Dom Care Dragon

Poor Sod

2008-11-23T11:33:00.000-08:00

It is a black cold night in the docklands. The stars are icy twinkling pinpoints around a clear moon as we pull into the residential estate. It is far too cold for people to hang about and the street is deserted as Col and I get out of Col's ratty Escort to go and put Betty to bed. I am covering a night run, one of the youngsters has got her mother to ring in and say she is ill. I suspect this is not true and that a Saturday night on the booze has proved more attractive than a night of hoists and octogenarians but that is Monday's problem. Tonight there are people who need help and there is nobody else available so here I am. I don't know Betty so I ask Col what we are to do here, he grins at me and cocks his head towards the house and I hear a raised voice coming from inside. "Oh, I think I will let you meet Betty for yourself" he says.
I follow him up the driveway and into the large bungalow. John, Betty's husband, lets us in and I follow Col into a through lounge where a tall lady sits watching the banal blare of Saturday night television. She squints up at me and barks "Who are you?" I tell her my name is Caroline and she continues to glare at me as she repeats the name several times like an accusation "Caroline! Caroline!" I try again - "My mother's name was Betty" I say with a smile "My name is NOT Betty" she barks "My name is Betty Eileen Clark, Mrs. Clark to you!" I look to Col for guidance and he steps in front of me, speaking soothingly "Hello Betty, we've come to get you into your night things. Shall we go to the bedroom?" "Go to the bedroom!" she repeats these words with only marginally less aggression but she allows him to place a handling belt around her and bring her zimmer frame from the corner. Betty walks well and I feel a little foolish holding the belt and almost scurrying to keep up. I make the mistake of saying sotto voce to Col "can't keep up" and Betty whirls round fixing me with a look of such venom I step back "Did I hear you say why don't we push her?" she growls. I hastily deny this and Betty sniffs and turns to continue into the bedroom.
The tirade continues as we wash Betty and get her in to her pajamas. She isn't too bad with Col, snappy but fairly civil but the slightest move from me elicits a vituperous attack of such force that I end up standing three feet away, ready to leap forward if needed but staying well clear of the field of conflict. I realise that Betty follows a pattern, she repeats the last phrase said to her in a hectoring tone and offers the odd statement herself but it cannot be termed conversation, it is an aggressive attempt to maintain contact with her surroundings. She is also obsessed with where the elusive John is. He has melted away after letting us in and Betty constantly shouts "John! John! I'm coming through in a minute" The mild voice floats back from the living room with the merest hint of irony "That's good dear" She subsides only to repeat the statement a few moments later, with the same result. She turns on Col "I want to watch Ann Robinson" Col doesn't look surprised, this is obviously a well worn subject. "She isn't on tonight Betty" he says and she glares at him "No Aunty Ann?" she shrieks in outrage "Bitch!" "Very accurate" says Col with gentle sarcasm and Betty lunges forward in her chair, hands outstretched in claws towards his face. Col steps back until she subsides and then carries on with the task in hand.
By the time we take Betty back in to the living room she is shrieking for John again, demanding a cigarette and he is waiting with one lit for her as she reappears and is settled back into her chair. I momentarily wonder if this is a good moment to mention the smoking ban but decide that discretion is the better part of valour and the three of us retreat to the far end of the through lounge while Col fills in the communication book. Betty is on a loop now "John! John! I want a cigarette!" she keeps shouting. John's voice is gentle and resigned as time after time he says "You've got one Betty" or "Yes, Betty, you're smoking it now". He looks at me, sad blue eyes in a kindly face criss crossed with weary lines "Do you smoke?" he asks. I tell him I used to but have given up. "I used to many years ago" he says and gives me a wry smile "I think I may take it up again"
Col finishes writing in the book and we take our leave, John stands at the door until we reach the car and then turns back to the distant shouting from inside the house. I look at Col, raising my eyebrows. It feels like we have just walked out of a war zone, the silence of the freezing air seems like a blessed relief. Col raises his eyebrows back and smiles at me over the roof of the car as he unlocks the door. "Poor sod eh?" he says as he gets in. I look up at the indifferent moon shining on the roof of John and Betty's house - beneath that roof John is living out an endless life sentence of hostility with a woman who can remember nothing much except that she is furious. Poor sod indeed.

Mad Uncle Barry

2008-11-10T07:07:00.000-08:00

One of the most frustrating things about doing this job is that we actually have very little control over how care is administered and managed. We can and do have our say but, ultimately, the decisions are ours to live with but not to make.
Iris has been an absolute beauty. A portrait of her in the lounge of her bungalow shows a woman with more than a passing resemblance to Elizabeth Taylor, right down to those amazing violet eyes. She is now in her eighties and is at an advanced stage of a dementing process. She is no longer able to speak and she can do nothing for herself beyond chew the food that is spooned into her mouth by her devoted son Barry.
I am asked to visit soon after care starts because, frankly, the care staff are terrified of Barry. The reports I have received are varied and bizarre, ranging from the video cameras Barry has trained on his mother when she is sleeping through to the fact that he insists all of the cutlery in the house is wrapped in silver paper in order to deflect the electronic rays that are being beamed into the house to monitor his conversations.
The bungalow is unremarkable, a large corner plot with a neat garden and a pleasant outlook. Barry answers my knock and ushers me into a large sunny living room with family pictures on a baby grand piano and furniture of the Waring and Gillow genre. It is the epitome of genteel and therefore serves as all the more startling a contrast to Barry. He is a small man, positively crackling with nervous energy who is wearing shorts and knee socks and has his hair in a long plait which bounces as he paces the room throughout our conversation. He is not hostile but his speech has the staccato delivery that tells of racing thoughts and what thoughts! He hurtles from subject to subject switching so seamlessly that he is almost impossible to follow. He believes his mother does not have dementia, she is suffering from post traumatic stress syndrome having witnessed a man having his head cut off when she lived in Kenya. He tells me he has been in the SAS and was tortured during guerilla warfare, rolling down his long socks to show me what is obviously a varicose vein as "evidence" of the injuries he received. There are lighter moments where he tells me his daughter is going to win X Factor and darker ones where he tells me that he is recording all of the things said by my home carers because, when he listens to them later, he alone is able to decipher the code words and hidden messages within their statements. I have worked in a mental health setting but even with no prior experience it is not hard to see that Barry is really very unwell, well, let's be honest, he is floridly mad. Having said that, Iris is beautifully cared for and she is my main concern. I just can't quite reconcile myself to thinking that it doesn't matter that Barry videos her all of the time just in case his enemies kidnap her and he tries to make the carers bring rubber boots to wear because his mother's powers are depleted by exposure to electricity.
I return to the office convinced that Barry must be known to local mental health services and indeed he is. He is known to Joanne the mental health social worker who tells me that his devotion to his mother is wonderful and she is very impressed. I control the squeak in my voice as I detail some of the things I have just observed and venture the opinion that Barry is really quite agitated and may not be totally to be relied upon to make the best decisions concerning Iris and her safety. Joanne does not agree, she says Barry is "eccentric but harmless" and when I ask if he has ever had any sort of diagnostic attention she as good as tells me to mind my own business.
She is right up to a point, as far as I can see Barry is harmless, and I get to see him rather a lot. Barry has decided that he loves me (thankfully in a purely platonic way) and he takes to visiting me at the office several times a week, usually with poor Iris in the car or in the wheelchair that he festoons with helium balloons, I hardly dare imagine why. I'm afraid we take to referring to him as "mad uncle Barry" - he burst through the door already talking and he attaches himself to the edge of my desk like a barnacle to tell me all about his news. One day he is a famous artist and has been exhibited all over the World, the next week he is writing his autobiography. I am, as you may imagine, thrilled to hear that I will be featuring prominently in this blockbuster and will receive my own signed copy. He always seems upbeat to the point of mania and I wonder if he has a corresponding downswing in mood, I almost long for it because, short of hiding under my desk when he appears (and I actually do this once or twice) there really seems to be no escape from my unwilling recruitment to Barryworld.
This continues for some weeks and then one day the carers tell me that Barry has taken to tying Iris into her chair. I visit and find this to be true, poor Iris is listing to one side in her chair and is bound up with what looks like a piece of washing line. This is a bridge too far, I ring Joanne and explain and she agrees to investigate. She rings me back later and tells me brightly that Barry feels Iris is less likely to fall if he ties her up and that this seems eminently sensible to her. I begin to wonder who is mad.....
Iris' bungalow is, according to Barry, the subject of a legal dispute between him and his sister, who lives in Australia. I don't ever find out if this is true but Barry suddenly moves Iris to his own house in the next village. This house is in a state of complete disarray, not least because he has taken most of the floorboards up in most of the rooms but again, Joanne says she feels Iris is fine, and I have to admit that Barry spends all of his time cooking for her and brushing her hair and generally looking after her, it's just that the whole set up is so bonkers that I cannot believe I am the only one who is worried. The move at least has the advantage that Barry stops visiting me as quickly as he started and gradually I no longer look up from behind my computer with trepidation when I hear the door buzzer go.
Weeks pass and things are relatively quiet and then, without warning, Barry cancels his mother's care. I ring up and question this but yet again it seems that I am the only person who is worried. As it happens, Barry's house is not far from where I live and I do see him pushing Iris in her balloon laden chair from time to time, once or twice I am ashamed to say I dive behind a display in the local Spar when I see him coming but at least I see that Iris still looks alright.
Iris died early this year. I saw the notice in the local paper and was amazed to read the roll call of extended family, I never saw any of them anywhere near her when she was alive but that is all too often the case. I agonise about whether I did the right thing in letting the issue go but the fact is, I did what I could, I am here to provide the care I am contracted to do, no more and no less. I expect I will never find out the circumstances of Iris' death, I console myself with the knowledge that Barry would never knowingly have let her come to any harm and she probably died as a natural consequence of her age and frailty.
Soon afterwards Barry's house was boarded up and remains so to this day. I have no idea what happened to him but I hope he is alright, he was curiously likeable despite his flights of fancy - maybe he has returned to Kenya to rejoin his regiment and sort out the civil war.....

Get the Vicar!

2008-11-05T07:41:00.000-08:00

The area we cover is really a series of small towns and villages spread over quite a large area and thus managed in area teams. It is really interesting how different teams, although a scant few miles apart, have different personalities. At one end of the scale we have Atown. Atown is built around a docks and is a little down at heel. It specialises in lasses that look as though they were raised on pies and for whom no good night out is complete without a large quantity of alcohol, a kebab and a fight. The people are what I would call "salt of the Earth" types in general. They don't have much in the way of material wealth but there is a community spirit. Those who are a bit eccentric or even downright unwell are largely accepted with affection and the older people still live in communities where they are known and usually to some degree looked after by neighbours and extended family.

At the other end of the scale is Btown. If Btown was a human being it would be a middle aged lady who wore white cotton gloves and court shoes that matched her shiny leather hand bag. The bungalows look out on gardens that are manicured to perfection and the little market square boasts four different establishments where you can purchase ye olde scones and Earl Grey tea but nowhere you can buy a loaf of bread or a pint of milk. Btown has it's own eccentrics, there is an enclave of local artists who have studios in the area and can be seen drifting around in strange hats and Peruvian hand knit sweaters although, in Btown, this is probably termed "Bohemian" rather than "oddball". There is still a sense of community, our relative isolation as a County ensures that people know each other and have a sense of local identity, but in Btown there is more of an expectation that people will conform to social norms than there is at the other end of the scale.

