Mailbox Response

The question was submitted Wednesday, 29 July 2009

Subject: safety/privacy in the nursing home

Mum is in a high care nursing home with other dementia patients who are a lot worse off than she is. My sister was looking after her but she had a fall after which she was considered needing 24 hour care. There are about four people who keep wandering into her room, one shouts at her, others walk in day and night, while another rumages through her cupboards and she was found wearing one of mums cardigans this morning. When the carer was informed she wouldn't believe mum and got quite cross about it until my sister asked her to check the label and of course it was mums. We do understand the patients can't help it, but we can't just accept the effect it is having on mum. It is literally traumatising her. She has lost her confidence, her trust and lives in fear, She is constantly watching the door and is really jumpy. She has stopped eating and has become withdrawn. She can't sleep at night in fear of the people who come into her room. She is depressed and her mental and emotional health has taken a real dive since she has been in there, which is really upsetting as this is contra to its aim and especially considering the way she was when she went in, ie happy confident and accepting of the fact she needed to be there. The staff say there is nothing that can be done. Surely she should be able to feel safe and secure, at least in her room. Is there anything that can be done? My sister also discovered to her disgust that mum and another patients knickers on, which she had been wearing for three days. Mum has plenty of her own knickers, and is reliant on the staff to toilet her.

Answer from DementiaNet

The description you give about your mother’s circumstances is not uncommon and highlights how difficult it is to provide care to people with Alzheimer’s disease. Entry to a nursing home is very emotionally traumatic to the patient and also for family members. Management of behavioural problems is the main issue for staff in nursing homes and it is inevitable that other residents will be affected by this. It is also very common for residents’ clothes and belongings to become mixed up. It is really quite difficult for staff to keep track of personal belongings for all residents. Nursing homes are usually understaffed and the caregivers are also very stressed and often paid poorly.

Nevertheless, you should insist on having your concerns addressed. You should ask the director of nursing to arrange a family meeting and ask that the GP and the allied health team be there. You have not mentioned what other medical problems Mum has but it is possible that she has a mood disorder that can be treated. It may be that some of the other residents that are causing the problem need to be medically assessed and treated. There are behavioural strategies that can be employed to alleviate problems like this. The OT should be able to provide some advice. The bowel problem should be dealt with by the GP. A rectal exam is needed and perhaps a plain abdominal x-ray. Her diet may need to be reviewed by a dietician. The usual cause of this problem is impaction with overflow but inflammatory bowel disease needs to be considered. In addition some drugs can cause bowel disturbances. If the GP cannot manage the situation then you need to ask that Mum be reviewed by a geriatrician or psycho-geriatrician.

If the above fails then you can consider moving Mum to another nursing home. There is no guarantee however that such a move will be successful because you cannot predict who she will be living with.

The answer was published on DementiaNet Friday, 31 July 2009