Home away from home

Sometimes committing a loved one to aged care is not a choice but a necessity

When Covid-19 shone a light on the miserable conditions of some residential aged care, a number of my friends took the radical step of pulling their frail parents out of the facilities to care for them at home.

They were not only worried that their parents would catch Covid, but were horrified by mounting reports of neglect, malnourishment and cases of abuse by staff and other residents that were revealed by the royal commission into aged care quality and safety.

If your elderly parents have a sharp mind and are a little frail, it is possible – with some help – to look after them at home or ideally keep them in their own home. There are around 428,500 “informal carers” of people aged over 65.

But if your parents have dementia, caring for them, with your own family and work commitments, is time consuming and exhausting. It is almost impossible not to run yourself into the ground.

There are many types of dementia. I know one man who has lost his short-term memory and often doesn’t want to get out of bed, but he is easy to look after in many ways because he is fairly content.

My mother Rosemary, who had vascular dementia, grew confused and increasingly agitated. She started to do some dangerous things, unaware of the consequences, such as leaving the pots boiling on the stove.

This meant she couldn’t be left alone if she moved in with my family. My husband and I were at work and the kids at school, so we couldn’t keep an eye on her and know she was safe.

Rosemary’s home care provider told us that a nursing home with dementia care was the solution. Around 243,000 Australturnover. ians are in residential aged care and over half have dementia, according to the royal commission.

With such a high proportion of dementia patients, you would think that nursing homes are experts at dealing with the condition. But this isn’t the case at all.

“Substandard dementia care was a persistent theme in our inquiry,” reported the royal commission. It was deeply concerned that many aged care providers don’t have the capacity or skills to deal with dementia.

Personally quizzing a potential nursing home for your parents about its dementia care is crucial. Forget the fancy, plush facilities that your parent may or may not be able to use; you want to know about the experience of the staff and how long they have been working there. Often a dedicated, long-standing workforce is a good sign.

I have been to modest nursing homes with wonderful dementia care and staff who understand the needs of their residents. They look after their residents with great care. Some staff had been working in the home for decades.

I have also been to nursing homes that are like luxury hotels with movie rooms, hydrotherapy pools and ritzy cafes and yet they don’t feel welcoming or cohesive.

Once I’d found a nursing home for my mother, I soon realised I couldn’t leave her care totally up to the staff. I needed to be vigilant about checking on her. Just because she was in a good nursing home with an expensive day rate didn’t mean every aspect of her care was done well. Rosemary – like many dementia patients – wasn’t easy to look after. It is really challenging work and the staff tried hard. But I found the home was understaffed and had high staff

The manager who had impressed me so much when I chose the home left and was replaced with a temporary manager who was unpopular with staff. Unanswered call bells regularly went off. The woman in the room opposite Rosemary screamed “help” all night.

Rosemary’s ability to feed herself deteriorated, her delicate skin needed special care and she was constantly getting urinary tract infections. She needed physiotherapy to help her walk after a hip operation resulting from a fall, but the physiotherapist’s hours had been cut from two days a week to half a day.

Staff didn’t have the time to help her eat and took her plate away virtually untouched because the kitchen was closing. Rosemary was wasting away and needed help from me to eat. I took in food she liked.

As many as 68% of people in residential aged care are malnourished or at risk of malnutrition, according to the royal commission. This can lead to other health issues.

Rosemary’s papery skin was easily injured and needed to be looked after carefully and skilfully to prevent pressure sores and infections. The royal commission found that often staff in nursing homes don’t have adequate knowledge and training to prevent pressure injuries and wounds. It can be painful and distressing and can have immense health implications, which sometimes lead to early death.

Choosing the right care takes time to research the options, and staying connected with loved ones wherever they are is important for their wellbeing.