Mabel was the local vicar's wife until he retired some fifteen years ago. Vernon is in his eighties now, a gentle scholarly chap who is a little vague but who still enjoys reading and spends a lot of his time tending his garden and feeding the birds that visit from the neoghbouring spinney. Mabel is also a little vague, unfortunately she is a little less genteel about it. Some people who are exhibiting signs of dementia will also become disinhibited. This is thought to be linked to deterioration in the frontal lobe of the brain. All I know is that, after a lifetime of the ultimate conforming role of vicar's wife, Mabel is kicking over the traces.

Some of the issues are distressing. Mabel will set out to go somewhere, often inappropriately dressed but always with her wicker shopping basket over her arm. I think that catching sight of the church triggers memories and she will suddenly appear there, distracted from wherever she was going by an urge to see Vernon. She completely forgets that Vernon is long retired and that she has just left him at home and she is then to be found crying in the church yard because she cannot understand why the doors are locked or, worse, bursting into a mother's meeting or a service and demanding to know where her husband is and swearing like a docker at the startled congregation. Even more worrying, Btown is something of a tourist spot and there are several buses to and from there which go all over the County. Mabel is quite fond of jumping on one of these buses and winding up thirty miles away with no idea where she is or indeed, who she is. This last was fairly easily solved when I hit upon the idea of circulating her photograph and details to all the police stations in the area and, more than once, Mabel has rolled up in the back of a squad car. She makes an incongruous sight, her hat on askew and her coat buttoned up wrong and her wicker basket on her knee, sitting with the bearing of Mrs. Vicar in the back of the panda car, but she never seems any the worse for her outing and dear old Vernon barely seems to notice she has gone missing at all.

The local people are generally pretty tolerant of Mabel, they let her go first in shops, because she sails to the front of the queue anyway and if they find her wandering and distressed in the town they take her home. There are mutterings about whether she "should be allowed to stay at home" but Btown people do not usually make a fuss out loud and the esteem in which Vernon is held ensures that any criticism is kept to a whisper. However, things have taken a sinister turn. Mabel has decided that the new vicar is an imposter and she has taken to stalking him. We now sit with her during Evensong. She retains the inner clock that tells her it is six o clock on a Sunday evening and, if left unattended, she will appear like the wrath of God himself and will charge down the aisle screaming obsceneties at the interloper who is impersonating her husband. At other times she lurks in the church yard and leaps out at the poor man as he walks up the path. He seems a lovely man and says he understands completely but I wonder if he is especially nervous this week.

Each year the Bishop comes to a service in the square on Rememberance Sunday. The great and good of the County gather to lay wreaths and remember those who fell in the service of their Country. This scene is enacted all over Britain, but I doubt anywhere else in Britain has a Mabel. Last year, the first of her vicar stalking obsession, she spent most of the service standing quite still, her eye fixed firmly on the poor vicar as he conducted the service with the Bishop. At the end of the formal service the Bishop worked his way around the crowded square, shaking hands and chatting to the townsfolk. Everywhere he went Mabel worked her way towards him, edging through the crowds and never taking her eyes off her quarry. When she finally reached the poor man she started to belabour him with her walking stick screaming to the Bishop "Look! Look! this man cant be a vicar - I was at school with him and he used to put his hand up my skirt!" Even allowing for the fact that Mabel is eighty and the vicar is probably forty at the most, it's still not in the top ten things you want your parishoners to hear is it? The Bishop was somewhat taken aback, Vernon, when told of the incident seemed mildly amused, a fact that may be due to his own memory loss or to the fact the Bishop is said to be not a terribly popular boss with his Ministers.

Anyway, It's that time of year again and the neighbours are suggesting we "do something". I expect we will have to do something, what I am not quite sure, but Mabel must be distracted. I can't help thinking it's a shame though. In Atown she would be just one more well loved local providing a bit of colour, in Btown she has crossed the line. The real shame is that if we sold tickets for the event we could probably raise enough money to fix the church roof. It was certainly embarrassing for the vicar but anyone who was there and witnessed Mabel hunting him down through the crowd with a light of battle in her eye had to admit that, it may have been inappropriate, but it was still rather funny.......

Counting the Pennies

2008-10-29T02:44:00.000-07:00

They call the houses down there "Millionaire's row" the land was unadopted and each person built their own property according to their means and specifications. It's actually not a place that appeals to me, it's ostentatious, in places it's positively vulgar, and it lacks the patina and charm that age and natural development brings. There are Spanish style "hacienda" houses, their white stucco and curved lines incongruous in the Welsh drizzle, there are mock Georgian mansions with pillars and gravel so deep you could lose a small dog in it, there is even a futuristic creation with a slanting roof and aluminium window frames. We don't go down there much, people who buy or who build there tend to be younger and the help they need tends to be of the "little woman who does" type rather than the commode and catheter type care that is our stock in trade. Our one customer in Millionaire's row is Celia.
Celia and her now departed husband did not have children. They devoted their leisure to breeding St. Bernard dogs and their name was apparantly a byword amongst the dog show crowd. The dogs have been gone for some years but the room is still redolent of dog, the smell echoing a doggy reprise from all of the furnishings which hits you as you open the door. I first met Celia when she was brought home after long stay in hospital following a stroke. Her house is circa 1970 and looks like a fledgling architect was let loose with a sketch pad and an open cheque book. There are Gone with the Wind style curved steps up to a huge metal portico and the double doors open to more steps, wide enough to drive your coach and horses right on in and up to the first floor. The whole living area is built at first floor level, a huge through lounge with French windows at each end and a wrap around balcony that looks down on a terraced garden. It's very kitsch and totally useless to a seventy five year old lady with restricted mobility.
Celia and her husband had some neighbours, Bob and Linda, who lived in the houses that back onto Millionaire's row. Bob used to help Mr. P. with restoration work on his vintage car and he and his wife had become good friends with the couple. They were there to greet Celia when she returned home and Linda told me that Mr. P. had asked them to look after Celia "if anything happened to him" and that they considered her part of their family.
That certainly seemed to be the case. Bob and Linda's teenaged sons were often to be found in the house when we visited and Linda certainly kept in close touch, mostly to say that we had not carried the bin down to the gates or we had used a full pack of toilet rolls or some other spurious complaint. I have no way of knowing how much of Celia's condition dates from her stroke but she is certainly eccentric now and she has some very strange behaviours. Linda is supposed to clean the house but the place is festooned with little bits of toilet paper that Celia has spread around and the whole place is generally grotty. There is never a great deal of food either but we don't do the shopping and there is enough to get by, it's just ...not very appetising.
Celia cannot get down the grand staircase to go anywhere and, while it is true that Linda has taken her to have her hair done once every couple of months since she came home, she has been nowhere else. Celia has two pairs of knickers that we wash out each day, her slippers are so downtrodden that I am sure she is going to fall over them and her few clothes are all stained and worn. We know this lady has a considerable amount of money and we also know that Linda and Bob have full control of it. Celia will not hear a word about the subject. I do not know whether this is because she sees nothing wrong with the situation or because she knows that saying anything could potentially deprive her of the closest thing to a family that she has. She is right, always supposing we could get a court appointment to oversee Celia's finances, the consequence would almost certainly be that her neighbours would have no more to do with her and without them her life would be completely bereft of relationships. She is not being physically or mentally abused and I suppose that, while she is certainly not getting the things that she could well afford and that would make her life better, she is not being starved or deprived of basic necesseties. It's horrible but it is typical of abusive relationships with adults, you can remove a child, you cannot make that judgement with an adult who has the capacity to make their own decisions. You just have to stand there and watch and try to get stains out of her underwear in that grimy kitchen sink.

What a Prince

2008-10-27T14:22:00.000-07:00

We have a system for new staff. They are interviewed and police checked and, once we know they have a clear record, they are sent out on shadow shifts. This involves going out with a Team Leader and meeting the customers to learn the routines. If somebody is new to the caring role they may need a full week of shifts, meeting each of the clients they will be visiting at least two or three times. Occasionally somebody is particularly nervous and they need an extra week of shadows before theTeam leader is confident they are safe to do the job alone.
Clare is twenty, a dumpy unprepossessing girl who seems young for her age. She seems keen to try the job out although she has no care experience and I put her with a local team to learn the ropes. Jane, the Team Leader, tries hard with her, she is a sweet girl and turns up on time but she has no instinct for the work. Jane comes back to me after a fortnight and says she doubts Clare will make the grade. She has to be told to do every little thing, nothing happens on her own initiative, left to her own devices she just stands staring into space. When Jane tells her to wash somebody and stands back to let her do the job, Clare dabs ineffectually at the customer's arm until she is told to get on with it, then she scrubs them so hard Jane has to intervene while the customer still has skin left. There is more. Jane is worried about the things Clare has told her about her life. She lives with her boyfriend and her year old baby but it seems an odd relationship. Clare's partner looks after the baby and Clare seems to have no say in anything. If Jane drops her at home and the boyfriend is out, Clare is locked out, she has no keys to the flat. The boyfriend rings her sometimes while she is working and she is immediately a gibbering wreck, agreeing with everything he says and making notes of the errands he wants her to do before she returns home.
There is no proifit in having a supernumerary member of staff. We are paying them to observe, to be additional to the carer who is actually doing the work. However, I overrule Jane and give Clare a further two weeks shadowing. The kid needs the break and instinct tells me that she is in for big trouble if she has to go home and tell the boyfriend she has lost her job. Clare doesn't improve, she seems to have no concept of what the job involves and at the end of four weeks my lovely blunt Jane says "Caroline, if you put that girl out on her own, on your own head be it, I wouldn't trust her to water a plant, much less to give someone vital medication." I still prevaricate, I send Clare out on a different team to get a second opinion. The second opinion bears Jane out, Clare is just never going to make the grade.
I had Clare in this morning and told her that we would not be continuing with her probationary period. She took the news like a whipped dog, barely responding and saying "thank you" as she left my office clutching an incongruous "Hello Kitty" handbag and looking as though she had no idea what was going on. I felt horribly guilty, as if I had done her a huge disservice in giving her a chance in the first place.
I wandered into reception after Clare left and was standing checking my post when the door was slammed open so hard it bounced back from the wall, barely missing my head. A man who resembled a warthog with tattoos hurled himself into the room and halted about six inches from me "Have you just sacked my effin' missus?" he bellowed. I was so taken aback I didn't understand what he had said at first and asked him to repeat himself. He did, even more loudly, "Are you the effing bitch who just sacked my effing missus??" The room shrank, there were other people there but I was only aware of his face, inches from mine, twisted in hideous rage. I said as calmly as I could "I'm not discussing this with you, I don't employ you and I have no intention of speaking to you" It was all over as fast as it had begun. He punched the screen by the reception desk, sending it flying across the room and slammed out into the showroom, kicking displays all the way to the door while he called me a selection of names that would make a docker blush. I leaned out of the reception door in time to see him hurtle out of the car park in his car, girlfriend beside him and, as I found out later from a carer who was just getting out of her car, with the baby in the back seat.
The incident was rehashed once we had all recovered our equilibrium and it was generally concluded that I had handled it with amazing calm. Actually, I was so shocked I dealt with it on autopilot. I listened as the day wore on and, in the way of offices everywhere, it became a wryly funny incident, a piece of office folk lore in the making and all the time I listened all I could see was Clare's white face as that car screeched out of the car park. It was a few frightening moments in my day....I hope that's all it was for Clare. I hope it was, but I am sure it wasn't.

