yourcarehome.co.uk blog

GUEST BLOGGER - Take care when planning a care plan

If you intend to help an elderly relative with their care needs, you need to prepare yourself for a lot of complex assessments and form filling. No form is more important than your relative's care plan.

By the time that I got my Dad to accept that we needed to pay someone to look after him, he could no longer remember his medical history and was incapable of stating his care needs.  I soon discovered that Dad could not be assessed for anything unless I was present. All Dad  wanted was to be left alone in peace, which  conflicted with my need to get on with my life without worrying that he was lying helpless in a bath of cold water, too confused to pull the plug and call for help.

This essential difference of viewpoint resulted in some bizarre conversations. When Social Services visited at my request to assess his care needs, Dad's objective was to demonstrate that he didn't need any help.  Had I not been there, I think he might have got away with it.  But I was there, cast in the uncomfortable role of bad guy, contradicting Dad's assertions that he could 'easily walk a mile' when he could barely get to the front door, betraying his trust by telling a total stranger about all the experiences that he preferred to forget about - or indeed, that he had forgotten about. Like the time when he nearly set fire to the flat by putting a towel to dry on a convector heater. I remember Dad looking at me with horror, as if to say, 'Why are you telling them about that, son, do you want them to put me away?'

Social services' assessment of Dad's care needs was a lengthy process. After the initial interview and health & safety assessment of his flat, a team of social workers visited him daily for six weeks. At the end of this period, they concluded that he would benefit from a daily one hour visit from a carer.  I was given a list of recommended care agencies to contact.

The care agency had to make their own assessment of care needs and conduct a further health and safety assessment.  Again, this required an initial interview followed by a period of observation.

After a few weeks of care in his own home, I threw in the towel for trying to support Dad in his semi-independent living. No care plan, short of 24 hour care, would enable him to live safely in his own home.  Yes, he only needed one hour of care a day, but he regularly  became so confused that it was impossible to predict when his needs would arise.

When Dad first moved into his care home, I spent several hours with the duty care manager completing his care plan - in effect a set of handover notes from me to the care team.  The form was about the size of an average novel.  I had to provide details about Dad's medical history, his family history, his care needs, his likes and dislikes.  I can remember feeling incredibly hopeful, that here at last was the opportunity to define the care experience that I wanted my Dad to enjoy. 

it sounds so simple- I wanted them to understand that the key to Dad's happiness is a regular supply of whiskey, some stimulating conversation and current affairs programmes on the TV. 

Looking back, I realise that my expectations were wildly optimistic.  The care plan is an incredibly important document, but the turnover of staff in the care home means that I constantly have to restate his care needs to new staff and agency staff. Someone who stands in for a few shifts will never have time to read thick documents on a dozen or more residents.  Just getting the staff to give Dad a nip of whiskey now and then has been a major struggle.

Eight months on, this continues to be a source of great frustration to me. Everything that I want Dad's carers to do is written there in the plan. The hard part is getting anyone to take any notice of it.  I know that I am not helped in this by Dad's tendency to refuse any activity that is offered to him because he 'doesn't feel up to it today', as well as his inability to ask for anything, even the glass of whiskey that he so eagerly accepts if offered.

Next week, I shall attend the first review meeting about Dad's care plan, which promises to be an interesting conversation.

You can read about my 'reverse parenting' challenge - trying to keep my Dad cheerful without losing my own sanity at www.declineandfalls.blog.co.uk

Choosing Dad’s new home

The most useful important thing you need to select a care home is a sense of smell. If you don’t happen to possess one, I recommend that you find someone who does.

I had to act quickly to find a home for my Dad. He was in hospital and every time I visited him, the senior nurse collared me to ask what my plans were, as they desperately needed the bed.

So I sat down with a map and a list of care homes provided by the local authority.  My first reaction was surprise that there were so many within a short distance of my home. Then I started to visit them.

 I shall never forget the first home on my list. From the outside, it looked like a conventional family home.  Then I saw, hidden from the road, a large 70s flat roofed extension, like a temporary office building. It looked ready for demolition.  Inside was worse.  A dozen elderly people in varying stages of decay sat facing each other in a long, narrow room.  The furniture –  a clutter of dreadful, wing back armchairs - looked like it had been salvaged from a skip. Some of the residents were remarkably cheerful and that depressed me even more; the ability of their generation to put up with anything.  It was like stepping into a documentary about Eastern Europe in the communist era. I asked to see the bathroom and nearly gagged at the smell of blocked drains.  For this they wanted £650 per week! 

