Meeting the Assessed Need

This is how our service works. We get most of our work through Social Services with a growing proportion through the Health Trust and some contracts from the Alzheimer's Society. The customer is assessed, the level of care they need is determined, and then we are contracted to deliver that care. We get a BPI - that is Basic Person Information, a great idea which was supposed to streamline information sharing and mean that all parties got a copy of the documentation and the customer only goes through the question asking process once. In practice the BPI is usually thirty sheets of blank paper with a page of basic info at the front - in other words, a ruddy waste of trees. We also get a care plan which details the time and duration of the call and the tasks we are to do. It is not unreasonable that the purchaser wants us to do only the tasks on the care plan, they are paying after all. Logical this may be, easy to do it isn't. People have needs and we all like to have our needs met....
Mary is not great on her feet. She uses a stick and various pieces of furniture to get around her bungalow and she needs help to dress, wash and get in and out of bed. Her life, like many of the people we care for, is damn lonely. Her son lives in Australia and her remaining siblings are not nearby and are as frail as she is. Mary doesn't mind too much though, because Mary has George. George is the biggest hairiest mongrel dog you could possibly imagine. His eyes glint behind a crazy mop of hair and his great plumed tail sweeps ornaments from tables and frequently has Mary swaying as it batters her when he leaps up to greet the carers. George is delighted to see everyone, if only the feeling was universally reciprocated.
Carers are like any other cross section of society and, as such, it isn't surprising that some of them are not dog lovers. In fact, some of them are downright terrified of dogs. We usually deal with this by asking the customer to ensure that dogs are shut away when carers visit but Mary is not quick or agile enough to put George away when we arrive. There is a further problem. Like his owner, George is not getting any younger and his bowels are not what they were. Mary cannot exercise George and sometimes George just cannot wait.
It's a dilemma. Social Services do not pay us to walk George and they certainly do not pay us to clean up after him. Some of the team do not want to go in to Mary at all and even those that do are less than thrilled when they step into a pile of dog pooh. Mary says she will do without care before she does without George and I don't really blame her. So - as so often seems to be the case - it is left to the Care Agency to apply some humanity and sense to the system. In practice this means that I pay the carers who are willing to do the call an extra fifteen minutes per visit to walk George. Mary is on a tiny pension, she can't pay, and I can't live with Mary not having care. It takes any profit out of the call but if I was in this purely for profit I shouldn't be here at all.
This would be a nice fluffy story if it wasn't for the fact that today I had to explain myself to the Care Assessor from Social Services. One of Mary's neighbours has complained to the Council that our staff are walking the dog...something along the lines of "Is this what I pay my taxes for?" I explained that Social Services were not footing the bill for George's service and that was fine by the Social Worker, though I think she was of the opinion I was a bit bonkers and would never be a millionaire (she is right on both counts) I just can't stop thinking about that neighbour, how could anyone be so mean?

The end justifies the means.....

Ness is tiny, a bustling, giggling bundle of fun who stands four feet seven and weighs about six stone. She came to us as a carer last year and when she arrived for interview I was momentarily speechless, and let me tell you, that doesn't happen often. Our moving and handling training is the best you can get, we go above and beyond what is required and I spend endless hours nagging for equipment when it is needed but still, I could not imagine this pocket Venus handling a sixteen stone client when she would be hard pressed to see over the side of a hospital bed.
She had no previous experience and at twenty two she had a checkered job history and a complete absence of self esteem. If I doubted Ness would make it, Ness herself doubted it more. I commenced the interview with the feeling I was going through the motions. Her size was against her and she was a bundle of nerves. She visibly flinched when I described the type of personal care tasks the job entails and her hands, with nails bitten to the quick, were constantly twisting as she avoided eye contact throughout our talk. Somehow though, I couldn't turn her away. I am a sucker for a sympathy story and Ness had never had a chance. Her family were travellers and she had missed out on a lot of education. Her mother had a long history of mental illness and Ness had spent much of her childhood with extended family because her mum was too ill to care for her. Ness confided that she had a boyfriend and they wanted to set up home and that she needed a job. Her eyes brimmed with tears as she told me that she could read a little but could not really write more than a few words and she had found it impossible to get work. All logic said I should say no but something about the kid made me smile and I sent logic to make a cup of tea and told her I would give her a trial.
The training was traumatic. The mere mention of the word had Ness shaking with fear and, in the end, I got her through the mandatory courses by paying for one to one training and allowing her to take tests verbally with the trainer. She could write basic entries in communication books although, in truth, they were never really that legible and her spelling was so eccentric that sometimes it was pure guess work to unscramble it until her team mates got used to her. Ness did have one break though. She lives in one of our rural areas and the only possible team she could work on is headed up by Clare. Clare is in her late twenties and is bright, feisty, stroppy and the most efficient Team Leader in the Organisation - and Clare decided Ness was going to make it. Over the last year they have been an education to each other. They are only a handful of years apart in age but their lives are diametric opposites. Clare is well educated and sporty, she plays Badminton for the County and spends her spare evenings teaching sport in a youth organisation. She has taught Ness to believe in herself, she gives her no quarter, Ness goes to all the clients and Clare has worked out ways for her to handle even the most disabled and the heaviest of customers. Ness has taught Clare to lighten up, to laugh when things go wrong and to spend a bit of time smelling the flowers rather than taking life at break neck speed. She has also taught Clare patience and tolerance of those who are not skilled in the areas that she finds effortless.
I went out to observe Ness the other week. She was getting Reg out of bed. Reg has had a stroke and his right arm just does not work, he weighs at least fifteen stones and his ability to weight bear is borderline. He can stand momentarily if he hangs on to a bar but it is touch and go - frankly, he could do with a stand aid but he is a young man and he desperately clings to what independence he has and I don't want to compromise that while it can be avoided. Most carers can manage him but I just couldn't believe Ness could swing his legs round and support him as he stands so that he can be cleaned. I was delighted to be wrong. Ness kept up a stream of banter while she bobbed around him like a humming bird, moving him seemingly without effort. She was literally unrecognisable as the anxious girl who had fought to make eye contact in her interview all those months ago. Reg is curmudgeonly but he shone like the sun when Ness teased him, he obviously loved her to bits. The only time she wavered was as we left the house. She looked up at me, suddenly timid, and said "Was I alright?" When I reassured her that she was bloody fantastic she confessed that she had been unable to sleep the night before because she was terrified that she would be found wanting and would lose her job. She told me that she loved the work, that it had given her confidence and that she felt useful for the first time in her life.
All carers have to undertake NVQ training. Much of it is practical assessment but there is also some research and written reports to be done. I avoided the issue for a long time. There is no chance of Ness managing the work. She is terrified of the assessment and the reading and writing aspects are just beyond her. When I have broached the subject she has been unequivocal - make me do it and I will leave. Even the suggestion that I get her basic skills training first has been received with a mutinous shake of the head.
I finally broached the subject with the Inspector from Care Standards, she who must be obeyed and the person who ensures that we meet the standards required of us. The Inspector was sympathetic but unmovable - Ness must be registered for the course. Clare was furious but determined that Ness would not leave. Before each assessment she coached Ness, playing the part of the Assessor with clients who were in on the scheme and who thoroughly enjoyed the subterfuge of being guinea pigs for Ness' practice runs. Today Ness told me she has handed in her final written work. I don't know if she dictated it to Clare or if Clare just did it for her. I don't want to know, I am turning a blind eye just as I did when they turned my rural team into a giant theatrical set with clients in leading roles for a week before each assessment. Ness is a wonderful carer. Clare has learned to be more gentle. The clients have felt useful and have had huge fun.The NVQ Assessor has ticked another box. It may be unorthodox but I reckon it has been a shining example of what teamwork should really be.