A tribute to Martine..and to Eileen

2008-10-23T04:16:00.000-07:00

Eileen originally came to us as an adult protection case. She had been in hospital for several weeks after sustaining broken ribs, a broken nose and extensive bruising. She claimed she had fallen over a coffee table but it was generally thought that her husband had been responsible for her injuries. There was a long history of alcohol abuse and a generally chaotic backround and there was some suggestion that Eileen should not go home. She had various mental health issues and it was felt that the home situation was just not sustainable. However, Eileen had been successfully sober throughout her stay in hospital and was determined to go home and so, quite rightly, that was what was going to happen.
I remember the first case conference I attended at the hospital. Eileen was a handsome sort of woman with hair dyed an improbable black and piled into a bun and the sort of two piece skirt suit that always reminds me of the 1970's - all hectic flowers and glittery buttons. She was softly spoken and appeared nervous but she was completely able to make her own decisions and she spoke positively of her husband. He had visited her a scant few times but had told the nurses that he wanted her home and, since her injuries were healed and she was taking up a bed, things were put in place.
Initially we did very little, some nights they had been drinking but all was calm and we assisted Eileen into her night things and left. Some mornings they were not up in time for the call because they had stayed up very late the night before but generally the situation was unremarkable. Bill, Eileen's husband, was a gruff man who barely acknowledged the carers and he certainly seemed to be attached to his beer cans but he left us alone and we left him alone. Then three weeks into the care Bill literally dropped dead, no warning, no previous ill health, he just keeled over and was gone, a massive heart attack.
Ah the assumptions - somehow everyone thought that Eileen would be ok once she got over the initial shock and grief, after all, Bill was the author of most of her problems and surely life would be easier without the constant roller coaster of drink and drama. Eileen grieved deeply and painfully - she grieved for a man with whom she had had many good happy years and she grieved for the latter part of their relationship when things had been so truly horrible. She grieved for things said and done and for lost opportunities to put it right - and while she grieved, she drank.
We embarked on an eighteen month downward spiral of despair. Eileen drank all day and all night and she truly wished she was dead. The carers regularly found her in a soiled bed, wine bottle in hand, weeping copiously and hurting so much the pain seemed to permeate the fetid air of her bedroom. Slowly her sons became estranged by this sad parody of their mother who rang them day and night to scream abuse at them and was frequently found by police or neighbours wandering the streets in a soiled nightdress, still clutching the latest bottle of wine. It seemed to be an unstoppable decline and, as so often happens in these cases, the harrassed GP had no time for her, the alcohol services could not help her until she stopped drinking and her family washed their hands of her. This last was with some justification, I personally witnessed some of Eileen's screaming tirades to her sons and their wives, hurling obsceneties and ornaments at them after she had rung them and begged them to come.
One person did not give up though. Martine is an old school social worker and for once I wish I could use her real name because she deserves the accolade. She never gave up on Eileen, she visited every week or more often, she stayed with the pain and listened to the ranting and she fought tooth and claw to get anti drinking medication for Eileen, even after the GP refused it three times on grounds of futility and expense. Martine never gave up and neither did we but we all felt that Eileen would either die or kill herself and that the sad end was inevitable.
I don't know what made her turn the corner. Undoubtedly the medication Martine finally got helped but I think her belief in Eileen helped at least as much. Eileen stopped drinking. At first we were on a knife edge - she was horribly depressed and with sobriety came the realisation of what she had done to her family. Day added to day and week to week and as Eileen became used to not drinking her personality reasserted itself. She became quirky and funny and artistic, putting her mark on her house with throws and paintings and gradually replacing the things she had broken in her drunken rages. Her one great aching agony remained in the fact her family did not want to know her, did not believe in her epiphany because they had seen it all before, with her and with their father and they just could not take the risk of going through it again.
We are six months on. A few weeks ago Eileen rang me because she was having trouble contacting the incontinence nurse for her supply of pads. Her voice was strong and melodious and she joked that the nurse should be renamed the incompetence nurse and I put the phone down marvelling at the fact we had exchanged a simple joke and a laugh, how unthinkable that would have been this time last year. Last week marked the second anniversary of Bill's death and the first one Eileen had been through sober and also marked Eileen's birthday. The carers tell me that she had a visit from her youngest son, the one who lives nearest and the one who was most affected and therefore the most angry and intransigent in his determination to have no more to do with her. I rang Eileen and she told me there had been tears and painful conversation but that they were now talking again and the relationship had been resurrected. Eileen said Martine had been to visit her on her birthday too, "thank God for Martine" she said. Thank God indeed, I know her case load is huge and nobody would have blamed her if she had given up on Eileen, but she didn't.

Having a good moan

2008-10-21T07:37:00.000-07:00

Grace lives alone in an isolated house that looks as if it was last modified around the end of the last war. She is ninety one and off with the fairies most of the time but she copes with four visits a day from us and a monthly overnight visit from her son who lives in Nottingham.
This morning Andrea went as usual to help Grace wash, dress and have breakfast. Grace may be getting forgetful but she knows what she likes and every morning she puts away bacon eggs and toast washed down with a pint of tea, food is one of the few pleasures left to her and she always tucks into breakfast with gusto. Things were very much as normal as Grace made inroads into her fry up - then Andrea went to get the medication - and discovered that Grace had taken three days worth before Andrea had got there. Now I am not a medic, but I know that three days worth of heart and blood pressure medication is unlikely to be a good thing, especially for a frail ninety one year old.
I rang the doctor and the poisons centre and the general consensus was that Grace should be taken to hospital and was likely to be extremely unwell, Grace, meanwhile was onto her second slice of toast and was about as inclined to agree to go to hospital as she was to part with the last of her bacon. I have every admiration for the ambulance service, in nearly thirty years I have only known them anything less than lovely on one occasion and today they lived up to my estimation. They arrived within the hour, even though the call was not an emergency one and they did their best to charm Grace into a ride to hospital. It looked as if they were going to be successful but, once in the ambulance Grace had a change of heart, conveying this fact by punching the ambulanceman right on the nose when he bent over to reason with her. Stalemate. The crew were reluctant to leave her but had no power to force her to co operate. Grace refused to get back in the ambulance and meanwhile Andrea had another five calls to do.
I rang around and conjured carers out of thin air to cover the calls (or at least that's how the task felt - staffing was as tight as usual) and Andrea and the ambulance crew spent a further half hour in negotiation with Grace before compromising with her agreeing to go so long as Andrea drove her in her own car and the ambulance followed behind and Andrea promised not to leave her or let her be admitted.
I then rang Grace's family and got her daughter in law. "Well this is most inconvenient" she said "Why couldn't you have rung an hour ago, Fred has set out for his monthly visit to his mother now and I wont be able to contact him" I swallowed the pithy reply that my crystal ball was faulty and I hadn't known a. that he was coming or b. that Grace was going to hospital an hour ago and apologised for the difficulty but Mrs. H. remained rather sniffy and was at pains to point out that this was extremely vexing. Hard on the heels of that phone call was one from the G.P.'s practice nurse asking why Grace had been allowed access to her medication. I pointed out that she has never touched her medication blister pack before in the seven years we have been going there and that we were not in the habit of hiding medication as a general practice. Besides, the medication had been delivered for the month before we got there that morning so we hadn't even seen it before Grace did her vanishing magic on the tablets. The practice nurse thought we were being at least naive and very possibly criminally negligent by not hiding the tablets and declared her intention of raising the issue with the Care Standards Officer.
All of this was at ten o clock or so. Andrea rang me back at about three to say she was bringing Grace home. We won't be paid for the additional five hours of Andrea's time although we will of course pay her. I spent a good hour of my day covering Andrea's calls and liaising with various medics about the issue and a further hour completing the necessary section 26 report for Care Standards because any abuse of medication is a notifiable incident. I have no doubt I will spend further time tomorrow explaining myself to the Care Standards Inspector. Grace is mad at us, we have wasted the time of the ambulance crew, Grace's family think we are incompetent and the G.P's surgery thinks we have been less than conscientious in our care. Some days I think I need a change of job...... Still, Grace is ok and that's the main thing - and we have hidden her medication...

Very very naughty

2008-10-19T08:39:00.001-07:00

I have debated whether I dare share this story - I guess it shows us in a light that may not be entirely flattering but I would say in my defense that a black sense of humour is a vital requirement in surviving this job.
All people are equal but some are more equal than others, to paraphrase George Orwell. Ada's son was a Director of Social Services somewhere in England. This may or may not have had a bearing on the fact she got round the clock care granted by social services, I will leave you to decide. At any rate, Ada was in her late seventies and certainly needed a high level of care. She was a painfully thin lady and she had a terminal diagnosis due to a blood disorder. This meant she had to have regular painful blood and platelet transfusions and she was at constant risk of hemorrhaging. The slightest knock caused huge bruising and Ada needed somebody with her all of the time because she was also fairly confused. It seemed her husband had endured a particularly horrible death in hospital and her son had promised her she would die at home and so we were drafted in to do round the clock shifts. The care was necessary but often there were stretches of time when we didn't have a lot to do except keep Ada company, there are only so many times you can clean the fridge or wash the windows but we did our best to keep ourselves occupied and Ada as comfortable and safe as possible.
It was late one afternoon and I was in the office when my mobile phone rang. At first I thought there was nobody on the other end of the line but then I heard a voice whispering "Caroline" in a desperate tone. After a moment or two I realised it was Carol, the carer who was with Ada that afternoon. "Carol?" I said "Whatever is the matter? Speak up!" "I can't" came back the anguished whisper "Her son is downstairs and he might hear me!" She was in a state of flat panic and she poured out her story. She had taken Ada upstairs to the lavatory and was waiting with her as it was not safe to leave Ada even for a moment. Carol is one of those people who does not know the meaning of inactivity and she had become bored because Ada famously took for ever on the loo. She had been a hairdresser in the past and she hit on the bright idea of giving Ada's hair a trim while they were waiting for nature to take it's course. All had been going well and they had been chatting while she snipped away until disaster struck, prompting her frantic phone call to me. "She's dead!" she wailed, in tears now "She just slumped over and died and half of her hair is long and the other half is short - her son is downstairs - what shall I dooooo?" "Are you sure she's dead?" I asked "oh yes, absolutely" she gasped.
I answered reflexively, pictures of having to explain ourselves to God knows who flashing through my mind - "Cut the other half - quick!" I whispered back "And don't shout him until you have!"
We never owned up and at the time I felt sick at the whole situation but I have to admit, in retrospect, it makes me grin to myself whenever I think of it......

