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Message: <blockquote data-quote="jrussell88" data-source="post: 2647276" data-attributes="member: 76095">Thanks for all the replies, and the helpful advice.The care homes we looked at are privately-run nursing homes, and are staffed with nurses who are on duty at all times. They seem like nice places and are expensive. The Care Inspectorate scores both at 4s and 5s on a range of measures - the quality of nursing care isn't separately assessed. Both have had complaints upheld in the last year, one apparently for not ordering medication in time; the other for 'medication issues'.We've discussed medical needs extensively with the managers of both. One has a clear programme of training their nursing staff to deal with specific issues, such as a diabetes protocol. They do need written guidance from the hospital or Diabetic Nurse for any treatment. They checked with their kitchens; the first could say how much carbohydrate was in the food; the other couldn't or wouldn't. The first, which is part of a large group, already cares for 4 diabetics, and was initially sure that they could follow the DAFNE approach - but later said it was too labour-intensive and they didn't have the staff for it. They also won't check how much of a meal has been eaten. So neither home will calibrate doses to carbohydrate.The Diabetic Nurse says that none of the care homes (there are many in the city) have the capacity to handle DAFNE and after discussion has proposed the fixed dosage regime I mentioned which the care homes are apparently using for others - although this is quite a change from the treatment implemented by the consultant. They told me that we were asking them to write a prescription, therefore it had to be fixed amounts. Also that 4 nurses are covering a population of over half-a-million so they can't accommodate any variation.I suggested to the hospital team switching to a self-funded automated insulin dosing system as that would work with the District Nurse's simple protocol, but they wouldn't consider this at all, due to age.I explained the problem to the hospital team; they supplied a note covering basal and carb ratio; I drafted a protocol for treatment - they don't have anything re DAFNE treatment - which the Consultant/hospital are reviewing.However that won't address the apparent inability of even well-funded nursing homes to count carbs and dose accordingly. In time it may change as more diabetics reach old age. @Elena1968 Is there a shorter DAFNE course for medical professionals? as the patient-level one I attended lasted five days, and I don't think any nursing home will be happy losing a member of staff for that long.Possibly the only answer is to keep looking for a nursing home which can do this, but they seem to be as rare as hen's teeth and time is running out.</blockquote>

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