I am off tomorrow for a week of walking and relaxation at the other end of the British Isles. See you all when I get back......

Going to Hell

In a grimy Northern Town many years ago......The referral was anonymous. It could have been from any of the neighbouring flats in the grim complex. I approach the door, passing graffiti and rotting rubbish and swear I see a curtain twitch as I hesitate before knocking on the cracked glass. She glowers at me as I explain who I am but leads me through to the bedroom willingly enough. It seems she doesn't see what I see, she seems to feel she is the unsung heroine of the story, selflessly devoting herself to caring for her husband.

I have never seen anything like it. His wife says she has been caring for him for years but it is hard to see what it is she has been doing that qualifies as "caring". Bert is a skeletal figure with a Catweazle beard lying in a bed that is beyond filthy. This squalid room in a rancid council flat has been his sole residence for God knows how long. His wife is called Mary, she is a squat creature whose fingers are stained with tobacco and who looks as if she hasn't washed or changed her clothes in weeks. She squints at me through the haze of stale smoke that hangs like a bad dream in the room as I try to talk to Bert. "Ent no point talkin' to 'im - e's a miserable bugger" she says round the cigarette that seems a permanent fixture in the side of her mouth.

I have to try and assess the situation but every time I try to speak to Bert she interrupts, talking over him with a litany of complaint about the doctor, the council and most of all Bert who is allegedly the most useless, miserable excuse for a husband a good woman could ever have been cursed with. Bert closes his eyes, passive in the face of her onslaught. He has given up. I ask Bert if he can stand and he says he can get to the commode. I ask him to demonstrate and she whips the sheet from him. I almost retch at the sight of his feet. They are completely black with grime and his nails are long and yellow, so long they are curled round almost to the sole of his foot. The professional mask slips and I insist she leaves the room so that I can talk to Bert alone. I have no authority to do so but maybe she sees something in the set of my jaw because she retreats muttering dark curses at me as she goes. I don't scare easily but somehow she exudes an air of malevolence that raises the hairs on the back of my neck.

I know I don't have much time so I get right to the point. I ask Bert if he wants to stay in this hell hole or if he wants me to take moves to get him away. To my despair Bert isn't playing. He says he wants to stay where he is. It is patently obvious to me that he is too beaten and weak to fight. He is as institutionalised as any maximum security prisoner.

Adult abuse is a complex matter. If it is suspected that a child is being abused then there are legal powers that can be invoked to remove that child to a place of safety. An adult of sound mind has the right to remain in an abusive situation if they so wish and there is nothing to be done about it except wait it out. The Psycho geriatrician reluctantly concludes that Bert is capable of making the decision to remain at home and the best I can do is persuade Mary that she deserves some help and get some home care in there to monitor the situation. This situation must break down soon and maybe if we win Bert's, or even Mary's confidence I can get the situation resolved.

I don't have long to wait. It is only a couple of weeks later when I get a phone call from the Home Care Department to say that the carers have found Mary dead when they went in for the morning call. I am shocked, she had appeared in good health, certainly in comparison to her husband, nobody could have predicted this. I race round to the house and find Bert more animated than I have ever seen him. He sits up in bed and grasps my arm as he tells me the most spine chilling tale I have heard in the whole of my career. "She was going on at me, you know, like she does" he said "And then she started clawing at her face and screaming and running around and then she just dropped dead" I must say he doesn't seem remotely upset, if anything, he appears excited. I ask him if she said anything and he actually smiles and nods "She was saying "They're coming for me, get them off me, get them off me!"

Bert is moved to a residential home for assessment. He is bathed and given new clothes and when I go to see him a couple of days later he is almost unrecognisable. He is still thin of course but he is clean and tidy and is sitting in the lounge talking with another chap and looking just like anyone else in the room as he tucks into his lunch. The staff are a bit baffled. They know his wife died suddenly but they don't know any details. Bert won't talk about it beyond to say that he doesn't want to see her body. They are trying not to judge but his cheerful demeanor and his total refusal to go to the funeral shocks them. It even shocks me a bit, despite everything I know. I take Bert into a side room and he is talkative and engaged, discussing the possibility of a permanent flat in a warden controlled complex but when I tell him the post mortem has shown that Mary had a massive brain bleed and ask about what funeral arrangements he wants to make his face goes blank and he will say nothing beyond the bald statement that he "wants nowt to do with it" This is unique in my experience and I am at a loss but I can't help feeling that he will regret not going to the funeral of the woman he has been married to for thirty odd years. She may have been a horror but she was his wife. Surely he is in shock, I try to broach the subject again and he looks at me with a matter of fact determination "I reckon the devil came for her and the devil can have her" he says.

Geraldine

We gather in the Doctor's office for the CPA meeting. The doctor is graced with the presence of me, the Mental Health Support Worker, the Occupational Therapist, the shiny new Community Psychiatric Nurse and Geraldine, the reason for our meeting.
Geraldine is delighted to be there. Her little round face is split with a beaming smile, the lips constantly moving over her dry teeth because the Anti Psychotic medication makes her mouth dry. We go to Geraldine each morning with additional calls to accompany her to the shops and to help with cleaning.It was hard to get her to accept it but now she loves our visits, adoring "the girls" and looking forward to their outings because she says they are trained to look after her and keep her safe. She is a complex mass of anxieties, everything is terrifying. She dwells on the sadnesses her life has brought, the death of her precious Mother, a heart operation her brother had some ten years ago. Her broad face is as expressive as a child's toy and her moods swing like a weather vane, going from laughter to tears to panic to despair and back to smiles in a matter of moments.
She has two touchstones in life - her love for her brother and her love for her home. And, although she cannot deal with the smallest decision or disruption to her routine, she has a character in there that is pure steel.
The CPN is newly minted, fresh on the job and bustling with enthusiasm, she just knows she can make Geraldine's life better. She is reckoning without Geraldine. Geraldine is only sixty six but every time it is suggested that she may need help she insists that it is only to be expected that she struggles because she is an old lady. The CPN is quite rightly worried that Geraldine is terrified of the stairs. She comes down in the morning on her bottom and returns at night one stair at a time, it can take her twenty minutes to get up to the top. The CPN tried to institute an evening call to help her to bed. We go at six - Geraldine takes to going to bed at half past five. The OT suggests a stair lift - Geraldine says she cannot possibly learn to use such a complicated contraption at her great age and she would be far more likely to fall with it than without it. The idea of a bath seat is rejected out of hand because it would spoil the bathroom her brother had put in for her. Any further discussion on these subjects is cut short by Geraldine launching into one of her diatribes about how she loves her brother (huge smile and hands clasped in ecstacy) or how she cared for her Mother and how much suffering she went through before she was "cruelly taken" at the unfairly early age of ninety one (trembling lips, face a mask of misery). She successfully redirects all attention to her story and the subject has to be dragged back to the matter in hand. The doctor is concerned about her Pancreatitis which has resulted in a recent hospital admission. He suggests that Geraldine needs a low fat diet. Geraldine says that she is a Vegetarian, she doesn't like fish and she has never eaten vegetables. The startled doctor asks gently what she does like. She likes jam sandwiches and chips. In large quantities. She is very old and it's all she can manage to make. More home care is suggested, Geraldine pulls her trump card. She screws up her eyes, her face a mask of misery, and with her hands over her ears wails "Stop nagging me, Please, please, can't I go home yet?" You would think she was manipulating and in a way she is but any exasperation disappears when she tells us that she wakes in the night and wonders if someone will break in and murder her because "she has never been popular" or when she says matter of factly that when she got home from hospital she cut off her hair with the kitchen scissors. The World is not safe and Geraldine needs to keep it exactly the same, even if that means that the life she has is needlessly difficult.
The professionals accept defeat and the meeting is brought to an end with no changes made. As I stand to leave I touch Geraldine's arm and tell her how nice it is to see her out of hospital and looking so well. She looks up at me with fat tears beginning to trickle down her cheeks "I haven't been rude have I?" she asks. I tell her for the umpteenth time in our association that she has never been rude, that she is a pleasure to visit and that we are only there to try to make her life easier. I have lost her though, her expression has returned to a distant smile as she clasps her hands together and looks beyond me "Oh I DO love my brother" she says.

