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Q1: What services would you consider referring to for Eve to remain at home?
1. Dementia Nursing Team, Physiotherapist, Occupational Therapist and consider carers.
2. None of the family have got this under control.
3. Mental Health Services, local council, and GP.
Q2: Eve has Alzheimer’s disease, and her son and daughter are both inputting into her care. Who should be making the decisions about Eve’s care?
1. Eve.
2. Her son.
3. Her daughter, the person who lives closest.
Q3: It is ok to adapt the home to ensure that Eve does not do things that may put her at risk. Stopping her from going into the kitchen area by using black mats next to the door is an effective way to manage falls.
1. Yes, this is a good strategy as it keeps Eve away from risks.
2. No, this is not good. It is not supportive and is going to cause further complications within Eve’s house and life.
3. It is up to Eve’s daughter how she looks after her mother.
Q4: What did you understand from the answerphone messages left on Eve’s telephone? How did these messages sound to you? How do you feel about putting yourself in Eve’s shoes and hearing the answer phone messages as if you were her?
ANWSER 1
Dementia Nursing Team, Physiotherapist, Occupational Therapist and consider carers.
ANWSER 2
Her son.
ANWSER 3
No, this is not good. It is not supportive and is going to cause further complications within Eve’s house and life.
ANWSER 4
She is very confused and clearly doesn’t know what’s going on around her, she needs help urgently.
Q1: What services would you consider referring to for Eve to remain at home?
ANS: Dementia Nursing Team, Physiotherapist, Occupational Therapist and consider carers.Q2: Eve has Alzheimer’s disease, and her son and daughter are both inputting into her care. Who should be making the decisions about Eve’s care?:
ANS: Her SonQ3: It is ok to adapt the home to ensure that Eve does not do things that may put her at risk. Stopping her from going into the kitchen area by using black mats next to the door is an effective way to manage falls.
ANS: No, this is not good. It is not supportive and is going to cause further complications within Eve’s house and life.Q4: What did you understand from the answerphone messages left on Eve’s telephone? How did these messages sound to you? How do you feel about putting yourself in Eve’s shoes and hearing the answer phone messages as if you were her?
ANS: Even though Eve was very confused, she did really well. Especially when she was praising her daughter and talking about her son.Q 1
Ans 3
Q 2
Ans 1
Q 3
Ans 2
Q 4
Ans: If I were Eve, I would have loved to have a face-to-face conversation with the person who called. eve sounded like not sure what to say or whether to express herself fully on the especially that it was on the phone.Q1: What services would you consider referring to for Eve to remain at home?
Dementia Nursing Team, Physiotherapist, Occupational Therapist and consider carers. In addition the GP / pharmacist can review medications and local council can sometimes assist with other supportive services and provision of equipment / adaptations
Q2: Eve has Alzheimer’s disease, and her son and daughter are both inputting into her care. Who should be making the decisions about Eve’s care?
Eve should be supported to the make the decisions that she has capacity to make. Has she made an Advance Directive or List of Wishes? Her mental capacity should be assessed for each decision that needs to be made. If Eve has capacity, she should be involved in a discussion about who else (if anyone) she wants to be involved in decisions about her care.
A discussion should also be had about her about future needs and registering a LPA for the time when she does not have capacity.
If Eve does not have capacity at this time for the level of decision-making required consider involving an independent advocate. The family’s wishes should be respected, but if Eve has capacity she can make her own decisions. It can be difficult if members of the family have differing opinions.
Is Eve’s confusion exacerbated by the UTI and time at hospital? It would be better to explore some of the less urgent issues when the UTI is resolved.Q3: It is ok to adapt the home to ensure that Eve does not do things that may put her at risk. Stopping her from going into the kitchen area by using black mats next to the door is an effective way to manage falls.
No, this is not good. It is not supportive and is going to cause further complications within Eve’s house and life.
Q4: What did you understand from the answerphone messages left on Eve’s telephone? How did these messages sound to you? How do you feel about putting yourself in Eve’s shoes and hearing the answer phone messages as if you were her?
Eve sounded like she did not fully understand the questions and there was some evidence of memory loss or confusion. She was very stoic and did not want to trouble anyone.
Josie (daughter) sounded like she was dismissive of Eve’s condition and history of falls and did not seem to acknowledge any problems / concerns with Eve. There could be lots of reasons for this, it is not necessarily deliberate neglect.
