All posts in Care and nursing homes

7 Important Things You Should Know About Care Needs Assessment

In my previous blog, How To Avoid Negligence Claims – Working With Elderly Clients I outlined ten important questions to ensure practice is sound and person-centred and said that I would explore each one separately. My first considers care needs assessment for older people.

Local authorities must undertake an assessment for any adult with an appearance of need for care and support, regardless of whether or not the local authority thinks they have eligible needs and regardless of their financial situation.

The duty is triggered under Section 9 of The Care Act 2014 for anyone who appears to be in need of support services.

The purpose of an assessment is to identify the person’s needs, how these impact on their well-being and the outcomes that the person wishes to achieve in their everyday life.

Even if the person doesn’t want the Council to support them it is helpful that they have a needs assessment to provide a foundation for care navigation and procurement.

There are two interdependent parts to the assessment and both must be met to qualify for social care funding. These are care and support and financial eligibility

Planning senior care on a whiteboard.

Using a Care Needs Assessment For Planning

  1. The criteria used to assess care and support needs

To be eligible for social care funding a person must be assessed to have a ‘substantial’ or ‘critical’ level of need. As a minimum, they are likely to need support with personal care and daily living on a daily basis.

  1. How financial eligibility is determined

The following rules apply to financial assessments for both residential care and care in the home:

  • People with over £23,250 pounds savings/capital will meet the full cost of their care.
  • People with between £14,250 and £23,250 will make a contribution from their savings/capital as a tariff income of £1 for every £250. A contribution from income will also be assessed.
  • People with savings and capital below £14,250 will not make a contribution from capital but contribution from income will be assessed.

The difference between the assessments is that for residential care, a person’s property is taken into account.

  1. The care assessment

A Care assessment is not always undertaken face-to-face. It is not unusual for an unplanned screening assessment to be carried out directly with an older person over the phone. This can come out of the blue to the older person, especially if they live alone. Older people are proud and often eager to minimise the help they need. Many are hard of hearing. Make sure you ask to be advised if and when a phone assessment will be taking place when making the referral, so you can prepare and support the person.

During the assessment the person should be advised to answer all questions as if it was their ‘worst day’ without any support.

  1. The person must have capacity to make decisions during the assessment

If an individual requiring assessment lacks capacity and there is no registered LPA in place, the Care Act imposes a responsibility to refer the matter to the Court of Protection who can appoint a professional Deputy.

  1. The person has to be offered support to participate if necessary

New rules under the Care Act 2014 allow the person to take the lead in explaining what support they need to make life easier for them.

There is also a duty to provide independent advocacy to represent and support the person, if needed, to facilitate their involvement in assessments.

  1. Unpaid carer’s needs and their need for support are entitled to be assessed

There is a duty for carers to receive an assessment regardless of their needs for support or their financial resources. Also to provide independent advocacy to represent and support them if necessary.

  1. Obtain a written copy of the assessment

The assessment and any other relevant information will be recorded and authorised. Make sure the person obtains a copy as they or their representative have the right to challenge or dispute anything they don’t agree with.

Here are some helpful links

The Care Act 2014 – Assessment and Eligibility

How to get help with social care for adults in West Sussex

Apply for adult care assessment in East Sussex

Apply for adult care assessment in Surrey

My next post will consider Health Assessments

Finding a Care Home For Barbara

We are often asked which the ‘good care homes are?’ in a specific geographical area. We cannot answer this as everyone has unique needs, preferences and expectations. Finding the right care home for someone takes time, expertise and the ability to see things from the person’s perspective.

Relative Matters were asked to assist with a Bob who had become concerned about his Mother, Barbara who had returned home after a hospital stay and it had become evident very quickly that she was not coping. Bob had found a care home willing to take her at short notice, however, soon after she had moved in, Barbara was demanding to go home, her behaviour had become challenging and the home were not coping with her. During this time, Barbara was being assessed for a diagnosis of dementia and the Deprivation of Liberty (DOLs) team had been asked to be involved as the home were concerned that they were holding Barbara against her will.

We responded swiftly and assessed the situation from Barbara’s perspective and it was evident there were some memory and capacity issues. A full holistic assessment of her objective needs, her perceived needs, and her home environment were completed and through this process, it became apparent that she lacked capacity to make an informed decision to return home and was not actually concerned about going home. Barbara simply did not want to be in the home where she was.

