AUTUMN’S COLOURS
By Nick Holloway RGN
Copyright ©Nick Holloway RGN August 2012
Published by Memoirs
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First published in England, August 2012
Book jacket design Ray Lipscombe
ISBN 978-1-909304-05-5
All rights reserved.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the prior permission of Memoirs.
Although the author and publisher have made every effort to ensure that the information in this book was correct when going to press, we do not assume and hereby disclaim any liability to any party for any loss, damage, or disruption caused by errors or omissions, whether such errors or omissions result from negligence, accident, or any other cause. The views expressed in this book are purely the author’s.
This book is dedicated to:
• My family. Please, when my time finally comes make sure that you choose a decent home.
• West Dorset School of Nursing, Dorset County Hospital, Dorchester, 1972-1975. Thank you for the firm foundation I was able to build on.
• The many wonderful care home staff I’ve worked with over the years.
You’ve been remarkable people! With just the one exception, you’ve been a pleasure to work with and I thank you for your friendship.
• Every resident I’ve cared for. I hope that I was able to make a difference.
• All the care home staff in Dorchester. One of you might be bathing me some day! Somerleigh Court Nursing Home (nice photo of you all on the website) was once part of the old Dorset County Hospital in Dorchester, of course. In my nurse training days it was the maternity unit (of all things!) which meant that it was out of bounds to us male nurses. You may be interested to know that in my nurse training I was actually asked to leave the lecture room when we got to the female reproductive system and get on with some essay writing on my own in the library. No, I’m not joking! Afterwards I asked my female colleagues what it was that I’d missed, and that’s how I’m the father of two daughters.
• Kelly Andrews. Thanks for standing by me.
Is my local care home the Golden Halo Care Home? How does it measure up?
Does it deserve a golden halo or to be closed down?
How would I measure up as a carer? I might have the will, but have I got the skill?
Find out in this unique quiz!
Answer the following wide-ranging and probing questions based on Nick Holloway’s book Autumn’s Colours and then decide which award you would give your local care home:
Absolutely Admirable? Averagely Average? Abominably Awful?
Have you got what it takes to be a carer - a good sense of humour, a bit of common sense and a really strong stomach?
INTRODUCTION
When I left school at seventeen I worked as a postman in Bracknell, Berkshire, delivering letters and peddling telegrams. Getting up at four was a bit of a shock after spending my last year in school as a hippy-lifestyle-loving sixth form student.
After my eighteenth birthday in 1972 I left home to start my nurse training at the West Dorset School of Nursing in Dorchester and Weymouth. Wonderful towns, enjoyable times. Qualifying as a State Registered Nurse at my first attempt in 1975, I worked in the operating theatres in Weymouth for a while. I counted all the instruments out and counted all the swabs back. I had a patient with a ruptured aortic aneurysm die on the operating table and my first caesarean section was a dead baby. I bought my first guitar in a second-hand shop in Dorchester high street. I passed my driving test in Weymouth, also at the first attempt. On the whole, happy days.
When my wife, also a Registered Nurse, and I moved to the Rhymney Valley area of South Wales around 1990, I began working in care homes as a Registered Nurse, including five years as a care home manager and some nursing for an agency. After a break of three years working as an NVQ Assessor in the incredible beauty of the Rhondda Valley with 16 and 17 year olds, it was back into care homes. Bored with nursing (‘Oh no, not another drug round!’) I gained Institute Of Environmental Health certificates and worked in my local care home’s kitchen for seven years.
A care home is a care home. A care home in the Rhymney Valley is the same as a care home in Dorset. You wash, you feed, you toilet, you medicate. I imagine that the only difference will be in the level of fees.
I should make it clear that I have never worked in a care home in Dorset. If I can afford it I might retire to Dorchester some day, so I could eventually become a care home resident and experience a déjà vu moment in ‘The Return of the Native Care Home.’
Lastly, I pay tribute to the many truly dedicated staff who have worked with me in various care homes over the years. I’ve enjoyed working with you all and hope that you’ve enjoyed working with me. Looking after elderly and sometimes confused residents is hard work. From time to time an incident regarding the abuse of care home residents by staff hits the headlines. I have never witnessed any such abuse. I have only seen committed staff working tirelessly for low wages to care for those whom the rest of us either have no facilities or no time to care for. Care home staff are worthy of our admiration! And our thanks.
Nick Holloway RGN
CHAPTER ONE
May Day
Nancy woke with a familiar realisation. There was a warm, wet patch in her bed. She knew what had happened because it happened most nights.
‘Blast it!’ she murmured. ‘Blast it, blast it!’
She sighed and lay there, motionless. After several minutes she thought to press the nurse call button on the end of a long flex that had been wound around the cot-side. A buzzer sounded somewhere in the corridor. She waited for what seemed like ages before she eventually heard footsteps approaching her door. It opened and Pauline, one of the night carers, came in and pressed the illuminated green ‘cancel’ button over the bed. The buzzing stopped.