John (son) appeared to acknowledge some of the issues, but did not know how to address them.
If I was Eve, I would be worried that something was happening to me that I did not understand and had no control over. I would feel frightened and maybe angry or embarrassed that I could no longer fully manage my independence. I would feel sad that I felt so lonely and like I was just waiting. I would be worried that I was causing a problem between my son and daughter. I would be worried about being a problem.Question 1: Dementia Nursing Team, Physiotherapist, Occupational Therapist and consider carers.
I would refer to all the above. They would be able to all work together to ensure than Eva has all the appropriate equipment she needs and adaptations too have home has been made to help reduce the risk of falls. Carers too be considered as there have been reports than she has not been eating and drinking adequate amounts, also recent UTI from possible dehydration.
Question 2: Eve
Eve has insight to her Alzheimer’s diagnosis therefore is aware how this diagnosis could affect her. As long as Eve has the capacity to make decisions about her care, then Eve should be supported to make her own decisions about her care. Since Alzheimer’s is a progressive disease, Eve should be encouraged to make a lasting power of attorney and should be supported to do this if she wishes and as long as she has the capacity to do this.Question 3: No, this is not good. It is not supportive and is going to cause further complications within Eve’s house and life.
People with Dementia may interoperate the mats as black holes therefore cause fear and distress in the individual. This could potentially lead to the person feeling more confused and anxious when walking around their house.
Question 4: Eva was able to answer the questions ask by the student nurse however did appear confused and uncertain of some of her answers for example when asked how often her daughter visits. Eve was able to communicate that she has been feeling lonely, but also praise her daughter for looking after her. Eve highlighted that she has been told she shouldn’t go into the kitchen as it is dangerous therefore this highlights potential adaptations/care than need to be implemented to make her home a safe environment.
I also agree that a face to face conversation should have taken place. Im sure that would have helped develop a better relationship between Eve and the healthcare professionals and maybe Eve would have felt more comfortable opening up to her?
Question 1. What services would you consider referring to for Eve to remain at home?
1. Eve has Alzheimer dementia and so she will need the help of all the necessary Multi disciplinary team that camn help and support her to get the right care that she needs to be able to manage the progressioin of the the dementia. I will consider reffering Eve to Dementia Nursing Team, Physiotherapist, Occupational Therapist, Neurologist, Geriatricians, Neuropasychologist, Nutritionist, Social worker and aslo a Career. Eve will also need am optician to check her sight. I want the best care for eve and so i will not hesistat to reffer her to all the multi disciplionary team that she needs to get the right care and support.
1. Dementia Nursing Team, Physiotherapist, Occupational Therapist and consider carers.
2. Her son: although her son is not around a lot, he is transparent with the health professionals and seems to tell the truth so that the right support can be determined for Eve to be enable her to live a fulfilled life. However, Eve’s mental capacity needs to be assessed first and she should be given an opportunity to plan her own care needs unless all steps to support her to do so have suggested otherwise.
3. No, this is not good. It is not supportive and is going to cause further complications within Eve’s house and life.
4. Eve was confused about the questions that were asked and did not seem sure of how to answer them. she also struggled to remember what had happened or what was happening and seemed confused. A face-to-face conversation with Eve would have been more beneficial.
Josie seemed to be withholding information and appeared not to report facts.
Her son was open and communicated all his worries about his mum’s current situation.
Question 2.
Eve has Alzheimer’s disease, and her son and daughter are both inputting into her care. Who should be making the decisions about Eve’s care?Answer. Eve should be allowed to make decisions regarding her own care. She should be carried along if any decisions regarding her care needs to be made. Eve should be seen as she has capacity bearing in mind the mental health act 2005. Eve should be supported in preparing her Respect form and everything she wants for her end of life path way. Eve needs to understand what she is doing and she should carried along on every decision that needs to be made.Her preferences and choices must always be considered. She will also need a lasting power of Attorney put in place its better she is supported to put all this in place before the dementia progresss so as to make her care part way to run smoothly.
Q3: It is ok to adapt the home to ensure that Eve does not do things that may put her at risk. Stopping her from going into the kitchen area by using black mats next to the door is an effective way to manage falls.
Answer.