Pay Back Time

Some people travel the World, Mrs. A. moved three houses down the lane when she got married and that was where she stayed, a fixture in the tiny village. She was a dinner lady at the village school and was remembered with affection by generations of local people. She was a stalwart of the village church, "God's little 'ouse" as she called it. She said her faith was a simple thing and once she could no longer get to the church she took her simple pleasure in having communion from the visiting Minister and reading from her Bible the lesson that he told her they were having in the service each week.
She had three boys of her own. The eldest followed a career caring for disabled children and became the Head of a special school. The middle one traveled, seeing a World his parents could only imagine and ended up living on a boat in Greece. I met John, the youngest, when we were contracted to provide care during her terminal illness. He had been his mother's carer for three years, only returning to his own house every other weekend when his eldest brother came to stay to relieve him. He worked in computers and when his mother became increasingly frail he negotiated reduced hours and then a leave of absence without pay. He was a big man but I have never seen anyone more gentle. He only ever lost his temper once that I knew of and that was when his middle brother returned home briefly and suggested that Mrs. A. was "put in a home to die". John broke his nose and threw him out, then apologised profusely to the carers and knelt down to reassure his sobbing parent that she wasn't going anywhere.
He teased her affectionately when she refused to co- operate and he spent hours cooking whatever he thought might tempt her to eat. She became increasingly confused and repeated herself endlessly. Sometimes when the night carers arrived he was wild eyed, his hair standing on end where he had raked his fingers through it. He joked he would lose the plot himself if he didn't get a break from the endless repetition but apart from the last half hour in the village pub when the night staff came in he stayed day and night.
He was an eternal optimist. Long after it was patently obvious that Mrs. A. was near death he kept talking as if she had indefinite time left to her. He never showed a moment of frustration that his life had been on hold for years. When even he could no longer deny the truth and his eldest brother had come to stay until the end he stayed up night and day, holding her hand and talking gentle nonsense to reassure the frightened old lady.
I never saw him in anything but old jeans and band t shirts but when he walked into church at her funeral he was suited and booted, red eyed but smart as paint for his mum's final day in God's little 'ouse. When I hugged him after the funeral he was shaking like a reed but he thanked me for all our help with that gentle grin I had grown so fond of.
All this was back in Spring. Last week I was driving through the village and saw John cutting the grass at his mother's cottage which is now up for sale. I stopped to talk and he was as self deprecating and pleasant as ever. I gave in to my curiosity and asked him what had made him so devoted as to give up his life for three years when his brothers had not. He grinned ruefully and said. "I was the wild one. Too much drink and too many women, I was the only one that brought trouble home, not serious trouble, but I was always the one that caused them worry" I protested that his mother had obviously loved him dearly and he acknowledged that this was the case. "But she was a wonderful Mam and a wonderful woman" he said "And anything I did she had earned a hundred times. She and Dad stood by me no matter what. You know what this was girl? This was pay back time"

Same Job, Different Day

From time to time I will be telling stories from times past when I was a Social Worker - They prove my point that some stories are universal - and some have been in my head for years.
In a grimy Northern City many years ago....
Our area office was situated on a roundabout near "The Precinct" - an area of tower blocks with a shopping centre, the wet dream of a planner who was assuredly never going to have to live with the misery he had created. The grass slopes of the underpass were a favourite spot on sunny days for the local drinking classes. They would gather with their plastic carrier bags and their drink of choice - White Lightening or Meths mixed with orange juice - a process they called "boxing", I never understood why. One or two of them would visit our office periodically and chief amongst those was William D. My mother didn't raise any rude children and, though he was often at best tipsy and at worst paralytic, I tried at first to call him Mr. D. He always reacted as if I had grossly insulted him, protesting that his name was William, not Bill or Billy but William. This strange formality was his hallmark, however drunk he was he was always softly spoken and polite, always hesitant to make eye contact.
William would turn up a couple of times a Month and the duty officer would see him. I look back on those days with nostalgia, call centres and performance indicators were still far in the future and although William was never formally on the caseload my Senior Practitioner recognised that he and I hit it off and he was happy for me to spend a bit of time with him, to try to win his trust. When he called he would always be in need of money for a bill or some other commitment and I would let him have small amounts from petty cash. I could set my clock by him on benefit days, he would appear before nine thirty, as sober as he got, and pay me back, anxiously insisting that I check the amount before going on his way to who knows where. After his death I found out that we were just one of his ports of call. He visited a couple of local cafes where he got meals on tick and the local corner shop where he got food on credit now and again.They all told the same tale, come benefit day this reticent Irishman would shuffle in and insist they count out the coins to make sure his debt was paid in full.
I left work one pitch black filthy November night and almost fell over him, stretched full length in the car park with the rain beating down on him. I ran back inside for my boss and together we managed to get him to his feet. He stood between us swaying and shaking his head at my boss and said "Oi've bin drinkin' since I wuz nineteen Mr. Miles. It's the brain d'ye see - it just canna take it" He staggered off looking like a ship tacking in a high wind and we looked at each other laughing ruefully, he constantly refused help, what could we do?
I decided I was going to have a last ditch attempt. I found out where he lived easily enough and I went round first thing one morning to see if I could catch him sober and weigh up the situation, see if I could find a way to help.He was delighted to see me. He ushered me into his high rise flat, hastily moving his sleeping bag from a sofa that was the sole piece of furniture in the room and insisting I sit down. He had just made his morning tea, it was in a battered tin tea pot big enough for ten people. That was his pattern. Each morning he drank a full pot of tea, one mug after another, without milk. When the pot was empty he went out and started drinking. He spoke softly, big hands dangling loosely between his knees as he told me about his life. He came over from Ireland at sixteen and worked on the road gangs. The money was good and he enjoyed the craic. He was nineteen when he sustained a head injury on Christmas Eve. The machine operator who hit him was drunk and in due course he received a nice sum in compensation. He wasn't able to work at the time so he drank..and drank...until the money was gone. There followed periods when he worked, he even mentioned a woman he had lived with for a while in a City some miles away but always the drink ruined it and each time he fell, he fell a little further. He spoke well, he was an alcoholic but he was an intelligent man. He told me that he had regular black outs, sometimes coming round to realise that he had been robbed as he lay senseless in his own vomit. I offered again to get him help and he momentarily met my eyes before saying "God love ye darlin' I don't deserve help an I don't want it now, it's all far too late"
I left feeling useless and when he arrived with a small box of Dairy Milk for me a couple of days later to say thank you for visiting him I could have howled with frustration. William didn't want my help but he said I was "an Angel from God" because I had bothered to go to his flat to offer.
He was found dead on the road outside his flat about three Months later. I went to his funeral and I was glad I did, I kept the caretaker of the flats company and the two of us gave the Priest someone to say the words to. Nobody knew if he had any family, we were the only mourners. He was forty eight. William has been dead for twelve years, today is the anniversary of his death and I tip a wink to his God to let him know I am thinking of him. It's not much but it's all I can do. God Bless William.