Care home being enjoyed by two happy residents

Care home being enjoyed by two happy residents

After liaising with Bob, the DOLs team and the care home, it was agreed that it would be in Barbara’s best interests to move her to a care home that could meet her needs, and through meeting her needs, promote better behaviour patterns that could be managed in a more person centred way. A carefully drawn up profile was developed with Barbara of what she wanted from her next move. Once research had identified a specialist care home that could meet Barbara’s needs and preferences, she was escorted for a visit, so that she was fully involved in the process and then supported with the actual moving process.

The move was a complete success. We had ensured that the new care home was understanding of the behavioural aspects of Barbara’s dementia and were willing to work with her so that her needs could be met in a cohesive environment where she did not feel institutionalised, activities were interesting and she felt valued.

Finding a care home is easy if you use a ‘one size fits all approach’ but just like you and I will inevitably have different needs, preferences and expectations about where we live, older people are no different.

This post has drawn on work undertaken by Liz Tremlett. Liz works as one of Relative Matter’s Occupational Therapy (OT) Consultants. OT’s work with people to identify the difficulties they are experiencing in every day life and to work with the person to find ways to overcome these, in order to promote health and wellbeing.

Three Critical Things You Should Know About Paying For Care Home Fees

Paying for care home fees is often misunderstood and care and support services have never been free for the elderly. The misunderstanding is because people often think care home fees come under  healthcare from the NHS which is free. However care home costs are considered social care. Everyone has to contribute something towards care home fees and many have to pay the full cost.

The difference between Health and Social Care funding

Social care includes personal care such as washing, bathing, dressing, toileting and managing continence, assistance with daily living (shopping, administering medication, social stimulation etc.) and maintaining independence (assistance with mobility and equipment etc.) Social care does not require trained health professionals and care homes do not employ nursing staff.

Health care includes the treatment of disease, and illness, which needs to be administered or supervised by a trained health professional. Nursing homes have to employ a registered nurse 24 hours a day.

Local Authority social care funding criteria

Many people don’t realise there are two interdependent criteria for social care funding. You need to meet both to be eligible.

Care home costs being enjoyed by residents

Care home costs being enjoyed by residents

1. Needs criteria

The local authority will identify your care needs and check they meet a nationally agreed set of criteria. Basically you must have a significant or critical level of needs. This usually means that you need a high level of supervision and support for personal care and things like drug administration and/or food preparation every day, to qualify for social care funding. BUT even if you do have a significant or critical level of need, you must also meet the local authority’s financial criteria.

2. Financial criteria

You will have to fully fund your care home costs if you have more than £23,250 savings and capital. This includes property no longer occupied by you, unless it is occupied by the following as their main and only home, which they have occupied continuously prior to your move into a care home:

  • Your partner, spouse or civil partner (except where you were estranged)
  • A lone parent who is your estranged or divorced partner
  • A close relative or member of the family who is:
  • Aged 60 or over or
  • is a child under 18 or
  • Is incapacitated

If you have between £14,250 and £23,250 you will have to make a contribution from your savings/ capital as a tariff income of £1 for every £250. A contribution from income will also be required.

If your savings and capital are below £14,250 you will not need to make a contribution from capital. However, a contribution from your income will need to be made.

NHS funding criteria

The assessment process begins with a National screening tool called the Continuing Healthcare Checklist, and must be carried out by a trained health or social care professional. If you are assessed as eligible for funded nursing care, you will receive a standard rate of £110.89 a week from the NHS to pay towards your nursing care (amount correct at April 1st 2015)) This is paid directly to the care home and will be deducted from the local authority’s contribution. It will therefore not reduce the amount you have to pay yourself.

If you are paying for your own care home fees, the funded nursing care contribution is deducted directly from the cost of the care home fees before you pay and therefore reduces your care home costs.

The Continuing Healthcare Checklist will indicate whether a full assessment is indicated. If you disagree with a decision not to proceed to full assessment for NHS continuing healthcare following completion of the checklist, you can ask for the decision to be reconsidered.

To be eligible for NHS continuing healthcare, you must be assessed by a multi- disciplinary team of health and social care professionals as having a “primary health need”.

