Dementia: I’m Counting My Blessings

Mixed Dementia,

One week has passed since the Best Interest Meeting that considered Maureen’s future care and accommodation.  The decision for Maureen to stay at home was one that I welcomed and I doubt there was any dissension in the room.  Unfortunately, it is no simple matter to secure wall to wall care for 72 hours to give me long weekend breaks once a month.  I have now accepted that my plans to have three nights away in a weeks time are not going to happen so I will be seeking additional carer sits with known faces from next week.

Sorting out my long weekends is going to take some time but there have been some really positive developments this week:

  • Occupational Therapy involvement is going to be ongoing with a hand stair rail and aids to make bathing easier already on order.
  • My meeting with a Carer Support worker went well yesterday.  This emotional and practical support will now be ongoing.
  • This morning will be the first of fortnightly meetings with my Admiral Nurse to review how things have gone and plan ahead.

There is no doubt that our Multi-Disciplinary Team has been very thorough in attempting to provide support that is appropriate to Maureen’s current presentation.   We are very fortunate to live in an area of the country where there are genuine attempts to support carers and their loved ones.  Once again I count my blessings over our decision to move to North East Lincolnshire!

Dementia: Pie In The Sky

Mixed Dementia

Image result for Pie in the sky pictureIt’s beginning to dawn on me that the idea of having a long weekend break this month is pie in the sky.  None of our usual Care Agencies are going to be able to provide the 72 hours of consecutive support that Maureen would need.  It would be unwise to go further afield and leave Maureen at the mercy of unknown carers.

In my blog yesterday I explained my reluctance to go to the fallback position of putting Maureen in a Care Home. Unfortunately, her family made it known at the Best Interest Meeting last week that they are unable to lend a hand.  Therefore,  a couple of days away together in an adult only accommodation might be the only way of getting a break.  I will explore this possibility at the meetings that are scheduled to take place today and tomorrow.

Maureen eventually lost her patience with our visitors yesterday and reared up on the Occupational Therapist with a diatribe that didn’t quite make sense.  Her Care Coordinator sensibly called time on their visit at this point. This was a rather unfortunate end to be an initial exploration of our set-up here that convinces me the OT will be a force for good in out lives.

Maureen also reared up on me just before she turned in for the night; hurling blankets at me because she was frightened that ‘a boy was going to be in her bed again’.  She doesn’t appear to be frightened this morning but is holding onto a photo of a little girl along with her mum and dad.  If only the little girl (her daughter) was still alive Maureen would be a very different person trying to make sense of her dementia and the infrequent visits of the remaining members of her family.

Dementia: Respite In A Care Home – No Thanks!

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Fire at a care home, Cheshunt, Hertfordshire

If none of our local Care Agencies can provide staffing for a 72 hour period then an option would be to put Maureen in a Care Home for Respite.

The article below, which I have reproduced with the with the kind permission of Roy Lilley, convinces me that this is a rather risky option:

News and Comment from Roy Lilley
Did you watch the TV reports of fire ripping through the roof of the Cheshunt care home?
People have lost their lives, families have lost loved ones and 20 people have lost their homes.
I watched the evacuation.  Frail elderly people bundled into the street, wrapped in blankets.  Walking frames, wheelchairs.  They looked, to me, more like the residents of a nursing home than a care home.
There was a time when relatively able, senior citizens, would sell-up and move to a care home.  They would have the company of likeminded folk, meaningful daytimes and a bit of support if they slipped in the bath.
The tectonic plates of eldercare are shifting.  
As ‘care home’ residents lose acuity they often need nursing care and would benefit from being transferred to a nursing home.  They seldom are.
A transfer means upheaval, plus a change in status.  Nursing home placements are funded by the NHS and care home placements are means tested.  No one has any money hence there is no desire to make the transfer easy.  People get parked in care homes.
Anyway, there aren’t the nursing home places. The consequence; care homes look after people they shouldn’t or they do and pretend they can.
Desperate funding means, one care home a week closing and the sector at best fragile.  Staffing levels are generally, only just enough.
It emerged last week that nearly half of care workers leave the job within a year, there are 84,000 vacancies.
Often, dedicated staff, struggle-by on just-about-living wages.  Many struggle-by on with just-enough-English, with no prospect of their employer providing skills enhancement.
More significantly they just-manage vulnerable residents with next-to-no-nursing-skills.  Skills that should be at the very heart of all elder care.
In some parts of the country it is left to the NHS to sort out the problem.  It is no longer unusual to find frustrated Trusts, trying to stem demand on A&E, recruiting community matrons to train and develop care home staff.
 
