Post No38…what to expect from the first few days / weeks in a care home

Introduction

The move into a care home is often a challenging and emotional time for families, both during the research stage and subsequent assessment stage, right through to the person being admitted and moving to the settling in stage.

The settling in stage is the theme for this post, it is something everyone goes through but is also different for each individual resident and their families. Below are listed some of the more common reasons and questions that people have about their loved one settling into a care home.

A lack of routine

When a person moves into a care home, they do not have a routine, and for some people this can cause anything from anxiety, to social isolation or behavioural issues. This may increase further if the person is living with dementia and can sometimes exacerbate a person’s confusion.

Some families are concerned about their loved one behaving in a way that would lead to the chosen care home potentially serving notice, but most care homes are used to settling residents and accept that any behaviour that is out of character may be the result of the person being unsettled and out of a routine.

If a person moves into a care home and does not have dementia, then they will be acutely aware of their change in circumstance and this can sometimes cause low mood or anxiety during the settling in process. It is important, in all cases, for the person to begin forming bonds with staff and other residents, helping them to shape a new routine within the care home.

Being ‘the new kid on the block’

This is something we all have at least a slight fear of…the unknown. When we move job, school, house etc there will be a period where we must find our feet, and moving into a care home is no different.

What is different is that the residents are mostly elderly and more frail, which can magnify this feeling of vulnerability.

Having regular family visits, building trust with staff members, and being invited to the communal areas of the home may all help ease this feeling as the person begins to form a new routine.

Behaviour concerns

This is relevant to those with and without dementia, but is more often a concern for families whose loved ones do have dementia. When a person has dementia, they may find it more difficult to formulate a response and sometimes this manifests itself in behaviour that could be considered aggressive.

Other behaviours of concern could be the person refusing to stay in the home or attempting to abscond, or refusing personal care. Again, in these circumstances it is important the staff remain patient and continue to build up bonds of trust, to help support the person to settle in to the environment and build a routine.

How long does the settling in process last?

The settling in process will be different for everyone, but common timeframes would be anywhere between 4-8 weeks, but could easily be outside of this depending on the person.

Should families visit during this time?

Again, this will be different for everyone, but my thoughts are that whilst settling having one’s family around is positive for the person and can prevent feelings of being cut off or left somewhere alien.

Should I have a trial of the home first?

It is very common for families to set up a respite stay which may then lead into long term care. If families are considering doing this it is often suggested to set up a 4-week trial; this is because if the trail is too short, the person may remain unsettled for the whole duration. If this happens, families may not know if the person would have settled and therefore the trail may be seen as a failure.

If the person begins but is not fully settled during the 4-week trial, an additional period of respite is often possible to set up to continue monitoring this, but equally most long-term care contracts have a cooling off period within them, acting as a secondary trial in some ways.

How is the settling in process reviewed?

Although every care home is different, it is often suggested for a care review to be set up around 4 weeks into the stay. This can include a discussion to reflect, implement new ideas, discuss the care plan up to that point and then the care plan moving forward. This can also be a time to discuss any potential referrals, perhaps to Older Persons Mental Health, or for a review of the medication.

Although optional, having a care review after 4 weeks is a good opportunity to analyse how a person is settling into the care home, and if they are not, to make a plan that helps support them further.

Conclusion

Although the settling in process can be a bit daunting, it is amazing how most people do settle well into care home environments.

I believe this is because care homes are well versed and understanding during this process, and that staff are caring and able to build bonds of trust with residents which can help with confidence and routine building.

I also believe it is important for families and the home to keep communicating during this process, and that families take up the offer of a care review if it is offered by the home.

Ultimately, it is human nature to feel more comfortable when in a routine surrounded by people who you know and trust, which is absent for anyone who is new in a care home. But this can be built with time, and perhaps a little patience!

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