‘A quick wash, Nance, just to freshen you up’ she said.
The warm flannel was quickly wiped over Nancy’s face and hands, Joan chatting all the while. The nightdress that had once belonged to someone else was removed and Nancy’s chest and back were washed, dried and powdered. Her knickers were pulled up to her knees and her vest, dress and cardigan put on. She didn’t wear a bra. Then the stockings and slippers. Stockings or socks were preferred to tights because they made toileting easier. The choice of clothes was Joan’s, since it was unlikely that Nancy had the slightest idea what clothes she possessed. The buzzer was pressed and while Joan waited for assistance she put a brush through Nancy’s grey hair. Then she rinsed the old lady’s dentures.
‘Open wide, Nance!’ Nancy opened wide.
For some reason she was particular about wearing her watch. Some carers forgot about it or couldn’t be bothered to put it on, but not Joan. Whether Nancy ever looked at it nobody knew, but it obviously had some sentimental value for her.
Joan had begun to strip the bed before Zoe answered the buzzer.
‘Hi! Need a lift with Nance?’
‘Yes, please.’
‘Morning Nance. How are you? Sleep well?’
‘No, not very well.’
‘Ah, never mind. I expect you’ll fall asleep in the armchair after breakfast.’
Between them they lifted Nancy off the commode and Joan washed her resident’s bottom, dried and powdered it. She arranged the incontinence pad, the first of four allocated to Nancy each twenty• four hours, pulled up her knickers and the two of them sat her in the wheelchair.
‘You’ll do!’ said Joan.
‘I’ll take her down with me’ said Zoe. ‘Anything else to go down?’
‘No, not yet, thanks.’
While Joan finished making the bed, Nancy was pushed towards the lift. For her, May Day had begun as monotonously as any other day.
* * * * * *
For Maureen Biddlecombe, life was somewhat more interesting. On a Monday she would attend a speech clinic at the nearby Dorset County Hospital, and would set her alarm clock for seven. She was able to wash and dress herself with a minimal amount of help and on clinic days she would apply a little make-up. Tony would ensure that she had her breakfast on time and the Registered Nurse would check that she had her midday medications in her handbag. Maureen would then walk, aided by her stick, gently down the corridor to the entrance foyer. She would find herself a seat and look out of the window for the hospital car that was booked to pick her up at nine-thirty.
At only sixty-four, Maureen was one of the younger residents. She had retired from full-time teaching, but had continued to involve herself in teaching ‘literary skills’ at evening classes. That was, until her brain haemorrhage or ‘stroke’. She had needed emergency hospital treatment that involved delicate surgery to remove a blood clot from somewhere in her brain. The subsequent improvement in her condition had been rapid and sustained. Having nobody to care for her at home and home being a fourth floor flat, she wasn’t too averse to moving into a care home, at least as a temporary measure. If all went well she hoped to return home in a couple of months. She was friendly enough towards the staff and other residents, but she was a woman who preferred her own company. An avid reader of classic novels, she remained a faithful listener to radio four.
The residual effects of the stroke had left Maureen with a slight weakness affecting her left arm and leg. She had difficulty in fastening small buttons and lifting some of her heavier books. Despite these restrictions she managed to do much for herself and had regained a near independence. She walked reasonably well with her stick, and though her speech was still affected to a marked degree she was able to make herself understood, even if this sometimes meant repeating herself. It was because her GP believed that her speaking could be further improved that she continued to attend the Monday dysphasia clinic.
The hospital car, a gleaming dark green Audi, would pull into the drive at nine-thirty. Maureen would pick up her handbag and make her way out into the fresh air. The driver was Ray. He would hold the car door open for her as she approached the car and they would exchange warm greetings. He would hold her handbag as she made herself comfortable in the front seat. He would then close the door. The two of them got on well and had become close friends; closer than anyone at the home realised.
* * * * * *
Two lines of school children, about twenty of them in all, dressed in red jumpers, bounced and skipped excitedly along the pavement. Each had a posy of crêpe paper flowers in their hand, put together with characteristic childlike enthusiasm during their craft lesson. The intention was that each posy would be given by its creator to a resident. Miss Graham carried the colourfully-decorated maypole, and when Mrs Brown pressed the doorbell, St Mark’s Junior School’s policy for ‘creating and maintaining meaningful links with the community’ swung into action once more.
Anna and her colleagues had done their best. Now, at two-fifteen, most of the residents were seated in the lounge with their chairs against the wall, leaving enough room for the children to perform their singing and dancing. Toileting had been completed and medications had been administered. Joan was left to keep an eye on proceedings, while the rest of the shift went off to the staff room for coffee or out the back for a cigarette. The concert was due to finish at three, the time the afternoon shift started.
It was obvious that Mrs Brown had the situation under control. She oozed confidence and authority.
