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Diabetes in Nursing Homes - should it be respected??

T

TheSparkyPony

Well-Known Member
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136
Location
Cheshire UK
I'm currently doing my nursing training at university. In order to fund my luxury lifestyle of baked beans and Tesco Value notebooks, I work bank for a well known private healthcare company, in a nursing home.

The knowledge of the nurses there of diabetes is appalling.
There is a lady living there who has had diabetes for a while. She was on insulin for years, and now she's simply on tablets. Their conclusion? It's a miracle! They cured her T1 diabetes! :roll:
Sweetener for drinks and diabetic icecream is provided as a pudding alternative. This doesn't get honoured for the lesser known T2s (e.g ones who are in bed all day, need feeding, aren't on meds).
Yoghurts are also provided (at 13.8g of sugar per pot! :shock: ) which can't be doing them any good.
It seems to be common feeling that they are at the end of their life, so why can't they enjoy normal icecream, sugar in their tea, and normal puddings?!

My point, and discussion point: Do you think their diabetes should be respected? Should they have to have a different diet? Or, as they are end of life, they should be allowed to eat what they like? Bearing in mind some of the resident's dementia is so advanced they cannot talk, so if their levels were high they could not communicate feeling sick etc.

My can of worms has been opened.....enjoy! :mrgreen: x

(As a serious note, am thinking of using this scenario as a case study, I personally think that the diet should be followed.)
 
Hi
I a gree with you their diabetes and diet come first, whether they have Dementia or not their health comes first. I cannot believe they have got a type 1 off insulin and is only on tablets. Sounds like they don't give a ****. They probably thing there old they won't now anything different but surely there families must see a difference in there family member. I would love to be a fly on the wall in your place of work.
I know you probably don't want to lose your job there but i think this needs looking into.
Good luck
Tracey
 
If only i were hat simple Tracy! There have been many appalling scandals about Nursing Homes but they are just dealt with on a case by case basis and the overall posiion is never addressed.

Over they years many well known figures have tried o campaign on the subject of Nursing Homes in general, usually as a result of having a bad experience with care for close relatives but very little notice is taken.
My father had o be in a Nursing Home for many years after his diabees was ignored by his GP.

Although there were many causes for concern in the Nursing Home his diabetes was kept under excellent control in spite of, or maybe even because of his dementia.

I myself ,worked part ime in a Nuring Home for a while . The relatives are all-important in ensuring good care. Unfortunately for many dementia suffferers he relaives are old that as the paient may not even recognise hem there is no point in them visiting and upsetting themselves needlessly.

I have known many people accept this gladly. the point is that patients need someone to take care of their interess, staff in these places are often poorly trained . They are someimes very young and uneducaed oo . Unless closely supervised hey can treat patients with cruelty. Not deliberately but because of ignorance or even because of pressure from lazy felllow staff.
Some quite frankly , have been employed for their sheer bulk and abiklity to lif heavy patients,
I have often seen bank Nurses and agency nurses absolutely horrified by what they see in these places. It totally militates against all their training. Ofen there are far oo many incidents to report.
I think that neglect of diabees iin diabetics wih dementia arises as a result of both ageisn =m and laziness,
There is a perception that it might be more difficult to reat these paients because hey don' understand what is going on -or of course , the what-does- it matter -attitude described by the OP.
An American friend recenly described to me how , when her erminally ill husband returned home
the Doctors told her not o test his blood and o give him whatever he wanted o ea despite his T2 diabetes.
She could not bring herself to do this . She felt she would be "Putting nails in his cofffin". Quite.

Even though he could not recover he might not have had the peaceful and painfree death he did have
had his bs gone compleely out of control.
 
My daughter works in a residential home, where some of the residents are old, but some are middle aged and have dimentia.

No, diabetes is not taken seriously there either. My daughter is shocked at how laid back the management are at dealing with it. The diabetic residents are allowed choc bars, and sweets. Their meals are not prepared properly for diabetes, and she said someone can easily have sugar readings in the 20's, but nothing is done. She took it upon herself to bring this up with the management, but their complacency was terrible. They more or less made out that she was worrying unnecessarily.

Helena
 
It's a big subject, and you need to very careful about definitions - which you seem to understand, which is good.

I have to declare that I am still a qualified RGN, have never worked in residential / nursing homes etc, although I have taken younger people who live in such places on activity holidays. I've not particuarly avoided working in such homes, just that I've done other jobs, some nursing, some other things.