‘Yes, Nance?’
‘I’m wet.’
Without a word the cot-side was lowered, the bedclothes were pulled back and an inspection made. Yes, Nancy was wet. The fact being established, Pauline pressed the buzzer for a few seconds, a prearranged signal, and several moments later one of her colleagues joined her.
‘Nancy’s wet.’
The old lady was lifted on to the commode next to her bed. Linda lifted the wet nightdress over Nancy’s head, took it with the sopping incontinence pad and dropped both on the floor at the top of the stairs. A clean nightdress with the name of a deceased resident crossed out and ‘Nance’ written on the label was taken from the middle drawer of her wardrobe. Clean sheets were collected from the linen cupboard and the bed remade. It was two-thirty in the morning and very little was said.
‘They’ve been sleeping’ thought Nancy. ‘I bet they’ve been sleeping and I’ve woken them up!’
‘Have you had a wee, Nance?’ Nancy wasn’t sure what she’d done.
‘Have you had a wee?’
‘Yes!’
With Linda taking her shoulders and Pauline her feet, Nancy was lifted back into bed. A fresh pad was put in place and the bedclothes pulled up to her chin. The cot-side was raised to prevent the confused old lady from falling out of bed or trying to climb out of it.
‘OK?’
‘Yes.’
‘Off to sleep, the
n.’
The light was switched off and the door left ajar. As the footsteps receded out of earshot Nancy noticed that the nurse call button hadn’t been replaced around the cot-side. It had fallen on the floor.
‘Blast it!’ she said.
* * * * * *
Pauline, her hands full of wet bedding, nightdress and incontinence pad, began making her way down the stairs. She would dump the bedding and nightdress in the large white canvas bag in the laundry room. The pad would be taken to the sluice room and put into the yellow plastic bag marked ‘clinical waste’. The waste contained body fluids of various colours and thickness and would be collected by a licensed company and incinerated.
‘I’ll do a quick check up here, Paul, and join you downstairs in a minute.’
‘Do you want some coffee, Lin?’
‘Yes, I’ll be there, now.’
Linda, a Registered Nurse, made her way along the first floor corridor, poking her head around the doors, pausing to look around the room and listen for the sound of the occupant breathing. She would go into the rooms of some residents to make a closer inspection, to offer a drink or words of comfort. Some slept with the dim light over the wash-basin left on and others with the main light on. Some slept with no light on at all, just the dim glow from the corridor shining in and casting strange shadows around the room. Some residents slept for long periods, while others hardly slept at all. Some watched the television, regardless of what was showing.
Sleeping tablets were given to a dozen or so residents; they were helpful to some and ineffective for others. A measure of whisky or something similar in a warm drink would often work, but alcohol had to be used with care. It interfered with some medications, either increasing or decreasing their effectiveness.
And then there were those who slept with the door shut, who didn’t want or need anyone checking on them during the night. They could press the nurse-call button if they needed something. After all, the leaflet entitled ‘An Introduction To The Tranquil Heart Care Home’, under the heading ‘Philosophy of Care’, clearly stated ‘every resident is entitled to have their privacy respected’. Unfortunately, many of the staff were not aware that the home had a philosophy of care. There was a framed copy of it in the entrance foyer, but nobody ever read it.
The first floor checked, Linda made her way downstairs and did the same on the ground floor. All seemed to be peaceful for the moment, so she joined Pauline and Sarah in the lounge.
‘There’s your coffee, Lin.’
‘Thanks.’
‘Are either of you watching this?’
‘No, turn it over if you want. It’s about time we had Sky put in. Don’t you think, Paul? Don’t you think the Hindmarshes could afford to put satellite TV in?’
The comment was not lost on Pauline. Linda settled back into the armchair and pulled the blanket up to her shoulders.
‘I’m froze! Don’t it go cold when the heating goes off!’
* * * * * *
It had been an uneventful night at the home. Those residents who usually slept well had slept well and those who didn’t hadn’t. Those who were usually wet or dirty had been wet or dirty. Nobody had died and nobody had fallen out of bed, so the Death Book and the Accident Book remained safe and snug in their filing cabinet. The uneventful nights at the Incontinental Care Home were the best ones.
When the long-awaited hour of eight o’clock finally arrived, seven residents, four of them in wheelchairs, were sitting in the dining room. The rule was that no resident should be got up before half past six unless there was a good reason. Needless to say, a good reason could always be found. Linda was not unique in having worked in care homes where residents in their eighties and nineties were got up at five in the morning to be bathed or dressed. Of the nearby Riverside Care Home it was said that all thirty residents had to be got up before breakfast. Since breakfast was at eight o’clock it was not difficult to imagine at what time these elderly parents and grandparents were dragged out of bed.
