People with experience of nursing homes for the elderly......a few questions....and your experiences please

[foxinsocks]

so I went to visit my nan today in a nursing home. She is very old, has v advanced Parkinsons and some degree of dementia. She can't walk any more and is in a wheelchair for all the time she's not in bed.

This is the second time I've seen her. I think she's in nappies and today she really stank. I don't know what the protocol is with this sort of thing.

Do they change them as often as say we would change a baby?

Also, another relative expressed concern to me about how much weight she had lost. And I think what is happening, is that she's so exhausted just being awake, that she's falling asleep before lunch. That is what happened today. We left as she was about to eat but she couldn't open her eyes. I said to one of the helpers, 'you will wake her up to feed her' and they said 'oh yes of course' but I'm not sure this is happening.

Just wondering what other people's experiences of them are.

drop the manager a letter or email saying that you (and/or whoever is taking responsibilty for her care in the family) have a couple of questions (not complaints) and ask how often she is changed and what she eats and when.

My Dad is in one and I hate it but my Mum is good at asking these sort of questions and keeps on until she gets a saisfactory response.

I've worked in a few in my younger years.

Truth be told they vary massively; i I ahve worked in some stunning ones but also in one bad one (now closed).

I would seriously say something: as with a baby someone can soil themselves just before ypu arrive and it slip under the radar but loss of weight should always be folowed with investigations. Are you the one who contact the GP? That person should perhaps have a chat with the GP

thanks Tommy, sorry to hear about your dad

it's hard isn't it and I'm also a good 90 minute drive away and work full time so can only really manage v infrequent visits too (though not sure if she notices anyway)

they really are like the motorway services on the highway to death aren't they

they seem very friendly and the staff always seem loving (and I think she does quite like it there)

she was in hospital a few weeks ago as she had a stroke and fell and broke her hip and they redid all her medication and I think have given her a much higher dose as her pupils were completely tiny!

I don't know who has contact with the GP. I'm the main relative left going to see her so I don't know how it works tbh.

who is her next of kin? Presumably that would be the one who is responsible.

My Mum has been told that the GP is not responsible anymore but it is the manager of the home

Not quite sure about that myself as GP is very competent and manager is a bit of a t**t but what can you do?

thing is, my mum and my mum's brother both live abroad (one in Africa one in Australia) so both are miles away. I don't know whether the GP talks to them. I suppose I could find out. My mum is also a bit gaga so I doubt they'd be talking to her.

One of my sibs goes a bit more often than me as she is closer and we wernt together today and the manager seemed to know her and talk to her so maybe I should ask her to give them a call and find out how it is supposed to work.

I think they may be understaffed too but I guess a lot of these places are, sigh.

I would make an appointment to see either the Nurse in charge, her keyworker if she has one or the manager. Find out what medication she is on and the dosage and then contact her gp if worried.

With regards to the smell, I have worked in nursing homes etc.. for 18 years and unfortunetly there are some less hygienic than others. Any resident reliant on staff for toileting etc.. should be assisted at least every 4 hours or more often if needed. It is completley unnecessary to have nursing homes smelling if well staffed

hello fox. I don;t have any recent experience - but I worked in nursing homes as a teenager and student. now this was a long time ago and I'm sure much has changed, however, because of this, and because I saw things I wasn't happy with it's an issue I've always followed closely in the media. my gut instinct - and reading -tells me that your nan's situation would ring alarm bells. I would talk to whoever is responsible (your parents?) and persuade them to request a meeting with the home. and/or go yourself.

go armed with specific questions - and expect specific answers. you're concerned about her weight - ask that she be weighed - regularly - and seen by a doctor. ask if they can keep a specific eye on her eating.

re incontinence - it probably comes as no surprise to you that staff are stretched - when I used to work in homes things like changing incontinence pads didn;t happen as and when needed - but in accordance with some routine/timetable. From reading about carehomes I believe this is still often the case - unfortunately. so again ask what system they have in place and tell them what you experienced. and if it happens again I'd have no hesitation in finding a member of staff there and then and asking them to change her. ask nicely - it is difficult to keep track of everyone, and often it is an issue of resources/staff ratios etc. However that doesn;t mean you shouldn;t stand up for your nan.

thinking more - the food/weight thing does worry me - combined with the reliance on inflexible routines etc - I would really make sure you talk to someone.

hope everything else is ok.

foxinsocks

i used to work in a home and my mum has managed homes in the past.

your nan should not have smelt! THEY HAVE A DUTY OF CARE, it makes me angry as there is an awful lot of bad homes out there tbh

They can not make her eat but they should be trying and ensuring she is at least hydrated! Her diet can be sumplemented by ensure its like a milkshake but full of nutrients etc to help build her up

may i ask what age your nan is.

