RAH

A Shiny New Hospital…But Have We ‘Forgotten’ Our Dementia Patients?

January 20, 2016August 22, 2016 Brett2 Comments

Our new Royal Adelaide Hospital is the 3rd most expensive building in the world…that’s right…IN THE WORLD! Who would have thought little old Adelaide could produce something so big and bold? It has cost us taxpayers 2.1 billion dollars to construct and will include world class facilities and cutting edge technology. Everyone gets their own ‘hotel-style’ room complete with robots zipping about, and we will never be more comfortable when sick. However when the new RAH opens and the ‘razzle dazzle’ of our shiny brand new hospital subsides, the underlying problems of our healthcare system in South Australia will emerge, and it is bad news for our senior citizens. The impact of the new hospital has a dark crisis looming for our ageing population and needs to be talked about.

There will only be 120 extra hospital beds more than we currently already have but here is the real problem. The geriatric wards of the RAH will be reduced and the overflow of people will most likely be sent to The Queen Elizabeth Hospital (TQEH). This is the engine room of our health services for our aged community, and has purpose built world class facilities (GEM unit) for our dementia patients including research departments trying to find cures. But here is the ‘game changer’. The Hampstead Rehabilitation Centre facilities at Northfield will soon be moved into the TQEH. In theory it is a good move to place all these services in the one location, but the cost is that to make room for this, the existing geriatric areas will be further reduced including their beds, gardens and facilities for dementia patients.

With our ageing population being one of our most significant issues looming in the next 10 years, where are our elderly going to be treated? The Repat hospital will be closed and their geriatric services moved to Flinders Medical Centre. Once again less beds for the elderly as the facilities are located in the one place.The only way the overflow of elderly and dementia patients can be treated is to place them back in the general acute beds within our remaining hospitals. This means that our hospitals (including the new RAH) will now have dementia patients mixed in with general patients having surgery or who may have diseases.

What’s the problem with this? DEMENTIA IS DIFFERENT….The patients wander and roam, they may have mental health issues and require an extraordinary amount of resources to look after them to ensure their safety. After spending 12 weeks in the RAH and 4 weeks in the Repat hospital I know exactly what kind of mayhem one single dementia patient can cause. My Dad required a ‘nurse special’ 24 hours per day, 7 days per week and had over 20 ‘code blacks’ which involved up to 6 security people each time. This is a lot of resources in anyone’s language. If someone is diagnosed with dementia every 6 minutes then we have a crisis on our hands. Our bursting hospitals will now resemble an aged care home and our wards will no longer be safe or effective.

But what if it is your loved one that has dementia and is sent to hospital? They will be placed in an environment that will scare them, it will be noisy, and may increase their behaviours. This means that security teams will need to be boosted and more nurses required to keep the dementia patients in their beds. The patients will naturally want to wander and may disturb other patients who are critically ill. Dementia patients often manically pace the hallways, they are no longer in touch with the real world so often resemble an overgrown toddler. They get lost, they touch things they shouldn’t, they cry & scream, they hit and throw things, they run around naked and sometimes they are just plain frightened.

What about their dignity? How do they feel?…I would suggest probably ‘forgotten’ (which is ironic when you have dementia) .

Our aged community need to be considered and looked after properly, they have surely earnt that right.

How Cute Is This?

January 6, 2016June 25, 2016 Brett0 comment

Bob has always been a very kind person, and during one of his stays in hospital (2014) was no exception. He loved all the attention he received from all the staff and he wanted to give a donation to the hospital to thank them. He asked the nurse for an envelope, he spent a lot of time trying to write the details on the front. He then paid the hospital in the only currency he had available to him…plastic counters!

It is the thought that counts:-)

A Fortnight in the RAH (part 2)

December 25, 2015January 27, 2016 Brett0 comment

Our 3rd time in the RAH and it is business as usual for us. Bob continues to have a nurse special following him 24 hours/7 days per week. Bob is more agitated this time round and the tasks we performed last time are now too difficult to manage. Showering Bob is almost impossible. Every time we would steer him into the bathroom he would walk out (and sometimes naked). This is embarrassing for all concerned as staff race to find things to cover him up. Unfortunately he will no longer just put clothes on when asked. The dynamic has changed and Bob is now in control.

