Pressure sore in Care home.

Share your ideas about the practical side of caring.
Hi

My 90 year old Mum has been in a residential care home since end of August 2016.
Mum lived with me for 3 years up to then.

Her health is failing gradually. She has previously had a stroke 7 years ago, has heart failure and rheumatoid arthritis, Osteo and osteoporosis. Incontinent.
She no longer gets out of bed since her chest infection in January and she cannot stand or tolerate the hoist.
Mum's diet fluctuates.
Mum had a nurse assessment 2 weeks ago and it was decided that as Mum deteriorates and if the family agree (my brother and I) then it was probably best if Mum stays in the rest home as she knows the staff and they her well and it might be upsetting for her to move in to a nursing home.
But as more nursing may be more of a requirement for Mum, then the community nurses can come into the care home and advise the care workers.

On last Friday, Mum was diagnosed with a chest infection again.
On Monday, the care home manager noticed Mum's left foot had a blackened heel about 1 inch round. She contacted the community nurse and the nurse has ordered an air mattress, Mum is on a foam hospital type of mattress at present.
The tissue viability nurse has been requested to visit Mum form the hospital.
Mum is to have 2 hourly turns until the air mattress arrives.

My main concerns are: The air mattress was ordered urgently on Monday - not arrived yet, I spoke to the community nurse and she said it it is out of stock then they will just have to wait.
Mum dislikes turning side to side and prefers to stay on her back most of the time - so she refuses to have her position changed.
The community nurse has now said that there is no pulse in Mum's left foot and that is a cause for concern and she has informed the GP - is there anything that can be done?
I informed the care home staff many a time in the last 2 weeks that as Mum's feet were cold and always her feet were left uncovered, could they make sure a light weight blanket was put on, which is what I did every time I visited - but it never happened.
Mum has very little speech, she gets very mixed up and is more frequently mixed up and never asks for anything.

I feel the staff may think I am very picky also but I cannot help noticing when things are not right for Mum and I feel I am her spokes person.

The staff do cover up for each other and are also very nice, very busy and cannot spend the time more than necessary to be with Mum, but they also miss so much but I can see they haven't got the experience of looking after Mum as I had.
My brother lives 250 miles away and visits once a fortnight for about an hour, so really I just have to be grateful that he manages that as it's another family member that visits.
He doesn't and hasn't got involved with any of her care though and leaves it to me. But I do only live 10 minutes drive away form the care home.

Any advice is very welcome - I thought I was exhausted with Mum's deteriorating health at home but I am worn out still with worry and what will be lacking for Mum if I miss a day going into Mum.
Christina
I wonder if the care home is really up to this. She should maybe have had an air mattress when she started spending all her time in bed, A nursing home might also be more skilled at keeping her comfortable and attending to all the -very important- small details.
There are also special heel protectors they could get to protect her heels.
What a difficult decision for you, but I think it is quite common for people to have to transfer from care home to nursing home.
Thanks Jessie04 for your reply.

Yes, I did wonder if Mum should be having an air mattress when she started staying in bed, but the community nurse who was called in by the care home manager said that as the manager reported Mum's pressure areas as being very good - 2 weeks ago, then she didn't need an air mattress yet!!
But looking back, it maybe should have been ordered in then.

I forgot to say that yesterday, heel protectors were put on, so that's something.

Maybe I should now discuss with my brother about a nursing home for Mum - I thought that as I don't know of any recommended ones in the area - the only 2 have had not good inspection reports, and they are very large.
I would need to look further away by about 10 /15 miles but away, but would the qualified nurse on duty be better than any community nurse coming into the home daily - but it does vary who comes in - and maybe it would be the same nurse on duty in the nursing home mostly or up to 2 or 3 different ones at most covering the shifts.

I shall have to look at what is available.
It definitely sounds as though mum needs a nursing home, which covers both nursing and dementia.

