Nursing home No-one (or very few) goes willingly into a nursing, or probably even a residential, home. Dad’s case wasn’t typical – emergency placement in a PCT Intermediate Care bed as an ‘admission prevention’ with only a very faint hope of getting him home again. (A previous rehab-to-home attempt had ended after less than a month in the fall which brought him here now).
There’s no point detailing our particular triumphs and disasters – each individual (and each PCT) is different. But the practical things I learnt in the first few difficult days are worth passing on. They’re not covered in the literature from the homes (and I’d recced plenty) and they’re not covered by the otherwise comprehensive fact sheets (‘Choosing a Care Home’ etc) available from agencies like Age Concern.
So, if you’re facing the prospect of managing the transfer of a spouse, parent or relative from home into ‘a home’ - or are thinking of making the move yourself - here are some things to be aware of.
- If the person is going in as the result of, or has recently had, a fall, the staff will photograph any bruising – to show they didn’t cause it.
- Some homes require all electrical equipment to be tested before you can plug anything in. As Dad’s blind and sleeps badly, the thought of being without his beloved radio through the first night nearly finished him off and had us chasing around 24-hour supermarkets for batteries.
- The homes’ literature says they do laundry, which was one load off my mind. (And it’s all in the price). However, all clothes must be marked, so, if you have time to plan, get a laundry marker pen. (Iron-in name tapes might seem tempting, but are no good: the homes go on room number, not names). If the person moves rooms, get in quickly to re-mark. ‘Laundry’ does not include ironing. If you want to see your loved one with ironed pyjamas or hankies, be prepared to bring them away and iron yourself.
- Read the contract. Some homes have zero-tolerance policies on alcohol consumption (though Dad has a virtual bar in his bottom drawer). Some will take pets, useful to know both if you want to take one in, or indeed to avoid them.
- Make sure you’re clear on the home’s charging policy for hospital stays and the period for which you’ll be charged after date of death. (For an authority or NHS-funded place you get 3 days to clear the room after what they tactfully call ‘R.I.P’; privately-run nursing homes average a week or until the room is cleared; the BUPA standard is 2 weeks).
- If the person goes into nursing care, any care formerly provided by district nurses (bandaging leg ulcers, for example) will now be provided by the nursing staff at the home. If the person goes into residential care, nurses from the community will come in and bandage, but they may not be the nurses the person’s used to. A care home literally over the road from one surgery may be served by nurses from another.
- The same applies to keeping one’s own GP. When it came to choosing a permanent place for Dad, the decision was taken on the basis of which home was served by his existing doctor. You can keep your own GP even if you’re out of catchment, but you’ll miss out on the regular ‘ward round’ provided by the GPs from the surgery which does cover that particular home and will also have to alert the home to contact the required GP for the standard six-monthly routine check-up.
- There can be a lot of politics between for instance, nurses in the community and those working in care homes. The nursing home view is that district nurses are only too willing to drop elderly people who’ve come to rely on and trust them the moment they come into a home; district nurses say that nursing home staff pretend they have competencies and specialisms which they simply don’t.
- The care and nursing staff will be wildly ethnically diverse, which can be difficult. It’s not about prejudice, it’s a matter of understanding. Catching someone’s heavily-accented English can be tricky if you’re a bit deaf or don’t see well – or in Dad’s case, at all - and are unable to read facial expression or body language or even know if someone’s in the room until they identify themselves.
- Buying a place in a residential or nursing home is like engaging the services of anyone else – if you want results you have to ask, ask and ask. Your relative will probably be disorientated and, frankly, depressed, and either more passive or more querulous than usual. But even if they are, there’s an element of ‘not wanting to make a fuss’ – you may well be on the receiving end of a lot of moans which could be easily sorted if they’d just speak out. Make a fuss yourself if you have to.
- Having said all this, most homes are flexible and happy to help problem solve (certainly Dad’s is). If a compressed-air mattress or a TENS machine would be useful or if shifting the furniture round or an extension lead would make all the difference to the room, just ask.
- The same goes for disability aids – raised stickers to help the blind or partially-sighted find things (the call button for instance); a bigger wheelchair than the standard one designed for a man/woman of about 5’8”. My dad’s 6’4” but, on request, a larger one was produced. When it comes to trips out, all black cabs should carry ramps - but make it clear you need them. There should be no extra charge.
- Take some time out for yourself and try not to feel guilty about it. It’s not easy seeing your parent or relative frightened, fragile, depressed and demanding. It’s not nice seeing the Zimmer, the commode, the nappy pads become regular fixtures, or the sick old people sitting in chairs, whether in their rooms or in the lounge, listlessly watching TV, seemingly waiting to die. In the early days and weeks everyone – you as well – will be grieving for a way of life lost and the inevitable decline to come – but in time, it is possible to come to some sort of accommodation with it.