If a stroke is suspected in a person in a nursing home what action should be taken

[KatyMac]

Please

My Uncle (with dementia) who is in a home is suspected a of having a stroke last Thursday, the home have apparently arranged blood tests next Monday

Is that time scale appropriate?

Do you mean that the carers suspected a stroke, or that they called out paramedics and a medical person has said they suspect a stroke ?

The carers suspected a stoke, and told me some tests had been arranged (last Friday)

I rang today & was told the tests weren't booked yet

I made a bit of a fuss & got a phone call 10 mins later saying they had been booked in for Monday

They should have dialled 999!

What were his symptoms,

what are his current symptoms,

what made them suspect this but not call an ambulance?

No, it should be immediate. My mother had a stroke on Sunday and called 111 who told her to go straight to A&E. Blood tests were done that night. MRI the following day.

When someone with dementia enters a nursing home, there are generally conversations with the family about what action they want the home to take in various situations like this, especially if any of the family members have health POA. That care plan will be changed after further discussion, where necessary.

I don't know whether you were involved in any of that discussions, or if not, who was. But it might well be that the care home was following guidance.

My mum in law was in great distress when she was taken to hospital. It was the absolute worst time of her dementia journey, and it was relatively early on. We never saw her do distressed before or afterwards. So in our discussions with the care home we asked not to have her admitted to hospital should she be taken ill.

It will all depend on the state of health that your uncle is in and what may have been agreed in advance.

When my mother was in a care home with advanced dementia, it was agreed we would keep her out of hospital as far as possible, and that we would not treat illnesses etc. So, when she had a chest infection, she did not have antibiotics. She did not have any regular flu or Covid jabs. We very much hoped each illness would kill her as her suffering and state of dementia was utterly hellish.

I’d expect a 999 call. It would be incredibly neglectful to supervise someone having a stroke and not call for medicinal help immediately. It’s an emergency, no matter how old or otherwise unwell you are.

A stroke is usually a medical emergency and the usual thing to do would be to call 999 or get to A&E straight away.
However if a person has dementia and lives in a care home there is usually some advance planning about which medical interventions would be beneficial and which would be futile. For patients who very frail and nearing the end of life it is sometimes agreed that hospital care would not be of benefit to the patient. The family are usually involved in these discussions.

I think it really depends on what decisions he and/or his next of kin and gp have made previously regarding end of life care with regard to level of intervention he might want in a medical situation like this. Is there a chance a decision has been made that he would refuse active treatment in this circumstance? I would certainly be planning ahead to that potential type of scenario if I had dementia. Can you ask the care home what his care plan says?

I phoned the gp to ask about timescales/correct steps etc

And was reassured they knew all about it and it was appropriate

Based on the "no aggressive treatment" things which had been discussed when he was admitted to the home

I feel much more confident about it - they are talking about tia's I think which his dad used to have

Maybe it’s a suspected TIA rather than a stroke ?

Surely someone (uncle himself if he previously had capacity, or his POAs, family) have already put plans in place for this sort of thing? With mil, she won't be going to hospital unless unavoidable because of say fracture. She's had several strokes and she will possibly die from one in time, but Investigations and treatment would not be appropriate

What stage is he at health wise and what decisions have been made? Has a doctor attended him in the nursing home? Has he had previous strokes? How is he now?

@ClaudiaWankleman - no, that's not always the case. If someone has advanced dementia or other terminal illness, then very often in this case, the best thing is to do nothing and let nature take its course.

Cross post

That doesn’t take away from the fact that it is still a medical emergency, and care home staff don’t have the power or duty to decide who received treatment. There’s no evidence of medical professional intervention until OP stepped in.

@ClaudiaWankleman - I can't comment on the OP's circumstances. When my mother was in a care home, it was usual, if there was suspected illness, for the staff to speak to a GP or district nurse, and to call me. Had my mother been taken to hospital for anything like a suspected stroke or heart attack I would have been beyond furious as it was expressly agreed with my mother's GP that we would not give any medical treatment in such circumstances.

If a patient is looking as though they are end of life then the GP will usually prescribe morphine and other drugs to try and ensure a peaceful ending. These are then administered at the care home by the district nurse.

Yes they do, if it's been agreed with the family. And OP's update shows that the GP was also involved in the decision.

I’m glad the GP reassured you.

When my grandmother went into a Care Home, issues such as these were discussed. We didn’t want an ambulance called without our permission.

Hospital can really confusing for people with dementia. My grandmother was better off in her Care Home with the carers that knew her.

Ah so they already discussed this with his children? That’s good. I hope you feel reassured now.

Does he have vascular dementia? If so, unfortunately vascular events are part of this type of dementia. The blood vessels in the brain gradually 'pinch' off (at least that's how it was described to us).

Thanks guys

He has no children- it's all on me and now I've been reminded I remember the conversation when he moved there - I hate my memory

My granddad definihad vascular dementia but nana had alzheimers and I thought he had altzeimers too

To serve what purpose? My stepfather had a DNAR in place for the last 2 years he was in a care home. He had advanced dementia, a brain injury from a time he fell and fractured his skull, Parkinson’s and was unable to communicate, feed himself, was incontinent and basically sat in a chair all day slumped over drooling. He would have absolutely hated what his life had become.
He was sent to A+E twice during his time there. Once when he fell and cut his head open and once when the paramedics thought he had sepsis. The first time, after a 2 day stay in hospital, he was returned totally disorientated and highly agitated. The second time, he spend 2 weeks on hospital then was sent back to the home to die a week later.
People with dementia severe enough to need to be in a care home need to be allowed to die with dignity, not kept alive in an even worse state.

That's good news @KatyMac

My first thought when I saw this earlier was that they should have called 999 but it is also true what other posters have said about health care agreements being in place for someone who is not expected to have good outcomes long term.