Whether or not you have a primary health need is assessed by looking at all of your care needs and relating them to:

  • what help is needed
  • how complex these needs are
  • how intense or severe these needs can be
  • how unpredictable they are, including any risks to the person’s health if the right care isn’t provided at the right time

Eligibility for NHS continuing healthcare depends on your assessed needs, and not on any particular diagnosis or condition.

You should be fully involved in the assessment process, kept informed, and have views about your needs and support taken into account. Your family should also be consulted where appropriate.

If you are considered eligible for full NHS continuing healthcare funding, it can be used to fund a package of care and support to meet all your assessed needs including personal care, mental health and physical needs. NHS continuing healthcare can be provided in a hospital, nursing home, residential care home or in your own home.

Paying for care home fees is a complex subject. Further information can be found below

Paying For Care

Age UK

Alzheimer’s Society

The 10 Boxes of Christmas For People Living With Dementia

Christmas is an important time for families – a time to catch-up with relatives’ news, have fun, build new memories and reaffirm bonds. But how do you do that when a key member of the family has problems with communication and memory? Maizie Mears-Owens, Care UK’s head of dementia services, has found a new way to gently lead loved ones living with dementia into the festive season and increase their wellbeing. Here she explains how to make the 10 Boxes of Christmas.

Throughout Care UK’s 114 care homes we use memory boxes to engage people. We fill them with personalised items that mean something to them. It may involve items from their hobbies, careers or sports memorabilia but for Christmas I am suggesting families try an Advent style approach, with 10 boxes containing single items that will trigger memories of Christmas. Not only will they unlock memories but they will also prepare your loved-one for what will be happening in the home over the holidays.General-DSCF0070-SWGM291013-400x400

Have fun making the boxes. You can use any size or shape, you can decorate them with themes or wrapping paper or Christmas cards and you can get the younger members of your family to join in.

Box 1 Smell is one of the most powerful prompts to memory and Christmas is packed with very distinctive smells. You can include a stick of cinnamon, a jar of all spice and many shops sell little bottles containing a liquid that smells of pine for people who have artificial trees. Sit down with your relative and talk about the scents and the memories they invoke

Box 2 Many homes, mine included, have a silver sixpence that has been handed down over the years to include in Christmas puddings. If you don’t have one they are easy to find in bric-a-brac shops and flea markets. The coin has a number of benefits to memory. Firstly you can talk about when they were young – did they ever get the sixpence? You can talk about years when they made the puddings and you can also talk about the year the coin was made: It may be worth doing a little bit of homework in advance on what happened nationally that year to prompt the start of the conversation.

Box 3 Now we take fresh and exotic fruit for granted, but a clementine or satsuma when our loved ones were young was a rare treat. For many people the smell and taste of a satsuma encapsulates Christmas. I have often put one in my parents’ stockings because when I was young we always laughed about what they had in their stockings, a satsuma being a prized item. Get them to rub it between their hands and feel the texture and to smell the skin in the wonderful moment you peel one. They will also enjoy the taste and the memories it brings.

Box 4 Looking around the shops, and online at sites like eBay there are lots of wonderful Christmas baubles and vintage decorations around this year. If you are not fortunate enough to have your original Christmas decorations, think about buying one of the modern replicas for the box. Talk with your loved-one about when you used to decorate the tree together and ask them about trees and decorations when they were young.

Box 5 – Have a look through your photo collection and theirs. Are there any from Christmas past? If you have visitors coming to the house for Christmas, are there any that include them so that you can start preparing your loved one for who is coming? You can add tinsel to the box. Tinsel has the added advantage of being very tactile, which is great for people with dementia. Try and include a really full length and encourage them to hold it and pull it through their hands.

Box 6 – The gift of music. Dig out one of your CDs of Christmas song or carols. You can have a sing along together or just sit and listen. Carols often take people further back as they remember singing them in school or church. For those who were grown up in the 1960s and 1970s the sounds of Phil Spector or Slade and Wizzard will bring back memories of family parties and work Christmas events.

Box 7 – Nothing sums up Christmas like a Nativity figure. Do you have a Nativity set that the family has used for many years? Put just one figure in the box – one you feel will particularly appeal to your loved one. It may be a person, an animal or the crib – it doesn’t matter as long as it appeals to them. Chat about Christmases when you have had a Nativity set. Did you ever have a large one in your church? Did they have a village one when they were young? Do they remember your school Nativity? Do they remember taking part in one? What is their favourite part of the Christmas story?