If it's a Nursing Home (as opposed to a residential or care home), then there must be a Registered Nurse present on all shifts, overseeing all aspects of care. That Regstered Nurse might be either General or Mental or Learning Disability (or 2 or even all 3 pf those) which obviously affects the likely level of knowledge of physical and mental health. However, al lhave a duty to carry out care, following NMC (Nursing & Midwifery Council) Code of Conduct. This includes taking responsibility for ensuaing they gain adequate knowledge, and keep it updated, to provide adequate care.

However, not all staff will be registered nurses, and thus generally less likely to have any training in diabetes as a specific topic. And they don't have a code of conduct telling them to get / keep informed.

While I wouldn't advocate poor care on the basis of age, I'm pretty sure that if I discovered I was terminally ill, I would let my diabetes care slip a bit - no point holiding off complications if a cancer, for example, would kill me first. However, when looking after other people, I would go by their wishes. Not sure what I would do if I developed dementia, though.
 
Tricky. Don't want to make light of this, and agree in general that diabetic needs must be taken care of, but if I knew I had only a year to live, I'd dive in to the roses orange creams, Cadbury's caramels and so on.
 
Grazer said:
Tricky. Don't want to make light of this, and agree in general that diabetic needs must be taken care of, but if I knew I had only a year to live, I'd dive in to the roses orange creams, Cadbury's caramels and so on.
Click to expand...

If you ate enough chocolate hobnobs Malc, you could probably make sure that you only have a year to live.

(I do agree though - most of us are worried about long term complications with diabetes, if the chances are that you're going to die of something unrelated, then why worry about the diabetes).
 
borofergie said:
Grazer said:
Tricky. Don't want to make light of this, and agree in general that diabetic needs must be taken care of, but if I knew I had only a year to live, I'd dive in to the roses orange creams, Cadbury's caramels and so on.
Click to expand...

If you ate enough chocolate hobnobs Malc, you could probably make sure that you only have a year to live.

(I do agree though - most of us are worried about long term complications with diabetes, if the chances are that you're going to die of something unrelated, then why worry about the diabetes).
Click to expand...
Silly boy! Hobnobs have zero carbs and are proven to extend life by at least ten years.
 
How often do you hear of doctors giving patients only a few months to live and years later they are still around?

My friends husband didn't have cancer but had other conditions and was old and exhausted. He had already spent weeks in hospital being poked and prodded anfd just wanted to die in peace.

To ignore his diabetes may well have meant that he would have suffered and died in more disconfor.

Dementia sufferers may live for years. Diabetes complications will hardly add o their quality of life and may majke the dementia worse. My father's dementia was dure to untreated diabetes.
Really not something to be made light of. There is ife and there is death -and many stages in between.
I am glad that some people carw sufficiently to express concern about these things
Dementia sufferers are so vulnerable.
 
The key is that Borofergie and I were talking about a situation where "if we KNEW..." you may not always KNOW, but if you DID.... And often you can know within limits. What we would do as we expressed was our view which obviously we're entitled to. Offence was not intended.
 
Of course you didn't intend any offence. Of course you are enitled to your view.

I am entitled to my view that this is something which may, one way or another ,affect many of us here.

There is a great deal of abuse in Nursing Homes. Very hard to combat. I have witnessed HCP's being intimidated into silence when they should have been protecting the vulnerable in their care.
I thought that the original post was too importan to be lost in the humour . No criticism intended.
 
It is my belief that any establishment offering care - medical or social - should offer appropriate care in all the areas that they take responsibility for. If a nursing home or residential home takes responsibility for the supply of food then that food ought to be appropriate to the needs of the person receiving care. That would not only be the type of food but also assistance with eating it, as necessary.

Doug
 
Regardless of someone having dementia or not the Nursing home has a duty of care to look after that persons medical and dietary needs...............failing to do so is both neglectful and shameful!!!

Personally Sparkypony I couldn't work in such a place witnessing a total lack of knowledge and care to their patients needs. In the case of the type 1 lady.....well a type 1 diabetic needs insulin for life as you know and stopping this treatment will hasten the end of her life through ketoacidosis and eventual coma..... this is a horrible but preventable way to die and not one that their relatives and friends would wish on their loved ones!

Good luck with your nurse training! :)
 
Personally Sparkypony I couldn't work in such a place witnessing a total lack of knowledge and care to their patients needs.[/quote]

That is the problem though, Noblehead. If all he caring ,concerned GOOD people are deterred from working in hese places then they are left with the other tpee'

I worked par ime in a Nursing home years ago and to complain was of less use han banging your head against a brick wall. There were a few nurses- the head one probably trained at Auschwitz, the others had o follow her lead and most of the other staff were temporary or kids straigh from school . The long term "care assisants" were not much better than thugs. Ignorant ,foul mouthed hugs at that.
Anyone decent , "real nurses" etc were unable to stomach the place {no cheap} and left after complaints falling on deaf ears. I complained myself to Social Services . This was a waste of time as inspections were announced weeks ahead.

