worse. Beyond what you have seen so far. It’s horrific.

I’m so sorry you and your family are going through it. But he will get worse and people often get worse when they go into a home because the people and surroundings are so unfamiliar.

I didn’t say he could manage his own personal care I said when he was cared for at home by me and my mum he had a shower every day and it didn’t take 4 people to wipe his bum. He still wanted to go for a shower albeit with prompting and help. He needed assistance with every single task at home. He can no longer make any conversation (he can say the odd word) and is incontinent.

I don’t think it’s right to say dementia patients can’t feel embarrassed. If they weren’t embarrassed or uncomfortable with being assisted with toileting then whey it is a common thing that this is something that causes agitation.

not being able to care for him ourselves anyone more isn’t a reason not to keep and eye on things at the nursing home. I know what he’s like I’ve been with him and involved in his care.

he has mixed dementia

Lose the anger we are trying to help ..

@IDontLikeMondays88 I would ask why your dad requires 4 carers and for a psychiatric assessment. The psychiatrist may think it necessary to prescribed PRN medication to reduce stress and distress. They don't do this lightly and will ask for a full account of how personal care is carried out and will offer advice on how best to do it.

Absolutely it will depend on the staff. Some people just have that natural calming ability and work wonders with agitated residents. Plus residents will learn who their favourite staff are (even with dementia, they just know), and will also take a disliking to others. Sometimes they take a disliking because of their approach, or other times it can be due to confusion, like they remind them of someone negative in their lives etc.
Hopefully once he's been there a bit longer, the staff will work out who has the magic touch, and fingers crossed it's a full time staff member! Then they would usually be the one doing most of the showering and changing.

Also a PP touched on "4 voices in the room"... definitely there should only be one staff talking, even if multiple staff are in attendance. So if you do speak to the home about this issue, I would ask if this is happening; they need to designate one staff to be "the talker". It will help minimise the overwhelm and overstimulation of the situation.

Oh my goodness... of course they feel embarrassment! What a terribly dehumanising thing to say.