What I mean by this is that if for example we try to take his shoes off, he may hit, become agitated or walk off. Bob dictates what is happening next and the control we had before is no more. This means we can no longer shower Bob everyday – we do it when we see a window of opportunity. If he is calm and starts to unbutton his pajama shirt we dive for the towel and toiletries bag. The little showering routines no longer work. I used to get Bob to clean his teeth and straight after have his shower. Now I am lucky if I can clean his teeth at all.

This means we ‘have a new normal’. The hygiene and dressing standards we have steadfastly maintained can no longer be reached. Bob may be smellier than normal, but it won’t harm him, and that is all that matters. By having a new environment makes caring so much harder. Things get lost, items fall, and the experience becomes a lot more stressful for the person with dementia and the carers. The nurse special follows Bob everywhere he goes and they are not allowed to lose sight of him. This means there are extra people in his room and constant conversations about him which I am sure he can detect. We are talking in front of Bob now as we can’t maintain that dignity as we are on constant alert in his presence, and do not have the luxury of walking to somewhere private to talk.We are finely tuned and constantly ready for a sign of his current mood and are also wary of any hostile move he may make.

Bob’s hands and eyes are the gateway to where he is at. When his hands are soft and floppy he is calm and relaxed. If his hands become rigid and stiff and his handshakes become too firm, we all know this is an indicator that his mood is escalating. When this happens we call for a PRN (extra medication) as we have a very small window of opportunity (4-5 mins) to get the meds into him in a compliant manner. If we miss this chance, Bob will escalate and hit out and yell verbal rants along the ward. This behaviour is confronting, embarrassing and sad in many ways. Bob’s eyes also become very dark and cold when he is agitated. He will look at people with an evil stare and shake his head in disgust. If he swears in general we know things re about to get out of control.

As a family we maintained a constant vigil in the hospitals and nursing home to try and keep Bob as calm as possible and de-escalate any behaviours to avoid any hitting out or code blacks. We are scared that he will be sent to mental health institution due to the violent behaviour and every time he gets a strike on his medical records, this brings him closer to being placed in a mental health facility. Doctors have told us that Bob would have been transferred a year ago if not for our efforts to calm him, look after his daily needs and our commitment to protect the care staff and nursing staff.

Bob’s behaviours are different this time in that he no longer engages in any activities at all and is constantly on the move. he will pace up and down the ward’s main hallway hundreds of times per day with nurse special in tow trying to stop him entering rooms, annoying others and keeping him safe. Following him all day is extremely taxing and mind numbing stuff, but has to be done. He will yell out wit no notice and this usually makes the ward ‘freeze’ and everyone stares as we try and deal with our next outburst. The environment aon the ward could not be any worse for someone with dementia. It is loud, busy and confusing. Buzzers and machines are constantly beeping, people are always talking and there is just so many people rushing past each other as they try to work in unsuitable conditions. The hospital is in terrible condition and has practically been untouched for 30 years.

The nurses have all experienced the ‘wrist grabs’ and overly hard handshakes. It is no wonder some of them ‘flich’ when Bob makes a sudden move. If they become scared it is very obvious to Bob and he seems to react accordingly and continue the behaviour. We try and teach the nurses what signs to look for and what to do if agitation occurs. I have a pre-written list of instructions placed in the front of his notes to act as a quick reference to ensure the nurses are up to speed. I often stand in front of Bob to stop him entering rooms. This can be confronting but I have few other ways of turning him around. Today he gave me a ‘warning punch’ in the stomach to let me know he was not happy and there is going to be trouble if I keep stopping him from going places.

The ‘Nurse Special’ – Caring at Close Range

December 17, 2015December 17, 2015 Brett1 Comment

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The ‘nurse special’ role is a unique one and at times can be challenging, mind numbing, exciting, dangerous, boring, difficult or tedious. It depends on the patient, the environment and the personality, skills and attitude of the nurse. The role of nurse special is to give ‘1 on 1’ nursing assistance to patients that require extra monitoring. If the patient is bed ridden the role may involve sitting there for hours and doing regular observations (obs). However if the patient has mental issues eg late stage dementia, schizophrenia etc… the role is extremely difficult and can test the patience and stamina of the nurse.

