Mrs S was a 77-year-old lady with dementia living in Romford. Her story is a great example of how we effectively cooperated with local healthcare professionals to achieve the best outcomes for her health needs.

Mrs S’s Story

Mrs S was diagnosed with dementia and so lacked the capacity to give consent. She lived with her elderly husband who made all the decisions for her. She also suffered from osteoarthritis in her knees & a recurring urinary tract infection. Her dementia meant that sometimes she would be aggressive towards our specialist dementia arers, either hitting out or scratching them. Our carers had the training they needed to both expect this & know how to diffuse these situations. They did, however, notice a rapid decline in her mobility as she was, at times, unable to bear weight.

Mrs S received 2 calls a day from our dementia care team & her husband didn’t want any changes to the care package. Our response was therefore to send a referral to Adult Social Services requesting an urgent Occupational Therapist review. The Occupational Therapist liaised with the Care Quality Officer at Lodge Group Care and we were given a detailed outline of Mrs S’s presenting difficulties. Next, we initiated an urgent joint visit at the property with the Occupational Therapist from the Community Treatment Team.

 

Problems identified by the Occupational Therapist

• Fluctuating mobility and several recent falls.
• Suspected urinary tract infection.
• An unsafe environment due to a lack of suitable equipment.
• Risks to both her carers and her husband when transfers occur.

Interventions Implemented

• Social Services agreed to change the current care package to 2 carers visiting 4 times a day with immediate effect.
• A mobile hoist was delivered by Occupational Therapy.
• Our Care Quality Officer requested a visit from the Community Nurse.
• Our Care Quality Officer requested an assessment by a doctor from the Community Treatment Team.
• The Occupational Therapy recommended using the hoist for all transfers. However, Mrs S’s husband refused the use of the hoist in the property.
• We implemented an emergency protocol to place Mrs S on bed care and identified the need for a hospital bed and airflow mattress.
• Our Care Quality Officer shared their risk assessment and ongoing concerns with Social Services, Occupational Therapy / Primary Health Care Services.
• A hospital bed was agreed and commissioned by the District Nursing Team.
• The GP requested to visit and prescribe antibiotics.
• We completed a referral to the Physiotherapy Department.
• Our Care Quality Officer continued to review the care package for its suitability in meeting Mrs S’s needs.

The outcomes

1. An acute care intervention was avoided.
2. Mrs S’s urinary tract infection cleared though her mobility still fluctuated but protocols were now in place to prevent avoidable falls and injuries.
3. Mrs S received more frequent daily care by not one but 2 of our carers, ensuring her increasing needs were met.

All of the above was only made possible due to the extensive local contacts and positive relationships we have fostered with allied health professionals in the local area. Together we were all able to ensure Mrs S received excellent dementia care so, despite her diminishing physical health, she could continue to live in dignity and safety in her own home.

The story of Mr W, a 77-year-old man living with his wife of 53 years in Havering, illustrates how our thorough initial assessments can have a transformative effect on the lives of service users by quickly identifying their needs.

Mr W’s story

 

Mr W suffered from a brain aneurysm at the age of 60, had 2 brain haemorrhages and was diagnosed with vascular and Lewy Body dementia. His wife’s and family’s wishes were that he received dementia care at home with our support, without any active interventions. We, therefore, carried out an initial assessment which identified an array of problems.

 

Problems identified

 

• Behavioural and memory problems due to vascular and Lewy Body dementia.
• Potential to be violent, aggressive and uncooperative when delivering bed care.
• Communication problems as at times Mr W would misinterpret and/or not comprehend what was being said.
• Visual and hearing impairments.
• Poor mobility.
• Contortions of arms and legs.
• Incontinence.
• Prone to skin breakdown/pressure sores.
• Poor compliance with medication.
• Poor dietary intake and reduced appetite.
• Dysphagia i.e. risk of choking on liquids.
• A high risk of chest infections and urinary tract infections.

 

Interventions implemented

 

• We requested that the GP prescribe Thick and Easy to be added to all liquids to reduce the risk of Mr W inhaling liquids into his lungs.
• We requested that the GP review his current medication and pain management, which resulted in a morphine prescription for Mr W’s pain.
• We requested an Occupational Therapy assessment which resulted in a hoist and suitable slings being provided.
• We requested a review by District Nurses who supplied a hospital bed, airflow mattress, slide sheet and nappy pants.
• District Nurses and Tissue Viability agreed to review his skin weekly.
• We requested a joint meeting between the social worker, District Nurse, GP and family.  This resulted in a referral being made to the Palliative Care Team at St. Francis Hospice, with the intention being to support the wife and family with Mr W’s deteriorating condition.
• Mr W’s family made a formal decision to implement a DNAR (Do Not Attempt to Resuscitate)
• We made a referral to the Community Matron for ongoing support.
• All carers were met on site by the Care Quality Officer and supported with the challenges in delivering Mr W’s care in an effective and dignified way.
• Hospice staff provided weekly psychological support for Mrs W.
• Our Care Quality Officer, a registered general and mental health nurse liaised with Mr and Mrs W to review the management of Mr W’s ongoing care needs and to provide regular support to Mrs W and her daughter.
• Our Care Quality Officer collaborated with the family and all other healthcare professionals on a continually evolving person-centred care plan.

 

Take home message

 

Mr W’s considerable heath needs warranted extensive, integrated care planning, which was spearheaded by Lodge Group Care. This ultimately resulted in Mr W having a peaceful end of days, free from unnecessary pain and discomfort, with his dignity maintained.