Fitting In

2008-10-16T13:47:00.000-07:00

Long years in this business have taught me the art of great British understatement and by those criteria Jack is "not a coper".
The block is warden controlled. It is typical of it's genre, a pale brick one storey complex with block paving and neatly kept shrub beds and a box hedge leading you up the path to the front door. The intercom system lets you into a foyer with framed pictures of parties held in the communal lounge and vases of slightly dusty plastic flowers. Four corridors lead off from the main hallway, each with half a dozen neat identical doors. Most residents have added personal touches, a name plaque here, a wrought iron plant stand there. Jack's flat has no ornament unless you count the black finger marks around the lock and the stale smell that emanates from the broken letter box. He has lived in the flat for a little more than a year, moved there by social services when it became clear that he could not cope where he lived before. It didn't take long for his house proud neighbours to unite in a common cause of trying to get him evicted again.
Jack is in his seventies and his needs are simple - beer, bookies, basic food and ..err...beer. He has had a cva (cerebral vascular accident, commonly known as a stroke) and he uses a mobility scooter to get to the bookies and the pub. His flat isn't the worst I have seen by a long way but it is cheerless and grubby. He lacks the basics, changes of sheets, changes of underwear, decent towels, and the stuff he does have is bundled in a cupboard in his bed sitting room. We take his washing to the launderette when we can persuade him to part with the money but it is a constant battle and there is always a backlog of dirty laundry which is piled in his bathroom because he doesn't even have a laundry basket. The warden has banned us from using the communal laundry because of complaints from other residents about his heavily soiled garments.
We go in each morning and help Jack to wash and dress and make him some food. He doesn't see personal hygeine as a priority and getting him to shower is hit and miss. His clothes are raggy and stained with beer and urine and the chances of getting him to buy replacements are slim to say the least. We are supposed to go each evening too but more often than not he is in the pub.
We have several other customers in the complex and they are vociferous with their complaints about how we care for Jack. It's frustrating - we don't get time for cleaning or general maintenance, we get two scant half hours a day and often only do, and get paid for, one. I understand that, in the eyes of his neighbours, we are in there so we should be addressing the issues but that can only be done with Jack's co operation and Jack doesn't see anything wrong with the way he lives. He chooses to spend his income on beer and horses and the idea of paying for help to remedy the squalor in which he lives is just not something he sees as necessary. It's a small village and it is openly acknowledged that Jack has always lived like this, his stroke is incidental to his lifestyle except that it helped to secure him his warden controlled home.
The complex had a tenth anniversary party recently. There was a buffet and entertainment provided in the lounge and all the residents were invited by means of a notice in the foyer. Nobody thought for a moment that Jack would attend and indeed he did not. Uncharacteristically though, he was at home when the carers called in the evening. He was sitting in his room, cans scattered around him and with the lights off except for a dim table lamp which barely pierced the gloom. He was obviously feeling very down and he refused to let us get him undressed, this was going to be yet another night when he slept in his clothes. The carer made him a cup of tea, which she placed to go cold by his side and sat down to talk to him since he was refusing to let her do anything practical. She sat in the semi darkness and tried to make conversation with the old man but he was unforthcoming and after a while she filled in the communication book and said goodnight. As she reached the door he looked up from his beer can and said "Thanks for coming girl, it's good to know somebody cares" Jack doesn't have the tools to fit in, he never did, that's why he drinks and goes out of his way not to fit in. Jack's tragedy is that nobody noticed he wanted to fit in while there was still some hope of changing things and that he has become so adept at pretending he doesn't care.

Clive Comes of Age

2008-10-15T11:58:00.000-07:00

May was referred to us first. She and her husband had run the farm but her husband died many years ago and she had given up the big house and moved to a bungalow on the edge of the land. These bungalows can be found all over the area, housing retired farmers or their widows who have passed the reins to their offspring and are spending their autumn years happily interfering from the sidelines while not having to get up at dawn to do the milking. May had three sons and two farms to pass on but that was ok because Clive was never going to need a farm.
If Clive had been born now he would have gone to a mainstream school, possibly had learning support one to one and then hopefully he would have gone on to some sort of vocational training, maybe even ending up living independently. As it was, he was born sixty years ago and when his family realised he was "a bit simple" they limited his life. I do not mean to imply that they did this with anything but the best of intentions. May loved her son but she had done absolutely everything for him and the result was a completely helpless man, totally dependent and hidebound by rigid routines from which he would not deviate. She kept him at her side and he learned to knit huge wonky scarves and watched all the soap operas with her while his brothers grew up and took their place in the adult world.
This did not pose a huge problem until May died. Various aunties, female cousins and neighbours were willing to help but it was hard to imagine Clive coping at all. It seemed May had left things arranged so that Clive was financially secure and social services stepped in with morning and evening care with his brothers paying privately for nights. Nobody held out much hope for it working but Clive surprised us all by coping better than anyone could have predicted.
He is still given to routine, meals at exact times, certain television programmes, getting up and going to bed at the same time but in other ways Clive has blossomed. He dresses himself, he does his own dishes, he even tries new foods occassionally - all new skills learned in the months he has been living in the bungalow alone. It isn't all plain sailing, his medication seems to make him very nauseous and very sleepy and there are times when he cries for his mother, it's been a long road. We have a male carer who does nights there and he was telling me today that Clive had told him he would like to stay up and watch the football with him. When the carer had said that was great but what had brought this on Clive said "It's nice to have a bit of time with the lads, there's too many women coming in here!" - yes, Clive is blossoming at last, I'm sure May would be completely horrified .....

Driving him Crazy

2008-10-14T14:02:00.000-07:00

I live in an area where public transport means two buses a day, if you are lucky - and if you catch it in my village it will take you ninety minutes to reach the market town five miles away because the bus goes round every other village before it gets there. The bus station in town is helpfully situated at the bottom of the hill that leads to the shops so, all in all, it's pretty much useless to anyone who is in any way frail. This means that people carry on driving long after they would probably have stopped in a city.
Cora is famous around here. She is eighty nine years old and she drives a huge old Ford which looks like someone has crawled all over it with a toffee hammer, no panel is it's original shape.She drives the narrow lanes at breakneck speed, flicking ash from her constant cigarettes into a crystal ash tray that she keeps on the floor. She doesn't reverse any more though - if she meets someone at a narrow point in the road she leans out of the window and shouts "I'm eighty nine dear!" until the other driver gets the message and reverses.
We visit their house twice a day to help Cora's brother Bob to get in and out of bed. Bob has chronic obstructive airways disease and uses oxygen. He is fifteen years younger than his sister, the baby of the family and the two of them squabble incessantly though they adore each other. The risk assessment says that Cora doesn't smoke in the house but we know she does, the wallpaper and all the furniture is stained orange and there are often ash trays around when we visit. Trying to tackle the issue just brings on a fit of filial unity and they both act innocent, agreeing that oxygen and cigarettes are a very dangerous combination and of course Cora wouldn't smoke around Bob "with his chest" Bob's chest is a worry though, some mornings he can barely breathe and even Cora hesitates in her constant stream of chatter and casts worried glances as we help him with his nebuliser. Cora talks incessantly, an outpouring of gossip and observations that has us all laughing and makes Bob smile in spite of himself even as he tells her to be quiet and let the girls get on with their job.
It was earlier this year when Cora first asked one of the girls to pick her up a little bit of shopping. The girls were tactful, they didn't ask why she was not going out for the groceries herself and they brought the items she had asked for. A few days later Cora asked if she could have regular shopping and we arranged to go to the supermarket once a week as a private call. To be honest, we were all relieved that she had lost her taste for the open road - she was a total liability, we never knew whether we were more afraid for her or more afraid of meeting her round the next bend. It was sad though, somehow not driving shrank Cora, she took to sitting in her armchair all day, entertaining herself with nagging poor Bob. We went many nights to find him sitting in the kitchen "for a bit of peace" while Cora hastily tried to waft the tell tale cigarette smoke away before the carers noticed. Their former camaraderie all but disappeared and the two of them were constantly gloomy,
Then one morning the carer rang me in stitches. She had arrived at the house to find a smart little hatchback sitting outside. She thought Bob's daughter must be visiting but when she got in the house there was just Bob, upstairs in bed, and Cora, busily putting on her hat. "Do you like my new car?" she said. The carer was astounded "But I thought you had given up driving?" she said. Cora met her eyes in the mirror and winked "Oh no dear" she said "The old car died, but I knew Bob would get fed up and give me the money for a new one eventually if I went on enough!"

Shades of Grey

2008-10-13T13:29:00.000-07:00

Our brief is clear - we are there to meet the needs of the client. I should say here that "client" is, along with "customer", my preferred term for those we look after. Like so much else in social care, fashions change, and last year's term is this year's ageism - we can't say "old" we have to say "older" We can't use the term "suffers" as in "she suffers from Chron's Disease" because that is disempowering and the term "victim" as in "stroke victim" is a hanging offense nowadays for the same reason. In my experience it is those in boardrooms that worry about these distinctions, the "clients" themselves just want to be treated with respect and when I ask, as I always do, how they would like to be referred to in our documentation they usually react with at best indifference and at worst incredulity. Doris does not care what term we use, Doris does not care about much. She is stone deaf and far more worried about the fact that we won't leave her alone.
As I said at the beginning, we are here to serve the client and to see that their needs and wishes are met as far as possible. This is often far from simple because most people do not exist in isolation, they have family, and families invariably have their own viewpoint - a viewpoint that does not always meet harmoniously with that of the client.
Doris is ninety seven. I don't know whether she has been particularly lovely in earlier years or particularly domineering but my money is on the latter. She has two daughters, both in their early sixties and both professional people. Julia is an architect and Mary is a nurse. They both live many miles away in England but for the past five years and more they have taken it in turns to stay with their mother in her tiny one bedroomed council flat. Mary comes when her shifts allow and Julia fits in around her sister's hours. Neither has ever been married as far as I know. They both call her "Sunny", short for "Sunny Mummy" which is their pet name for her and they both have very firm ideas about what should happen to their mother, namely she should not die. Ever.
Doris has been in failing health for a long time, nothing specific unless you count chronic arthritis and a bad heart, she is just wearing out. Some months ago she had flu and had to be nursed in bed. The doctor was extremely worried about her heart and told us that she should be moved as little as possible. Each morning we had a stand off with whichever of her offspring was present when they demanded that she be got up to use the commode. This culminated with Julia screaming at me, so close to my face that I was wiping away her spittle. I maintained a calm exterior until she leaned into her mother's face with a similar attitude and started screaming at her "Get up Sunny, get up! This bitch says you have to shit in the bed if you don't get up!" I know I was overstepping the mark but at this point I grasped her arm and physically propelled her from the room, standing with my back to the bedroom door until she calmed down enough to speak reasonably, albeit through hysterical tears. The battles have been endless and exhausting. We wanted a profile bed ( a hospital type bed with a pressure relieving mattress that sits up electronically) to make movement easier for all of us and to protect Doris' fragile skin. They refused because they like to sleep with their mother and they dont want her in a single bed. Doris got a bit stronger and the doctor said she could be got out of bed for brief periods but she seemed to lack the trunk strength to sit up. Julia and Mary insisted we got her up. I said this could not be done safely without a hoist and a reclining chair, it took three weeks and the combined efforts of myself, the Occupational Therapist, the doctor and the District Nurse to persuade them to have the equipment. I wanted the chair by the bed, at least initially, they tried to insist we walk her down the corridor to the living room when she patently could not walk. They wanted us to use a handling belt and physically drag her - I refused on the grounds of my staff's well being and of the risk to Doris with her failing heart and her poor creaking legs. They bought a wheelchair and insisted she was put in the living room. Doris, slumped in a chair and seemingly unaware of her surroundings, now spends most of the day "keeping us company" in the living room. We wanted to change her pad in the living room, bringing a bowl in to wash her and thus only hoisting her once but they insist we take her through and lie her on the bed and then bring her back to her chair, putting her through the trauma of hoisting eight times instead. Each morning we arrive to find whichever of the daughters is there "exercising" Doris' legs, pumping them up and down and ignoring her cries so that she can take her weight when we put her in the chair. They have fallen out with every branch of the medical profession as, in turn, they tried to explain that Doris was highly unlikely to "get better" in the sense of walking independently again and now I am told they have hired a private physiotherapist to work with Sunny Mummy each morning. Sunny Mummy seems weary beyond measure and pretty much unaware of the drama going on over her bowed head.
I understand they love her and although I can't pretend I understand this hysterical refusal to believe that a woman of almost one hundred years has had enough, I accept they are not trying to be cruel. They are not trying to be - but they are and tonight, as I pray the private physiotherapist stands up to them and refuses to put Doris through futile painful exercises, I ask myself - Who's needs are being met here? - I'm pretty sure that we are no longer meeting Doris's.

