The Happy Memories Home for the Elderly had several residents who suffered from various forms of dementia such as Alzheimer’s Disease. Some of these folk were good on their feet and presented a considerable risk in regard to their security and safety. They were capable of escaping!
These individuals were taken to the downstairs lounge, where it was easier to keep an eye on them. It was, the Manager said, simply a matter of risk assessment. Despite everyone’s best efforts, though, occasionally someone would manage a brief escape, wandering optimistically down the street before being recaptured.
In much the same way as these residents might, in years gone by, have sat as parishioners in the same church pew each Sunday, so most of them now sat in the same armchairs all day. This allowed staff to cast a quick glance around the lounges and guess with reasonable accuracy who might be in the toilet, who might be in their own room and who might be somewhere they shouldn’t be. It also presented a problem. Squabbles would occasionally break out because someone was sitting in someone else’s armchair.
* * * * * *
Dave didn’t say much. Except to himself.
She’s coming over to you. You know who she is. She always comes over to you. Never fails to. In a minute. Give her time. The poison woman. The guard with the poison. Here she comes, regular as clockwork. They’ve sent the pretty one to me this morning, but she won’t be on her own. There’ll be others. They all work together. Resist, Dave! Be brave, Dave! It’s useless to resist them, but you must! None of the others will resist, Dave, but you must. I must resist them. Perhaps the others don’t know what is going on, but I do. Don’t drink it, Dave! It’s poison, Dave. What are you doing, you fool, you’re drinking it!
‘Finished with your coffee, Dave?’ asked Lisa.
‘Yes thanks, I have. I’ve drunk it all, thanks.’
* * * * * *
With the drinks trolley safely back in the kitchen, it was time to toilet those who needed to be. The ‘feeders’ would be taken to the loo first because they would be the first sitting at lunchtime. The results of this toileting varied, depending upon the administration of diuretic water tablets earlier that morning and opening medicine for the bowels the previous evening. An over-enthusiastic administration of the latter could make the situation on the following day somewhat dire.
‘I tell you what, if I don’t win the damned Lottery this week, I’m never going to!’
* * * * * *
Lisa, Dave’s pretty carer, Adrienne and Steve were in the staff room, since things were relatively quiet and the chance to have a break couldn’t be passed by. Breaks were taken when the opportunity arose. You couldn’t be sure about getting another one.
‘You know, those huge Summer Fayre signs that go along the front of the home. Those blue and white boards with the date and time and things. Where are they?’
‘Under the fire escape, Steve, aren’t they?’
If you couldn’t find anything, you asked Adrienne. The most thorough of cleaners, she knew every part of the home like the back of her hand.
‘It’s not that time of year already! Where are we going to put all the stuff? In room 10?’
‘We’ll have to sort out a date first, Lisa. That depends on the Manager and the owners. The Hindmarshes like to be consulted on these sorts of things.’
‘Leave a note in the diary, Steve. We’ll have to choose a date soon because we’ll need to start collecting.’
‘Mind you, we was lucky with the weather last year, remember? We had the only dry day the entire week! Let’s hope we have the same again this year. Then some of the residents can sit outside. Perhaps we can raffle one of them!’
‘If you can help me get those signs out some time, then Trevor can paint the new date on them.’
‘Any time, Steve. Just let me know,’ replied Adrienne.
Lisa was twenty-three and had been working at the home for fourteen months or so. Attractive and an avid party lover, she had an exhausting social life. This meant that she was not at her best first thing in the morning, especially a Saturday morning. This Saturday morning was no exception. Her head ached. Her thighs ached. She sipped her coffee. She’d asked to work this morning because she planned to be out again that evening. As far as Lisa was concerned, Saturday evenings were not made for staying in and watching television. She would be out with the boyfriend and her mates in some pub or other, or a nightclub, until the early hours.
The exception to this routine was when she was broke, which was once a month, just before payday. She would then be cadging cigarettes off anyone.
‘Just one, thanks. You’re a life saver!’
Yet, despite her erratic lifestyle, Lisa was a caring, conscientious and reliable young lady. The old people liked her. Perhaps they saw something of their own younger selves in her. The world in which Lisa lived was, maybe, not so very different in some ways from the world they remembered growing up in.
‘I’ll ask my mum for some Avon bits for the raffle. No harm in asking, is there?’
Over £400 had been raised at the previous year’s Summer Fayre. This money was kept separate from other monies in a residents’ bank account to which only Joan, Carol and Steve had access. Last year’s money had been used to buy luxury items such as birthday presents for the residents. It also bought bubble bath and talc for those residents whose family didn’t provide such items. The provision of toiletries was not included in the care home’s fees. Neither was the hairdresser or the chiropodist.
The fund had allowed some of the residents to enjoy a day out at a local bird sanctuary in August. It had also been possible to take a few of them to a pantomime after Christmas. In recent years the local fire service had gained a glittering reputation for putting on a good panto. Organised in support of some charity or other, it was an evening of lunacy, mayhem and forced audience participation in the nearby community centre. Carefully-selected senior citizens from the home were able to forget their age and enjoy being young again.