Tell me what you want....

She never married and now, at almost ninety, she is the last surviving member of six siblings. We looked after two of her brothers and I can see a family resemblance. They were married though, they had families and were somehow more in touch with the everyday world.
She lives in the house she was born into. I don't know what she did for a living, it's hard to picture her anywhere but in the little terraced cottage with it's two steps up to the kitchen and it's coal fire. Her nephew shops for her once a week but apart from that she has no help. Every day she ties up her hair and does "her jobs". There is a strict routine, floors one day, washing another and all to a background of an ancient radiogram, she has never had a television. She is tiny, doll like, and she tells me that she has never bought a skirt that she hasn't had to shorten, showing me tiny stitches in her hem with a justifiable pride. She is called Minnie - never was anyone more aptly named.
Her nephew has contacted us because she is losing her memory, forgetting where she has put things and burning pans. I can see that her mind is failing a little but she appears to be functioning in her familiar surroundings, a check call to make sure she has taken her medication and isn't distressed should keep her going for a while. Situations like this are like a house of cards, enough help and she will tick over indefinitely, too much and her independence will be compromised, her routine disrupted, and the card house will collapse. What fascinates me though is how she lives. She has never had a bathroom, her toilet is in a shed in the yard with gaps in the walls that a mouse in a tall hat could stroll through. She has no hot water, she boils it up in a copper the like of which I have only seen on television and I assume she washes in the unheated kitchen because she looks immaculate. We are in the Twenty First Century but the Twentieth seems to have largely passed the little house by.
We make a mission of her. Her nephew is enlisted and a grant is applied for. Minnie accepts the idea of a bathroom with mild pleasure but no great enthusiasm. She likes the workmen though, she mops the floor where they have left footprints and makes soup for them every day. God bless them, they eat it with loud praise and when I call in I swear this tiny elf of a woman is flirting with them, looking up through her little round glasses and twinkling as she makes mugs of tea and doles out Welsh cakes.
The bathroom is lovely. Her niece has made curtains and her family have bought towels to match. The multi point water heater is a success, it sits in the middle of the antiquated kitchen like a visitor from another planet but the copper is gone and she is agog at the miracle of hot water straight from the tap. The bathroom is unused though. She doesn't see the point, or maybe she can't adopt new habits at this point in her life. She still washes in the little back kitchen, a private ritual that stretches back almost a Century. She is grateful though, visitors are given a tour of the transformation of her back bedroom and she points out the various features like a proud mother. The bathroom is pristine, keeping it clean is now one of "her jobs".

Skewed Perspective

It is a standard bungalow. It was probably built in the 1970's, the front garden is neat with a pocket handkerchief lawn and a stone path to the neat double glazed front door. They bought it when they retired in the early 1980's, moving to the area where they had enjoyed holidays when their children were small.
I walk into the living room and it is breathtaking. Huge windows make up almost the whole of one wall and the view is filled with sea, for a moment it is disorientating - you feel you could be on the prow of a ship. Pure light floods the room and I wish I could paint, anyone who lived here would surely be inspired to try to produce art in this light, with this view.
She is not an easy woman, but then, she is not having the retirement she anticipated. Her husband has Parkinsons and their life revolves around caring for him, day hospital and carers, incontinence sheets and hospital beds. She is grieving the life she didn't get and the husband who is gone, replaced by a confused and sometimes aggressive man. I comment on the view and she turns blank eyes to the windows. "We thought we would be here for life" she says "We are putting it on the market this Month, we can't afford the fuel bills and the running costs"

He is a proud man, he fought in the War and he and his wife brought up a family in this tiny cottage. He got up at dawn or before each day and worked as a farm hand, walking the five miles to and from work. They never had a car or foreign holidays, they didn't have holidays at all but they had a simple life where you lived within your means and that was good enough for them. He is ninety now, his skin is paper thin, marked with purple stains where the steroids he takes for his breathing have thinned his blood. He lives in one room, the single bed in the corner with the family pictures still on the wall above it, a reminder that this used to be an ordinary sitting room. A portable gas heater is on constantly in front of the gaping fireplace - he doesn't have an open fire any more, he cant keep it in all day. The house has central heating but he doesn't switch it on, he can't there is no oil in the tank.

Twenty five thousand older people will die this Winter because they cannot afford to heat their homes properly. You know it, I know it, the Government know it, and yet it will still happen. I don't believe that help to insulate lofts will solve this problem, what's more, I think that the Energy Companies will put up their prices to cover the cost of providing it. There is real poverty going on in your street, in your village but the people who are dying cannot go on strike. It appears that they are expendable in our Society. Yesterday a friend of mine was in London and had a wander around Harrods. She saw a handbag on sale for £19,000. Something is very, very wrong with our values.

Falling through the cracks.