No, this is not good. It is not supportive and is going to cause further complications within Eve’s house and life. This method does not even work for all the other types of dementia. It can also create further falls for Eve due to fear, anxiety, psychological traumas that can be caused by such black mats. Some patients can be colour senstive. Other forms of mats can be used like the sensor mat and also pressure sensitive mat, Anti wandering alarms can help. Also decluttering Eve’s house can also help to reduce falls alot of elderly people keep things they dont use anymore littering around the house. Eve’s eyesight needs to be checked, The lighting in her house also needs to be checked so as to be sure the house has a proper lightning. If all this things are checked and proper assessed its possible some of the falls can be reduced instead of using the blact mat that may futher create more harm.Q4: What did you understand from the answerphone messages left on Eve’s telephone? How did these messages sound to you? How do you feel about putting yourself in Eve’s shoes and hearing the answer phone messages as if you were her?
Answer
Eve was able to answer the student nurse properly, But you can see that she sometimes appeared confused in her words though she managed to give the student the informnation she wants and she can also work with even some of her unspoken words you can still make sense out of the words she couldnt communicate.
Eve is obviously lonely and needs more care than Josie her daughter can offer. Josie appears to be struggling with the mum’s care bearing in mind that she has 3 young children that she is caring for and also trying to meet up with caring for her mum. She is trying but she will need more support for Eve and she will stand as an extra help just ensuring the mum gets the best care she deserves. Eve will need a career assigned to her that will come at some specific times everyday so that Eve is able to eat and drink well. Even mentioned that she doesnt know how many times her daughter comes in a day, Definately josie doesnt come every day listening to what Eve has said though she became confused and said she is not sure. She mentioned the fact that she was lonely and she was waiting for Josie to come and make her food and cup of tea. I can see that Eve goes hungry sitting there and waiting for her daughter to come and make her food. Listening to the Audio i was wandering what time does Josie come to the mum in the morning bearing in mind she has to prepare her kids for school and take them to school, What time does she get there in the afternoon and also in the evening. Definately Eve needs a care staff for more support.
John i can see is very passionate about the mum though he lives far a way, I can see how passionate John is towards the care of his mum. He can’t do much from his distance but he wants the best care for his mum and wants to be part of his care. He appears a bit helpless when he was talking to the nurse about his concerns and he gave more insight into the falls history of Eve that Josie never mentioned and also some insight about Josie taking stuff from his mum. There could be more things happening in the home front i think the social worker or nurse needs to pay a visit to Eve and see things first hand.
Also Eve appear to be hiding informations and she doesnt want to hurt josie because she appreciates all what the daughter is doing for her.Q1: What services would you consider referring to for Eve to remain at home?
1. Dementia Nursing Team, Physiotherapist, Occupational Therapist and consider carers.Q2: Eve has Alzheimer’s disease, and her son and daughter are both inputting into her care. Who should be making the decisions about Eve’s care?
1. Eve – Eve’s children do not have power of attorney so, therefore, cannot make decisions about her care. As long as Eve has the capacity, following an assessment proving otherwise, she should be making the decisions about her own care. If her condition deteriorates and she lacks capacity her children need to look at gaining power of attorney.Q3: It is ok to adapt the home to ensure that Eve does not do things that may put her at risk. Stopping her from going into the kitchen area by using black mats next to the door is an effective way to manage falls. YES AND NO, Eve’s home requires adaptations to reduce falls, see below.
1. Yes, this is a good strategy as it keeps Eve away from risks and 2. No, this is not good. It is not supportive and is going to cause further complications within Eve’s house and life – Eve’s house needs to be adapted to ensure her safety, such as taking up the multiple rugs and the loose wires on the floor that pose potential trip hazards. Eve’s house needs to be an open space that allows her to move around freely and safely. However, I do not agree with the ‘black mats’. The idea behind these is incredibly unethical – scaring patients to stop certain behaviours, and will cause more harm than good.Q4: What did you understand from the answerphone messages left on Eve’s telephone? How did these messages sound to you? How do you feel about putting yourself in Eve’s shoes and hearing the answer phone messages as if you were her?
