Carer Training

I think that is always the problem MA. I feel we have been very lucky, for various reasons, to find the carers we have. The gap is in how they understand - or don't - people with Alzheimer's.

We have the close gap at the weekend between lunch and evening meal. I would suggest that we leave out something cold for mum to have when she is ready in the evening but she hangs on to Wiltshire Farm Foods for lunch and WFF in the evening - it's all about feeling safe. I have no idea how we could introduce something different without a) upsetting her and b) her not eating it and me getting a call that no one has made her meal and having to go over - which would mean she was eating very late by the time I get there. As my mother would tell me when I was young - no one said it would be easy.

Sometimes (often) my mums day was condensed into 11am breakfast, 1.30pm lunch, 2.45 dinner, 4.30 bed time call.
She didn't have dementia, but it was difficult to tell what was going on, and of course she refused food because she had only just eaten.
Also difficult to complain, because I realised we were lucky to get care.

We have just had our second carers visit.
Last night two came to do the initial assessment, then came back 2 hours later and put H to bed.
This morning a lovely woman came and got him washed and dressed, but it was 11:20 and it was hard not to do it myself but I know I couldn't and shouldn't.
As she was going she said we wouldn't see her again as she was a floater today, it wasn't her "round".
I think we will have to go down the private route if we need it after the 6 weeks.

There is mandatory training for carers: first aid, food hygiene, moving and handling, safeguarding, infection control, I think they are, but after that you're sent out to care for vulnerable people.

The care system is in crisis so they are probably taking on people and sendig them straight out to care for people. It is wrong but there is such a demand that can't be met. Sending people for training probably takes them out of the work force as well and even for one day that would put a huge strain on the system. It is shocking, but it's how things are.

I think I am going to have a word Witzend. I have no wish to upset anyone though. I would bet a pound to a penny they have had no dementia training. I don't think they have to. Eventually their will no doubt there will be government insistence on training in this which will then put the costs up - which is as I believe it should be. Being the person trying to work out how we (mum) will be able to pay these costs just brings home the need for a care system on the same basis as the NHS - but that's another story

Sounds as if they've had inadequate dementia training, if any. I think you'll have to make it clear to the agency that while you appreciate that in non dementia cases, of course it's the done thing to ask, but where dementia is involved, asking first frequently means that the default answer is 'no' to everything - and very little gets done.

Which means that if they are going to achieve anything during their visits, they will have to 'ask' in the way a pp has described.

It's not perhaps surprising that cluelessness about the practical realities of dementia are common in the general public who've never had to deal with it, but care agencies really should be up to speed on this sort of thing.

'Professional' Carers are required to ask the 'cared for' persons permission or agreement before carrying out any task. This works perfectly well for someone with a physical disability but not for someone with a mental impairment e.g. Dementia which makes it very difficult for them to 'choose'.

During our 'Carer's Course we were taught that we should never give a choice of more than 2 things at a time e.g cake or biscuit and the question should not be asked in such a way that it invited a Yes or No answer. So ' Bath now or in 20 minutes? is OK, as is Breakfast now or Get dressed first? where either is possible. If a Jacket is necessary, only give a choice of the Blue One or the Brown One. don't ask in a way that implies a third choice i.e. no jacket at all.

A good company should train the carers in exactly these kind of issues. As a carer for the elderly it was pretty sparse, but working with challenging people focused more on techniques, body language, in some cases, and positive outcomes for everyone. That's all everyone wants.

This is assuming that carers have even the most basic training which some don't. The carer they sent for my husband did not know about wearing gloves or using the sharps bins for health and safety. Neither did he know how to use microwave or toaster or run hot water for a wash or shave. I was astounded at the lack of knowledge of how things work in this country.

I was watching teachers dealing with difficult (excluded) children this morning. I am sure they could not have done their jobs without training. This is not all that different.

That would be nothing I couldn't deal with, trisher.
I have years of experience, and training, and common sense.
And if someone was not eating or drinking adequately I would raise the issue with my line manager.

At least I am not criticising the carers and I thought I had made that clear. What I am criticising is that there is not sufficient training available for them.

I'm most certainly not criticising trisher.

It's easy to criticise but the carers have my sympathy in that they are in a very difficult position. If they are seen to be denying the person they are caring for the right to choose they may well be disciplined, or family may object. They therefore ask before they do anything. They have so little time to do the jobs they are expected to and they are usually paid minimum wage, if they over run caring for one person they may be late for their next job.
MissAdventure that's great in theory but would elicit a reply from my mother-'Neither thank you' (she's always very polite)

That's the thing, isn't it? All the pieces of paper and assessments in the world won't ensure your mum is getting the care she needs unless the carers are more proactive in their approach.
Its very easy to write down every day that you asked someone, and they declined, and no doubt its the truth, too, but common sense has to prevail.
We were taught that yes, we must always give people a choice, but sometimes the choice should be limited for their own benefit. E.G "what would you like to drink, tea or coffee?".

That's the point MissAdventure. You have to give the poor person at least half a chance of being in the moment. When I go to mum's I always say "I'm just going to put the kettle on" she will say "oh, will you make me a cup" I say "I won't forget you mum" and we have a little chuckle. If I said "would you like a cup of tea" she will say no, I've just had one. A lot of what she says are just safe bits of conversation that she knows people will understand.

No one wants to deprive someone of their liberty and that only really applies to someone going into care against their will with a deprivation of liberty order. We had to have a mental capacity assessment for mum in order to disconnect the cooker but that only applies to that and you would have to have one done each time you wanted to do anything that completely stopped her from doing something she wanted and felt, misguidedly, able to do. That's a bit different from being positive rather than asking someone to analyse what they want. As I said, I think that carers could be taught more techniques for this.

It is not that long ago that the message was that you must try and bring people back into the moment all the time by explaining and trying to get them to "remember", now it seems to have gone to the other extreme. Being able to estimate to some extent what stage the person is at is, I think, pretty essential but the poor carers are very unlikely to have had any training for that and each of us, if we are caring for someone with dementia, has had to learn the hard way.

I would say "hello 'so and so'. Today is the day we change your sheets, so would you like to sit in the chair and have a cup of tea whilst we do them?"

Meant to add my grandma refused most offers from the carers and quite often her "care log" read like a piece of fiction.

I completely sympathise GGM2 I had similar experiences with my late grandma. She would often refuse the carers offers of doing things because they asked her and didn't tell her. For example..... "would you like some tea B?" answer would almost always be "no, I'll wait for Gilly to get here". Asking if she wanted them to give the bathroom a once over, change the sheets" etc. would always be met with refusal again saying she would wait for me. It was so frustrating when they were supposed to be helping her (which in turn helped me iyswim) .

I think the carers need to learn not to ask but to tell her what they are going to do. "I am going to make you a cup of tea" or "I am going to change your bed".

Good luck GG

Its a very grey area regarding giving care.
Its correct to ask before doing any of these things, but of course, it leaves someone able to decline something which is in their own best interests.
There is such a thing as 'deprivation of liberty', where decisions can be made on a persons behalf, but an assessment needs to be done, and I think there is a long, long wait.
There are ways and means of getting around these hiccups, and sensible carers will know how to word questions in a way which will sway the person towards the 'best answer'.