I have a poor sense of smell but I can tell which flat it is from the entrance hall. Even if I couldn't, the neighbours waste no time in letting me know I have reached the correct address as I hover outside the slightly open door through which a slice of dark hallway scattered with debris is visible.
The neighbours are two neat older ladies and they are baying for blood. They tell me about the smell and the rotting rubbish in the hallway but they can tell me very little about the gentleman who lives there, it appears nobody speaks to him. "Something must be done" and it appears I am the person they feel should do it.
I push the door open and the smell intensifies as I call his name, there is no response. I advance hesitantly into the gloom and pause at the bedroom door, I try to adjust my eyes to the scene before me. Mr C is so thin that I can see the whole outline of his pelvis. He is lying on a rancid divan bed with a sheet half over him, I cannot see his chest moving and I creep closer, taking in the gaunt face and the straggly growth of beard. When he opens his eyes and starts I cannot repress a small squeak of alarm, I had been certain he was at least unconscious and possibly dead. He struggles up, hastily trying to cover himself and clearly horribly embarrassed. I back away, making my apologies and saying I will wait for him in the living room while he gets some clothes on.
While I wait I survey the scene. The place looks as if it has been comprehensively vandalised. The sofa cushions are missing and the strips of webbing beneath are mostly broken, the filthy carpet is barely visible beneath the covering of clothes and food wrappers and there are stains on the walls and the windows which could be blood or food or something even less savoury. Bizzarely, the door of an automatic washing machine leans against the fireplace. I can see through the doorway into the kitchen because the door is off it's hinges and propped against the wall. It appears there has been a fire in there at some point. The walls are blackened and a tower of cartons and rotting food balances on the charred worktops.
I turn as he staggers into the room and half falls into the sagging chair. He is breathing heavily and he has put on a pair of trousers and a shirt which flap unfastened around his emaciated torso. I realise how much of a judgement I have already made when I hear his voice and am surprised by it. He speaks with a BBC accent and his tone is refined, he is a wreck of a man but his manner is that of a gentleman. He cannot sit still, settling only for a moment in each position before moving restlessly again, his face twisting in pain. He tells me that his hip is agony and that he rang an ambulance the other night but was told nothing could be done for him at Accident and Emergency, he needed to see his doctor. His doctor had seen him before of course but he had been told nothing could be done for him until he stopped drinking. I suspect this is only half the story but I get the general picture. He says the only thing that eases the pain is the whiskey, he cant remember when he last ate, he thinks he had a Cup-a-Soup yesterday but it quickly resulted in explosive diahorrea. This is hardly news to anyone standing in that room with him.
Slowly I coax the story from him. He is only sixty two. He lived with his mother until he was in his late forties, she "suffered with her nerves" and he looked after her until her death. He then found out that, although she was long estranged from his father, they were still married and their will had never been changed. His father took possession of the house and he was left effectively homeless.
He moved into a holiday cottage on a small farm belonging to friends and stayed there for nearly ten years. He says the farm became too remote for him as his hip condition worsened and he was moved to this council block for older people three years ago. I suspect that his drinking may have played a part in this, at any rate, he says he has no contact with these friends now and he has no other connections in the area. It is a paradox, the flat is a vile health hazard in an otherwise pristine small complex. He is vilified and avoided by his neighbours and it is hardly surprising that this is the case, and yet his whole demeanour and bearing is that of a man who should be living a genteel middle class life far from council accommodation.
Back at the office, I speak to his social worker, who had asked me to check out the situation and report back whether we would be willing to attempt a clean up of the property before putting in a regular service. I cannot bring myself to refuse to help, even though I know I will have to help with the operation, I couldn't square it with my conscience to send the staff in there without joining in. The thing is, I can't imagine undertaking the task with Mr C in residence, we have to find a way to get him out of the flat. We debate the issue, we both feel he has a medical problem but there is no chance of getting him admitted while he is permanently drunk, he is well known to all the medical services and, frankly, they have tried everything to help him and they have run out of sympathy. The social worker somehow persuades her senior practitioner to sanction some emergency respite care and we both hope Mr. C will manage to sober up while he is there so that she can get him some medical attention for him.
We take sixteen bin bags of rubbish from the flat and it takes three of us a full day and buckets of bleach to get the place even half way habitable. We get through it with an overlay of hysteria, laughing as we uncover each new atrocity, shrieking at the mouse droppings but taking a pride in putting up curtains we have brought from home and making the bed with sheets we have ferreted from the backs of our own cupboards. The social worker negotiates a grant to replace the burnt out cooker and the council come and repair the toilet and emulsion the walls. At the end it still doesn't look like a normal home, we have taken up the carpets but he will have to make do with linoleum and the whole flat is bare, but it is serviceable and it is clean and I am happy to take the fall for the difference between the time we have been there and the time we will be paid for because we have made a difference.
In the meanwhile Mr. C. has thrived on regular food and less regular alcohol and has got an appointment to have his hip assessed for replacement. He is not horribly dehydrated now and the pain is more manageable. He returns home with an hour alloted for each morning to make him food and maintain his environment. The social worker must have begged and pleaded, it is more than most people in Mr. C's circumstances would usually get but by now we all have an investment in turning him around and there is a team spirit invested in his future.
And now six months have passed. We go to Mr. C. each day and, for the most part he eats. He has fallen spectacularly off the wagon once or twice but in general he has kept his whiskey consumption within reasonable levels. He has proved to be the gentleman I suspected lurked in there, he is softly spoken and intelligent and it is possible to glimpse the fragility that led him to drop through the cracks in the system in the first place. He reads the Independent each day and enjoys documentaries on the little television set that a carer donated after swearing she no longer needed it. He rang me this morning to tell me that he had been to see the Specialist. He wont be having a hip replacement. He has advanced bone cancer.

Life in the Old Dog Yet

Old people are just young people with badly fitting skin. They may be a bit more set in their ways but they are just the same as any age group really. They can be sweet, kind, bigoted, intelligent or so dim it's a wonder they get their shoes on the right feet, just like the rest of us.
We have something like three hundred customers and over one hundred staff and, with all the possible permeatations of carer and cared for it is inevitable that sometimes there is something of a personality clash. I don't know about you, dear reader, but the idea of having strangers in my house makes my toes curl and I have every sympathy with anyone who feels they would rather have hot needles in their eyes than see a particular carer coming into their house in the morning.
The problem is that carers must have work and clients must be cared for and so a balance must be maintained. Les has reached that fulcrum point where, if he doesn't stop turning carers down, we aren't going to be able to provide care for him any more. He has only been with us a few weeks and he has already placed the black spot on four carers of a nine carer team. He has come up with a variety of complaints, all of which may or may not be valid but are difficult to verify one way or the other. I am beginning to suspect that Les may not be the most...reasonable gentleman I have ever encountered.
This morning he was on the phone again but this time he had made a tactical error. He had a complaint about a worker who has been with me for years. She is no more perfect than I am, but what she is is scrupulously clean. I would go so far as to say she is bordering on obssessive compulsive about cleaning. So when Les said that she had left his dishes unwashed and his bathroom looking like the Wreck of the Hesperus I smelled a rat. I jumped in my car and paid our Les an impromptu visit so that we could discuss his concerns in person. After all, it's only good customer service isn't it? Sure enough, the bathroom was pristine and the sink was gleaming. I fixed Les with a beady eye and said "Now then Sir, whatever the issue is, it isn't Maureen's standards of cleanliness, what is really the problem?" Les blustered a bit and looked everywhere but at me and then he said. "Well, when I agreed to have the service I did think they might be a bit ...younger and prettier" There was a moment when I hovered between righteous indignation and hysterical laughter and then I firmly explained that we were here to do a job and not to be a decorative interlude in his morning. I finally lost the battle with my giggles when he, unabashed, looked me up and down and said with a sniff "Just as bloody well!"

Silent Love

Working class must have meant something different then. The basic expectations were far different. Bob worked all his life, hard manual work that has left him arthritic and worn out and, by the standards of today, he has very little to show for it. He lives in a council house and although it has the basics it has precious little else. The carpet is worn and the suite is circa 1970, that shiny dark plastic with hectic floral cushions and little black legs ending in brass discs. The fireplace is the beige tile that came with the house and it is adorned with an alarm clock and a small framed picture of his wedding day. The picture shows a red faced young man, smiling shyly at his foursquare bride and looking as though his shirt collar is strangling him. She clasps what looks like half a garden in a bouquet and looks directly at the camera, a slight smile the only hint of a positive emotion on her broad face.
He doesn't talk about her. She has been dead seven years and he is not the sort of man to share his emotions. He sleeps in what was the "best" parlour now, the stairs lead to a no man's land, uninhabited except for a twice daily trip by his carers to empty his commode. He is pleasant to the staff, even makes the odd joke, but if they ask how he is the answer is always the same "I'm very well" He says this even when he can barely get his breath, coughing until it seems his lungs will burst and clasping his inhaler like a drowning man, which he is, he is drowning from the inside.
He is a creature of habit, cereal for breakfast, soup for lunch and orange squash from a huge economy bottle left on his scarred side table. It isn't comfortable preparing food in the little kitchen that is so clearly the domain of the wife long gone. Her pinny still hangs on the door and a mug hanging beneath the wall cupboard bears the legend "Mum" - we never use that one.
He must have had a heart attack. The carer found him when she went to make him his cocoa and help him to bed. He was lying on the rug, quite cold, he must have been gone for hours. She ran for his son who lives in the next street and they ran back together, hoping they weren't too late, knowing they were.
The carer was distressed but she said he looked peaceful, she thought he must have been doing some tidying up, his wedding picture was lying where it had fallen from his lifeless hand....