Bob is constantly moving and will not sit still. This means the nurse has to follow him wherever he goes within the ward. It is a fine line that has to be tread by the nurse as they try and engage Bob, and distract him from dangerous situations but may also put themselves in the firing line of ‘hitting out’ or verbal tirades. The nurse is usually stationed outside the room on a small desk with his medical notes on it. They have clear vision of the patient at all times and have to battle with boredom most of the time. When Bob gets up he tends to wander aimlessly and is unpredictable. The nurses are usually informed of his behaviours and are often on edge until they work out his body language and triggers. In an 8 hour shift the nurse may be walking up and down for 7 of the 8 hours which is extremely tiring.

When a new nurse special is allocated, our family usually explains the tips and tricks to looking after Bob. We teach the nurse what to look for signs of agitation and how to handle them when they do. Many of the nurses have little or no experience with dementia patients and have no idea about the ‘repetitive’ nature of the disease and the cognitive issues associated with it. There is no point in trying to argue or reason with a person with late stage dementia as they simply do not have the capacity. We explain that it is best to ‘agree’ with the patient and ‘go along’ with whatever they believe they are doing or saying. If the dementia patient does their buttons wrong on their pajamas etc it doesn’t really matter and you tend to accept a lot more things that are not normal. I tell nurses to ‘take the blame’ for things with dementia patients as it is the best way to avoid trouble.

Many of the nurse specials are new to nursing and is why they have been allocated to the specialling role as they are essentially babysitting the patient. Sometimes you have very experienced nurses allocated and the experience shows and is evident immediately. The way the nurse interacts and handles the patient is vital. With Bob he likes to touch people and this can be really confronting for a new nurse. They also need to be aware that when agitated he may grab their wrist or hand and squeeze it to hurt them. This makes the nursing role a very stressful one and I really do feel for them. They cannot leave Bob’s side, but also have to take action for every move that he makes.

We tend to ask a lot of questions of the nurse and always want to know when meds are given, any difficulties and be advised if there have been any ‘code blacks’ (security team restrains). Bob has been in the RAH now for just under a week and had 10 code blacks which are vital to protect the nursing staff and also the patient. Bob can take up to 45 minutes to subdue and often needs extra injected meds as required. Inexperienced nurses tend to call for ‘code blacks’ too quickly which really frustrates the family as we are trying to avoid the trauma if possible. Having said that – an early call for help can also be a safe call (and life saving). I have been with Bob when he has become violent and within 30 seconds we have gone from calm to out of control and knowing security is on it’s way can be very comforting when in the heat of battle. (refer restrain teams blog)

I like to discuss with the ‘nurse special’ the following when I first meet them:

brief history on him and advise how nice a person he was before dementia
interacting with Bob and understanding his speech
encourage the nurse to read the case notes during quiet times
how to detect mood changes (eg. the tension in his hands, an evil stare, or swearing)
how to get Bob to take his medications (eg place tablet in his right hand then give him cup in the same hand)
monitoring his behaviours, toileting, drowsiness and sleeping patterns and reporting things accordingly
tips for his meal times, changing his clothes, showering and bed times
tips for de-escalating bad behaviours (eg do not make sudden moves, do not show fear etc)
advise them to rest when Bob sleeps as once he awakes they will be walking some serious kilometres
letting them know they can call me 24/7 if things get out of hand
advise them what we will be wanting to know when we turn up or call

As nurses change shifts 3-4 times per day we end up having to explain the above topics over and over again. This is taxing on the family but we believe if we can teach each nurse about dementia in the process they will become better nurses in the future. If we get a feeling the nurse is not up to the task we will contact the Ward Manager and suggest extra help for them if required or perhaps ask for a switch if they are really scared etc.(which is totally understandable). When we have the same nurse caring for Bob, it is very comforting as we can relax (to a degree) and know the nurse is fully informed and can usually handle the situation. We often create a relationship and bond with the nurses as we work together with them to deal with Bob. I have to admit that he is extremely difficult to handle and will test out each nurse.