Like all the residents, Ralph was accustomed to strangers being shown around the home, his home. Many were looking for a room for their aging relatives. As one of the consequences of his stroke, Ralph’s speech was indistinct and he had difficulty in communicating effectively. However, being a determined man, he usually managed a few discernible words to indicate his genuine delight at seeing visitors. He was also able to make gestures. Appropriate gestures, thankfully. Ralph was always hoping that when the new resident arrived it would be another man with whom he could strike up a friendship. He accepted that it was difficult for anyone to have a proper conversation with him these days, but the thought of future companionship was one motivation for him to persevere with efforts to speak clearly.
The small group made its way along Ralph’s corridor, led by the home’s Manager, Mrs Jenkins. There was some snippet of conversation about a special diet, Ralph thought.
‘Sweeteners, the cook will use sweeteners. We have several diabetic residents. Ah! This is Ralph. Good morning Ralph. How are you?’
Mrs Jenkins didn’t wait for Ralph to attempt a reply. She gestured and the visitors followed her into Ralph’s room.
‘There, you see? Its not too difficult to make a room look homely.’ The visitors were predictably impressed.
‘Your father can bring in bits of furniture. As long as it’s not got woodworm or whatever. A favourite chair, a small bookcase, some army photos or some of the family, that sort of thing.’
Ralph’s room was tastefully decorated with personal mementoes. Pictures and photos had been hung on all the walls. If a room was to be shown off to visitors, it was Ralph’s. And Ralph kept his room tidy, which made him very popular with Adrienne.
Mrs Jenkins had much to do, but a high room occupancy level was vital for the good of everyone, so time had to be made for these tours. She had found that a tour could be completed in fifteen minutes, plus a five-minute chat in the office to bring things to a tidy conclusion. Upon returning to her office she handed
the visitors a copy of the home’s brochure.
‘You’ll find the home’s contact details in this booklet. Don’t hesitate to ring me if you have any questions. If I’m not here the staff will help you. I’m sure our staff will do everything to make… I look forward to hearing from you…Thank you for your interest… It’s been a pleasure.’
The elderly Mr Sainsbury would now have to be persuaded by his three daughters to become a resident in a care home. Ralph had heard Mrs Jenkins remark that the man could bring army photos in with him.
‘An old soldier’ thought Ralph to himself. Once again, he was full of anticipation.
* * * * * *
It should come as no surprise to learn that there were those among the residents who did not know what time of year it was. Or what day of the week it was. Or who the current prime minister was. If you asked they would probably say Tony Blair. Their mental faculties had deteriorated to the point where they seemed to be living either in the distant past or in a continuous ‘now’, unable to remember the recent past and unable to anticipate the immediate future.
An assortment of daily newspapers was delivered to the home each morning, the delivery time depending on school terms and school holidays. The cost of the papers was met by the resident concerned. Thus it was that some of the residents at The Golden Farthing Care Home were very much aware of the world around them. Natural disasters such as floods in Asia or earthquakes in South America, political scandals, bombings, the contestants in X Factor or the runners and riders at Ascot, none of these things was able to pass by entirely unnoticed. For others, events seen on television or read about in the tabloids could have been taking place on another planet. The distinction between fiction and fact, between Coronation Street and Panorama, was blurred and no longer understood. These residents were perpetual spectators of events that never touched their lives.
Sometimes a resident’s mental state deteriorated to the extent that even a wife or a son would no longer be recognised. This was a cause of considerable distress for those concerned. And so it was that Fathers’ Day, Sunday June 21st, dawned to a very mixed reception.
For Ralph it would be a day for receiving genuine affection from his family back home. It would be a day spent with Vernon, his eldest son, with presents, gin and tonics, home cooking and good company. Ralph would come back to the home at about seven, tired out but happy in the knowledge that he was valued and appreciated.
Both Vernon and Patrick were in business, the elder in computer software for industrial robots and the younger in banking and finance. They both worked hard, earned enormous salaries and had expensive, palatial homes. They both managed to find some time for their father, even if it was just popping in for ten minutes on the way home from work. They took turns at having their father home for Sunday lunch, so every fortnight dear old Ralph would be at one or other of his son’s homes being fed and watered, entertained by his grandchildren and feeling that his life had been productive and useful. Perhaps he was just another item in their overloaded diaries, but they both seemed to have a genuine commitment to him and rarely missed their turn at having him home.
No greater contrast could there be in Fathers’ Day celebrations than that between those enjoyed by Ralph and those refused by Dave. Who could know what went on in Dave’s head? He lived in his own world, at odds with everyone else. His son Paul would visit regularly, but was often unrecognised. Dave had only been out of the home three times since the day of his admission and two of those had been attempted escapes. The tale was told that on one visit from his son, Dave had gone down the corridor to the loo and refused to come out until staff could convince him that Paul had gone home. Nevertheless, there would be a visit sometime during this Fathers’ Day from a very loyal son.
