Relative Matters were recently requested to review the care of an elderly lady in a nursing home. A care review involves a complete review of every aspect of a person’s life to ensure both their financial, physical, psychological wellbeing and religious/spiritual needs are met safely.

Care Reviews

It is often a complex piece of work because it involves reading the care plan through thoroughly, talking to care staff and other involved people such as families or external health professionals, talking to the person whom the care review is about and observing the environment. This then enables Relative Matters to make appropriate recommendations which can include things such as the purchase of more clothing, education and advice to care home staff on how best to interact or engage with the person, particularly if they have a cognitive impairment or dementia or provision of aids such as ipads to facilitate supported communication with loved ones if they live far away or other aids to enhance their ability to engage.

In this particular instance, the lady in question was withdrawn, and in discussion with care staff, Relative Matters were advised that because of her poor hearing she was choosing to disengage. There was some concern about the decline in her mood as a result. Comments such as;

“We know she can hear things but she’s choosing not to be involved”.

“You can’t engage her if she doesn’t want to be engaged”.

“She’s choosing to give up”.

Whilst for some people this may be the case, in this specific case, things just did not add up – her friend who visited frequently kept reporting she can talk and be involved if given one to one time, and her Solicitor who commissioned Relative Matters was saying the same. The inference was that the home had given up on her and that she had been labelled as someone who had withdrawn.

Our intervention

Relative Matters made enquires with the service that completed the hearing test, and were advised that the lady had been issued with new hearing aids, but that she had severe to profound hearing loss and standard hearing aids (although they were high powered ones) would only minimally help due to the specific type of hearing loss that the lady was experiencing. So, it was clear she wasn’t choosing to disengage, she just couldn’t hear!!

Relative Matters never give up on a person; the first tack in addressing this issue for the lady was to rephrase what care staff was saying in an attempt to re-educate them that the person is still inside the lady. In many discussions with various care staff members, when Relative Matters were told “she chooses not to respond to you” this was rephrased as “she has severe to profound hearing loss so it is likely she is really struggling to hear what has been said. We will keep trying to give her every opportunity to engage with us”.

Breaking down pre-conceived labels or thought patterns about people is so important. If you can change an established thinking pattern, just by rephrasing a negative statement into a positive one, this can have astounding positive effects.

On further investigation, advice was sought from the local Action for Deafness service about whether there was any device that may assist so that all opportunities had been explored and exhausted. It was identified that a personal listener device may work for the lady. Relative Matters swiftly acted to escort the lady for assessment and amazingly, one of the personal listener devices worked first time.

Fitting a personal listening device

When asked by the assessor at normal speaking pitch if she could hear, the lady said; “No I can’t hear!” Which of course she could as she heard the question at normal speaking pitch, but that her wry humour which Relative Matters had been told she possessed was coming to light immediately! The magical part is that the lady smirked and even managed a chuckle! Sharing a joke was priceless after being unable to fully engage with her in ‘normal’ conversation up until this point.

Facilitating engagement

The device has transformed the lady’s ability to engage. To capitalise on this, Relative Matters provided some education with care staff to ensure they fully understood the importance of the lady having it with her and on at all times. Within 24 hours, Relative Matters received an email from the care home Manager stating she had come downstairs, engaged in a game of dominos, had been invited to a poetry session but was most insistent she had no interest in going!

This demonstrates how this lady was given a wonderful opportunity to re-engage, have choice in what she engages in, and be able to communicate again.

Our Occupational Therapy consultant and dementia specialist, Liz Tremlett, undertook this piece of work and wrote this blog post.

Relative Matters Ltd

Relative Matters is an independent consultancy for older adults made up of a small, dedicated team of health and social care professionals, all of whom are fully insured, registered with the Health Care Professions Council (HCPC), and public disclosure certified. Working together they offer an unprecedented knowledge-base of the local care market and ensure care is highly personalised.