The nursing role in a hospital environment is one which is totally valued by me and and is so vital to the patients. We like to advise the nurses of Dad’s kind nature as dementia can often mask the real person and give the nurse the false impression that the person may have been aggressive and violent all their life. We always worry that the nurse may ‘pigeon hole’ Bob as a nasty patient and treat him accordingly. By discussing his former life and nice qualities we hope they can see through the behaviours and tap into his good side where possible.

Our nurses are underpaid and are under extreme pressure and their care and understanding is greatly appreciated. Keep up the good work!

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A Fortnight in the RAH (Part 1)

December 17, 2015January 18, 2016 Brett0 comment

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Bob spent his first week back at the RAH in Ward R8 and it has been a nightmare. This ward is not a geriatric ward and is more general, but is still a locked ward. It has women only rooms and there is a constant beeping as machines monitor the patients and the nurse call bells keep being pressed. There is a constant hustle and bustle in the ward with people always in the main hallway as doctors, therapists, nurses and administrators cram into tiny bays to document the medical changes with each patient. I do not know how the medical team can think as they have up to 10 people in a bay/station in a space that is only 4 metres long and 2m wide. I can see how information would get lost and how mistakes could be made as the environment is often one of disruption and sometimes chaos.

The conversations between people are very public as they have to be had in the main hallway. There are sometimes patients in beds actually in the hallway due to overcrowding. The nurses set up a temporary screen to try and give the patient some privacy, but it is so public and so undignified. The patient is also not safe as wandering patients can grab at the person in the bed and are almost tempting for the mental health patients. As I am a people watcher, I quickly sum up the situation with many patients and work out the routines and personalities of the nursing and medical teams. I usually find out who is in charge (ward manager), introduce myself and then give them the lowdown and caring tips for Bob.

The doctors usually do their ward rounds between 8am and 12 noon. We are often desperate to to catch the doctors, but it is a frustrating wait as they usually come past us at 11.45 at the end of the round. We anxiously wait for hours and often miss them when we have a coffee break or toilet stop. I tend to stand outside the locked doors as I can see all 3 locked wards from this vantage point (R8, S8 and Q8). I look to see when our doctor has entered a ward and can estimate when they may reach us. This time round we were desperate to speak with the doctor to tell our latest story but have a much more low key approach this time as we know we have limited options and ‘saving’ Bob is not an option, this time we are managing him.

The hospital facilities are really run down and no money is being spent on maintaining them. The side rooms are better than a ward, but the setup within them makes for a very frustrating stay. The super thin single cupboard has no hanging rail so all the clothes are piled up on the bottom shelf. Every time you open the cupboard the contents have to be collected off the floor. The window ledges are too narrow and the same problem happens. There are no shelves anywhere and the ledges over the sinks are so thin your toiletries bag usually ends up in the sink. Some small carpentry work could alleviate the problems. I understand the new RAH room will be like hotel rooms, however we have a long way to go before then and some maintenance is long overdue. We don’t care what the rooms look like, but they have to be functional and more shelving would eliminate much frustration as we often have to work fast to grab clothes, pull-ups, towels, cups etc very quickly due to Bob’s behaviours. Shower heads are hand held and will not stay on the wall which means you have to shower the person one-handed, which is extremely difficult. We are trying to protect ourselves at the same time and the setup is simply not suitable.

Bob is now probably the most difficult patient in the ward as he is mobile 95% of the time and will not engage in any activity for longer than a minute. This means he is in the main hallway day and night and often tempted to enter the wards. Bob heads for the locked glass doors every 10 minutes and shakes at them and tries to find a way out of the hospital. The doors were recently fixed but are now once again broken as Bob had ripped the doors apart in a rage and damaged the closing mechanism. Bob has been allocated a ‘nurse special’ 24 hours per day (refer ‘nurse special’ post). They follow him for 8 hours at a time and try and interact with him and keep him out of trouble.

