Tag Archives: Better Practise

Dementia: Going On Gardening Leave

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It’s a struggle here this morning as nothing seems to be grounding Maureen.  Even music on YouTube has not done the trick!

Her initial concerns were about the wellbeing of her children: she wanted the phone number of their school to let them know she would be unable to pick them up today.  Now she is packing to go home and wanting me to put some of her belongings into the car.  Fortunately, the sun is shining this morning and I am going to try to entice her into helping me tidy up the garden.

Dementia: Foreplay Makes Sense

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Out Little Diamond always plays it cool when she arrives for her carer sit.  She is not of the ‘wham bam thank you mam school’: telling Maureen what she is going to do to her as soon as she walks in the door.

I watched her again yesterday as she eased Maureen off the sofa to join her in household duties.  If I’d been able to video her in action it would have had an excellent training video for her colleagues to watch.

Yesterday Maureen was eased into:

  • A short car journey into Grimsby.
  • Changing unsuitable clothing in Tesco.
  • Drying up the pots and pans.
  • Changing our bedding.
  • Preparing vegetables for lunch.
  • Volunteering for dusting duties.

On my return from some time out, OLD and Maureen were singing along to YouTube. She’s back again today and I know Maureen is in for another busy few hours.

I’m hoping she can help resolve an early morning underwear crisis: once again nothing fits.  As OLD is here for four hours today we might even be able to fit in a trip to Marks and Sparks so Maureen can choose some new undies.  Her current method of getting the necessary support up top; with a belt, or trousers almost pulled up to her neck, must be so uncomfortable.  This is a no-go area for me when Maureen doesn’t know who I am – particularly if she thinks I’m the guy who troubled her so much in her past!

 

Dementia: Is The Real Problem The Act?

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The case for a review of the Mental Capacity Act has been made and accepted.  Unfortunately, Brexit has meant that it is not a priority at the moment.  However, I would humbly suggest that in this area common sense has gone out of the window and the MCA is being misused.

I’m very concerned about the way the MCA has been applied to us:

  • Meetings have not been recorded accurately.
  •  Professional staff who know Maureen have been excluded from meetings.
  • Meetings have been called when telephone conversations would have sufficed.
  • The Application to deprive Maureen of her liberty is appalling.

From our experience, it  is time for the Local Authority and NAViGO to review their guidelines to employees on the application of the MCA!

Dementia: Bah Humbug?

A recent article in Linkedin caused me to think about how to deal with Christmas now Maureen’s dementia is classed as severe.   Written by Rick Phelps it made the point that flashing lights, along with lots of noisy folks around, are the last thing he needed during the Festive Season.

When Maureen and I were out walking the other day I asked her if she would like us to put up a Christmas Tree.  She responded with we didn’t need to trouble ourselves as there were already plenty around.  However, we one spot of impromptu carol singing that evening and some friendly neighbours were delighted with our efforts.

Maureen woke this morning with anxieties about not wanting to get up the chimney.  Just to ease her concerns I held her tight, told her she wasn’t going anywhere and burst into song:

Happy Christmas and a Healthy and Peaceful New Year

 

Dementia: Let’s Stop Elder Abuse!

 Stop Elderly Abuse.. Stop Abuse Period! This includes financially misusing their $ as well for your own profit or gain !!!
The following is an extract from today’s nhsManagers.net copied with the permission of the Editor Roy Lilley:
‘I can’t imagine older people putting-up with the way we treat them, for another year.  What other patients would accept being abandoned, dumped, marooned, shoved out, trapped and stuck in a revolving door?
Forget kindness or compassion.  Think about giving the supermarket your money, up-front, popping in for bread and bog-rolls, only to be told… there isn’t any.  It’s a rip-off.
Fees are a rip-off, inspection should ripped-up and looking at the quality of some homes; the owners ripped into.
Think about a lifetime of work, paying into the system, then being told; you’re a bed-blocker, a drain on the system, the cause of the problems, no room for you.   But, if and when there is; we’ll grab what few quid you have left… make you pay twice.
 
The organisations ‘representing’ older people should hang their heads in shame.
There’s an ugly cult of slyly and sneakily blaming older people for what is essentially our our failure to notice their presence in the system…  entirely predictable.  We have had a generation to prepare, save up and get ready.
The way we treat our seniors is disgusting.  I predict a backlash.  The Boomers, articulate and net-savy will not put up with what my mother’s generation endured.  Super-agers will be a super-handful.
There’s a discrimination that care services would not get away with, with any other patient group.  I predict, this year, ageism will become as unacceptable as sexism.  A new organisation, with real clout, will emerge to change the face of eldercare’.