Aunty Molly

It's only just gone 7 .15am when I pull up outside. The call isn't officially until 7.30am but if I am covering calls I tend to start early to allow for the fact that I am slower than the regular girls because I am constantly the new girl, not knowing the routine, not able to find the tea bags or the clean underwear.
She is well over ninety years old, she likes the staff to call her Aunty Molly and it is a tribute to her that even the most cynical carer does it without irony. She met Lloyd George when she was a little girl, it still stands out in her memory still though she never voted anything but Labour. She is known throughout the village by her first name, the sort of fame shared by Madonna and Sting, but on a small town Welsh scale. She delivered babies and laid out the dead and was the woman that the local kids ran to when Mammy wasn't well. She is a local legend.
Her life has shrunk now, she is all but blind but she is fine in her own environment - knows her way round the terraced house she came to as a newlywed by touch and memory. I let myself in and call her name up the stairs but the answer comes from the kitchen. She is up and eating breakfast, sitting at the scarred kitchen table buttering toast and drinking tea from a china cup with roses on it. She doesn't need me for much, make the heavy old feather bed, put out her meds, what she really wants is a chat. It's a debatable point whether she needs the call but she is one of the ones we lay low about because we know the day will come soon enough when she will falter and knowing the girls who care for her may make that easier for her.
She always tells me the same tales, I don't know if that's because she does that to everyone or because she rarely sees me and forgets between visits. She says she is lucky, "she doesn't have an ounce of pain" She doesn't mention that she can no longer read or see television, her hearing is too poor to hear the radio and though her son phones every day she only knows it's him for sure because her speaking clock tells her it is twelve o'clock, the time he always phones. She used to have two boys but she lost the younger one in a road crash at twenty one. Her husband went five months later, a broken heart she reckons, she tried to revive him on the rug that is still in her front room but he died in spite of her efforts and she was widowed at fifty six. She was left without much money and with a grieving son to care for so she took in lodgers. Her face brightens as she talks about "her boys", mostly mine workers who lived in her back bedroom for a few months or a year or so and gave her a purpose in the dark days and an income in days when the State contributed little.
I listen to the stories again, sharing the stewed tea and enjoying her laughter but I have one eye on the clock and soon enough I have to extract myself and go on to the next call. As I stand to go she says musingly. "I had a strange dream last night girl, made me feel quite funny - I had to come down and have a cup of tea". I sit back down and she looks at the spot where she knows I am. "I dreamed I was stood on one side of a little brook and my Billy was stood on the other side. He looked so sad and he said "There's a long time you've been Molly, When ARE you coming girl" We are both silent for a moment and I reach out and touch her hand. She seems to give herself a little shake and smiles again. "I can't go can I?" she says in a brisk tone "My boy needs me".

Picture This

We are all going to get old or die young, it's a fact, but you have to be middle aged before you believe it applies to you. Many of the (mostly female) workers in my organisation are young, under twenty five and in some cases, even in their late teens. There are mixed feelings among the people we serve. For every curmudgeon that reckons anyone under thirty cannot possibly do the job there is a client who finds a young face and a tale of parties and boyfriends brightens their day. My unenviable task is to make sure that, young and old, they stick to the uniform. As uniforms go it is unremarkable, tunic, dark trousers, flat shoes and a fleece when the weather demands it (and it usually does). I also stipulate minimal make up, no obtrusive jewelery, tied back hair and no perfume. This last may seem picky but many of our customers have breathing difficulties and a lung full of body spray from someone leaning over you is at best off putting and at worst positively distressing. So far so good - until the advent of the facial piercing. NO NO a thousand times NO! Now I admit I actually don't like face furniture but that is a personal preference. I don't like tattoos either - why would you? You wouldn't commit to having the same picture on your wall for the rest of your life so why would you indelibly decorate your body with a winsome cartoon character or some Chinese writing? At least from a professional point of view, tattoos are (hopefully) not on show when you are working, not so the piercings. Facial piercings are not desirable when people may be touching their face and then touching food they are preparing. More than that, they are a risk when we have some clients who are prone to lash out at their carers from time to time, I shudder at the thought of a nose ring or eyebrow ring being ripped out. These are perfectly valid reasons but it's more than that. I may be a stuffy old git but I do not want my Company's image represented by carers who could not pass through a metal detector.
Cut to an incident a couple of months ago. A young carer rang me because her co worker had failed to show up for a double carer call. It was a new client and she was waiting outside, unsure of what to do. A quick telephone call ascertained that the missing carer was caught up with a previous client who was feeling unwell. I abandoned my warm fireside, changed out of my lazing around gear and shot off to meet the abandoned carer. A missed call puts a client at risk and damages your reputation. You can't put a value on the well being of a vulnerable person who depends on us. However, the expression on my carer's face was also priceless as the boss screeched to a halt beside her and the headlights lit her up in her jeans, boots and with, you guessed it, her nose stud in! In the event I couldn't tell her off too much, I was laughing too hard at the poor girl's horror. I made her take the piercing out and we went and did the call.
It made me think though. In forty years or so the first of them will be trickling into the residential homes. The Ernies and the Cissies will have given way to the Kyles and the Leannes. I just have a little trouble picturing the nose studs and the lip rings let alone the generation of old ladies with weird hieroglyphics disappearing down their spines into their inconti knickers.....I wonder if they will play house music in the lounge and replace the bingo with magnified Nintendos? We are all going to get old....be warned.

How I ended up here.

Sarah was my great Aunt. She was said to have been a beauty in her youth. It was long before the age where size zero was considered remotely ideal. She had been buxom and stately with long golden hair and a strong square jaw. It must have been true because Sarah had been quite a girl. She had been married to a distant member of the Royal family, quite a leap for a Lancashire mill girl. She was widowed young, I remember her telling me about how God had taken her two little sons, both born too soon. One had lived for a few days and she had used a shoe box to put him in because he was so tiny. Could that have been true? At any rate, Lyle followed his sons to an early grave and in due course Sarah ran away to live with a married man. My grandfather and his brother were reputed to have found her after consulting a Ouija board about her whereabouts and she somehow ended up back in her home town. Did her brothers bring her home or did she come back spurned and needing help? So much of family history becomes a story with pages missing, I know the broad strokes but so much is lost with the people who have now gone.
When I first remember Sarah I was about five and she was already in her early eighties. She was an imposing figure, her once golden hair was white but it was still long enough for her to sit on. She wore it in a long plait curled up to make a bun. She was a large woman with one of those bosoms that make a shelf, she used to balance her side plate on it to catch crumbs when she ate the cakes she loved so much. Sarah was a curious mixture of refinement and typical mill girl. She crooked her little finger when she drank from a tea cup but she loved Mackeson stout and got through plenty of it. She lived in a little terraced house and looked down on her neighbours while realising it wasn't the done thing to show it. I got into trouble for laughing when we stood at the front door and she waved and smiled to a neighbour across the road while saying sotto voce "silly old cow!" She hated old age, railed against the fact she needed any help. My father resolutely went round each evening, standing in the street to protect her sensibilities and then shouting through the letter box to see that she was alright and safely into bed. He went each morning and laid her fire and made breakfast. He arranged meals on wheels, she hated them, called them "muck on a truck" but she submitted to them because it meant she stayed in her little house.
Every Thursday evening my parents brought her to our house for tea and she always brought me a chocolate digestive biscuit wrapped in silver foil. She was reputed to have smelled like a pole cat but I don't remember that. I remember her whiskers when she kissed me, I remember her demanding a brandy as it was "good for my stomach" or a whisky because it was "good for my bones". Most of all I remember her claiming to be psychic. She used to tell my father that his mother was in the room and was smiling at him. My father used to try to gloss over it but she would insist and would tell us all her messages from beyond the grave. I was too young to identify the odd atmosphere in the room but, looking back, it was pure embarrassment.
I don't remember how Sarah ended up in hospital when I was about ten. I do remember being taken to visit her after a long campaign where I stormed and cried because I wanted to see her. She was in a long stay geriatric ward. It was hell. A long room with beds down each side and a linoleum floor, the noise of wailing and screaming greeted us as we came through the swing doors. I can see it now, Sarah was in a bed near the bottom on the left hand side. I remember being surprised when my parents slowed down because I didn't recognise her. She was tiny, all the bulk was gone and she couldn't have been more than six stone. Someone had cut off her long plait and her hair stood up in a crazy halo around her shrunken face. She didn't know me, she thought I was my Aunt but she gripped my hand and her eyes filled with tears as she talked to me of a picnic she thought we had gone on. She asked me how old she was and I said "eighty six". "Eighty six?" she said in bewilderment "Then my mother must be dead!" and she filled up again with tears. I looked at my father, waited for him to explode at someone, to remove her from this hell hole, to make some sense of this insanity but he didn't seem to see anything wrong with the situation. We stayed for about half an hour, trying to make sense of her rambling, trying to make conversation with this shell of Sarah who was living in a time long gone and all of the time the wails and screams echoed off the distempered walls from the beds around us.
The bell for the end of visiting rang and we stood up to go. Sarah grasped my hand tightly as my parents started to walk away. She pulled me close and said urgently "They hit me you know, if I wet the bed, they hit me!" I told my parents but they dismissed it as the fantasy of a dying mind. They said Sarah was being looked after well and the nurses were kind people doing a hard job in difficult circumstances.
Every now and then I wonder how I ended up in this crazy job with it's stress and frustration. Then I remember Sarah....and I don't wonder any more.