Due to the decline of Dad’s brain his behaviour is nothing short of unpredictable and violent. I do not use the word violent lightly, but is the most accurate description this time round. He will lash out at whoever is in reach when his behaviours escalate and he is in need of medication to de-escalate them. We have timed the meds effectiveness and it takes 45 mins for the prescribed meds to take effect. This means the staff have to identify agitation early and get the meds into Dad before the ‘window of opportunity’ closes and he is too wound up to take them orally. Once the meds are in we have to distract him until they begin to take effect. This is a various tense time and we are all looking for signs of de-escalation. Extra staff tend to be drawn into the situation as Bob becomes verbally aggressive and yells out and hits out at people and the equipment.

Bob engages most people as he walks past them and often grabs at them. This is confronting for all and difficult to handle. His brain decline is at a stage where previous calming strategies no longer work, and he has very little reasoning. This means that changing his pants could take multiple attempts across 3-4 hours and we may not have any success at all. Showers used to be done daily in the nursing home by family members, however we now can rarely get Bob calm enough to have a shower in the hospital. We continue to attempt, but often his behaviour dictates how this goes. Nurses tell us patients from other cultures may not wash for weeks, but we continue to attempt each day regardless.

I Got Caught In Charlotte’s Web

October 22, 2015October 29, 2015 Brett0 comment

I have to share this great story about a nurse called Charlotte.

When Dad was in the Royal Adelaide Hospital (RAH) we had a nurse look after Dad who showed a special warmth and compassion towards him. I remember asking her at the time if she was a ‘country girl’ as she was so open and caring. Charlotte is what I would describe as a real traditional nurse in every way.

As a family we warmed to her in the RAH, and one day on her shift she ‘broke Dad out’ of the locked ward and took him and myself to the hospital cafeteria. Dad then felt like dancing in the middle of the café and chose Charlotte as his partner. It was an awesome scene to watch a nurse (in uniform) and patient (in dressing gown) ‘rock and roll dancing’ in the middle of a café with no music, in front of everyone else without a care in the world. (I may have video of it somewhere)

As I could tell that Dad had really warmed to Charlotte I took plenty of pics of them together. I think we probably ‘bent’ a few hospital rules that day, but Charlotte was totally cool with it.

Anyway here comes the twist in this story…..

The best photo I took of Charlotte was the the one above. I loved the pic as it captured a ‘special moment’. The day Dad was transferred from the RAH to the Repat, I went in to ask Charlotte for permission to use her pic on my websites. Unfortunately she was not in the ward that day and I have never seen her since. I then had a decision to make – do I use her pic still? I took the gamble thinking Australia is a big place, and she will probably never ever see it.

Sure enough her boss at work comes across my website and recognizes her picture and tells her. So Charlotte checks herself out on this site and then joins the ‘Dementia Downunder” Facebook group. I had no idea who Charlotte was when she joined (a few months back) and today it “clicked”. I realised that Charlotte was the nurse from the RAH in my pic…..she found us!

I thought I better come clean and ask her permission about using her pic, even though it has been on the net for 6 months. Luckily she was more than happy to.

Ashlee – Another Great Nurse at the RAH

October 18, 2015October 29, 2015 Brett0 comment

When Dad first went into the RAH we knew nothing about dementia and Ashlee was one of the first nurses to help settle Dad into Ward S8/Q8. What was unique about Ashlee was that she created a connection with Dad really quickly and gave us confidence in her care, and she taught us about handling dementia.

We used to bombard Ashlee with 100 questions every time we walked into the ward and we always received a friendly greeting and she would always fully brief us on Dad’s progress. As family members we are constantly hanging off every word the nurses tell us, as it was important for us to report any changes to Docs and Psychiatrists etc.

Ashlee exudes a quiet confidence and makes you feel like “everything will be ok on her shift”. This was very comforting for our family as we battled with some pretty bad behaviours and incidents. we were exhausted and could go home knowing that Dad was being well looked after.

12 months later when we had to return to the RAH in identical circumstances, the first person we saw in the ward was Ashlee, and she remembered Bob’s name, (and our entire family after all that time). Ashlee remembered Dad’s condition and methods to keep him calm and was able to handle him with ease.

