Case Study of PW

Robin, one of our Client Managers reflects on the journey of one of our Clients in the case study below. We hope this provides some insight into the level of care we provide here at Home Instead Senior Care Southampton. This outcome was only possible by having the very best trained CAREGivers plus and most importantly ensuring the same CAREGivers saw the Client as well as consistency of visits.

W better known as P started her journey with Home instead on the 7th May 2019.

PW was born and grew up in Bridlington, East Yorkshire.  PW had always worked as a bookkeeper and payroll clerk, mostly part time, up until the age of about 70 years old.  PW met her husband DW, also from Bridlington, at a young Conservatives dance and they were married in 1954.   They also lived in Chessington and DW worked for the Ordnance Survey.  Their daughter, DD was born in 1964.  In 1965, they moved to Southampton to a family home, and where DW continued to work for the Ordnance Survey in Southampton.  In 1966, CW was born.  DW took early retirement, but sadly he passed away quite suddenly in 2000.  PW felt that she could no longer stay in the family home as it was too big for her to manage by herself.  There were also too many memories attached to it and after a year, PW moved to Oakley Road where she lives now.

PW was coping very well until she was experiencing pain in her hip.  She had a successful hip replacement around 2014 but contracted a serious UTI.  She was sent to Brownhill House (now closed) to rehabilitate but there, she began to hallucinate and was diagnosed with Paraphernal – a mental disorder, characterised by delusions and hallucinations, but without deterioration of intellect or personality. 

PW has had 2 brain scans since then and was diagnosed with mixed Alzheimer’s with vascular elements making PW quite blunt and aggressive and also she would refuse entry in the house or if you were allowed in to the house you were soon told “to get out” or “when are you leaving”.

PW’s was also non-compliant with her medication, some days she would only take one of her three tablets and on other days none of the tablets. Also the eye drops that PW was meant to take would never get administered.

DD, PW’s daughter approach Home Instead as her last chance otherwise it would mean that her mother would have to go straight in to a care home because DD and her brother CW couldn’t carry on supporting their mother and felt exhausted.

I remember the first time I met PW at her house was when I was introducing Catherine one of our CAREGivers.  DD was also present and managed to let us gain access to the house after a lot of pushback form PW.  PW was very blunt in saying to me “I want you to leave right now otherwise I will hit you with my stick” and also saying similar things to Catherine.  Catherine and myself took this in our stride and only stayed a little longer making sure not to upset PW too much.

When we got outside I remember DD saying to me that they have tried other care agencies and not one of them were able to get one foot in the door and that Home Instead came highly recommended by local health professionals saying that if they can’t gain access then no one would.  I reassured DD that we would give it a go and that it would take time but I was sure that we could get in and support her mother going forward and take the strain from DD and CW.

PW had a rigid routine which kept her sense of purpose and her behavioural pattern was actually sustaining her ability to live alone, despite concerns about her vulnerability and self-neglect.  It was important to PW to go out every single day to the shops to buy her ready meal, the Telegraph, bread and butter.

So Home Instead put in place four one hour visits late afternoon Tuesday, Wednesday, Thursday and Friday to support PW with a meal and cleaning and to see if we could get her to take her medication.  This was with CAREGiver’s Catherine and now Lesley who was introduced by Catherine on one of her visits. Lesley was introduced by Catherine as we ensure that no CAREGiver meets the Client without first being introduced by someone the Client knows.

For the first few weeks the CAREGivers were only able to get PW to open the front door and have a few words and she would shut the door in their faces.  Sometimes the offer of a Kitkat was helpful and got a longer conversation normally one way and the Kitkat would be snatched out of their hands. Catherine tried with a book and various other items that PW would like but still the same outcome.

DD would still visit and help try and get Catherine and Lesley entry in to the house and on one or two occasions this did work but they were soon told to go with a little tap on the bottom.

DD was able to keep an eye on how things were going because we were using an online portal in which the Clients families were able to view all the notes written about each visit. This was a great help and provided reassurance for DD especially later on when it was advised by myself and the Admiral Nurse that she would need to take a step back to see if that would make a difference.