‘If she had not been a schoolteacher, she could have been a very capable nursing home manager’ thought Joan.
‘On behalf of the children of St Mark’s Junior School, we would like to thank you for allowing us to visit you this afternoon’ she began.
‘The children have been looking forward to coming to see you, haven’t you, children?’
‘Yes, Mrs Brown.’
‘The children have also been very busy, haven’t you?’
‘Yes, Mrs Brown.’
‘They have each been making a little gift for you.’ She turned to the youngsters. ‘Now, children, would you like to give these ladies and gentlemen their flowers?’
The boys and girls had been standing just inside the door of the lounge. Mrs Brown had been warned that it might be best if they did not sit on the floor. Cautiously at first, the children moved nervously among the residents, each dutifully offering his or her posy of flowers to whichever resident looked least frightening. It took about two minutes for this ‘social interaction with the planned outcome of developing interpersonal skills’ to be completed. Then the children gathered once more by the door. Adam was particularly happy. He was the envy of his peers, because he had arrived back with a fifty-pence piece in his hand.
The may pole stood in the centre of the room, and the energetic boys and girls hopped and skipped their way through the presentation. Those who were not gifted with the artistry of gracious flowing movement formed the choir and sang as best they could. Mrs Brown conducted the whole show with aplomb, finishing within a minute or so of three o’clock, much to Anna’s relief.
Joan stepped forward and thanked the children and their teachers on behalf of the residents, adding that she was sure that they looked forward to the next visit. The children were led to the dining room for their reward, squash and chocolate biscuits. Mrs Brown and Miss Graham were grateful for the pot of tea.
Quiz
Some suggested answers are in italics.
‘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.’
1. If you woke up in the middle of the night and found that you had wet yourself, how would you feel about it?
• I would feel -
<
br /> • Embarrassed. What am I going to say to my partner, my parents?
• Worried. Is there something wrong with me?
• Shocked. I can’t believe it!
• Panicky. Do I need to see my doctor?
• Puzzled. What’s going on?
• Annoyed. Now the mattress is going to smell!
2. How might Nancy feel about wetting her bed?
• She simply accepts it as part of growing old.
• She no longer cares about what she does. This includes wetting her bed.
• She feels embarrassed and bad about it, but staff seem to accept it as normal behaviour.
3. In January 2001 an official report condemned the use of cot• sides. There had been some nasty injuries and a couple of deaths caused by their use or misuse. Do you feel that their use is justified, or do you agree that they should be banned?
• Your answer.
• Although frequently referred to as ‘cot-sides’ the correct term these days is ‘bed-rails’. The word ‘cot’ is deemed inappropriate when used of adults.
My opinion is that a risk assessment should be carried out for each resident who needs to use them. Carers should be aware that the misuse of cot-sides may cause injuries. Padded ‘bumpers’ should be used with them.
4. List all that Joan did for Nancy as she got her up, ready for breakfast.
• Joan -
• Greeted Nancy by name.
• Asked her if she wanted to get up.
• Sat her on the commode.
• Undressed her.
• Explained what she was going to do.
• Chatted all the while.
• Washed her.
• Brushed her hair.
• Dressed her.
• Put her watch on.
• Cleaned her dentures.
• Put an incontinence pad in place.
• Stripped and remade the bed.
• Made a visual inspection of Nancy’s skin condition.
‘Sleeping tablets were given to a dozen or so residents and proved to be helpful to some and ineffective for others.’
5. One of your residents is unable to sleep tonight. What could be the reason?
• They’re worried about a relative, friend, neighbour or pet.
• They’re frightened of dying.
• They’re upset about the death of a friend, relative or another resident.
• They have a stomach ache, arthritis pain, toothache.
• They’re disturbed by noise from another resident’s television.
• They’re hungry or thirsty; too hot or too cold.
• The light has not been turned off or left on.
• They’re spending too much time sleeping during the day.
6. What are you going to do to help this resident sleep?
• Find the time to talk to them and ask them why they can’t sleep.
• Use common sense to ascertain the problem.
• Offer words of comfort, a warm drink, paracetamol tablets, to switch the light off or on, fetch another blanket, etc.
• Consider if this should be reported to senior staff.
• Ask that they be kept occupied during the day.
• Consider if a visit from a church minister might be helpful.
7. What alternatives to sleeping tablets could you suggest for your insomniac residents?
• A warm, milky drink.
• Watching television, listening to the radio or to music.
• Tea and toast.
• A covered hot water bottle (if allowed).
• A drink of whiskey or brandy, possibly in warm milk, after checking with senior staff.
• Reading a book, newspaper or magazine.
• Doing a crossword puzzle.
‘Elderly people and young children seemed to get on well together, at least for short periods. These youngster’s visits had become popular with the old folk and had become a regular feature.’
8. Why do elderly people and young children often get on well together?
• Your answer.