Box 8 – A Christmas cracker can bring fun. You can find inexpensive make-your-own kits in hobby shops and supermarkets. Is there something you can put in that would make them smile? You can use the cracker to reminisce about Christmas lunches past and also to discuss what will be happening this year and to ask them for their ideas.

Box 9 – Christmas paper and ribbons can be placed in box nine and, depending where your relative is in their pathway, you can either sit together and wrap a present, which will make them feel involved both at the time and when the gift is given, or you can get them to feel the paper and scrunch it up while you talk about opening parcels. You can laugh about the fun you have had in the past trying to wrap up bicycles or tennis rackets.

Box 10 – Finally what could be nicer that sitting down together with a mince pie? That morning, box up a piece of whatever cake symbolises Christmas to your family. Form some it is Stollen, for others Tunis cake or Dundee cake. Sit down with a cup of tea and have a chat about what cake to choose this year, and what they had in Christmases past. Did they make it with you? Did they make it with their mum? How did they manage during the years of rationing?

The boxes can contain whatever you want in whatever order – the important thing is that you share the experience and that the items mean something to your loved one. Encourage them to take in the smells and textures and do the same yourself – these boxes will help you to create your own memories for the future.

Whether you are visiting a loved living with dementia in their own home or in a care home, I hope that my idea of 10 Boxes of Christmas will help you to have enjoyable and helpful conversations that bring the whole family together this December.

And may I wish you a very happy and peaceful Christmas.

What Good Care Looks Like

Every older person has the right to live safely, in a warm, clean environment and be treated with kindness and respect for their individuality.

Unfortunately despite some good care practice carried out by dedicated staff, the media has frequently highlighted the poor care and shocking treatment given to some of the most vulnerable people living in our communities.

Someone you know may need or be receiving care and support. They may be either living in their own home, a care home or somewhere else and you need to know what good person- centred care looks like, to root it out if you are looking for it or ensure they are receiving it already.

It is important that everyone feels able to say if they are concerned about someone else’s safety or the care they are receiving (or lack of it) who perhaps is unable to speak up. Some things to look out for that demonstrate good care are: iStock_000004809750Medium

  • People are treated with privacy, kindness, dignity and respect and seen as individuals before their disability, illness or needs. (“We cannot care for people unless we care about them and we cannot care about them, if we don’t know who they are”)
  • Care records are kept and include what is important to the person, what is important for the person and how they like to be supported
  • Needs and expectations are reviewed regularly with the individual and/or the people who know them well
  • Eating and drinking well and maintaining a healthy weight. (People’s likes and dislikes for food and drink are investigated. Drinks put within reach and people with a memory impairment reminded to drink)
  • The right medication is given at the right time and taking it observed
  • Well trained staff are available and training includes dementia care (80 per cent of people living in care homes have a form of dementia or severe memory problems)
  • The right sort of equipment is available
  • Meaningful and age appropriate social activities are available and informed by choice.
  • Relatives are made to feel welcome and included
  • Financial security is investigated
  • Care home is integrated with the local community (e.g. joint gardening or history
  • Leadership is strong and supportive. (Senior staff set a good example)

If you have a concern about someone else’s care and the danger is immediate dial 999. If the danger is not immediate, contact their Local Authority and ask to speak to the Adult Safeguarding Team.

If you are concerned about the quality of care provided by a care or nursing home or domiciliary provider, contact the Care Quality Commission on 0300 061 6161 or

Levels of Care Within West Sussex Revealed with an Interactive Tool

The differing levels of care in England have been revealed with the launch of a new interactive tool from Caring Homes, a UK care home provider. The tool uses data from over fifteen thousand checks, carried out by the CQC, to uncover the truth about standards of care in England.

CQC standards

The Care Quality Commission (CQC), a non-departmental government organisation, is responsible for regulating UK care in the following areas:

  • Care homes
  • Care given in your home
  • Dentists
  • Hospitals

The data used in the tool was sourced using these results via the Open Government Licence.

Key findings

Shropshire is crowned as the highest scoring county, with 94 per cent of its care homes passing CQC quality checks. On the other end of the scale, Nottinghamshire is exposed as the worst performing county, with 36 per cent of care homes failing inspections.