Over time Catherine and Lesley started to build up a rapport and gained access to the house by themselves. They knew not to over stay their welcome and take it a little at a time, each time they were building the relationship and rapport with PW.

A sort of relationship grew and even thou PW would only allow them in to her house for half an hour to forty five minutes this was enough time to be able to support PW with her meal, fluids and do some house work with PW when she wanted to.

DD was over the moon and by our CAREGivers being able to support PW it meant a significant amount of stress and pressure had been taken of her and CW.

At this stage we started to go in to visit Monday to Friday, we also introduced another CAREGiver Shirley to the team as well and after a while she built up this relationship with PW similar to Catherine and Lesley.  In PW’s eyes these were the people who would be coming in to do her washing up and sometimes she would get KitKat’s or chocolate biscuits or a book to read.  They still got the odd slap on the bottom when it was time for them to leave because PW had had enough, but that was fine they had managed to do what was needed.

This would carry on for many a month and the CAREGivers would also be keeping an eye on whether PW was taking her medication but this was still an issue.  I arranged with DD that we would take over the administering of her medication to make sure PW was taking them on every day we visited.  The medication was then put in a locked safe box and administered but PW would still only take just one of her tablets the same one every time and the other two discarded.  The Doctor agreed that this would always be the same so looked at taking her off of the other two tablets.

All seemed to be going very well with DD and CW were very happy and the CAREGivers were enjoying going in to see PW.  Then there was an incident which we highlighted to social services and this was about PW and her safety crossing roads when she went out and whether she was still safe in her own home.

Southampton Social Services arranged a Best Interest meeting on the 13th February 2020 to discuss whether PW could stay at home safely or would the best place for her be is in a Care home. 

DD, CW, Catherine (CAREGiver) and myself attended along with Social Services.  The overall outcome from this meeting was that with extra support from Home Instead and the family PW could still live at home and be safe.  So we decided that we would put in an extra visit mid-morning to help and support PW with her personal care.   Having these extra visits in place only helped for a short while then PW’s health became a worry to DD, CW, CAREGivers and also myself.

I had a discussion with DD and she spoke with Social services and it was agreed that it was time for DD to look for an appropriate Care Home for PW.  This did take a few weeks to find the right Care Home and that they had an available room for PW to move in to and the CAREGivers supported PW to help herself through these troubling times. First of all this was only going to be put in place as respite to see if PW would accept these surroundings.

On the morning of PW moving DD asked if Catherine would help with the move because Catherine had built up a special friendship with PW.  PW moved in to Stanway House on 23rd March 2020 and the moved seemed to be a success, PW has settled in well and DD and family are very pleased on how well everything went.

This is a little review from DD that she sent through to me shortly after PW went in to the Care Home.

"Hi Robin

Spoken to CW & hope below is ok

Home Instead supported us with our mum for 10 months until she moved into a care home recently. She has dementia and with the slow decline meant my brother and I could no longer offer the support she needed to keep at home which is what she wanted. She didn’t have awareness of her condition or the help she needed to remain at home and resisted all attempt of support. The first care provider we used failed to even enter the house.

Home Instead carers persevered over weeks to gain her trust and acceptance to allow them into her home, in the early days this was a five minute chat on the doorstep but at the end she was willing for them to assist her in her home. Their expertise with dementia sufferers, time and patience with mum paid off to reach this acceptance and through this time they were dealing with a very difficult person who was aggressive both verbally and physical to them.

Towards the end of their service they provided 9 hours care a week yet mum only ever had 3 different carers, again this consistency throughout helped mum so she was familiar with them and them with her.

The portal recording each visit was a massive help to my brother & I who both work and it enabled us to log in after each visit and read the report instantly, reassuring us all was ok or informing us of any shopping needs, missed meals, concerns etc.

They supported us throughout the 10 months with regular reviews meetings and always rang us with any immediate concerns and advised us in making decisions for mum as the situation deteriorated. Robin (client manager) and Catherine (main CAREGiver) attended a best interest meeting with us at Southampton City Council.

Their care may cost more than other agencies but you get what you pay for and we have no hesitation in recommending them, without their help mum would have been in a home much sooner."