 Then I visited some other nearby homes that although modern and clean, were eye-wateringly expensive.  I went back to my list and adjusted my compasses to look at care homes within a 5 mile radius from my home.  This added a large number of new options. When I got on the phone, the list quickly reduced to a handful. Some were nursing homes rather than care homes, some were single sex or only took referrals through a charitable trust.  More than one subjected me over the phone to an interrogation about my Dad’s level of confusion, because they were reluctant to accept any new residents with any dementia problems, due to the increased burden of care.  I had visions of Dad being kicked out for becoming too needy.  At the other extreme, one very upmarket home referred me to their ‘business development manager’, who continued to hassle me with phone calls for three months after.

 I quickly developed a preference for larger homes run by trusts with a strong emphasis on values, rather than smaller, private homes or those run on a purely commercial basis.

 I visited several more homes, often taking my daughter with me, whose sense of smell is acute.  In almost every home, there would be some pathetic lady who was convinced that I was her son and some were very insistent in their delusion.

 In the end, I selected one of the nearby homes, whose charges I initially thought were eye-watering. The home is quite large – around 60 beds, but they are organised into smaller units, with separate lounge and dining facilities, so there is still a local feel on each floor. It may not be to everyone’s taste, but I am convinced that you need scale to get a balance of value for money with an acceptable standard of care.

Six months on, I remain happy with my choice and the costs, although high, no longer seems like too bad value for money.

 

You can read in more detail about my experiences on my blog www.declineandfalls.com

When is the right time? by Guest Blogger Peregrine Pickles

We are really pleased to announce the first post from our new guest blogger, Peregrine Pickles, who writes about his experience of realising his father needed a care home....

When people hear that I recently moved my Dad into a care home, I am often asked, ‘how do you know when it’s the right time?’

The answer of course depends upon individual circumstances, but my experience is that you know very quickly when the time has come. The question suddenly becomes not whether or when, but where.

My Dad lived on his own, in the house where I grew up, for a decade after my mother died.  It took me three years to move him to a sheltered flat near me, where I could ‘keep an eye on him’.  At first Dad resisted the move. Then we couldn’t sell his house.  Then he didn’t feel up to the move, saying he thought it would ‘finish him off’.  Yet every time I spoke to his neighbours, whom I relied upon as his life support system, I knew that time was running out.

When we finally moved Dad to sheltered accommodation near my family home, it felt like a great achievement. People told me he would discover a ‘new lease of life’ when he made friends in his new home. But this never happened. Instead he was bullied and later shunned by the more active residents who clearly thought that Dad was not fit to join their community.

During the course of that year, Dad gradually gave up his independence and allowed my wife and I to take over.  We hired a cleaner and we did his shopping and laundry.  I sorted out his admin and finances, organised his medical appointments, took him out to a country pub every week.  We got him meals on wheels and eventually booked a care agency to visit him daily to help with his morning routine.

In the last two weeks of Dad’s supported independent living, these were the signs that told me the time had come to place Dad in a care home:

• visiting him in the evening to find his meals on wheels untouched on his dinner table  

• a note from the carer saying she had found Dad ‘already up and dressed’ when in fact he had never made it to bed from the night before  

• having to leave work early because I was so worried that Dad wasn’t answering the phone

• finding Dad shivering and exhausted in a bath of cold water that he had been stuck in all day without pressing the panic alarm because ‘he didn’t want to be a nuisance’ 

• finding that I was too embarrassed to tell anyone what I was going through because I knew what they would say 

• realising that the cost of a care home was nothing compared to how I would feel if Dad died of hypothermia as a result of my neglect

• realising that Dad’s welfare was now absolutely my responsibility and that the ‘buck stopped with me’

 

Six months later, Dad is well looked after in a good care home with some exceptional staff. While the cost of the home is eye-watering by any standards, I now consider it pretty good value when you realise what’s involved in 24 hour care.  As an only child, Dad is completely dependent upon me to make all his decisions for him.  He has become my ‘fourth child’ and now I write about my reverse parenting challenge in a regular blog at www.declineandfalls.com