Dementia: Finding The CQC Something Useful To Do

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The following article is posted with the kind permission of Roy Lilley, editor of nhsManagers.net:

‘Write about the CQC (them again) and I have to

prepare.  I need to reinforce my inbox.  I have never known an organisation to incite so much ire.
The inspected, the inspectors and the expectant all take to their keyboards.  Tales of woe, tales of the expected and unexpected.
For the moment, I’m going to park the ‘futility of inspection’.  We all know it doesn’t work.  You either get it or you don’t.
If the CQC are to warrant a place at the table and their huge budget, they have to do something useful.  They are not useful… and it may be be there fault.
Earlier this week I referred to the Competition and Markets Authority and their report on care-homes.  Pretty grim reading.
Finding a care home for yer-granny, untangling entitlements and getting a feel for what is a good home and what isn’t, is, as the report says ‘overwhelming’.  A situation made worse by contracts that vary from home to home.
Once in a home; it’s difficult to change a poor choice and there’s always the fear that complaining with result in subtle reprisals.
Rip-off pricing means the private sector is subsiding the skint, public sector.  Sometime paying double for identical care.
Service users and their families find themselves in the Bermuda Triangle of Local Authorities as the commissioners and purchasers, consumer law (clunky and dense) and the aloof CQC. 
Looking more widely at the landscape; funding is down by 8%, costs are up.  The CMA report tells us 75% of care home residents are LA funded and on average they are paying 10% less than their actual costs; a total deficit of £300m.
The consequence; care homes will reduce the number of LA clients they will take-on and the NHS will have to build bigger A&Es.
Is it any wonder the Times is reporting the care home giant, Four Seasons, is on the brink of collapse.  I wonder if the DH has a Plan B?
Is there a way out of this mess?  Yes; give the CQC  more powers.  I bet you’d never expected me to say that!
Their quest to ‘inspect’ quality into care homes is futile.  Turning them into a proper regulator makes much more sense.
The CQC should have total powers over the sector.  Clear accountability and someone to nail if it goes wrong.
I can think of a dozen new powers:
  1. Develop and publish an annual, independent, strategic assessment of the sector, with recommendations for government on the realistic cost of care and funding levels.
  2. Provide national model-contracts for care home providers, so the public know what to expect and where they stand.
  3. New powers to decline any home registration that does not have a CQC recommended safe staffing and skill-mix.
  4. End the difference between care homes and nursing homes.
  5. Develop accredited training for the care-home sector workforce.
  6. Publish clearer ‘Which’ style reports on care homes, making it easier for families to chose through an improved, user friendly website and help line.
  7. Publish ‘advisories’ on the viability of care home operators and prepare contingency plans for failure.
  8. Create a centre of excellence making it easy to find and share best practice.
  9. Provide an easy to navigate complaints and dispute resolution service.
  10. Create an identifiable, accessible local presence, that includes elected members, to improve public confidence in the CQC and democratic accountability.
  11. New powers to prevent differential charging between the LA and private sector clients.
  12. Powers to require care-home providers to post a performance bond to guard against the cost of failure.
Focussing these functions, in one place, makes one organisation accountable for the care home market, its conduct and it gives the CQC something useful to do…’

 

 

 

 

Dementia: Dealing With Side Effects

 

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One message that is coming through loud and clear from  NAViGO at the moment is the risk of side effects from medication.  This was evident in the entire time that Maureen was in the Konar Suite.  It was stressed again on Monday when  Maureen’s Care Coordinator said ‘it’s much better if she can get away without taking any more tablets’.

One side effect of dementia that I’m struggling with at the moment is Maureen not knowing how to fill her time.  This is particularly problematic on these dark and cold evenings.  Addressing this as ‘sundowning’ is unhelpful – Maureen simply can’t remember how to fill her time!  To help her on this front I have decided to come out of retirement and start organising evening activities again.  This is how Maureen and I first met: we worked together facilitating adult learning opportunities in Coventry

I’m spoiled for choice in my programme that begins tonight.  Maureen has such a wide spectrum of interests that it shouldn’t be too difficult to persuade her to join me in a learning adventure.  She has always been a good linguist so French will be on offer this evening.  There are all sorts of informal ways I will try to hook her into what should be a fun evening.  I have also set up the Sun Room as an Art Studio in case she gets bored with ‘parlez vous Francais?’