West Sussex

West Sussex was found have 288 care homes, which passed the CQC inspection, and 65 that haven’t, which gives it a 18 per cent pass rate. I was also one of top ten lowest scoring counties.

 The tool includes an interactive map element, which allows you to click on areas of England for a statistical report of care homes that have and have not passed CQC standards. The results include the county’s ranking, so you can make a rational judgement on the quality of care compared to other counties in England

Life expectancy and affluence

Astonishing results have also been revealed with the life expectancy and affluence elements of the tool. Surprisingly, those living in less affluent areas, such as Dorset, as more likely to live longer than those in better-off areas, such as Hertfordshire. In Dorset, where the mean salary is just £24,464, the average life expectancy is 85.3 years for females and 81.1 years for males. In Hertfordshire, where the mean salary is £33,831, males are expected to live to 80.4 years and females are expected to live to 83.8 years. In West Sussex  the average income is £26,453 and the average life expectancy is 81.6 years.

Simple search

The intuitive tool allows users to simply enter their chosen county into the search bar and uncover the truth about care in that area. The tool is likely to be used by those seeking care for loved ones who are looking for impartial advice. The simple elegance of the tool makes for fluid, intuitive searching where objective results are beautifully presented in seconds.

Person-Centred Care Home Search

As Ivy looked around her new room there was no way of knowing what was going on in her head. We had taken great care to make sure her new room looked the same as her old one. Photographs had been taken of her old room so it could be laid out the same and her ornaments arranged accordingly in her glass fronted cabinet. Her new room had been painted the same colour blue and a  new carpet had been laid, similar to her old one.

Ivy aged 85 had been living with dementia in a care home in West Sussex since her husband died five years ago. Her only son Paul had moved Ivy into the home before returning home to his family at the other side of the world, New Zealand.

Three years ago Ivy’s solicitor in West Sussex recommended Relative Matters to Paul and we have been monitoring his mothers health and well being ever since in addition to arranging for someone to take Ivy out for a drive and a meal out once a fortnight.

As time went on we became concerned about the quality of care Ivy was receiving and eventually, and in consultation with her family, decided that Ivy needed to move to another home. In the course of our assessment we identified that Ivy had a sister she hadn’t seen for years who still lived in Skegness where she had grown up. Thus the possibility of moving Ivy to a care home in Skegness presented itself and  our search began.iStock_000004762284Small

When a potentially suitable care home had been found we arranged to take Ivy for a weekend trial during which a tea visit was organised with her estranged sister. We made the 200-mile journey with Ivy, spent time assessing risks and most importantly, monitored her reaction to the new care environment and her sister. However, we needn’t have worried, Ivy was delighted to see  her sister and beloved ‘Skeggie’ again and it quickly became clear that we had got it right.

And so the move was arranged. We arranged for Ivy’s things to be taken to her new home the day before and her son and grandson flew over to help with the move. They arranged the room ready for Ivy’s arrival so it was ready when we arrived the following afternoon. By the time we left Ivy had reconnected with another resident she had made friends with on her trial visit.

As Ivy beamed up at us from her wheelchair we felt the warm glow of knowing we had made a difference to another person’s life.  We had reunited Ivy with her sister; in the area she held fond memories from her childhood. Job satisfaction doesn’t get much better than that!

Top Tips For Choosing a Care Home For People Living With Dementia

 I have covered the subject of choosing a care home before but get asked about it so often I thought I would cover it again and aim it specifically for people living with dementia so as to draw on my own experience of choosing a care home for my mother.

Moving into their final home is a life-changing event for your elderly loved one and paying for long-term care is the second greatest investment a person will make in their life after a mortgage. Make sure you get independent, specialist financial advice and spend the necessary time to match their needs, expectations, uniqueness and life style to your ultimate choice. Alternativey get a professional like Relative Matters to help you.


Local Authority Funding   

To be eligible, a person needs less than £23,500 in savings/assets including their home and a significant or critical level of needs

If you and the Council agree your loved one needs to go into a care home, they must arrange it if the person can’t do it themselves and no-one is willing or able to act for them. This applies whoever is paying.

Your loved one has a right to a place in a care home ‘that meets their needs’, as specified in their written assessment, even if it is in a different county.