See here how the Vanguards are getting the hang of it!
The costs? It’s cheaper than the Trust grinding to a halt.
The care and nursing home sector is stuck in the ’80s and is long overdue a reboot.
Too few operators can claim to provide end-to-end care, too many operators provide thread-bare care.
The sector depends on private families paying over-the-odds for a placement, subsidising the pitiful amount local authorities can pay for citizens in their care.  
We need more places with the skills to see us through an elegant retirement, joyful days, secure nights and a peaceful end.
According to Quality Watch;
‘… care home residents aged over 75yrs are three times more likely to be admitted as emergencies than over 75s in the general population.’
This has to stop.  Admission from a care home should be a last resort.  Who can blame under-skilled, under-resourced care assistants ringing three nines.
The CQC has to get busy and recalibrate licensing requirements.  Here’s nine ideas on the back of a fag-packet for starters:
  1. No care home should be licensed that does not have permanent, qualified, supernumerary nursing care, available on every shift.
  2. An on-call pharmacist that visits once a week…
  3. …and a nutritionist once a fortnight.
  4. All the residents of the care home should be registered with the same GP practice.
  5. The practice service should include a weekly surgery visit…
  6. …and rock solid OOHs.
  7. All care homes should have a qualified end-of-life specialist nurse available to provide hands-on care and as a training resource for care assistants.
  8. All care home staff should undergo regular dementia care training.
  9. A specialist continence nurse should provide regular training to all care staff.
If you think that’s tough or costly, ask yourself what an unplanned A&E admission costs, how much a three week stay in hospital costs and the damage it does.
Nine ideas that will work and Becky Malby has the proof.
Our nation was built by old people, who entrust it to the young to take it into the future, run it and hand it on, better than they found it.   They should not have to fear the future by feeling they are a commodity or a burden.
What is a government for if it can’t take care of the youngest, the poorest and the oldest…

Dementia: Deprivation of Liberty Safeguards

Mixed Dementia

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Musical beds took on a new dimension last night when I was ‘sent off’ – evicted from the bed in our spare room.  I had gone to bed before 10 pm as my leg pain was making it difficult to stand let alone walk.  Maureen joined me some later asking me if it was ok for us both to be in the same bed.  A conversation arose early in the morning and my contribution led to me being told to leave the bed and go into the spare room.  I beat a hasty retreat to the marital bedroom where I remained for the rest of the morning.

I’m looking forward to the arrival of Maureen’s Care Coordinator along with an Occupational Therapist this morning.  It is an opportunity to have discussions about how to make our home a safer and more stimulating place for Maureen.  The one cloud on the horizon is  DoLS and this sensitive issue will be on the agenda this morning.

I hadn’t realised that DoLS needs to be explored in the home environment.   When I reflect beyond my initial concern about such discussions I’m optimistic that it will be possible to consider how dementia has the potential to deprive us both of our liberty and how safeguarding can protect us both.  It is fortunate that I was able to obtain wise counsel on this matter from several sources yesterday and now see today as an opportunity rather than a further nail in the coffin of the independence that Maureen craves!

Dementia: Moving Forward

Mixed Dementia

This week is an opportunity to move forward following Thursday’s  Best Interest Meeting with three meetings already scheduled:

Related imageTuesday:  Maureen’s Care Coordinator is here with an Occupational Therapist to give us advice on how to make our home a safer and more stimulating environment.

Wednesday:  I have a meeting with a Carer Support Worker to explore how she might be able to make my load a little lighter.

Thursday: I have a meeting with my Admiral Nurse as the start of a schedule of fortnightly meetings to review my role as Maureen’s Care Partner.  These meetings will offer the support/supervision that I have been seeking.

