Yesterday I had to make a very difficult decision with dad and shift our care strategy to one of ‘pain management’. He has been displaying excruciating pain whenever he gets up out of a chair or out of his bed. This was as a result of a bad fall over a week ago (he has had about 8-10 in two months). Whenever a carer would try and move his legs or try to get him up, he would yell out and grab the carer to channel the pain. As I witnessed this multiple times and I understand Dad’s body language- I knew he was reacting to serious pain even though he had no bruising. The loud outbursts were ‘pain driven’ and I literally could not stand to watch him in this much pain. We suspect a hip or pelvis fracture but x-rays are out of the question and likewise fixing it if the fracture was confirmed.
I have concerns that if we were not across the situation and not have such great relationships with the nurses, carers, DBMAS (and our GP) this incident could play out completely differently. For example – if an agency carer came in and tried to move his legs to have a shower, dad may grab the carer due to pain and yell at them. This could be seen as a hostile or ‘aggressive’ move. The carer then has to report the incident and the person in charge may sedate him or call paramedics. This may lead to a hospital admission (a disaster) or potentially given sedation (PRN) that is unnecessary. If the incident was in the middle of the night, who would know if Dad’s pain was ignored just to get a task done? Overnight shift is a real worry for me and you have no idea what has happened or the circumstances. A massive level of trust is required. If the carer is aware of the fracture – they can at least avoid the injury and be safe and not put Dad through any agony.
Our family came up with a strategy to buy a whiteboard for his room and place any key issues on the whiteboard to alert the carer or nurse to his hip pain. That way if the agency carer or nurse arrives with no knowledge of Dad – they can at least be warned to be very careful of his hip at the very least. I am sharing this information as I would assume in many circumstances the family would not have any idea of the current condition of their loved one and when visiting the person they may not be showing any pain. This is the case with dad. The pain only kicks in when he moves – so when doctors or nurses examine him or observe him, they detect nothing.
My personal opinion is this – monitor the person with dementia as much as you can and continually communicate with care staff. Be a detective and investigate anything that seems ‘not quite right’. Report to the nurse any concerns and have them placed on the computers for all to see. The role of the agency carer is so difficult with no patient knowledge – I would hope that aged care homes would try to use their own staff in priority areas and memory support units where possible as they know the person with dementia best.
I could only imagine how terrible life would be if I had a fractured hip and people were making me get up and down constantly and not being able to tell anyone due to my dementia. A massive lesson in dementia care.