This morning’s early risers were at various stages of eating their breakfast. The always bright and cheerful Tony had started his shift in the kitchen at seven.
Pauline stood in the doorway of the office, putting her jacket on. Linda sat behind the desk, pen in one hand, covering a yawn with the other. The night report was in front of her. Sarah sat opposite her, shoulder bag dangling on the floor.
‘Is it all right if we go, Lin?’
‘Yes, thanks a lot.’
‘See you tonight, then.’
‘Bye!’
Pauline stepped out into the fresh morning air and pressed the button on her key ring. Indicator lights flashed as the alarm on her dark metallic blue new-registration BMW was deactivated. She would sleep for a couple of hours before going round to the gym for a moderately energetic workout. In her rush to drive off she didn’t notice Dave watching her from his first floor cell. Sarah would walk home.
A weary Linda went to the staff room to round up the morning shift for the handover. There wasn’t anything of note to mention, but the staff drifted into the office and Linda went mechanically through the list of residents.
‘Fine… no problems with her… slept well… also slept well… painkillers given at 2... wet a couple of times… talking to himself… fine… no problem… slept well…’
The report given, she handed the drug keys to Anna Peters, the Deputy Manager, and wearily left for home.
* * * * * *
And so began another day at the home, one of the many of its kind in West Dorset. Able to accommodate forty residents when it was full, it had only thirty five at present. It was rarely full, because residents either became ill and had to be transferred to the hospital or died and had to be collected by the undertaker. The local authority budget was as tight as ever and funding was only available for care home placements if an individual could not be cared for in any other way. It was usually cheaper for an elderly person to be looked after in their own home if this was feasible, and obviously this was where most of them would rather be.
Some care homes were registered for nursing residents and some for residential residents. Some were dual registered and could accept both. Residential residents were expected to look after themselves to a large degree, to be able to wash and dress themselves, be mobile and be continent. Supervision and minimal assistance, at least in theory, were provided. A residential home would often have no Registered Nurse on the payroll and this would be reflected in the lower level of fees charged, around £550 a week. It was of the utmost importance to maintain a high room occupancy level, because an empty room was a waste of space. It earned nothing.
Apart from the Registered Nurses, staff were paid the national minimum wage for day shifts, nightshifts and weekends. It was time and a half all round for bank holidays.
Anna sat behind the untidy office desk and allocated tasks to the carers, who then went off to tackle their assigned duties. The home’s diary was open on the desk and Anna dutifully glanced at it.
An attractive twenty-seven year old, Anna Peters had been working at the home for nearly six months. She hadn’t worked for a couple of years following the birth of her first child and was anxious to get back into the cut and thrust of the intensive care unit at a nearby hospital. This care home appointment was a stepping stone on her way back. She would be taking some time off to attend training days and hoped to be back among the cardiac monitors, intravenous infusions and respirators by the end of the year.
The diary reminded her that a group of local junior school children would be making another visit to the home after lunch. This time they would be entertaining the residents with May Day songs and dances around the maypole.
‘Why do these visits always happen on my shift?’ she thought. But Anna knew that most of the residents would thoroughly enjoy the children’s visit. Elderly people and young children seemed to get on well together, at least for short periods. These youngsters’ visits had become popular with the old folk and
were now a regular fixture. Even so, there would be one or two residents who wouldn’t enjoy the visit. You meet such people everywhere, including care homes • people who seem determined not to enjoy anything.
It occurred to Anna that Tony might not have been told about the school’s visit, so before making her customary tour of the home she made her way to the kitchen to break the good news to him. Orange squash and biscuits were usually provided. The children’s previous visit had been just before Easter, when they had worn Easter bonnets which they had made in their classes. Appropriately, each child had been given a cream egg.
* * * * * *
When Joan bustled into room eight she glanced at the figure in the bed to see if it was awake. It was. In fact, Nancy had been awake for some time. A warm wet patch in her bed had woken her up, but she’d been unable to do anything about it. She now had a cold damp patch in her bed.
‘Morning Nance! How are we?’
‘I’m wet.’
‘What’s new?’
Nancy was always wet in the mornings. Even if changing her was the last thing the night shift did, she would still be wet before it was time to get up. Nancy liked Joan, probably because she was one of the older members of staff, being fifty-something and looking forward to retirement. Her husband, Arthur, had already retired from his factory work and they had plans to move away to Bridport. Joan had worked at the home since its opening nine years before and had worked as a carer in hospitals for many years before that. She had the ability to truly understand elderly people, a somewhat rare attribute in care homes.
‘Ready to get up, Nance?’ she asked.
Nancy would have said something if she hadn’t been, but she said nothing, so Joan drew back the bed covers and in one practised movement pulled the diminutive Nancy up and swung her thin legs around so that she was sitting on the edge of the bed. The commode was by the bedside and Joan helped Nancy on to it. She ran some warm water into the basin.
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