Fighting the Odds

2008-10-12T12:27:00.000-07:00

It was an autumn romance. Chris and Ann had both been married and raised families. Ann's marriage had ended in divorce when her children were quite young but Chris had nursed his wife through a long degenerative illness, finally losing her, after years of hope deferred and heartache, at the age of sixty.
I don't know their story, except that Chris and Ann met through church and were in their mid sixties when they married. There was a picture of their wedding day on the landing, Ann elegant in a cream suit, Chris standing behind her with a hand on her shoulder. Ann's face looked radiant in the photo, laughing eyes that followed you as you went on up the stairs, wondering how life could be so cruel..
Ann and Chris had five good years and then Ann was diagnosed with Multi Systems Atrophy, a degenerative illness that does what it says on the tin, it destroys you on all levels, attacking organs, muscles and nerves and leading to a protracted and difficult death.
We became involved about three years after Ann's diagnosis. She was no longer mobile and her voice was a tiny whisper that seemed to cost her a huge effort. We visited three times a day but it was the morning visit that became famous. Ann was a feminine woman and she didn't let her disability change that. We used to joke it was a free beautician's training course doing that call. Ann had a shower with expensive gel and then there was a plethora of lotions and potions, some for her legs, others for her hands, face creams and the whole finished off with hair blow dried and liberally sprayed. Ann could hardly speak but that bathroom rang with laughter as she rolled her eyes when we used too much cream or accidentally gave her a quiff with the hairdryer. Disability cannot confine personality and Ann managed to make a genuine relationship with all the girls who cared for her.
Chris coped about as well as a man struck by lightning twice might be expected to. He was angry and frightened and he was far from happy to have his home full of carers and nurses. He denied each stage of Ann's illness, fighting against each piece of equipment as it was needed and bolting from the house to the shop as soon as the carers arrived each morning, returning so simultaneously with their departure that it was obvious he must have been waiting outside until the coast was about to be clear. The evening call usually found him well into a bottle of wine and often ready for an argument. He would complain about the amount of washing we were creating, the carers being five minutes late, anything he could find to vent his frustration. Gradually though the girls learned to cope with him, speaking back to him in a way that made me shudder but which made him laugh. Once or twice he was so unreasonable that he reduced one of the girls to tears and it was only Ann, gentle loving Ann, her eyes full of answering tears, squeezing their hands as they took her out of the room, that kept them there. Chris was always contrite the next day and the team stuck at the call because they understood that Chris was fighting his demons and because they loved Ann and her courage.
Ann had reached a point where transferring her to a wheelchair to get to the stairlift was becoming impossible. It was with a sinking heart that I suggested the solution to Chris. A tracking hoist runs on a rail set into the ceiling, it is smoother for the patient but it is quite a radical change to a house and, predictably, Chris would not countenance it. We were still circling the situation when Ann's health reached a crisis. She just seemed to fold in on herself, the staff could barely wake her and she didn't have the strength to sit up. The doctor was summoned and the carer was there when Ann said to him, in a tone more distinct than we had heard in two years "I've had enough" That was it, even Chris could not insist she was fine and Ann went to bed for the last time.
Our society is strange about death in older people. "He had a good innings" "She lived a full life", the trite phrases we hear used all the time imply somehow that nobody is devestated by the death of older people. We expect stoicism from the elderly bereaved and often it seems that this is how it is. Chris was not stoical. We continued caring for Ann for three days after the doctor's visit. She seemed unconscious but she squeezed the girls hands when they spoke to her and each morning they washed her in bed and put her creams and unguents on, they said they had done it for four years and they weren't changing now. It was highly emotional but the worst part was seeing Chris. He never left her bedside and he cried almost constantly saying "Don't leave me, don't leave me" Chris was not ready to let her go and it was agony to see the big determined man still railing against the lousy hand he had been dealt.
I went to the funeral and it was packed. I watched Ann's children directing people to the correct area, the members of the choir she had sung in, extended family, workmates. They smiled and shook hands but they looked devastated and I had the selfish thought with an accompanying moment of panic, that one day my children would be in this position and, like Ann, I wouldn't be there to put them back together afterwards. Chris followed the coffin and he had changed overnight into an old old man, dry eyed but visibly shaking and supported by the tearful children of his own first marriage, more people who were playing out this scene for the second time.
Chris died six weeks later, it wasn't "a good innings" it was a rip off, and he never got over it.

No Right Answer

2008-10-11T12:17:00.000-07:00

There are certain things we take for granted in this age of technology. Here in Britain at least, surely everyone who has a roof over their head has the basics? Nope.
Bridie lives in the most idyllic spot. Her house nestles in a natural bend in the road, it's old stone walls seem to grow out of the hillside behind it and it's cobbled yard slopes gently down to a stream draped with Willow trees that dance a silent swooping ballet in the wind. Bridie is, as her name suggests, Irish. Her husband died a few years back and she lives alone except for a roiling flea ridden semi feral congregation of cats. She is an amazing figure, wrapped in shawls with a woolly hat that she pulls down over long grey hair and a pair of man's hob nailed boots that she wears without laces. She lives about five miles from the biggest town in our county and well over a century away in terms of lifestyle. She refuses to use electricity and her house does not have a good enough supply to use appliances anyway and, unbelievably, she has no running water. Every morning the girls bring water from the well which is situated a good hundred yards from the house and believe me you have no idea how much controversy this has caused over the months we have been doing the call. Inside the house is dark and stained black from the smoke from her open fire and the fat cheap candles she uses. There are huge dark oil paintings on the walls but I could not tell you what they depict. They are covered with the biggest, thickest, blackest cobwebs I have ever seen, each as thick as my finger and hairy with years of accumulated dust and smoke. She sleeps upstairs but we have yet to make it beyond the downstairs rooms, Bridie is up when we arrive and she will not countenance letting us into the upper storey.
Bridie is deeply suspicious of everybody. Dates and times have slipped from her grasp, if they were ever within it, but she knows that at some point a couple befriended her and made off with a substantial amount of her savings - ah yes, her savings. Bridie gives us a paw full of crumpled notes spirited from who-knows-where each week to do her shopping and we are allowed to cash her pension once a month, money which she secretes within her shawl immediately we return. Bridie trusts nobody. Her neighbour, a Welsh farmer of few words, used to look after her before we were contracted to visit twice a day. He told me it took him months to get inside the house, she would open the door an inch or two, take the food his wife had made and shut the door in his face. It is a credit to the man that he persevered and that he went over her head to get her more help last winter when she was wracked with bronchitis. Even now, she is part of his checking rounds, he peers through the window soon after dawn each morning and makes sure she is already up and getting her fire going.
Earlier this week, Penny (yes, Penny again!) rang me in some distress. It seemed Bridie had thrown her out, screaming Gaelic curses foretelling what would befall her if she ever darkened the door again. "What happened?" I asked. It seemed Pen had found a tiny newborn kitten outside the back door in a cardboard box. It was a filthy morning, the kind where the rain comes down Bridie's valley horizontally, and Pen had asked why the kitten was out there. Bridie had responded that the kitten had been abandoned, she had put it there to see if it's mother would return. Penny protested it would die and Bridie said that yes, it would if it was not reclaimed, but that it's mother knew best and if that was the case "The Lord would take it quicker out there" My lovely daffy teenage Pen had decided this was the height of cruelty and had taken the kitten, box and all, to her car to rescue it.
"Put the kitten back, Pen" I said - cue wailing and crying from the other end of the phone. "You cannot steal her kitten and anyway, she is right, sometimes a cat isolates one kitten, they sense there is something wrong with it" "I didn't steal it" she said hotly - in what sense does removing it to your car not constitute stealing it? I explained again gently that the kitten was not ours, that it was, at least nominally, Bridie's and we had no right to interfere and I was not about to summon the RSPCA and lose any chance of access to Bridie in future. Pen was not pacified "You have to do something, I thought you were lovely, you cant let it die!" her voice rose to a shriek. "Pen, I have the files of six human beings on my desk and I can't fix THEIR problems - I cannot fix this - PUT THE BLOODY CAT BACK!!" Pen agreed through loud sobs and I put the phone down shaking my head and wondering why it seems I have been appointed person responsible for the whole Universe. The thing is - I know I was right, I know a relationship with Bridie is my priority and that she was probably right about the kitten anyway - so why do I still feel guilty?