It also seems likely that I will need to meet our Key Worker at some time during the week for a progress report on the arrangements for Maureen’s care during the first of my long weekend breaks.  The thought of a break in a couple of weeks will hopefully keep me going as Maureen’s presentation becomes even more challenging by the day!

Dementia: It’s Working

Mixed Dementia,

Image result for It's Working Dementia Picture

I’m now sleeping upstairs at night following the removal of the single bed from our lounge.  Maureen still plays Musical Beds generally spending some of her time in the marital bedroom after an earlier stint on the sofa.  I initially take to the spare room and only join her following invitation.

There was a real bonus yesterday when Maureen told me she ‘had a young man in her bed on Thursday morning’.  I thought it would have been reckless to have mentioned this at the Best Interest Meeting a few hours later as  I didn’t want to risk any further ideas about the need for a Capacity Assessment on this front.

It’s clearly Maureen’s emotional memory that allows her to recall the events of  Thursday morning.  To be called a young man at the age of 71 is rather reassuring!

Dementia: The Tablet Tinderbox

Mixed Dementia, ,

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Maureen and I have never been a couple who have taken any medication willingly.  We are great believers in ‘physician heal thyself’ and won’t even take painkillers unless the discomfort becomes unbearable.  Considering Maureen has had a stroke and has suffered from high blood pressures for years the medication she has to take is minimal:  one tablet in the morning and another in the evening.  She has refused to take a statin and her G P and I have given up on this battle.

Despite being told on numerous occasions that she is on her current medication for life Maureen still wages a campaign to be tablet free.  She took up the mantel again last night and refused her early evening medication – questioning if I had the authority to give her tablets.  Four hours later she woke me up from my slumbers worried that she had missed her tablets.  When I offered them to her she refused them once again as I was not a chemist or a Doctor.  Two hours later I heard her crying for her mum via the baby alarm.  When I made it downstairs she was terrified that she had missed her tablets and had put her life at risk.

Earlier in the evening, there had been shenanigans over cleaning her teeth.  Neither of the toothbrushes I presented belonged to her and were being used by others.  This is not an unusual series of events.  It is possible that not cleaning her teeth and finding it unpalatable to use a mouthwash are contributing to having a sore mouth and tongue: a condition that has now become chronic.

This morning a new challenge presented itself –  how to get out of the bath quickly to attend to my distressed wife.  Soaking in an Epson salts the bath is great but it is not easy to get in or our since my hip replacements.  I slipped and cursed at my first attempt: perhaps doing more harm than the good of the bath.  When I eventually arrived at Maureen’s side she was ‘wanting to go home to Nottingham to be with her family’.  She cannot understand ‘why she is being imprisoned here as she has done nothing wrong’. Today is a good day for distraction and redirection as a trip to Freeman Street Market is a fixed feast.

My first scheduled long weekend seems a very long two weeks away at the moment.  My accommodation at the Buddhist Meditation Centre in Pocklington is booked, as it is for the remainder of the year but home-based care for Maureen is not yet in place.   Her challenging presentation shows no sign of letting up and leaves me wondering whether I should have stuck to my guns on Thursday.  My wavering on the need for the immediate respite continues to put me at risk of Carer Burnout and was certainly not in my Best Interest!

 

Dementia: One Small Step

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Image result for A Small Step For Man Picture

The decision at yesterday’s Best Interest Meeting represents one small step in maintaining Maureen’s wish to remain at home and mine to have a life outside of being her Care Partner.  Our Key Worker is now charged with putting additional care in place so I can have a break one week in four from 10 am on Friday morning until 1 pm the following Monday.  I’m hoping that such arrangements can be put in place as soon as possible.

Unfortunately, the start of the BIM was delayed and did not finish on time.   Following the meeting I declined an opportunity to explore any further issues with the Chair and Decision Maker as I wanted to try to return home on time.  What I hadn’t realised was that my early departure was in vain as  Girl Thursday and our Care Agency already had the matter in hand.  I await the minutes of the meeting with interest and look forward to working with our Key Worker to carry out the spirit and intention of our discussions.

The domestic scene was not very pleasant last night with Mrs Dementia in full flow.  I was told in no uncertain terms that if I trespassed into the room that she was sleeping in she would ‘scream the house down’.  The thought of the peace and solitude of a long weekend break helped me to make it through another long night of Musical Beds!