For Ted and Samuel, the only other male residents in the home, there would be visits from family members during the day and cards from distant and not-so-distant relations with expressions of remembrance, love and devotion. Each card would be put in the recipient’s own room or placed in one of the lounges for a few days.
* * * * * *
The care home inspection team, known as Care Standards, arrived at nine thirty on Tuesday 23rd June. On this occasion the team was made up of two women and one man. Joan showed them to the office and then went to the kitchen to organise some coffee and biscuits. Steve was in charge, as Primrose Jenkins was enjoying a holiday in Spain.
Inspection visits were either ‘announced’ or ‘unannounced’. The former, as in this case, were advertised by phone and letter a month in advance. Posters were supplied to inform residents and their families of the impending visit in case they wanted to raise some matter with the inspectors. These announced inspections took place at least once a year. On the other hand, any number of unannounced visits could be made, some of these out of hours at weekends or late at night.
The purpose of each inspection visit was to ensure that the premises and the level of care provided were of a satisfactory standard. There were umpteen pieces of legislation with which the home had to comply. There were Health and Safety laws, Food Safety laws, Fire Safety laws, Employment laws. The staff had to be properly trained, the electrical equipment had to be properly tested and the residents had human rights.
The long list of statutory care home administration items had to be inspected and approved. Rachel Stevens and Kimberley Thimble would work their way through this paperwork as efficiently as possible. Though both women were Registered Nurses, neither had worked in a care home; having experience of care homes was not a pre-requisite for inspecting them. Fire alarm log books, resident registers, accident books, nursing care plans, complaint forms, staff criminal record checks and a thousand other matters would be duly scrutinised.
The third member of the team was a retired butcher, Gordon Knox. Gordon now made his way to the ground floor lounge to talk informally with some of the residents.
Because this was an announced inspection, written details of which the Manager had received a month prior to the visit, there had been more than enough time to ensure that everything appeared to be in order. For instance, in those weeks when the fire alarm test had been overlooked, an entry would nonetheless be entered into the fire log book. Resident care plans that had been dormant for months would be updated and rewritten to give the impression that they were frequently referred to and regularly revised. The many resident assessments would also be reviewed and updated. Nutritional assessments, wound assessments, Waterlow or Norton Scale assessments (for predicting and avoiding bed or pressure sores), incontinence assessments, mobility assessments, assessments for the use of cot-sides, assessments of inappropriate behaviour, assessments of the likelihood that a resident might wander off the premises - if it could be assessed, it was. There is nothing like an impending inspection to motivate staff in the creative updating of all these matters.
Similarly, the kitchen record books would confidently show that fridge and freezer temperatures were rigorously noted three times daily as required and were always satisfactory. The testing of food temperatures would appear to be done regularly and to be satisfactory. The mantra of the day was that if something had not been recorded, it hadn’t been done, even if it had been. This attitude was seriously flawed. Someone’s initials in the kitchen cleaning record book was not evidence that the fridge had been cleaned. A tick in the bath book was no guarantee that the resident had been bathed. If ticks and initials needed to be seen, then ticks and initials would be provided. The greater the mountain of paperwork, the less chance the records would tell the truth.
Rachel and Kimberley waded through the list, never questioning the validity of anything they were presented with or doubting any word that fell from Steve’s lips.
‘Let’s move on to the kitchen then, shall we?’ said Rachel. The women picked up their checklists and left the office to make a visual inspection of the kitchen, its microwave, toaster, cooker, fridges and freezers, its floor, walls and ceiling. They might decide to inspect
the fridge and freezer temperature record book, the food temperature record book, the food thermometer calibration record, the kitchen cleaning record book and the food store, but these were often left to Environmental Health Officers to look at on their inspection visits.
Mr Knox had, in the meantime, wandered into the lounge.
‘Hello, how are you?’ he said to one of the residents. Dave gave him a blank look.
Don’t give away any secrets, Dave. Don’t put your life in danger. Keep quiet.
‘I’m Gordon Knox. My friends and I are visiting the home today and checking to make sure that you’re comfortable living here.’
Be strong, Dave. Be strong and brave. They want you to talk and give the game away. Don’t let them make you, Dave. The escape, remember the escape. You’ll never escape if you give the game away.
‘Are you happy here? Have you made new friends?’
Dave looked away as if he hadn’t heard. Mr Knox realised that he had chosen the wrong resident. He thanked the silent man and moved across the lounge.
Well done, Dave! Brave Dave. The plans for the escape are safe. No secrets given away. Good old Dave!
Dave had a broad grin on his face as he clapped his hands together loudly, got up and walked out of the lounge.
‘Good morning, I’m with some friends who are visiting the home this morning. Checking to see that all is well. The name is Gordon.’
‘Good morning to you, sir! I’m Ted White.’
Twenty minutes later, having had a couple of useful and illuminating conversations with residents and staff, Mr Knox joined his colleagues on their tour of the home. They were in the laundry. It would probably take all day to look at every room in the place, but every room would be looked at.
Autumns Colours Page 3