Dr Mack

2008-10-09T15:31:00.000-07:00

Doctors polarise opinion. I could name every G.P. in our county and, for each one, I could produce an equal number of our customers who believe they are candidates for sainthood or who think they should be strung up by their own stethoscope. (Interestingly, the only exception I have ever come across to this rule was Fred, a.k.a. Harold, Shipman. I worked in his area and he was universally loved - go figure). The fact is, G.P.'s are like anyone else, they have good and bad days, types of work they excel at and types at which they do not. Thank God that Barry had Dr. Mack.
Dr. Mack is close to retirement, a dour Scot with the bedside manner of a rattlesnake and a heart of gold. Some people cannot get past his absence of small talk and his inability to hold hands, metaphorically or otherwise, but I love him to bits.
I knew Barry for several months after he was referred to us for personal care. He was seventy two but looked younger, a tall good looking man with a salt and pepper beard and a laugh that started at his toes and filled the room. His wife, Caro, adored him and he adored her right back. They welcomed the staff from the first day like long lost family. We tell the staff that there are professional boundaries, they should not be hugging and kissing clients and they certainly shouldn't be popping back at the end of their run for cheese on toast and games of cards on Barry's bed covers. Barry and Caro weren't our employees though, and they ripped up my rule book. Everyone was hugged to Caro's ample bosom on arrival and leaving and it got to the point where she suggested I rang the house mid afternoon rather than individual team members because they were usually there anyway. Barry had Lung cancer with bone metastases, particularly cruel given that he had never smoked and had been, in Caro's words, a health freak, running marathons into his sixties and eating an organic vegetarian diet. He was obviously weak and often breathless but he joked about his illness, telling the girls he was a dire warning - being good got you nowhere, they had better heed his fate and party like mad while they had the chance. I confess, I probably visited Caro and Barry more than was strictly necessary myself and more than once I found myself dangerously close to telling Caro my own sadnesses over a mug of coffee at her big kitchen table but I resisted and settled instead for being treated like a favourite daughter and getting one of those hugs on leaving.
Barry stayed relatively well for about three months but then he started to really deteriorate and eventually he got an infection that had him rushed into hospital, his lungs had filled with fluid and it looked touch and go. He survived but it was then decided he needed a last ditch blast of radiotherapy and he remained in hospital. Weeks passed and although the girls kept in touch the waters of my work life moved on and, beyond asking how he was doing, Barry moved down the list of my priorities.
Caro rang me late one afternoon to ask if I would let the girls know Barry was very ill. A quick call to the social work team confirmed this, they had been told he had days , maybe hours, rather than weeks. I was confused - everything I knew and everything the couple had said had led me to believe that Barry wanted to die at home. I was horrified to learn that the necessary equipment and services could not be put in place for at least a week, the hospital had been caught unawares, sometimes the progress of a disease just cannot be predicted. Anybody else I know, including myself, would have been raging but when I rang Caro back she was full of praise for the hospital and, more importantly, Caro was in huge denial. Her stance was, "They don't know Barry, he will hang on until he can get home, he cannot die yet"
I found myself ringing Dr. Mack . I hardly knew why but I knew Barry had been his patient and I just needed to vent my anguish. It tells you all you need to know about the man that he rang me back within half an hour. He was his usual irascible self though, greeting my outburst with a non committal "Is that so?" and ending the call with the information that he would go up to the hospital to see Barry "if he had time later"
I got the call next morning, Somehow the equipment had been found and the Macmillan nurses were primed and Barry would be coming home - could we take the care back at an increased level? If it had been impossible I would still have said yes and we arranged for care to start with the evening call that day. I went myself with the team leader to find two Macmillan nurses and two District nurses and a shiny new hospital bed ensconced where Barry's old bed had stood. Barry looked...like Barry. He was painfully thin and a terrible colour but his grin was the same and he teased me that I would be overcome with jealousy when I saw how shapely his legs had become. We carried out the care as if he was made of glass but the familiar laughter echoed around the room as we did it and Caro hovered at the door, joining in with eyes that were too bright but which remained fixed on her beloved Barry. She told us Dr. Mack had arranged everything but I don't think she knew what a miracle the grumpy doctor had perpetrated and I didn't enlighten her. We hugged on the driveway, all pretense of professional reserve gone now and I drove away wondering whether Barry would be there in the morning. He was, but the morphine from the driver had kicked in and he barely stirred when his beloved girls changed him and made him comfortable. He slipped away just before lunchtime, surrounded by family and with Caro holding his hand. It was heartbreaking but he was at home, as he and Caro had wished, and his family rejoiced for that. I don't know if even now they know that final blessing on a lifetime of love was down to the inimitable Dr. Mack.

Not my Day

2008-10-08T12:43:00.000-07:00

Ruby's discharge had been delayed twice and was finally scheduled for this afternoon. Let me say here I am not having a good week and the window I had in which to carry out a risk assessment for this lady before commencing care tonight was barely wide enough to squeeze my ample hips through, thus when she had not appeared by 3.30 I asked the receptionist to ring hospital and check if she had left. He rang the social work department rather than the ward and proceeded to harangue the Senior Social Worker and then tell her "not to speak to him like an idiot" when she tried to explain he was speaking to the wrong people. Some days it feels like trying to herd cats.... Thankfully said Senior has known me for years and was very generous when I apologised. I will gloss over my subsequent meeting with the staff member, the bright spot is that he is only covering Mat leave and I may still have a business when he leaves.
I arrived at Ruby's at 4.30 pm with raised blood pressure and about thirty minutes to conduct a full environmental and personal risk assessment. The front door was unlocked and I let myself into the hallway, my high heels echoing on a splendid tiled hall floor. Ruby was in the front room, a room that had obviously been used as a storage cum dumping ground for some years. I have no idea why some old people put piles of clothing and towels and general detritus on a sofa and then put a blanket over the resultant mountain range but they do, and this was where I found Ruby perched. Her zimmer frame was in front of her, plonked on top of the hose for a vacuum cleaner that was helpfully wound around its legs. It didn't really matter a hell of a lot since whoever had put it there had obviously lifted it into the room, there was no way it was going to fit through the tiny gap between the side board and the sofa if she wanted to get out of the room. Ruby had a blue hospital carrier bag on the floor beside her and very little idea about anything.
She didn't know the number of the key safe on her front door, her next of kin was not listed with a phone number and she was extremely worried about the whereabouts of her cat and didn't want any sort of conversation until Tiddles had been located. Perfect.
A further examination showed that the house was not actually too bad, there was an adapted bathroom and a big kitchen with a cosy armchair and, best of all, there proved to be a further sitting room that had been converted to a bedroom and had a commode and a raised armchair. I extricated Ruby from the defunct front room by the unusual method of lifting the zimmer out first and going back for the customer and took her through to the bed sitting room while I made her the cup of tea she was gasping for and looked for the cat.
The cat was awol, the bed was unmade and Ruby had no idea where the sheets might be and bizarrely, I could not locate a cutlery drawer so I had to measure sugar into the tea from the canister and stir it with a knife. Searching for the cutlery did locate a pack of sheets and a mattress cover so I set to to make the bed, unsurprised when the sheets had to be wrestled onto the new deep mattress as they did not even approximately fit. Job done, I finally sat down and started to fill out my forms and then the family arrived.....
I accept that I have prejudices, we all have them, and the only way to deal with people fairly is to allow for your preconceptions. Ruby's family broke new ground though. Her son in law was wearing a pair of trousers that looked as though they had enjoyed their heyday in the psychedelic Sixties teamed with an unraveling sweater and a large woolly hat. His eyes looked in opposite directions and he seemed reluctant to speak to me although, on the bright side, he did know the combination for the key lock. Ruby's granddaughter was probably as wide as she was high and had long black tangled hair and a full mustache. She didn't want to speak to me either, she just stood behind her father in the hallway tearing bits off a full cooked chicken and stuffing them in her mouth - you couldn't make it up.
I completed the paperwork in record time, now forty five minutes late for my next appointment, and packed up my things, promising Ruby that a carer would visit at about 9pm to put her to bed. Ruby had taken a shine to me by this time and didn't want me to leave but I extricated myself and shot out of the front door at a run - to fall over the missing cat and land head first in an extremely muddy puddle - obviously herding cats is not my forte....

Penny for Your Thoughts

2008-10-07T13:26:00.000-07:00

She's picking on Penny and I don't know what to do.
Jenny is in her mid sixties, a bit of a kid by our standards. I did the assessment myself and we got on. She has had a lot of ill health and, though she disguises it well, there is a definite problem with her short term memory. I am a bit perturbed by a long and rambling tale she tells me about a family feud involving several siblings, it seems at odds with the friendly open demeanour she has shown up to this point. She tells me about her daughter, Beth, at length though. Beth has a hairdressing salon in a town about ten miles away and is a loving daughter who has asked for some help for her mum while she is at work. Jenny has been having a lot of falls and she wants us to help her with meals and personal hygiene - simple stuff to make sure she is coping.
Penny is one of our youngest carers. She is only nineteen and she is full of fun, a bit giddy but a thoroughly nice girl with a real knack for the work. She tells the clients to call her Twopence because there is too much of her to be a Penny and she demonstrates her karaoke skills while she strips beds and empties commodes - she is a live wire and they all love her. She lives in an out of the way bit of the area and she does the hard to get to calls near to where she lives. The people she goes to would be hard to cover without Pen, she is an asset.
Things seem ok at first. Pen says Jenny is enjoying the help and seems better. We record what we have done at each visit and Pen makes a note of what Jenny has at each meal. The first indication of trouble comes when she notes that she couldn't find any fresh bread to make the sandwich Jenny had asked for, Beth leaves a note saying that there were fresh rolls in the bread bin and Pen should open her eyes and while she is about it should get someone to teach her to make a proper cup of tea. Pen is upset but I jolly her along, these things happen, not to worry.
It's like a dripping tap though. Beth rings me and says Penny is too young to do the job, she is slapdash, she is careless. I defend the girl, I know she is good at her job, some of the people she cares for are severely impaired and the work is complex and she is universally praised in every other call.
The situation is not helped by the fact Jenny does not always remember things. She will tell Pen she doesn't fancy the salmon Beth has left, Pen makes her egg on toast and then Beth rings and plays hell because she hasn't has the meal that was left for her.Jenny then denies she has said she doesn't want the salmon. Beth questions everything Penny does and Jenny is getting the drift and starting to be cold to the girl too. I would take Penny out but there is nobody else to do those calls without sending Pen and another carer ten miles in opposite directions and depriving two sets of customers of the regular staff that they trust and are used to. The complaints are impossible to prove either way, each one not serious in itself but I wonder if the big one is coming, if soon the complaint will be something that puts us all through the wringer, scars Pen for life, and casts a pall of doubt on the agency as a whole.
I have tried to reason with Beth but she is totally unreasonable on the subject, almost frightening in her vitriol about this young girl that she has only met a handful of times. The package is shared with another agency and I rang their manager last week. It seems she is having similar problems and I learn that we are not the first agency to have been in there, in fact, we are pretty much the last ones covering that area who have not already handed the call back. The social worker is sympathetic but she has always found the daughter to be pleasant and reasonable, she only got the case recently and the worker who preceded her has moved on.
Penny was in tears today, she says she now wonders if this is the job for her. She says she has never been bright and the way she keeps making a mess of things in Jenny's is typical of her - she thought she was good at the job but maybe she should try at Tesco, she has heard they are taking on staff.
If I hand the call back I will feel we have all failed. Who will look after Jenny and who will defend us against Beth's condemnation? On the other hand I keep seeing Penny's face without it's trademark grin as she left the office today. I asked her if she wanted to come out of the call but she knows that will mean losing her other calls and she says she wants to stay - for now.
...She's picking on Penny and I don't know what to do.....