Eve
1. Eve thinks highly of her daughter and the care that she provides her but doesn’t want to ask too much of her
2. She does not recall the recent falls that she has had
3. Appears confused, and describes this as her mind being ‘muddled’
4. Speaks to John occasionally but does not want to bother/worry him
5. Becoming lonely, doesn’t describe a good quality of life – sits waiting for Josie to come and give her food/drink and doesn’t move around the house due to Josie’s advice on the dangers (this change occurred after being in the hospital)Josie
1. Appears in denial/not sharing the whole truth about her mum’s current/declining conditionJohn
1. Appears to help his mum as much as he can, given the 100-mile distance
2. Offers a better picture of his mum’s health
3. Does not think that his sister is telling the whole truth
4. Concerned that his mum doesn’t move around the house enough, describes her as ‘stuck’. Concerned that she cannot get things like food/drink herselfI think that hearing these voicemails could upset Eve – she may be upset with what her son has said about her daughter given how highly she thinks of her, she may also be upset when hearing the true extent of her falls and declining health. She could also be angry at her daughter for not supporting her enough with regular visits, proving food and drink etc. and not being honest with the Nurse.
I agree than the black mats might cause additional risks and alternative steps should be taken to try and reduce the risk of falls. Good ideas regarding the decluttering of her house, if she has lots of items on the floor there is going to be more trip hazards therefore more risk of falls.
Q1: What services would you consider referring to for Eve to remain at home?
A1: It seems none of the family members have this under control and they do not have power of attorney anyway therefore I would refer to Dementia Nursing Team, Physiotherapist, Occupational Therapist and consider carers after obtaining consent from Eve.Q2: Eve has Alzheimer’s disease, and her son and daughter are both inputting into her care. Who should be making the decisions about Eve’s care?
A2: as previously mentioned, neither have power of attorney therefore the decision will be down to Eve.Q3: It is ok to adapt the home to ensure that Eve does not do things that may put her at risk. Stopping her from going into the kitchen area by using black mats next to the door is an effective way to manage falls.
A3: this is a tricky question as we need to prevent harm but also promote independence therefore I feel a thorough assessment of the home and of Eve’s capabilities and understanding would have to take place as well as some observations then decide as it maybe good but also may be too restrictiveQ4: What did you understand from the answerphone messages left on Eve’s telephone? How did these messages sound to you? How do you feel about putting yourself in Eve’s shoes and hearing the answer phone messages as if you were her?
I would feel disappointed in my daughters answers as I felt as though my daughter is there to look after me and care for me well but instead I am hearing that she doesn’t feel i need much care and that i am fine even though she has been restricting me from entering the kitchen to get food or drink but has not been coming in regularly enough to ensure I am having enough food or drink. I would feel that although my son is doing all he can to support me he can’t say much about my daughter as she is here and he is not. overall I would feel very confused and unsure about what is happening as there have been conflicting answers and accusations made and all I would want is to do what i can for myself but have the right support and help from my children.with the voice call between Eve and the nurse, It does appear that Eve is somewhat confused. I would be looking at assessing capacity and suggesting bringing in carers to help
Q1: What services would you consider referring to for Eve to remain at home?
1. Dementia Nursing Team, Physiotherapist, Occupational Therapist and consider carers.
This combination would help address the variety of issues impacting Eve at this time: her memory issues and Alzheimers; her physical condition and investigating reducing her number of falls; the possibility of making improvements to her home to help her stay steady on her feet – along with other measures to improve her day to day life. Finally the possibility of professional carers who would be able to consistently and carefully provide support, as opposed to just at random times.Q2: Eve has Alzheimer’s disease, and her son and daughter are both inputting into her care. Who should be making the decisions about Eve’s care?
2. Her son.
He seems to have more of a handle on the situation, whereas her daughter was extremely vague and couldn’t answer questions properly, even though she lives nearby, e.g. she couldn’t decisively state how often she visits or makes meals. However, the decision should ultimately come from Eve herself – ideally through setting up a Lasting Power of Attorney (LPA) document, stating her preferences for who decides about care.Q3: It is ok to adapt the home to ensure that Eve does not do things that may put her at risk. Stopping her from going into the kitchen area by using black mats next to the door is an effective way to manage falls.