I would speak to your nans gp ask them to go and see her, its not down to the manager sometimes they do have a gp that checks on all patients rather than several gps.

maybe if possible you or your mum need to do a couple of surprise visits.

good luck with it hun x

sorry just read that your mum lives abroad.

thanks everyone

this is my first proper experience of them and it's hard to understand how everything works iyswim

I think I will have to go in (probably with other sibling who goes) and speak to them as no-one else can do it.

She may be not with it at all but I too think she needs to be looked after a bit better. She also seemed cold to me, even though it's warm inside - when you have parkinsons, because it wears you down SO much, you need to be wrapped up warm and she felt cold to me.

Thanks for the support. I will draw up a list of concerns, speak to my sister and we will go back and ask for a meeting.

Sadly, I do think they are understaffed.

thanks yes I think it's a good idea that I call her GP. I don't know him/her at all but I will find out who it is and just check who is monitoring her medication because I have a feeling it is the care home manager and I don't think that person is a doctor so I wanted to check how often the GP comes round etc.

It saddens me that this might come to us all.

Hi fox - this is hard for you, but it is great that you care. She should not smell of stale urine, but it may not mean he has been left in soiled pads, she may have been dressed in clothes which have dried urine on them. So when you go in check that she has enough clean clothes, or that there are no dirty clothes loitering in a wadrobe. In many care homes there is often a general stench of urine, if your nan is compleatly incontinent she possibly could have a catheter (tube from bladder to collect urine in a bag) rather than wetting into pads - this would ensure her skin does not breakdown. Lots of the caring in nursing homes is done by very poor paid staff, who although they care very much, are not well supported or trained, its also really really hard work.Changing a babies nappy can be done by one person in a couple of minutes, changing a pad for an elderly person can take two people twenty minutes.
Ask to speak to the nurse in charge, who should be qualified.Nursing homes generally have one GP who covers the whole home, some residents will retain their own Gp.

yes that's a good point glucose. The home did have that air of stale urine. I think she had done a poo just as we arrived sadly. I feel annoyed with myself for not asking them to change her, I probably should have done but was a bit taken aback by it all. I think I just need to develop a bit of a tougher skin arrghh!

I am surprised she hasn't been given 'more' than nappies as she is permanently sitting or lying down so I imagine too long in a nappy and she will start getting bedsores.

But I guess this can be one of my questions when I call the GP and find out what's going on!

The smell of poo lingers longer than wee! If it was me (easier as I am a nurse) I would change her myself, or if I could not move her, I would find a member of staff, and say, 'hi there I know you are busy, but I think my nan is dirty, can you help me change her?' Then I would be able to get a good look at her skin, to see what condition it is in. Yes, they have a duty of care, and in an ideal world there should be enough staff on duty to ensure residents are cared for properly, but the reality is different from this. There is an OFSTED equivelent for nursing homes- can't remember the name.
If she has recently been in hospital for a broken hip, she could have developed a bedsore in hospital - so best not to assume it is the nusing home at fault. If she is always sitting or lying down the staff should be moving her, to relieve the pressure from her bottom/thighs/heels/elbows every two hours, even if this is only out of bed and onto a commode to try to wee/poo. Elderly people eat very little, I would always go in with a little something I know my nan would enjoy.

My nana is in a home and its very hard isn't it I am a student nurse and have worked in homes as well.

It is unlikely your nana would qualify for a catheter as incontinence is usually not enough to need one (its less 'risky' to use pads). She should be changed often, is she sitting on any presure reliving equipment (a special cushion?).

They should have a weight chart for your nana - ask to see it, she should be weighed at least once a month.

She will have a careplan which should include some info on nutrition, and her skin - ask how recently they have been assessed. These assessments should help guide how her care is given.

I am relentless with my nana's care, I live 3 hours away and often find my other relatives are less pushy than me. I ring every week and double check on her skin and weight - I am sure it irritates them but if it means I know my nana is ok then whatever. I do feel bad for being pushy but IMO her care has improved since I started my phonecalls...

Def ask them to change her if you go and she smells.

Ask them to keep a food and fluids diary for you and your relatives to check.

Just a thought , but if you can smell stale wee (and shes generally not well/ eating) - she may have a UTI (water works infection), mention your concern and ask for it to be checked......