Update: At 9.30 Maureen is singing and dancing to the Sound of Music in our Sun Room.  Her joy is infectious and it is so wonderful to see her in such good spirits.  I’m really back in the working groove now as we organised classed for adults during the day: even integrating them into classes alongside school pupils!

Dementia: Time For Tweaking and Sleeping

 

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We are now halfway through the cycle agreed at the Best Interest Meeting.  Two weeks today Maureen will go into Alderlea Care Home for a week.

Maureen’s Care Coordinator is due this morning and this will be an opportunity to discuss how things are going.  Tomorrow our Key Worker and I are meeting our Care Agencies to review progress.

Our carers; the girls’ as Maureen calls them have been remarkable in the skill and compassion they have shown in helping Maureen to settle at home.  They have worked tirelessly to involve her in domestic duties despite her claims that she is entitled to be a Lady of Leisure.  In her view, such things as general household duties including the preparation of food are my job ‘as I don’t do anything else for her’.

Although I will have a week off in a fortnight, the current arrangements are no longer adequate.  I have already clarified that one of our carers is available for an additional three-hour shift a week.  This will mean that I can have six hours to myself on alternate Tuesday’s and Wednesday’s.  Such an arrangement is a phone call away.

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Paul McKenna could help me to solve my sleep deficit.  When Maureen wakes distressed in the night I’m finding it increasingly difficult to get back to sleep.  I’m hoping I can find my ‘Sleep Like A Log’ CD as McKenna has helped me to count myself back to sleep at previous difficult moments in my life.

 

Dementia: A Must Read

The following article is reproduced with the kind permission of the author Roy Lilley

Image result for Roy Lilley Picturethe Editor of nhsManagers.net:

‘Ten elderly people with dementia live, in a care home, supported, but as independently as possible.
To provide meaningful day-times, they take part in daily chores and contribute to light housework and preparing meals, under supervision.
Two residents have taken on the responsibility for opening and closing the curtains, night and morning.
One morning it all goes wrong; whilst opening the curtains a resident falls and breaks a hip.  This is reported as a serious untoward incident, the regulators are informed, as are the relatives.  The press get hold of it and the roof comes in.  The whole care model is under threat.
The resident’s participation in their care model comes to an end.
Had the incident been thoroughly investigated, it would have been discovered there was a leak from a radiator which meant the client slipped on a puddle of water.
The rules have now changed, the lives of the residents less interesting because everyone is risk averse.  Managers are thinking about their careers.  Now it’s all about the rules.
Let me ask you some questions…
  • Can you name five rules, in play, where you work?
  • What is the purpose of the rules?
  • What rules would you delete and change?
  • If you could invent three new rules, what would they be?
  • Do you think rules should be made in agreement with the client; if they want to take a risk they should be allowed to do it?
Think about the dignity of risk.  In our lives we compute the risks and decide; we cross the road before the little green man appears…
Now think about a lady with dementia.  She screams.  She screams and screams and screams.  The staff can’t stand it and the other residents complain.  So, they lock her in a room until she stops.
This is called negative behaviour.  A resident with limited communication resources reacts in the only way they can.  They either get violent, withdrawn, or scream.  She has to scream to make a point.
The question is; what point?
More questions:
  • Have you even demanded attention in a negative way?  What was the response?
  • Statement; ‘If a client cries out for attention, it says a lot about you’… discuss.
  • How do you find out the cause of negative attention?
  • What do you think of the statement; ‘if only she didn’t have become a client…’
These are not my questions.  I’ve pinched them from a book by Geert Betting,˜Moving on and Sending Still“.
Fundamentally a book about caring for difficult people in a care home setting, LD and dementia clients but it is so much more…
By accident the book explores the psyche of care and the people we care for.  It asks tough questions and made me think.  The signals we give to the outside world and how we misinterpret them… to our cost.

What group of patients do you work with?

  • What are the similarities among them?
  • Can you, clearly, describe the work you do, to friends and family.
  • Have a few people around you and ask them to write five key words about the work you do.  Ask everyone what they’ve written… what are the similarities?  What do you notice?
  • Do you sometimes say, ‘I don’t have time’… could you have made a different decision?
This is a very good book and read with an open mind can be applied to wherever you work in the care system, regardless of what you do.  Do that and it comes a great book.
Working under pressure, working with scarce resources, working and managing at the very edge…
…this is a clever book designed to make us reflect and is a must read’.