So welcome to ‘Dementia Downunder’ Ashlee and on behalf of our family I want to say “Thank you for looking after us”….Take a bow! (centre in pic)

Day 1 – A Month in Royal Adelaide Hospital (RAH)

August 13, 2015September 27, 2015 Brett1 Comment

Today was one of the worst in my life. I visited Dad at the nursing home at 8.30am like I usually do,but today was different. I usually get handed my day by the registered nurse or a carer. My usual routine is to hunt down the first person I can find and say ” Goodmorning…Where are we at?”. The Nurse knows what I am looking for…Did Dad take his morning dose of Oxazepam? This drug is the saviour of any family with a person with dementia. It is the drug that settles the resident and calms them. The doctor allows us to have a PRN which is an extra tablet of Oxazepam which can be administered when the resident is highly agitated and aggressive. I went into Dad’s room and he was twisting up a bed sheet and I knew instantly what I was in for.

I went back to the nurse and said ” Can I have a PRN ready , I think I am gonna need it today”. Dad was pacing and coming in and out of his room. Before I arrived I did not realise he had already hit another female resident who had been crying and was very upset. The normally happy carer that knows Dad well was trying to have her usual light hearted banter with Dad. He was acting strangely and in a highly ‘amped’ sorta way.

I have been watching Dad’s body language on a daily basis for a year now and I didn’t like what I saw, He kept putting his hands out to grab people’s arms and would try and shake your hand but then try and crush your hand whilst looking you in the eye as though nothing was happening.

The carer had a small round fridge ice pack in her hand and whilst Dad was charading as a happy resident I knew damn well he was in that ‘dark’ mood where he could hurt someone. Dad reached out to the carer and she was laughing off his clumsy moves and touched his arm with the ice pack for a bit of light-hearted fun. Dad went a bit quiet and then grabbed the carer’s arms in almost a bear hug. It is not unusual to allow a resident to hug or embrace a resident, but this time I didn’t like the way his body was moving. It was jerky and tense and I could almost feel the tension he was putting on her arms. Before he could put the ‘real squeeze’ on the carer I reacted in a lightning fast manner and peeled his hands off of her. I had to use considerable force to release his grip and when I did the situation simply escalated out of control.

Dad let go of the carer and then turned his anger on me. He swung a big elbow at me, which luckily missed me. I then lunged for his arms to stop the immediate danger, but as I grabbed his left arm he raised his right arm in a very threatening manner and raised it above his head as he tried to ‘ hammer fist’ me to smash my arm away. i saw it coming and released my grip so he missed me again. I then grabbed both his arms with force to stop the frenzy. My mind was swirling but I was running on adrenaline and was hyped up for anything. Dad was wrestling with me and then bent forward at the waist. His head went down towards my arm and my gut instinct was that Dad was trying to bite me, his head was facing away from me so I could only assume this was what he was doing. I knew instantly that we had a major problem and that Dad was simply out of control.

Somehow we got Dad back to his room, I called for the male carer to hang around as I felt I needed him. He was reluctant but almost had to because he was the only person strong enough to help me. Dad continued to pace around the room in a highly agitated state. We are very specific when describing Dad’s behaviour as this determines what is written in the progress notes and daily report. We are used to writing words like ‘agitated’ or ‘slightly aggressive’, but today’s word was ‘violent’. This puts Dad in a new category where decisions have to be made for everyone’s safety, and things may be escalated if required. My single goal was to get some Oxazepam into Dad to settle him down. He had already refused his medication with the nurse before I arrived so I knew he was wound up already. I attempted to give Dad a tablet with water in my usual way and bribe him with a cup of tea afterwards. I knew I was going to fail today so the carers became creative. We decided to crush an Oxazepam and mix it into a half a cup of tea. We had never given it to Dad this way, but it was worth a shot. I grabbed the cup and a few biscuits and headed for his room.