  • You can get a list of care homes in the area your loved one wants to live by contacting their Local Authority Social Services Department, or the one in the area they want to live
  • Make a list of the homes that 1) are in the desired area 2) are the type of care home you are looking for (dementia or dementia with nursing)
  • Check selected homes are meeting national care standards. You can do this by going to the Care Quality Commission (CQC) website click on ‘care homes’ and enter name of the home.
  • Complete a care home profile with your loved one that sets out what is important to and for them. If they are unable to contribute themselves, ask people who know them well or put yourself in their position and choose for them.
  • Make appointments to view the homes, with your loved one if possible. A glossy brochure is no substitute for a visit! Only show them two at a time or you will confuse them.
  • Make a list of the key questions you want to ask when you visit care homes. Age UK offer a  checklist to help with this and provide other useful information about choosing a care home.
  • Your attention and questions should relate to the care home profile you have developed for and with your loved one. Here are a few questions I asked when researching a home for my mother.
  • Can you give an example of how you retain a person’s sense of identity and self worth?
  • How is dignity and respect embedded in practice?
  • How do you meet the communication needs of people with dementia? (I was looking for things like “maintaining a calm environment, reinforcing the need to approach people in a calm sensitive way, treating people with dignity and respect etc.
  • How do you manage difficult behaviour? I was looking for an answer that goes something like “There is always a reason and we try to find out what it is and seek help from other professionals when necessary” etc.
  • Does the home have Wi-Fi? (Needed for Mum’s iPad)
  • What training is in place for staff about dementia? I was looking for a regular training programme that included relationship-based memory care, which uses a compassionate, innovative, respectful method of dementia care that keeps clients calm and staff members engaged.
  • What is your policy for end of life care? Do residents have to move to hospital or a hospice? Are you linked to a palliative care or end of life team?
  • If your loved one has to fund their own care, ask what would happen if their money runs out after a year or so. Would the home be prepared to accept the council’s standard weekly rate?
  • Remember who you are choosing the home for and look at things from their perspective

The Secret To Finding The Right Care Home For Your Elderly Relative

Finding the right care home for an elderly loved one can be time consuming, stressful and overwhelming. Where do you begin when presented with a long list of care homes in their area? How will you know which one is best for them?

The secret

  • The secret is that you need to personalise your research by using personal selection criteria. Here are some of the things you need to think about:
  • What geographical area do they want to live in?
  • What kind of care home do they need? A residential home, a care home with nursing or a specialist home for people living with dementia?
  • What budget do they have? If your relative is being funded by the local authority, they will have a limit to the amount they will pay so find this out before you begin your search

What is important to and for your relative? 009_old_woman_smiling_optimised[2]

When looking for a care home for my clients, I begin with the question, ‘What is important to you about living in a care home?’ If they are unable to answer for themselves, I ask the people who know them best. Sometimes they need a little help so I prompt them. These are a few of the things I have been asked to include in a care home search.

Having a nice garden, being pet friendly, having a nice view from the window, WiFi access, living near family, access to public transport, being part of a small group, having people to talk to, having plenty to do, being treated with dignity and respect, feeling in control, not having to move again if condition deteriorates, ensuite facilities, being able to take my own bed and chair, having breakfast in bed, be near church, male as well as female staff, somewhere quiet to meditate etc.

Then I find out what is important for them. For example, level access, staff trained in managing dementia, access to trained health professionals, cater for special diet, staff trained in end of life care, meets National care standards etc.

See things from your relative’s perspective

When looking for a care home, it is important to try and see things from the person’s perspective rather than your own.

For example when we had to find a new care home for my mother who is living with dementia, it was more important to find a home that would be able to manage her difficult behavioural and mental health issues than one having nice furniture, matching bedding and ensuite facilities. We initially found it difficult to visualise Mum in a home where the decor and furniture didn’t match and there was an expectation that she would be brought to the dining room for breakfast (she had been enjoying breakfast in bed for over 10 years) and have to sit in the lounge or conservatory with others all day. In her previous care home she had refused to move from her room where she stayed all day every day.

We soon realised our fears were unfounded. Mum has responded magnificently to the calm atmosphere and gentle, confident approach from staff. The staff team who are multicultural and dress in their own individual way, treat our Mother with dignity and respect and always have a warm smile for us when we visit. She is also oblivious to the functional and uncoordinated decor, furniture and equipment, despite these things having been important to her in the past.