9. Why might older people only be able to tolerate young children for short periods?
• Your answer.
10. Why would the children have been warned not to sit on the lounge floor?
• There could be wet patches caused by urine from incontinent or confused residents.
• Drinks might have been spilt on the carpet.
11. In what ways might elderly people in your care home be treated like young children by carers like you and by their own relatives?
• They are not asked about or involved in decisions being made concerning them, eg the clothes they are going to wear today, the foods they are going to have for lunch.
• Childish expressions are used in speaking to them.
• ‘Stand up for me, there’s a good girl!’
• They’re told off when they have done something wrong, such as wet themselves. - ‘You dirty boy!’
• They’re spoken down to or threatened.
• ‘You don’t want me to have to tell your daughter, do you?’
• They are given bibs to use at mealtimes.
• Their medications are not explained to them.
• They are told to ‘eat their vegetables’.
• ‘Just one more spoonful for me! There’s a good girl!’
• They are pushed around the home in a wheelchair when there is no need for this.
12. Why might you be treating them like young children?
• They sometimes behave and talk in a similar way to young children.
• They make a mess at mealtimes.
• They wet and dirty themselves, wear nappies and have to be toileted.
• They can’t talk and make themselves understood.
• It’s easier to control them.
• They don’t object to being treated this way.
CHAPTER TWO
An inspector calls
Most of the residents at the Golden Dawn Care Home would be woken, washed, dressed, breakfasted and tableted by eleven o’clock. Some would have endured, or possibly enjoyed, a bath before or after their breakfast in order to comply with the bath rota which was displayed on the office notice board and in the downstairs bathroom. The more dominant carers kept the bath rota under review, Tippexing out and adding names as residents died and fresh faces arrived. The majority of residents didn’t have any say when it came to the when, where and by whom of bathing. They were simply told at what time and on what day they would be bathed. They would be bathed by whoever was available.
‘Maude, my dear. Hilary has had to rearrange the bath rota and now your bath day is Tuesdays. All right? Not Thursdays any more. Tuesdays!’
It was inconceivable that there could be any plausible reason for Maude to object to this change.
‘That’s settled, then!’
Residents were bathed at least once a week, more often if incontinence made it necessary. The more sensible residents might be allowed to choose the day and the time of their bath, and if the resident was insistent enough, a bath could be taken when a favourite carer was on duty to do it. But for those robbed of a sound mind, life was different. It was they who were likely to be bathed as early as six o’clock on winter mornings, since they had no idea what the time was.
The time of day was irrelevant to them, anyway. Baths, together with bowel movements, were recorded by ticking the appropriate column in the ‘bath and bowel book’. As if this wasn’t enough, a comment would have to be made about both matters in the resident’s individual care notes hastily completed at the end of each shift.
As eleven chimed, the majority of the residents would be performing according to the script written for them and be sitting in one of the home’s three lounges. The likes of Maureen Biddlecombe, Ralph Edwards and their ilk preferred the peace and safety of their own rooms.
A trolley would set off from the kitchen, and its ra
ttle would be heard announcing the arrival of the mid-morning drinks long before it actually appeared in the ground floor lounge. It would be equipped with an assortment of jugs, cups, mugs, beakers, jars and spoons and offer tea, coffee, drinking chocolate or Bovril. On the bottom shelf a Cadbury’s Roses tin would be half full of plain biscuits. Chocolate biscuits or Jaffa Cakes would have made a welcome change, but these were only rarely available. This, it was said, was ‘because of the diabetics’.
This morning it was Lisa’s turn to dispense lukewarm drinks to the fifteen or so residents that occupied this lounge. She adhered to the advice she had been given when she had first started working at the home.
‘Don’t give no one boiling hot drinks. If one of them spills it and scalds themselves, their family will more than likely sue us. And bang goes any hope of a pay rise!’ Thus it was that none of the residents at The Singing Kettle Home for the Aged could ever remember receiving a hot drink. Warm was the best that could be hoped for.
When the ground floor drinks had been distributed, a tray of tea and coffee was taken to the upper lounges. Those who stayed in their own rooms enjoyed a form of room service.
The large television in the lower lounge was on all day and was always on ITV. Any attempt to change the channel was met with immediate protests from Old Rose, the older of the two residents with that name. Old Rose also protested whenever a window was opened, no matter what the time of year.
‘I don’t care! I want it closed. I’m perished!’
There would be five or six folk in the first-floor lounge. It was a smaller and quieter room than its downstairs equivalent and its television was off more than it was on. Two framed black and white photos of ‘Old Dorchester’ hung on one of the walls. Like the other lounges, the walls were the same boring magnolia and its chairs were high-backed and made from a blue vinyl that could be washed easily should any mishap occur. The carpet, also blue, was of a special type that was suited to ‘environments where urinary incontinence might otherwise be a significant problem.’
Autumns Colours Page 2