NCF Managers Conference November 2006

1
NCF Managers ConferenceNovember 2006

• Risk the relatives perspective
• Gillian Dalley
• Chief Executive
• Relatives Residents Association

2
The starting point

• From the experience I have just gone through, I
  wish professionals and those caring for our loved
  ones in homes would understand a bit more just
  how hard it is and help us has been carers as
  I felt I was viewed the instant I moved my mother
  to a care home through this emotional time.
  Long term carers cant just pull out from
  caring, and anyway I dont wish to altogether.
  Just like most relationships, you need to develop
  trust in your newly-found carers, who after all
  are complete strangers to both of you once you
  start to develop this trust .. only then can you
  begin to start to let go.
• Letter
  to RRA from a relative

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The risk conundrum

• Relatives want and have a right to expect that
  their loved one will be kept safe and her human
  rights will be observed
• but
• Residents have a right to take risks within a
  protective and nurturing environment
• and
• Staff need to know what level of risk taking
  is appropriate (to safeguard resident and protect
  themselves)

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What does this mean in practice?

• Relatives want the best but are often reluctant
  to hand over. This may lead to confrontation
  with staff and disagreements among themselves
• Staff may think they know best. This can sour
  relationships with relatives if they do not
  handle difficult situations skilfully
• Residents may be frustrated and caught between
  the two. They may feel they are losing their
  individual autonomy

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The risk continuum

• overprotected.taking riskat risk
• Examples
• cot sides going
  out alone unlocked,open doors
• chemical sedation smoking
  no help at mealtimes
• locked doors
  accessible environment self medication
• ????
  ???? ????

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The risk continuum (cont)

• Where do relatives, staff and residents stand on
  the
• continuum?
• Example Going out alone
• Relatives may say no because too great a risk
  (at risk or being over-protective?)
• Staff may say yes (sensible risk-taking, not
  wanting to be over-protective and not at risk)
• Resident may say yes (sensible risk-taking
  but may be at risk)

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Relatives experiences case studies

• Aunt is in shared room on the ground floor of a
  residential home. Family want her to move to top
  floor single room. Home Manager is not keen on
  health and safety grounds. She is not mobile
  without help. Therefore in the event of a fire
  she would be at risk.
• Where on the continuum?

8
Case studies (cont)

• Mother has some short-term memory loss - but
  otherwise coherent but can be up 11 - 12 times at
  night - needs comforting. Was agitated and
  depressed after losing health - heart attack 6
  months ago. Now beginning to settle. Home has
  good social activities which she likes. BUT she
  was taken to hospital after being given wrong
  anti-depressant medication by care home staff.
  Family know of another that is has good safety
  reputation and is tempted to move mother there
  BUT daughter really likes current care home
  because it is active but is worried about their
  bad record on medication, especially with
  mother's tendency to be restless.
• Where on the continuum?

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Case studies (cont)

• Mother recently moved into care home. She has
  moderate vascular dementia, and has been
  disoriented by the move. Daughter is concerned
  about quality of care. Mother wakes and pulls
  night cord. Manager says they can't cope with
  her BUT staff sleeping in overnight are not
  working staff. She says she has to pay them 15
  each time they have to wake. (They have day jobs
  to go to and do not want to be woken). Manager
  says they can't cope with mother and want her to
  move implying this has been a trial period.
  Manager says she was not the sort of person "in
  the habit of turning people out". Caller feels
  her mother needs a proper assessment. GP has
  been prescribing medication without seeing her
  (sleeping tablets). Caller and the manager had
  arranged to see GP but manager has now said she
  must leave the home and pulled out of the
  appointment.
• Is the resident at risk?
• What is the homes responsibility?
• What should daughter do?

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Case studies (cont.)

• Mother in care has dementia. History of disputes
  with authorities - EPA removed on grounds of
  interfering in mothers care (now restored) ASBO
  to keep away (now lifted)
• Current dispute about whether or not she rather
  than home called doctor social worker regarding
  it as another case of interference.
• Now a dispute about medication daughter thinks
  its the cause of her mother falling frequently.
  Home denies giving it but later shown they were.
• The doctor agreed that her mother should not be
  given this medication at night. Despite this, the
  home continued to give the medication for several
  days.
• CSCI agreed medication given wrongly but also
  reported that daughter accused home of abuse.
  Daughter denies it.
• Is the daughter being over protective and over
  intrusive?
• How to de-fuse the situation?

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Some solutions

• Risk assessments that take account of personal
  history and background
• Involve relatives (if residents agree) in the
  risk assessment
• Most relatives want the best for their loved ones
  build on that commitment
• Avoid escalating disagreements into full-blown
  confrontations
• Mediation, advocacy
• END