History Lesson

2008-10-05T07:03:00.000-07:00

Many of our customers have some degree of dementia. This can range from some short term memory loss through to profound disability. People are remaining in the community far longer than used to be the case and I believe this is a good thing. Familiar landmarks can be the thing that keeps you in hailing distance when your mind is drifting out from a foggy shore into unreachable waters. Resources to help carers are better than they used to be but the burden on families can still be terrific and of course, resources are only useful if people are willing to accept them..
I have never seen anyone like Flo still living at home. She has a diagnosis of classic Alzheimer's Disease though there is an element of guess work in any diagnosis of dementia. The file says that in 2001 Flo had very limited speech and mobility, seven years on it is amazing she is still here given the progressive nature of the disease. Flo is cared for by Martin, her youngest son and Martin is not the easiest person to help. Martin accepts a sitting service for the five hours a day that he goes in to his office and respite at home for a few days twice a year. He wont consider respite away from home and he will not countenance having a hoist to lift his mum. Flo cannot weight bear so the only way we can do personal care is if Martin lifts his mother bodily and we attend to her. I know, I know - it isn't good for Martin or Flo but I live in the land of compromise ruled over by the jealous Gods of Moving and Handling. We cannot move her without a hoist and her son can, I hate it but that's the way it is.
Occasionally I do the first hour of the sit in call and, frankly, it distresses me beyond measure. Martin rushes off to work and I am left with Flo. She sits in the middle of the living room, resplendent in a special chair that supports her in a semi fetal position. Her physical needs are met, sheepskin bootees to protect her heels, a soft scarf around her neck, holding the bib in place which stops her drooling on her fluffy cardigan. Martin leaves us with the remainder of breakfast, a soft chewy breakfast bar and two lidded plastic beakers of weak blackcurrant juice. The bar has to be broken into tiny pieces and popped in her mouth, it takes an eternity for her to mumble each piece and I am haunted by what I will do if she chokes - she is too heavy to move by myself, panic crawls in the pit of my stomach all the time I feed her. I tip the beaker up to her slack mouth and hold tissues at her lip to catch most of it as it runs back out. Does she want it? Does she wish I would leave her alone? I have no way of knowing. Flo does not speak any more, she makes the occasional groaning sound but it doesn't really sound distressed and the timing of it is random and does not seem to be in response to anything I say to her. She doesn't make eye contact, her eyes seem unfocused but her gaze flicks upwards all the time, scanning the ceiling for something I cannot see or for nothing at all.
The house is truly depressing. The chair dominates the small room, all that it contains apart from that is a formica table with two mismatched chairs, a cabinet with a small television and a high chair, stained and worn, that was obviously Flo's when she could still support her own weight. The walls are painted a cream colour and are none too clean, the whole place looks as if it has not been touched since Flo became unable to look after herself. The most poignant part is a plain crucifix which hangs over the door. This doorway leads to the front room which holds the hospital bed, it's air machine providing a sighing counterpoint to the silence of our company. I look up at the figure on the cross and wonder where Christ is in this sad silence, Flo must have been a believer or this sole ornament would surely not be in the room, if anyone needs Him she does now. I try to speak to Flo but it is incredibly difficult to hold a one sided conversation when you don't know if the other person can hear you, if she wishes you would be quiet or if she is silently screaming while I mouth inanities about the weather. Sometimes I read from the local paper, my voice sounding unatural as I describe fetes and rugby matches and Flo's restless gaze rakes the ceiling. There is more, I am haunted by the image of Martin's life. We help him put Flo to bed at 9pm and - and then what? What does he do in this bleak little room, night after night, week after week. He is a bright man, the newspapers that lie around are broadsheets and the occasional book is always intellectual. A picture of a younger Martin,smiling in cap and gown, stands on the mantlepiece. I admire him for his dedication and decency but I can't help it, I am appalled at how bleak his life must be.
Flo's death was unexpected. She became acutely ill and was gone within three days. The funeral was in a Church of Wales chapel. It wasn't Catholic so the crucifix remains a mystery. The church was typically Welsh, very plain stone with clear window glass and plain pews, no frills at all save for a fabulous carved rood screen. I sat at the back as I always do, I am not there to be noticed, just to pay my respects and slip out quietly. I wondered how this funeral would be, who could grieve a death that was for once surely the embodiment of that cliche "a merciful release" and for everyone, not just for Flo.
The family filed in and the service began. Martin and his older sister talked about their mum. They described the lynch pin of their early lives, always busy but with a wicked sense of humour. A woman who worked seven days a week and who tried to discipline her unruly brood but always ended up laughing. They told funny stories and detailed a proud family roll call of people who had gone before but who had adored Flo. They both stumbled over their speeches, tears barely held in as they gave tribute to a fantastic mother. They named all of the family and one grandson broke down as his name was mentioned, his loud sobs echoing round the church, his raw grief making the back of my throat ache in sympathy. The trouble with this job is you are dealing with a lifetime of family history and you have no idea what has gone before the tiny slice of a person's life that you see. I left the church with a new perspective on the helpless soul Flo had been at the end of her life and some insight into why her son was determined to fight for what he thought was right for her.

The Ghost of Christmas Past

2008-10-03T10:52:00.000-07:00

Many years ago in a grimy Northern town...
I sat opposite Jan for years - we shrieked with laughter and cried bitter tears and saw each other through the death of parents, the desertion of duff boyfriends and the wrath of Managers for over ten years. Like a bolshy version of the Blues Brothers, we wore black jackets and sunglasses (it was the fashion, honest) - we were social workers with a side order of cynical humour and a determination to do the job right, if not always strictly according to the rules.
It was the dead first week of January, Christmas decorations drooped on the windows and we drooped in sympathy but an emergency referral came in and we hit the road to do our thing. The referral had come in from a neighbour who was worried about Mr. F., the old gentleman next door, she said he had flu and he was not being cared for properly by his daughter, she had not seen him for days and she was concerned. We wondered why the neighbour had not tried the radical step of knocking on the door and asking how the chap was but decided we had better have a look. It could have been anything, abuse, inadequacy or more likely nothing that couldn't be dealt with by medical attention- you learn quickly not to take any referral at face value, relying instead on the evidence of your own eyes.
The evidence did not look promising as we pulled up outside the house. Any social care worker will tell you that you don't always need the house number, sometimes you see the house with the filthy curtains, the broken fence and the peeling paint and you just know that you have reached your destination. We knocked several times before the door was opened by a disheveled young woman whose age could have been anywhere between thirty and forty five. There was something in her bearing that told me she wasn't quite right, not seriously impaired, but as she introduced herself it was clear that Mary had a mild learning disability. She told us that she and her dad had been suffering with flu since Christmas Eve but that she was now feeling a bit better. As Mary let us in I was thinking that the referral was probably simply an over anxious neighbour, this family obviously did not cope well by conventional standards but had undoubtedly ticked along like this for years.
My opinion changed rapidly as we walked into the lounge behind the young woman. The armchair held a tall gaunt man in his seventies who looked close to death. His breathing was rapid and shallow with an underlying bubbling that sounded ominous to me. "He's looking much better" said Mary brightly. This is where colleagues who know each other inside out are invaluable. A brief meeting of eyes and Jan swooped Mary off into the kitchen while I leaned over the gentleman and tried to wake him. His eyes flickered open briefly but they didn't really register that I was there and his skin was hot and papery under my touch. I gently pinched the skin on the back of his hand and it remained in the telltale ridge that says someone is seriously dehydrated. I don't call ambulances lightly, potentially every non urgent call could prevent a crew from attending a real emergency, but this time I could see blue lights were going to be justified.
I called Jan and Mary back. Jan had been extracting some details from Mary about her dad and already had the salient points noted down to go with him. I explained that Mr. F. needed to go to hospital and we got details of an aunt we could inform so that Mary would not be left to cope alone. We phoned for an ambulance and tried to reassure a very tearful Mary that her dad would be alright and that we weren't suggesting she hadn't looked after him properly. The atmosphere was tense with emotion, the semi conscious man and the daughter veering dangerously close to hysteria with the two of us trying to explain what he would need to take to hospital with him when suddenly Mary brightened. She rushed into the kitchen and came back with an enormous cooked turkey. The meat was obviously rancid, the partly carved breast meat was slimy and had a covering of fluffy mold. "See?" said Mary "I have been feeding him, we cooked this on Christmas Eve and we haven't felt well enough to eat it until the last few days!" "Err, that's good Mary" I said "But I think maybe that the turkey is...past it's best".....I said before that colleagues who know each other well are invaluable - they are, but not always. I caught Jan's eye over the malodorous corpse of Christmas dinner and suddenly felt a bubble of hysterical laughter rising in my chest. I had to look away rapidly as Jan disappeared into the kitchen with her shoulders shaking suspiciously and it was good luck that the ambulance crew arrived at that moment so that I could turn my back and get a grip on myself while they dealt with the situation.
Mr. F. was taken off to hospital where he made a full recovery, Mary's aunt arrived and turned out to be bustling and lovingly competent as she swooped Mary away. And the turkey? Sadly the turkey was beyond help, we took it away and gave it a decent burial, we made it sit in the boot on the way back to the office though.....

The Mysterious Clarissa

2008-10-02T11:37:00.000-07:00

The referral landed on my desk on a rare slow morning and I read it, at first with mild interest, and then with increasing curiosity. Clarissa had the double barreled surname to match her aristocratic forename and had been a Barrister . She was in her fifties and the referral was for daily visits to prepare food and to help with daily tasks in her caravan...her caravan? What was a youngish Barrister doing in a caravan? I read on but there were no further clues beyond the information that she had arthritis, so I set out to do the risk assessment.
The address turned out to be a field Clarissa owned adjoining some land belonging to friends of hers, from a distance it looked idyllic with a little pond and ornamental trees and shrubs surrounding the caravan. As I approached however I could see that the van was pretty dilapidated, streaked green and generally shabby. I knocked and heard a distant shout so I opened the door - and was bowled over by a tide of small dogs and, believe it or not, two lambs. From my rather undignified position on my bottom on the floor I could see at least two more dogs, three cats and a large jolly looking woman who was regarding me with some concern and a definite tinge of amusement. "Oh dear" she said, in a distinctly upper crust accent "I was expecting somebody else so I didn't put the menagerie away. Are you alright?" I regarded my ripped tights and my scattered papers as best I could through the face washing attentions of a what looked like a small mop with legs and tried to assess whether anything more serious than my dignity was hurt, it seemed I was indeed alright so I struggled up and waded through the livestock to shake hands with Clarissa and introduce myself.
The whole place was scruffy and smelled of damp and animals but such was Clarissa's charm and warmth that I soon found myself chatting away as if sharing a sofa with a lamb was something I did most days. Clarissa kept up a stream of highly amusing and charming conversation while I filled in my forms and got no closer to satisfying my curiosity. She offered no history beyond saying that she had not been well and had made some bad business decisions but things were being resolved and she intended to have a house built on the site "when things got sorted out".
I was distracted from my form filling by a huge oil painting which incongruously almost filled one wall of the van. It was undoubtedly of a much younger Clarissa, captured in evening dress with one arm draped over the chair on which she reclined. She was not an especially good looking woman and was carrying a fair amount of weight. The painting showed that she had been handsome rather than pretty as a younger woman but the figure in the picture exuded a smoldering languid sex appeal that had me mesmerized. She saw my sideways glances and said "That was my coming out painting - I was wearing a corset that was crippling me!" I commented that she was quite a girl and she winked at me and said "You have no idea how right you are".
Time passed and the girls went in each day to Clarissa. She often had friends visiting and some days she would seem positively joyous. Other days would find her alone and melancholy though she never complained and she had every member of staff squabbling over who would go and see her, livestock and shoddy surroundings were more than outweighed by half an hour of Clarissa on form. We worried about her though, she was on lots of medication and her arthritis wasn't good even in summer. The caravan was bitterly cold in the winter and Clarissa fretted about her books which were getting damp - we fretted more about her swollen joints and her mood which was constantly low. Rumours abounded about how Clarissa had ended up in such a sorry state - she had taken to drink or drugs or both ( if so there was no evidence of it now), she had gambled, a married man had seduced her and swindled her, she had been in a mental hospital. She was always charming and forthcoming on all subjects except an explanation for her situation.
As time passed Clarissa told us stories of how the plans for her house were coming on and she would soon be out of the hated van but nothing ever happened and two more winters passed with the van and Clarissa both looking more and more desperate. Earlier this summer her social worker, who incidentally is probably one of the best I know, rang me and we had a discussion about what could be done. It was increasingly obvious that Clarissa could not do another winter. The only option seemed to be a council flat but the idea just wouldn't fly. Clarissa in a council flat, without her precious animals - it didn't seem melodramatic to say it would kill her. We came to no better conclusion but before any suggestion could be made Clarissa threw a curve ball.
She had talked to her friends and had decided that she would sell them part of her land and in return they would make one of their stables into a home for her until her ship came in and she could build on the remaining part of the field. Work started immediately on the stables and today that's what happened - a motley crew of carers carried stacks of books, furnishings and a large oil painting into a converted stable, finally assisting Clarissa herself to make her flamboyant progress across the field, scarf trailing behind her and with a retinue of tail wagging attendants dancing around her at every step. I seriously doubt they have planning permission, for a Barrister Clarissa seems incredibly naive, but the inside of the stable is cosy and smells of the wood they have used to partition rooms. A wood stove has been installed and the rooms are warm with an aristocratically shabby sofa and rugs brought out of storage making the place look homely. I don't know whether Clarissa will ever resolve whatever mystery has tied up her finances but when I left her this evening, leaning back in her chair with her stove blazing and a canine carpet reclining on the rug before it I couldn't help smiling. Clarissa isn't worried so maybe I shouldn't be either. One thing is for sure - you get to see all sorts in this line of work....