I can remeber being told that it was OK to give undiluted fruit juice to diabetics several times a day .. If patients were transferred from one "house" to another =a few yards apart heir notes took
a few weeks o follow. In the intervening period they did not receive any medication.
It was quite common for them to die under hese circumstances but this was always aributed o the move itself. Who knows?

From time o time I hear noises about the situation changing but it is difficult in institutions. It all
depends on the management. I have great admiration for those indivisduals who do manage o stick it out for the sake of some patients at least. It is not an easy matter to combat the culture
of neglect and indifference found in some such places.

The general attitude is often that the inmates are there to die. The sooner that happens the better for all comncerned so treaing a condition such as diabetes is counter producive.
Dementia sufferers are not necessarily advanced Alzheimer cases. The lower end of the secrtrum includes those with short term memory loss. If they live alone this can be dangerous and hey may well move into a Nursing Home. it seems ciminal to me to deny them reatment and expose them
o all he dangers and consequences of diabees complicaions.
 
We went to sing at a local care home. We were treated with fruit juices afterwards. I declined, & was assured by the assistant that there was NO ADDED SUGAR on the label. She said she was diabetic herself, & drank the juices.

4 years ago I was in serious muscle pain, & had difficulty getting out of bed, walking, driving, etc. I feared becoming disabled. A change to a low carb diet (thanks to this forum) completely restored my mobility, tennis playing, etc. If I do eventually get into a care home, will they respect my diet, or will I be force fed with carbs, & suffer the consequences?
 
IanD said:
We went to sing at a local care home. We were treated with fruit juices afterwards. I declined, & was assured by the assistant that there was NO ADDED SUGAR on the label. She said she was diabetic herself, & drank the juices.
Click to expand...

Not quite sure if you're saying this is good or bad?? I drink robinson's fruit juice "no added sugar", and it's just 0.7 ml carbs per 100 ml of concentrate, so a normal strength glass is virtually no carbs. So good to my mind!
 
Grazer said:
IanD said:
We went to sing at a local care home. We were treated with fruit juices afterwards. I declined, & was assured by the assistant that there was NO ADDED SUGAR on the label. She said she was diabetic herself, & drank the juices.
Click to expand...

Not quite sure if you're saying this is good or bad?? I drink robinson's fruit juice "no added sugar", and it's just 0.7 ml carbs per 100 ml of concentrate, so a normal strength glass is virtually no carbs. So good to my mind!
Click to expand...

Robinson's isn't fruit juice - fruit juices have about 10% natural sugar - 25 g in every glass.
 
IanD said:
Robinson's isn't fruit juice - fruit juices have about 10% natural sugar - 25 g in every glass.
Click to expand...
OK, understand, it's fruit cordial. Having said that, I also get "no added sugar" cranberry "fruit juice" DRINJK, which may not be pure fruit juice as such, but again it's only 2 grams carbs per glass. Could be that what they were offering you was similar, just described it as fruit juice.
 
SparkyPony, the home you are working in should have regular visits from a local GP. I know the one my cousin is in has these, for the patients who can't get to the surgery. You could try having a word with him/her if you coincide. You could ask a genuine question along the lines of:

"1'm Type 1 diabetic, like patient X. What is the drug that X is on that means they don't have to have insulin - I might be able to use it too."

If that doesn't work, maybe have a word with a visiting priest, if they have one. Any denomination. Or ask at CAB if they have any idea what you should do. Or ask your own GP, or the University Health Centre. Or email any of the Health Ministers and the local MP (available via the parliament.uk website).

You're in an awful situation, but if you refuse to work in that care home, matters certainly won't improve for the residents. I admire you - I don't think I could ever have done that job.

Viv 8)
 
I've realised I haven't responded to the intention of SparkyPony's post:

I believe that everyone's health needs and conditions should be respected and treated correctly, whether they are fit, sick, terminally ill, demented or dying. But like some others, I'm pretty sure that if I was told I had a terminal illness I would go off the rails, at least for a while - my only concern would be whether my income would be sufficient to supply enough red wine to last to the end :lol:

On the other hand I might get a 'Sod 'em' mood on, and be as good as gold in order to prove them wrong! I've got a lot still to do.

Deliberately witholding medication from a Type 1 diabetic in my view comes very close to attempted murder.

Viv 8)

edited for mega-typo :oops:
 
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