There’s no peace for the wicked this morning as Maureen tries to make sense of her life.  She has been talking to me for some time about how she thought others people have been controlling her life following her stroke.  As her Care Coordinator once said ‘with vascular dementia, you think that you have got it then it changes’: well I never!

Dementia: It Has To Be Gentle Persuasion

Mixed Dementia,

Image result for Gentle Persuasion Picture

The Best Interest Meeting to discuss Maureen’s future care and accommodation is now hours way.  It is an opportunity for family members to get together with the Multi-Disciplinary Team to discuss the best way forward.

This morning Maureen has returned her theme that she doesn’t live here.  Yesterday morning she was talking about going back to Nottingham to live with her sister.  During the afternoon she was telling her aunt that she would like to go back to Coventry where she has lots of friends.

I am never clear who Maureen thinks I am.  On occasions I’m her husband, at other times I am her dad, grandad, ex-husband, or manager of this Care Home.

Maureen no longer knows what time, day or season it is.  She has been worrying this morning that she has no clothes that will be warm enough for this time of year.  Whenever she wakes up from sleeping it is time for breakfast, even after a late evening nap.

This morning’s meeting is an opportunity for all parties to put their cards on the table and for the Decision Maker to determine Maureen’s future care and accommodation.  I’m pretty tired at the moment and my immediate priority is to get a break from my caring responsibilities.  Holmfield House is primed to receive Maureen this afternoon and subject to assessment could accommodate her for a week.  However, I do not think it is in our Best Interests for me to trick her into a week in a Care Home: I’m quite clear about that!  What I still have a nagging doubt about is whether a holiday in an Adult Only Hotel would be a better option for sustaining our close relationship.  Once again the problem remains on how we shift Maureen from the sofa.  Whichever option is decided upon: gentle persuasion has to be in our Best Interest rather than trickery!

You will gather that there is uncertainty about where Maureen will sleep tonight.  We often play Musical Beds here and last night we slept well together in the marital bedroom: taking the single bed out of the lounge may have worked!

 

Dementia: ‘I’m Not Lost!’

Mixed Dementia, ,

Image result for I'm not lost Picture

Maureen has thrown down the gauntlet about being allowed to be out on her own.  She was reluctant to accompany me to the corner shop yesterday afternoon and when I returned she had gone out.  When I went to find her she said ‘why are you looking for me I’m not lost?’ The interesting thing is that she was walking around the Court that I had encouraged her to follow the previous afternoon.  I think I now have to pluck up the courage to let her go off by herself and wait in the house until she returns.  I’m wondering if it is a good time to suggest using the Digital Tracker that I bought some time ago and Maureen declined to use.  I also have a similar dilemma over changing our sleeping arrangements’

I’m not sure if sleeping on a single bed in the lounge is achieving anything.  What it may be doing is encouraging Maureen to sleep on the sofa rather than retiring to a bedroom. My inclination is to take the bed back upstairs – yet again – and see what happens.

Maureen may not feel that she is lost when she is walking out by herself but I often feel spoiled for choice in how to respond to her presentation.  My Admiral Nurse is on holiday at the moment and I have chatted to one of her colleagues a couple of times already this week.  She has suggested reframing my suggestion that we need a holiday.  If Maureen takes up the bait it would be interesting to see how we cope with a couple of days in new surroundings.  The plan is to be on holiday close to the family members in the Midlands who Maureen is crying out for more contact with: predominantly her granddaughter.   What a shame it will not be possible to meet her parents: I’m sure ‘Union Jack’ and I would have had lots to talk about and I would have loved to have met his ‘Diamond Lill’.

While I’m on the subject of holidays we will need a World Cruise to thank all the people who support us via this blog.  I’m particularly grateful to Di Brooks this morning as she suggested taking an Epson salts bath which has been so refreshing.  I would recommend anyone to read her Blog where she shared her experience of being a Care Partner to her late husband so openly.

It is my six weekly appointment with my Counsellor this morning.  Ironically it is exactly 24 hours away from the Best Interest Meeting.  How fortunate I am to be able to chat over the challenges in my life with someone who has such an extensive understanding of dementia.