She's so grateful....

She lives in a council bungalow which is stuffed with photographs including an aerial view of a farm. She sees my eyes stray to the picture and gets it down for a closer look. It's the farm she and her husband, ten years dead, managed for forty years. There are lots of women like Cissie in this area. She spent a lifetime working alongside her man, up at dawn, working on the farm and cooking for the men. She is tiny and wiry and seems welded to her cross over apron and she is broke. A lifetime of hard graft but the farm was rented and when her Gwyn died there was no choice but to leave. She was allocated her bungalow and she moved with the minimum of fuss, coping as she had coped all of her life "I just get on with it". The heavy farm furniture wouldn't fit in this doll size house - she has an armchair and a dresser and a single bed from the farm, the rest is cast off, make do, without history or charm.She talks of life on the farm, up at dawn and fighting every day to make a living but the spin she puts on it is all about how lucky she has been, what a wonderful husband she had, and how much God has blessed her. There was no chance of a pension or savings, it was hard enough to pay the bills so here she is, living her last years on the basics and "just getting on with it"
She is riddled with arthritis, she walks slowly, leaning heavily on her walking frame and you can actually hear her poor old bones creak as she moves. I met Cissie on shopping day. Her groceries had been delivered and left on the table and when I arrived she was transporting it, one item at a time, on the tray of her zimmer, into the kitchen where it was easier for the care staff to put in the cupboards she would never reach again. She didn't want to be a bother. I fought a battle royal to get her to let me help and when I put her washing on the line she acted as though I had carried out an act of extraordinary kindness.
Cissie has one son "a wonderful boy" who lives away and works as a teacher. "It's a hard life he has, girl, too much hard work" she says with no detectable note of irony. She has three beautiful grand daughters and their pictures are duly brought forth for admiration. She says her daughter in law is an angel. She doesn't see them often but they ring every few days and she says she is blessed and so, so grateful. Grateful is her watchword. She finds the fact that people come to look after her needs, to help her dress and to cook her food and to do the things her twisted bones no longer permit her to do, nothing short of miraculous. She cannot get over her good fortune. She thanks me over and over and refuses to believe that I do this job for any reason but my incipient sainthood. I stand to leave the poor little room and she touches my face with a gnarled hand and says once more "thank you girl, you and your staff are angels, I am so lucky."
I leave feeling humbled and privileged to have the opportunity to know someone like Cissie. The shine is taken off this feeling when I speak to the Team Leader for the area the next day. I declare that I want to take Cissie home and adopt her as an antidote to the stress of the job. The Team Leader laughs when she hears how much I enjoyed my visit. Apparently Cissie greeted her in tears when she arrived this morning. She had been awake all night worrying because she thought my visit meant that the Council felt she wasn't trying hard enough to do things for herself and she was going to have her care taken from her. She felt she didn't deserve the help....

Soldiering On

She's a dragon. At 8am the carers arrive and she opens the door smartly as they walk up the path past the water feature and the ranks of blooms on parade. Her make up is immaculate, from the electric blue eye shadow to the coral lipstick, her hair is a Thatcheresque helmet of gold waves. She is every inch the corporate wife, seventy eight now, she could pass for her early sixties and one glare from those gimlet eyes has us wiping our feet and saying good morning while fighting the urge to curtsy.
He is eighty two but, like his lady wife, he looks a good ten years younger, or he would if he wasn't dying. It's been a long pitiless onslaught, a brain disorder that has left him cognitively intact but physically ebbing away year after year. He could walk, albeit slowly and painfully and using a frame, until two years ago. Then he no longer walked. He submitted to the indignity of a hoist, a mo lift, a wheelchair and a life of cricket videos and pureed food. He became physically rigid and could no longer speak except in a whisper, but my God, he was well cared for.
She terrified the staff for years. The routine was as rigid as his poor old limbs. He was showered and dried with a variety of towels for each part of his body. His teeth were brushed, his tongue scraped and white spirit painted on his toes with a soft artist's brush (in all these years we have never dared to ask why) Then back to the bedroom and God help us if a towel was not replaced symmetrically or the floor was not completely dried. His hair had to be blow dried just so, his watch fastened around a wrist that had shrunken until the gold strap flapped like a bangle where it had once fitted snugly. Wet shave and after shave and cashmere sweater and slacks and then into the gracious living room with the views of the garden and the cut glass decanters. She hated each new worker for months and I grew to dread the clipped tones on the telephone as she rang to catalogue their deficiencies. But even in the darkest days of our relationship we forgave it all. We knew that she would go quiet about each new carer within a few weeks and within a few more they would become acceptable to her. More than that, she loved him, oh how she loved him. When she spoke to him the clipped tones would relax, the icy blue eyes would soften and the rigid lines of her face would relax to show a glimpse of the pretty girl she had been and the handsome woman she still was. The illness marched on but she was the stuff of which the Empire was made. She didn't compromise. The house was pristine, mellow wood and Turkish rugs, fresh flowers and oil paintings. The garden was manicured and she looked ready to host a garden party in it at a moments notice and above all, he was cared for with every ounce of her formidable will.
But now he is dying. The creeping process is racing to it's conclusion. In the space of a month he has gone from his armchair to his bed and now his breathing is shallow, his eyes never open and the rigid limbs are still, barely making an impression on the Egyptian cotton sheets and the appliquéd bed cover. The hospital said take him home, his notes say not for resuscitation, they can do nothing for him now. It took us a few days to persuade her that it was too exhausting for him to have a shower. She allowed the bed bath but she stood at the door, only the nervous twisting of her hands betraying emotion as she made sure he still had his hair blow dried, his watch fastened. Her voice trembled slightly when she asked him which after shave he wanted and got no reply, but she recovered and chose for him, telling him brightly which one he was having today.
We would be okay if she had kept it up, but this morning when he didn't respond to our voices, or to hers when she told him their grand daughter had postponed her wedding she couldn't keep it up any more. This morning she cried. And so did we.

