Day care options and respite for carers of a person with dementia
Respite is any provision which allows the carer to have a break from what is otherwise a 24 hour per day responsibility. In the early...
Care, and in particular care of the elderly and people in need of mental health support, is supposed to be high on the list of priorities in today’s health and social services. But the experiences described by people who support people living with dementia we talked with demonstrated serious gaps in the service provided (see ‘Assessments and care plans’).
Several carers suggested that what they needed was for there to be a care manager who would be responsible for the detailed understanding of the circumstances of each person requiring care and the ability to ensure that it was provided from the appropriate source. As one carer described, this person should be able to anticipate the problems that are likely to arise so that there does not have to be a crisis.
Another suggestion was that a person at home with dementia should be assigned a Community Psychiatric Nurse (CPN) who would make regular visits where they could assess the state of affairs and be able to predict the possibility of impending breakdown in the arrangements before a crisis arose.
Failure to communicate within the services causes unnecessary confusion for carers. Failure to point them in the direction of the invaluable sources of advice and support outside the health services leaves them deprived of help. All those who had benefited from advice and support organisations agreed it made an enormous difference to the quality of life both of the person with dementia and of their carers. Many doctors have little real knowledge of the problems associated with caring for dementia but they should make the effort to make sure they refer people to the agencies that do have this knowledge.
Failure to liaise effectively can result in delays, misunderstandings and actual damage to the patient’s health. Carers have their work cut out caring, but several carers described how they also had to fight to get essential equipment and to overcome intolerable delays in delivery. In this case the item required was expensive and while that doesn’t excuse the failure to get a move on it may be one reason why this happened.
Seemingly ridiculous bureaucratic complications could also mess up the provision of much more mundane items. Incontinence pads, which are incredibly important both for relieving some of the laundering problems of the carer but also for protecting an immobile person from skin damage, were sometimes unavailable for a newly incontinent person being discharged from hospital because they had to be ordered through social services and there was a 6 week delay. One carer said that she was rationed to 5 pads a day which was nowhere near sufficient for her husband, but that after he had died, no-one was prepared to remove unopened packets of pads which hadn’t been used.
Other items essential to the care of a bedridden patient took months to arrive. Until a suitable hoist could be installed one carer was unable to lift her husband even with help from another person. She had to choose whether to risk serious injury trying to lift him on her own or accept defeat and allow him to be admitted to hospital with the risks, and expense to the NHS that that involves.
People described to us when the person living with dementia begins to experience falls and hospital stays in the later stages of dementia, hospitalisations were often problematic. One person talks about how his father who wore hearing aids was unable to have his hearing aid batteries changed while hospitalised. Another person talks about her mother who was transferred from the hospital to a rehabilitation centre in a taxi and was missing for eleven hours.
Some of the most difficult caring problems occur with younger people suffering from frontal lobe dementia. While often physically fit and active they may sometimes be very difficult to look after because of out of character behaviour towards others including their carer.
There was a strong suspicion among carers based on their experiences that the quality of care suffered when social services decided to privatise some of their provision. Their complaint centred mainly on the home carers but also concerned carers in residential homes. There was a feeling that there was no effective training and that many nurses and carers had little experience and no understanding of the problems of people with dementia.
Keith and Neil described their concerns with the quality of care in residential homes for the person living with dementia. One person made an effort to advocate on his civil life partner’s behalf to address concerns he witnessed while visiting.
Considering the enormous benefits provided by carers, removing as they do much of the burden which otherwise would have to be carried by the health services, it is shocking how many gaps there are in the support available for carers.
Some people may be in a predicament where they are the next of kin for an extended relative in their family. They may suddenly have a phone call from health services to attend to this relative as they do not have another immediate next of kin to contact. One person described how she is in a predicament as the living next of kin for her aunt. Her aunt, whom is single with no children, planned in advance to give Power of Attorney to two close confidantes. The next of kin does not have Power of Attorney, but receives calls from health services for her aunt. There is confusion about who has rights to make decisions about her aunt’s care and whether the next of kin has power to make decisions when there are two people with Power of Attorney in place. Care decisions have to be mediated between the next of kin and the Power of Attorneys to come to an agreement. The care responsibility for the person living with dementia becomes muddled and it is difficult to enable care quickly and effectively. The situation can cause anxiety for those involved, but communication is essential for this type of situation.
Last reviewed November 2023
Last updated January 2024
Respite is any provision which allows the carer to have a break from what is otherwise a 24 hour per day responsibility. In the early...
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