Living Within Your Means

2008-10-01T12:54:00.000-07:00

She has lived in the house since she moved in with her parents at the age of fifteen. The house was brand new then, a garden semi in a nice area, each pair of houses different to it's neighbours, each with a garden in front and a long sloping lawn down to the river behind.
Myfanwy is in her eighties now and lives alone in the house. She has never married and her parents are long gone, she still refers to them constantly, with reverence and not infrequently with tears in her eyes. Within the house time has stood still, possibly since they moved in, and certainly since her dad died thirty years ago.
Money is not an issue, we know this because we do Myfanwy's banking. She has over three hundred thousand pounds in the bank but she lives as if she is a pauper. I have tried gently to discuss this when she refuses herself the smallest of comforts but the idea of "frittering it away" horrifies her. The money is going to be left to the British Heart Foundation, because daddy died of a heart attack. This is non negotiable, Myfanwy will not listen to arguments or pleading, the lady has decided and the lady is not for turning
There is no central heating and the floors are mostly linoleum with enough rugs overlapping to give a health and safety assessment officer a heart attack. Each morning we let ourselves in, eventually, because the lock on the door is faulty. Some mornings it is colder inside the house than outside, you can see your breath in the tiled kitchen as you go in. We go upstairs and plug in the kettle in the hall - you have to boil a kettle for hot water, she wont have the boiler on. We go into the bedroom with it's uncarpeted floor and wake Myfanwy. She still sleeps in the bed she was born in. It has an original feather mattress which has to be shaken out each morning, it weighs a ton. Myfanwy is incontinent and the bed is usually wet, her breathing is awful and I am sure the feathers and the damp don't help but Myfanwy wont hear of changing it. We go into the bathroom and wash her as best we can with rapidly cooling water and cheap green soap. She wont have a shower put in because that would mean changing things and there is no chance of getting her into the high sided cast iron bath. She worked in the same office all of her working life and she believed in buying "good" skirts. I'm sure they were good thirty years ago but she is very much thinner now and the skirts are shapeless and faded to a fetching shade of mud. Getting Myfanwy dressed is comical, she wears a vest, a liberty bodice, an over vest and then a girdle that has only faded pretensions to being elasticated. There is a ready, steady, go! moment when you let go of the girdle and pull up her skirt quickly to stop it falling off again. Her big toes are sore and she wears little knitted covers on them inside her darned stockings, the little pink crocheted covers are somehow poignant on the end of her poor gnarled feet.
It's downstairs then and breakfast. She lives in the kitchen and she settles herself in her chair at the table while we prepare tea with long life milk from the pantry, she wont have a fridge. She has bran fibres with hot water so as not to waste milk and one slice of toast with margarine and it's God help you if you spread it too thickly. It is a meal without charm, merely a matter of fuel.
When I do the call she calls me "cart 'orse" because I keep tripping on the piled up rugs and laughs at me for suggesting that I might pop back with fish and chips one day as a treat. As I walk away, leaving the little figure hunched in the cold kitchen with a shawl around her shoulders I always wonder - what does she DO all day in that freezing house with no company and no television?
Jane, the Team Leader, told her for days that her leg looked sore but she refused to have a doctor, the best we could do was to persuade her to have it creamed each morning and even then Jane bought the cream from her own money. After about four days of this, on a Sunday morning, it was obvious that there was an infection in the leg and Jane insisted that she was calling the emergency doctor. She changed the bed and made Myfanwy get back in it but when she came back two hours later to check she found her on the floor where she had fallen trying to get up and go downstairs. Jane says she is still haunted by the distress on Myfanwy's face as the Ambulance crew took her out of the house, as far as we knew, the first time she had been outside for at least five years.
It turned out that she had broken her hip. She didn't respond well to physiotherapy after the operation and the decision was made that she would have to go into residential care. It is hard to describe the frustration of her carers, we all felt a degree of guilt that we had never persuaded Myfanwy to care for herself better, to get the doctor earlier, to heat the blasted house, and now the consequence was that she was losing her precious home and was going into care, the thing she dreaded most in the world.
The house is sold now. There was a raft of builders skips outside for weeks and now a new young family have moved in. The metal Venetian blinds are gone and pretty curtains hang at the windows and most mornings I see a young mum herding her children into a car on the newly tarmacked drive. I never pass without remembering Myfanwy and that freezing bathroom and that corset that fitted where it touched. I never have got the nerve up to visit her but I know she is still alive - I hope the British Heart Foundation appreciate whatever is left of that money.

Meeting the Assessed Need

2008-09-30T12:24:00.000-07:00

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.....

2008-09-29T14:07:00.000-07:00

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.

2008-09-18T15:47:00.001-07:00

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

2008-09-18T15:47:00.000-07:00

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

2008-09-17T11:18:00.000-07:00

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

2008-09-16T10:33:00.000-07:00

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

2008-09-15T11:31:00.000-07:00

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....

2008-09-14T10:31:00.000-07:00

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

2008-09-12T05:53:00.000-07:00

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.

2008-09-11T12:30:00.000-07:00

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

2008-09-10T05:55:00.000-07:00

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

2008-09-09T12:08:00.000-07:00

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

2008-09-08T13:41:00.000-07:00

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

2008-09-06T13:37:00.000-07:00

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.

2008-09-05T08:36:00.000-07:00

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....

2008-09-04T13:51:00.000-07:00

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

2008-09-03T12:08:00.001-07:00

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

2008-09-01T10:40:00.000-07:00

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"

Twisted Fire Starter

2008-08-31T12:49:00.000-07:00

Jim's bedroom is bleak. The hospital bed is marooned in the middle of the pock marked linoleum which is a testament to a thousand dropped fag ends before he became too shaky to attempt smoking in bed. He wont have the curtains open, afraid that people will see him because he finds his life desperate, his body embarrassing. There are no pictures on the walls, no personal touches to say who he is, just a wardrobe filled with the tracksuit bottoms and t shirts that the carers can put on him without too much discomfort and a television in the corner, constantly tuned to comedy gold channels. We care for him to a backing track of Gerry and Margo and Stephen Fry, canned laughter and scripted applause.
His speech is distorted by the illness, he has a verbal tic that makes him repeat everything three times, this adds flavour to the insulting nicknames he has for us all. He grimaces at each carer as they bustle in with a cheerful greeting and spits out the epithet he has bestowed "dyke, it's the dyke, dyke" or "pikey, pikey, it's pikey". He complains and grumbles throughout the care, saying we are too rough, hanging on to his filthy trackie bottoms with convulsing fingers because he is ashamed of his shrivelled legs, calling us perverts if we look at his genitals as we wash them. We ought to dislike him but that is far from the case. The fact is, Jim pretends to be something he is not. He may be insulting and grumpy but his words are belied by the look in his eyes, by the occasional grin he cant hide and by the wry comments that can make you hoot with laughter when you least expect it. Jim is a sweetheart but he would eat his own liver with a spoon before he would admit it.
There is much talk in social care about quality of life, dignity and choice. These high ideals are the stuff of the politician's rhetoric, of white papers and manifestos, the reality is reduced to it's barest components for people like Jim. "What has he got at the end of the day" as Dire Straits asked in a song whose tone was sufficiently jaded and world weary to make a social worker proud. He has his comedy shows, he has the pleasure of insulting his carers with a twinkle in his eye and he has his cigarettes....and there's the rub. Jim can't smoke in bed any more, one forest fire too many on his fleece top and he was banned for his own safety and for the peace of mind of the neighbours. Jim can't walk. His only means of getting from his gray sheeted bed is via a hoist operated by two carers, four times each day. These calls are to wash him, to change his pads and empty his bag and to try to persuade him to eat and to drink. To Jim, these calls are fag breaks, a desperately longed for, clock watchingly ached for opportunity to feed the nicotine monster, to reclaim something of the wise cracking lorry driver he used to be. As soon as the door opens, long before the sling is slid beneath him and he is hoisted into his chair, he starts saying "hurry up, hurry, hurry, fag, fag, wanna fag" Only now everything has changed.
In April last year the smoking ban was introduced. The full joyful implications of this legislation on a service whose employees use their own vehicles for work is for another post, for Jim the legislation was a potential disaster. The thing is that the moment a carer sets foot in Jim's house it becomes his/her place of work and therefore a smoke free zone. If I fail to comply with this rule I stand to be fined several thousand pounds and potentially sued by the staff member for several thousand more. We get around this in most cases by getting the customers to sign an agreement saying they and other members of their household will refrain from smoking when the carer is present and for half an hour before each visit. So far nobody has refused to sign and the day somebody does is one of those scenarios that has me lying awake at 3am wondering why I didn't become something less problematic, like a politician with a penchant for recreating the nanny state of his over privileged childhood. Anyway, back to Jim. He can't smoke unless he is out of bed. He can't get out of bed without his carers. He can't smoke when his carers are present. Smoking is all that gives his life even a small punctuation point of pleasure. Bugger. There's one scenario the smug bureaucrats never thought of.... So what do we do? Do we tell Jim his human rights are less valid than those of his carers? Do we tell the carers their human rights are suspended when they visit Jim? What we do is a masterpiece of side stepping the issue - we fasten the seat belt that holds Jim vaguely upright in his chair, we light the blue touch paper, or at any right the Silk Cut King Size, and we retire to stand in the garden - viewing Jim through the conservatory window to make sure he doesn't choke or drop his fag and torch himself and his surroundings. It's ridiculous, it's fudging the issue and it's only made slightly more bearable by the wicked smile Jim cannot completely hide as he contemplates us through a blue haze of smoke and misery when the rain is running down the back of our necks........