I held out a biscuit to Dad to disguise the real reason I was in the room, to dose Dad up with the loaded cup of tea. Dad was smart and often instinctively knew when we were giving him medication hidden in something. A few days before I had placed an Oxazepam tablet inside a banana which I thought was really clever. When he took a bite he noticed the texture change and instantly spat out the banana and tablet into the toilet. Watching that tablet floating in the toilet bowl is heartbreaking. ( I did not want to waste the tablet as they are vital for bad behaviours).Today we used a cup of tea and as it was the first time we did it this way so Dad did not pick it. He normally slams down his brew and today was no exception. I breathed a sigh of relief as I knew he had swallowed it. I now had to distract him for 15 minutes while the drug took hold. I would talk about nothing, offer him biscuits, offer to play footy, but then I thought maybe a family photo album may calm him? I had Dad sit next to me on the bed and I would pick out random people and just create conversation to divert Dad’s thoughts. I went as slow as I could and Dad seemed to calm down and eventually lost the aggression and he moved towards the bathroom. I then decided that maybe a warm shower may have a further calming effect and as it was his normal morning routine he may comply and just go through the motions. Thank goodness Dad did just that. This routine saved me as there are many steps involved and Dad was completely distracted. Unfortunately the damage had been done, and the fact that he had hit a family member sent alarm bells with nursing home management.

The Head of Nursing Manager came over and watched through the crack in the bathroom door when I was showering Dad and she saw him at his worst. He grabbed a toothbrush and did his hair with it. I then had to clean his teeth for him (even open his mouth) and he simply did not know what to do. It was a new low point in his personal hygiene standards. The Head of Nursing Manager had been monitoring Dad closely and she knew that he was almost beyond their care. He had up to 8 aggressive incidents on report in the last two weeks and was escalating. Dad was now a danger to himself, family, care staff and other residents…action had to be taken. I even remember saying to carers in the heat of battle ” Dad has tried to hit and bite me…and I am family…..this is unacceptable”.

Once everything was calm again Dad returned to the ‘circle’ ( the resident’s lounge) where he conducted the music on tv and threw the footy to other residents. I was hiding behind a wall over Dad’s shoulder to ensure he did not flare up and hurt anyone. I observed him for probably half an hour and I was satisfied that the danger had passed and Dad had returned to his normal happy self. I then went to work but was in a zombie like state. I walked around Burnside Village trying to rationalize what had just happened. People would talk to me and I was vague, and I was unhappy with a staff member not watching the store properly but I was not in the right frame of mind to address the issue. I handballed this to the store team leader to fix. I also explained that we have family health issues and people will have to handle stuff.

Mum was at the nursing home with Dad and I was in regular contact with the Nursing Manager on the phone who was advising me of our options. She rang several agencies to help us and advised the doctor of progress. I was doing no work so I decided to head back to The nursing home to be with Mum. My instinct was to get everyone in the same room so we can discuss the next move. I was tired of passing on the story multiple times, and we needed a meeting to make the calls. The Manager joined us in Dad’s room and we had the conversation in front of him as he was clearly not listening. We were. closely monitoring his every move so we were comfortable talking in code in front of him.

It was decided that the Adelaide Clinic was the best course of action, however the protocol is that the resident has to be assessed at the RAH first. Due to our trauma there over 12 months ago, we were reluctant but knew we had to put the wheels in motion. The nursing manager arranged medical reports, doctor’s letters, pill charts and power of attorney info on our behalf. She was amazing and having her step through things was very comforting.

We tried to load Dad into the car but he was getting agitated, Mum was trying to remove baby seats as I tried to keep Dad off the road away from danger. He went towards my van and triedto get in, so I changed the plan and told mum to get in my van and I will drive to RAH. On arrival I was determined to make a scene at the entrance to get quicker attention for Dad. I dropped them off at the ambulance entrance and then parked the van. Security moved me on so I had to drive kilometres to get back to the hospital carpark. It felt like an eternity.

Mum and Dad were in the admissions triage of the RAH and everything was still fairly calm, but with the potential to flare. Straight away I assessed the room. We had two prison guards with one handcuffed to a prisoner in a green tracksuit. There was a bizarre looking lady with long dark hair who I thought may be a mad prostitute, and a couple of other people with more conventional injuries eg. Broken ankle etc

We waited about 30 minutes before we were called into the ER. Dad refused to get on a stretcher bed, so we walked alongside it. We reached cubicle 27 and this was our new temporary home. We had doctors,nurses and Registrars all talking with us. I connected with a male nurse , who told me he had worked in Dementia before. I latched on to him as he “get’s it”. We formed a bond instantly and he personally called for the best people in Geriatrics to look after us.It was almost like we were talking our own language and we could ‘cut to the chase’. The male nurse found me the doctor in charge. He was hard nosed, but trying to be compassionate. He had to make the big calls and was making them. We had limited medical options as Dad reacts badly to anti psychotics, so he could only have benzo’s. ( diazepam, etc). It is amazing how quick you pick up and adopt the lingo when in this pressure cooker environment.