Lessons to be learned

There are lesson to be learned here. Firstly, don’t assume that your mother or father will find the same things important to them as they did in the past, as like my mother this might not be the case. Secondly  routine and a calm atmosphere are important for people living with dementia.

Another example of a personal approach to finding the right care home is one of my recent clients. Something that was important to her was that the room was big enough to accommodate her double bed and bedroom furniture, the home was plush as she was leaving a large luxury apartment and there were regular social functions and people she could talk to as she craved company.

Good luck with your search and remember , the secret is to find the right home for your loved one rather than yourself.

The Cost of Failing To Review Medication

My  mother has suffered with poor health all her life, having multiple and long term mental and physical health problems, including severe depression and vascular dementia.  When she was at home I managed her medications  The point I would like to make here is that I would always look up a new medication she was prescribed  to view the side effects and contra-indications if I was unaware of them.  I also regularly sat down with the pharmacist to review them.

Since Mum moved into a residential care home, 3 years ago, I have not only lost control of her medication, but also the knowledge of what she has been prescribed.  Soon after being admitted to a care home she was prescribed Aricept, it’s pharmaceutical name is Donepezil. My mother  also prescribed another drug for her dementia, although when I looked it up it’s primary use was for schizophrenia. Her medication for depression was also changed.   These drugs are very powerful.  Unfortunately I did not look up the side effects of these medications, as I would have done had my mother been at home.

Mum’s health deteriorated significantly

Several months ago Mum’s condition deteriorated, she began feeling and being physically sick, and more latterly became floppy, to the point she had to be fed and given her drinks.  Her speech became slurred and incoherent,  she was disengaged, unable to follow conversation and was sleepy all the time.  I kept asking for her GP to investigate Mum’s condition. She was seen by a variety of GPs but never her own, and had various blood tests and changes in medication, including another prescription for a drug to ease her sickness.

Preparing for Mum’s demise

At Christmas my son and I became so concerned about her rapidly deteriorating condition we decided  to let the family know we thought Mum was dying, to prepare them for how bad she looked when visiting her at Christmas.  It was a heartbreaking time for us.

Diagnostic intervention

After Christmas I asked for her own GP to attend and she contacted me to discuss Mum’s situation and possible courses of action.  As one of the considerations was that Mum may have had a stroke I asked that she could have a brain scan to confirm this.  I also requested a psychiatric assessment.

The brain scan identified that Mum had not had a stroke.

The psychiatric assessment identified a serious deterioration in her mental state and a detailed review of her medication was undertaken, with the result that the two powerful medications prescribed for her dementia, the one she took for depression and one for sleeping were discontinued. 91 years of life

Dramatic improvement

Following the withdrawal of these drugs, there was a dramatic improvement in Mum.  She became coherrent, more lucid, stopped being sick and regained control of her body again.  She was able to eat and drink independently, without the need for being fed.

Although my Mother obviously still suffers from dementia, with periods of confusion and forgetfulness, I could finally hold a conversation with my my Mum again, like I could before she was prescribed the drugs.

My family and I feel angry that despite seeing several doctors Mum had to experience sickness and other unpleasant side effects over a number of months before the matter was resolved.  Had her drugs been reviewed properly earlier on, the dramatic deterioration in her health could have been avoided.

I wonder how many other older people living with dementia are suffering unnecessarily.?

I want to make sure you are all aware of the danger of neglecting to ask for your elderly loved one’s medication to be reviewed regularly (not just given a once over at by a GP and hope you find the following tips helpful.

Top tips for reviewing medication

  • Make sure medication is reviewed regularly for your elderly loved ones. I believe GPs are too busy to review psychiatric medication thoroughly enough and pharmacists and community psychiatric nurses are better placed to carry out the review and make recommendations to the person’s GP.
  • Find out what each medication has been prescribed for
  • Are there any contra indications you/ the care home should be aware of?
  • What are the likely side-effects (if only we had known that a common side effect of Aricept (Donepezil) is sickness
  • Do the benefits outweigh the risks?
  • Does the dose need to be adjusted (people need less as they become older and often eat less and lose weight, as was the case with my mother

In addition to the human cost of failing to keep medication up to date for older people living with dementia, it also wastes valuable NHS money!