Narnia

It was like entering Narnia. A hatch back car of uncertain vintage stood on a concrete drive but the bungalow wasn't visible until you stepped behind a screen of over grown shrubs and dangling willow, the ground slick with leaf mould. The house had been white but it's pebbled walls were now dirty and streaked with green and the curtains were all drawn, a long abandoned rake lay on the ground and the letter box grinned a lop sided welcome, dangling from one hinge.

"Not coping" the referral said "carer under stress". Rupert had been looking after his wife, Constance, through the many years of her mental illness but now his own health was failing and things were deteriorating. I rapped on the frosted glass and at once there was an explosion of barking and the sounds of someone fighting their way to the door through a whirling dervish of canine bodies. The door opened and I was almost bowled over by two Springer Spaniels, desperate to get out or to get at me, I couldn't tell which. Behind them came Rupert, tall and gaunt, wearing a mustard waistcoat, mushroom coloured trousers covered in stains and a tie in a bizarre parody of a Windsor knot around a fraying shirt collar that may have been white at some distant point in history. He looked like an army officer who had been left in a corner to gather cobwebs since the last days of the Raj. His hair was wild and his glasses hung from one arm at a crazy angle across his patrician nose. The barking continued and behind it I could hear a plummy voice crying "Who IS it Rupe? Do shut those blasted dogs up!" "Huntley! Palmer! down!" he said and the dogs turned back to him, leaping on him in delight and causing me to reach out a hasty hand to steady him as he staggered against the onslaught. I finally managed to make myself heard above the din and explained that I had come to make an assessment for the home care services that they had been allocated. He extended a hand and said "How very nice of you to come" and together we battled past the dogs and into a parallel Universe

The interior looked like the house had been shaken vigorously - the big pieces were there - a sofa (Chesterfield of course) a large oak table with high backed chairs, a corner cupboard and a handsome grandmother clock whose hands never shifted, but every surface was covered in chaos. There was a tower of papers on the table with one shoe on top of them, a milk bottle on it's side on the floor, an ironing board with a table lamp and a loaf of bread on it and a trail of detritus across the floor which totally obscured the carpet. Through the patio windows the surreal scene was completed by a green plastic picnic table suspended in the air by washing line from an overhanging tree and as I gazed at it in confusion a voice behind me straight out of finishing school drawled "It's the bloody rats darling, they eat the bird food if we leave the table on the ground" I turned around and got my first look at Constance. She was small and round with hectic make up and glasses on a gold chain. "Hello darling!" she said in a gay social tone, as if we were meeting at some county set garden party "Are we having a little drink?" It seemed that we were, but it wasn't sherry, it was coffee, strong enough to wake the dead, brewed at great length and with huge ceremony and served in a mug, a half pint glass and a small pewter tankard, crockery was apparently in short supply. Con and Rupe didn't need two half hour home care calls a day, they needed a miracle.

It transpired that Connie had been diagnosed with manic depression long before it was re branded bi polar disorder. Her tablets came in a blister pack once a week from the local chemist. Unfortunately Rupe didn't always remember to collect them and, when he did, Connie liked to peel back the plastic sheet over the front of the pack and swap the tablets around into more pleasing colour combinations. Then there were the other tablets, the ones she squirreled away in boxes and behind cushions and took when the mood took her, washed down with brandy, well brandy after four in the afternoon, it was sherry before that. And Rupe? Rupe was worn out. Thirty years of covering up, keeping it normal and soldiering on had left him tired and worn and gamely clinging on to his failing memory as the weight dropped off him and the hospital appointment cards dropped through the gaping letterbox to join the sea of paper on the floor.

I came to know them well. Rupe rang the ambulance when Con became stranded in her chair or stuck on the three steps up to the bedroom, he just wasn't strong enough to lift her any more. The ambulance officer complained. He rang me and explained at some length and with some volume that they were not there to pick people up three times a night and anyway, what were we doing in there? the place was a health hazard, they were at risk, nobody should have to work in that environment, let alone live in it. He was right, we tried, we really did, but the chaos refused to be tamed and as fast as we cleaned up Rupe and Con consigned our efforts to oblivion. The Social Service budget doesn't extend to cleaning service, it isn't a priority and our calls were to encourage Con to eat, to distract her while Rupe walked Huntley and Palmer because if he was out of her sight she became frantically worried and reduced him to tears with a torrent of abuse as soon as he returned. The community psychiatric nurse suggested we encourage Con to peel some vegetables and start meal preparations while Rupe was out, but they lived on frozen food and as Con said with a sniff "It doesn't take long to put something in the micro and go ping does it darling? Let's have a little drink instead"

They became a puzzle I had to crack. They rang me now, too frightened to call the ambulance after they had been told they couldn't continue like this without ending up "needing to go somewhere where they would be safe" I hand delivered the medication, hid it on top of the cupboard where Rupe could reach it and Con couldn't, persuaded him to have the house sprayed for fleas. Sometimes I sent carers to the house, sometimes, late at night, or when there were no staff in the area, I went myself. I helped Con to get out of the chair or back into bed, calming her down when she railed that Rupe was unfaithful and she was going to leave him to his other women and his dogs...and Rupe, pacing in the background, protesting his innocence and unfailingly charming "Thank you so much for coming" and "My word, how kind you are to us" and only once cracking and shouting "Oh you BLOODY woman will you ever SHUT UP!"

All the time, Rupe was deteriorating, he got thinner and thinner, went for tests and never disclosed the outcome. We all knew time was running out and one night when Rupe rang, Con was hurt, she lay on the floor among the tissues and the newspapers and I could see from the angle of her body that something was broken and I would need an ambulance. A broken hip, so often killer of the elderly and Con was off to hospital and then to rehab. Two months passed. I called at the house frequently but never found Rupe there, he was either visiting Con or walking his dogs or hiding, at any rate the door went unanswered and the shuttered eyes of the Narnia house remained closed.

Con was in a short stay unit. She couldn't remain there more than three months. She couldn't go home, that was obvious. Her mobility was atrocious and everyone knew it but Con. She gamely set off by herself and got stuck in the loo or had to be rescued from the floor. Rupe visited her every day and they talked about her coming home and how it would all be okay then. There are few things more professionally nauseating than the case conference where everyone knows the outcome in advance except the people who we are there to talk about. Rupe had made an effort. His brogues were polished, his tie was straight and and his hair was smoothed down into a semblance of normality. The people gathered there had known the couple for years, the CPN, the day unit staff, the social worker. We all looked away as Con was wheeled in, gay in her flowered scarf and with a smear of crimson lipstick that almost followed the lines of her mouth, and Rupe stood up gallantly and came over to kiss her cheek and remained standing until she was positioned at the table. Then it started, the long winded explanations, the reasoning and slowly it dawned on Rupe that Con wasn't coming home. He tried to argue, suggested one of those hoist things but accepted that he would not be able to use it alone. He tried to be assertive, saying what happened if he just took Con home and then a terrible moment when his eyes looked suspiciously moist as he accepted he couldn't manage any more. Still he kept trying to find a way out. Maybe she could come home in the days - but how would he get her out of the car? We became jolly, he could visit every day, why didn't they just give it a try? Eventually he gave in and it was explained to Con that she would be going to a residential unit - just for a trial period, just until she got her legs working a bit better. We all knew we were lying. We didn't meet each other's eyes.

The meeting ended, arrangements made to take them to the home for "a look around" and we left, shuffling our papers and desperate to escape and as I stood to leave Rupe stretched out his hand across the table, I took it feeling like Judas. "Thank you for coming" he said "You really have been most kind"