The doctor needed to get bloods and temperatures etc, but unfortunately this sent Dad into a rage. The nurse was able to get about a quarter of a syringe if blood, but was not enough. It was at this point that Dad started to thrash and was grabbing my hands and trying to crush them. The doc called for a code black and in under 15 seconds I had 6 burly guards bear down in Dad. The power enforced on his 69 year old body was unbelievable. I remember the ‘whoosh & thump’ as they all grabbed Dad and held in unison. I went from being under threat on my own to being under threat with up to 8 people watching. Mum was moved to another room as we struggled to hold Dad down. It went on for at least 15 minutes and Dad was still punching and trying to bite me. It was instinct to put my hand in his even though I knew he was going to try and break it. I guess his hands are the biggest indicator of where Dad was at. If he released his grip I would know he was settling.

The guard next to me near Dad’s head said through his mask ” We cant have 6 guys hold him forever” (it was 15 minutes I was told by a guard later) . A supervisor must have given the all clear for an intra muscular sedation injection. I was so busy at the head end that I never saw the injection given. He started to weaken eventually and the doc asked me to give him a Diazepam tablet. I had to force his mouth open and shove it in his mouth. Dad then went to sleep. We spoke with doctors and nurses over the next 45 mins and it was time for an x- ray. Dad was moved to a another ward and I noticed a different prisoner handcuffed to a bed. He was rattling the cuffs/chain which certainly keeps you alert.

I then had a young guy from the x- ray dept take me to an isolated room for a chest x-ray for Dad. I warned him that we had just had a code black and he needed to be careful of Dad’s hands as he will try and crush your hand if given a chance. The X- ray guy told me he was an MMA Fighter ( mixed martial arts) and could handle the situation without any problems. As soon as the film board went underneath Dad he rolled over and tried to crush the guy’s hand and tried to bite my wrist when I went to release his grip. He was thrashing, kicking and punching and I managed to block everything. As there was a commotion, their people joined in to help restrain Dad. It was a really public and moving circus as we dodged punches and kicks whilst Dad was in a moving bed. I remember seeing a group of 5 visitors all scatter for their own safety as they saw us coming. One lady was on the phone and had the most terrified look on her face as we passed by. She was barking down the phone what she was witnessing in real time.

Another Code Black was called and it was all hands on deck as we tried to restrain Dad. Eventually the male nurse in charge ordered me to step down as they needed to be more forceful and inject Dad again with more sedatives. I walked away past the visitors we scared and I stood alone facing the other way. The tears came and I was exhausted both physically and emotionally and in shock with what I just saw, and was involved in. I knew people were watching me, but I simply did not care. I had a polar neck knitted jumper on, which was soaked with sweat by the end of the ordeal. It was not exactly the best outfit to be wearing during such a physically demanding situation.

As I composed myself I turned to face the visitors and I apologised for what had just happened. I explained my Dad had Alzheimers and was not himself, and out of control. What happened next blew me away. Mum walked up to the large group of people with tears in her eyes. All the visitors were between us, and they showed some compassion once they knew what was wrong with Dad, and asked us some questions. The horrified lady who was on the phone then stepped towards Mum with open arms and gave her the biggest hug. She said to her “you look like you need this”. This was a really pivotal moment for us at an extremely emotional time, and made us feel good when we were so flat and upset.

We had gone from calm and joking in the waiting admissions area to full blown mayhem in an hour and continued to escalate. I will never forget the visions of Dad screaming out in pain, him trying to bite me and kick me and the restraint team forcing Dad to stay still. I remember sitting with Mum and saying to her “I think we made a really tough decision today, we may not feel it was a good decision , but it was the right decision”. ( taking Dad to hospital)