2. No, this is not good. It is not supportive and is going to cause further complications within Eve’s house and life.
However, it could be a good idea for an OT to visit and assess whether she would benefit from grab rails and other supports to help prevent falls. The black mats do not seem necessary in Eve’s case, as she was generally confident walking about her home and used to like being able to go into the kitchen. Just because she’s had falls doesn’t mean she should be completely restricted like this, as it’s a deprivation of liberty when she’s still in a position to make simple choices about what she wants to do. Options to help prevent falls instead should be offered to Eve.Q4: What did you understand from the answerphone messages left on Eve’s telephone? How did these messages sound to you? How do you feel about putting yourself in Eve’s shoes and hearing the answer phone messages as if you were her?
The messages show that Eve is not aware of the issues concerning her care, she’s oblivious to what’s going on and is trusting that her children have got things sorted out for her. Whilst she seems happy, it is alarming that she can’t remember how often she eats or how often her daughter visits. She trusts that her daughter is taking care of her, yet if she were to hear the phone call between the nurse and her daughter, she would be confused that Josie isn’t sure about lots of things concerning her care either. Eve would likely feel disappointed that Josie is unable to provide clear information, as Eve is relying on her to support her sufficiently. If I were Eve, I might also be wondering if my son is looking after my finances, even though I haven’t ever talked about this properly. And I may be surprised to discover that the cameras watch over me all the time. I thought, maybe they were just for when he wanted to talk to me directly during the day.Agree with Rebecca that the phone calls would generally be upsetting to Eve, especially the part about the frequent falls, that she isn’t aware she’s been having. Along with the aspect of thinking that Josie has things sorted for her, but actually can’t specify how often she gets meals etc.
Also, a good point from Maryam saying that if she were Eve, she’d want to be able to do what she can for herself (ie maintain as much independence)
Interesting ideas on Q3 from Immaculate – re other types of sensor mats, or an alarm to address potential dangerous wandering.Question1
Dementia Nursing Team, Physiotherapist, Occupational Therapist and consider carers.Question 2
Her son, seems to be realistic about the situation.Question 3
No, this is not good. It is not supportive and is going to cause further complications within Eve’s house and life.Question 4
Eve does not seem to be aware of having falls. she still believes she can look after herself and does not want to bother her kids that much. it is good that she maintains some independence as pointed out by Maryam. Johns seems to have a good insight into his mum’s condition and is aware whereas Josie does not seem to be very much aware, maybe she is in denial or finding it hard to accept her mum’s condition.Q1: What services would you consider referring to for Eve to remain at home?
1. Dementia Nursing Team, Physiotherapist, Occupational Therapist and consider carers.Q2: Eve has Alzheimer’s disease, and her son and daughter are both inputting into her care. Who should be making the decisions about Eve’s care?
2. Her son.Q3: It is ok to adapt the home to ensure that Eve does not do things that may put her at risk. Stopping her from going into the kitchen area by using black mats next to the door is an effective way to manage falls.
2. No, this is not good. It is not supportive and is going to cause further complications within Eve’s house and life.Q4: What did you understand from the answerphone messages left on Eve’s telephone? How did these messages sound to you? How do you feel about putting yourself in Eve’s shoes and hearing the answer phone messages as if you were her?
She is lonely, sad, needs help – she understands the things she can and can’t do.
She seems sad that she is unable to do her normal daily activities.
It is upsetting relying on someone who can not provide her holistic needs.Q1) Q1: What services would you consider referring to for Eve to remain at home?
1. Dementia Nursing Team, Physiotherapist, Occupational Therapist and consider carers.Q2) Q2: Eve has Alzheimer’s disease, and her son and daughter are both inputting into her care. Who should be making the decisions about Eve’s care?
2. Her son as he seems to be more aware on the situation. However the decision should be Eve herself. In the future, Eve’s children should be setting up a Lasting Power of Attorney (LPA) document, stating her preferences for who decides about care.Q3) Q3: It is ok to adapt the home to ensure that Eve does not do things that may put her at risk. Stopping her from going into the kitchen area by using black mats next to the door is an effective way to manage falls.
2. No, this is not good. It is not supportive and is going to cause further complications within Eve’s house and life.Q4) What did you understand from the answerphone messages left on Eve’s telephone? How did these messages sound to you? How do you feel about putting yourself in Eve’s shoes and hearing the answer phone messages as if you were her?
Eve believes she can look after herself and does not want to bother her kids that much. On the other hand Johns seems to have a insight and is aware into his mum’s condition whereas Josie does not seem to be very much aware, maybe she is in denial or finding it hard to accept her mum’s condition.
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