CQC reports only give a snapshot on the day. If there is a bad report then usually that leads to a rapid improvement, so if you visit a home which was told to improve, read the full report, then go and talk to the Matron about it when you view the home. My mum's home had a negative report when she moved there, as staff were not responding to calls quickly enough, but it was then uprated again.

Before mum moves, Google "NHS Continuing Healthcare" and look at the checklist. IF mum qualifies, all future care will be free, but it's very much a postcode lottery I'm afraid.
bowlingbun, thanks for your reply.

Mum had a continuing healthcare assessment from the community nurse 2 weeks ago and the nurse decided that mum did not qualify and that if her health deteriorated she felt that mum should stay in the care home with increased visits from the community nurses, which is now daily since discovering mum's pressure sore on Monday.

Both she and the manager asked if my brother and I agreed, we said ok.

They said it would be too traumatic to move her and my brother said that he very much agreed as our mum had stated that she liked being there a few months ago.

I don't want to be the cause of any further deterioration/mental stress of her health with moving BUT I should look around at Nursing homes as in the next few days, I may make a better judgement.

My brother has POA for finances (and I have secondly, if he is ill/unable to).
We don't have one for health.
Mum does pay for her own care, but that won't be a problem if my brother agrees, but I think it's going to be very difficult to persuade him.
I shall look at nursing homes anyway.
Hi Christina
How about asking the Care home manager for a chat to discuss Mums future options? That way you are not complaining, but you can thank her about noticing the sores and then move on to how worried you've been since and that maybe a move would be better for her after all?
By phrasing it as a 'what are we going to do' conversation she may well come up with other ideas or at least monitor the staff more closely. It gives her the chance to improve care for mum without it all coming up as formal complaints or adversarially.
You in the meanwhile keep looking at nursing homes and visiting mum.
Mum is lucky to have you in her corner xx
MrsA
H Christina
Just wanted to say how much I feel for you. I am a former carer and can understand the worry. I was lucky that my mother could remain with me until she had a fall broke her hip and needed hospital treatment. She was in hospital for only 2 nights but the worry and need to protect her was all I could think about. Sadly she died the next morning. Looking back it was a relief because that she was frightened of hospitals and wouldn't have wanted to be there for long.

I just wanted to say I can understand your worry but remember to take care of yourself. We all want the best for our Mum's but much as we don't want to sometimes we have no choice but to hand the care to others. Remember you have done your best for her.

Take care hope things are better soon.
Thanks for your replies Mrs A and Gillian.

I will speak to the care home manager and have a chat with her about my concerns, which will be Monday now when she is back in.
I think Mrs A's idea of a discussion with the manager is very good. I do hope it goes well and they can provide the greater nursing care your Mum needs. It's nice that they are willing to do this. I feel a bit bad for mentioning a nursing home and I hope that you can manage without moving her. It would be a shame also for you and your brother to be falling out about it. Hoping for the best for you all.
I definitely agree with making it a 'discussion' in which 'you ask the question' (ie, so they feel like 'the experts') and make it 'we' (to involve you BOTH in any outcome!).

That said, I do think, don't you, that the most important question now has to be the very, very difficult one of 'How long do you think Mum still has?'

If the answer is 'maybe months, probably not a year' then you could decide that it would be too traumatic to move her elsewhere, and that it wouldn't be 'worth it', as she wouldn't have time to settle into a new place. BUT, maybe if they say 'no reason your mum hasn't got another few years still' then moving her might be worth it, as she'd have time to get used to a new place.

One thing about care homes and nursing homes - the staff there have 'seen it all before'. It's something I bear in mind with my own MIL. Her home always tells me if there has been an 'incident' (eg, fall), but I always ask 'is this par for the course given her condition' and they put it in context for me, which I find very helpful.

As for the feet problem - you say they aren't always covering her feel to keep them warm. If so, would bedsocks (loose warm ones) not be an answer? If circulation is poorly, wouldn't manually exercising her feet help? I had to do that for my husband when he went into end stage cancer and lost consciousness. I was told to bend and flex his limbs to aid his failing circulation.

Just a thought, and sorry if it's not appropriate.