Autumns Colours

by Nick Holloway

  * * * * * *

  Mrs Jill Hindmarsh was making her way to Salisbury. Her father had not been too well in recent weeks, so she was planning to spend a couple of days with her parents. She made frequent visits to see them, not least because she loved Salisbury for its shopping. On this occasion she was bringing some groceries with her and two new pairs of trousers. Though her elderly mother was still quite active, she didn’t share her daughter’s love of shopping. Jill would take it upon herself to go through her father’s wardrobe and replace old trousers with new.

  Later that day a dark metallic blue BMW with a new registration would drive into the Hindmarshes driveway.

  It was past six-thirty when the inspectors finally left The Golden

  Star Care Home. All seemed to have gone well. Nothing dreadful had been discovered and no embarrassing mishap had occurred. A written report of the findings would be received by the Hindmarshes and by the Manager within a few weeks. It would also appear on the inspection team’s website for anyone to read. Copies of these reports were always made available to members of the public.

  Quiz

  Some suggested answers are in italics.

  ‘The majority of the 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.’

  13. If this was your care home, what would it tell visitors about the quality of care you were providing for your residents?

  • The quality of care is not like that expected in a care home, but more like that expected in an institution.

  • Residents are not involved in decisions being made on their behalf.

  • Residents are treated as if they were children, being told what to do.

  • The quality of care is adequate, in that residents are bathed regularly and do not smell of urine or faeces. Incontinent residents are bathed more often to prevent their skin being excoriated.

  ‘Lisa was twenty-three and had been working at the home for fourteen months or so… 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.’

  14. What has Lisa’s life got in common with the earlier lives of her residents?

  • Parents who might not understand young people.

  • The need to get a job and earn money.

  • Enjoying parties, dancing and nights out.

  • Wanting a new boy/girlfriend.

  • Dumping your boy/girlfriend.

  • Planning to get married.

  • Avoiding getting pregnant.

  • Liking new clothes and wanting to be fashionable.

  • Hearing about wars all around the world.

  • Smoking!

  15. In what ways is Lisa’s life easier, better and safer than the earlier lives of her residents?

  • Better healthcare.

  • Immunisations against diseases.

  • Contraception easily available.

  • National Minimum Wage.

  • Holidays abroad.

  • Computers and the internet.

  • Mobile phones.

  • National Health Service.

  • Health and safety laws at work.

  • On line shopping.

  • Childcare, nurseries and child minders.

  • The right to maternity leave and maternity benefits.

  • Nicotine patches!

  ‘Like all of the residents, Ralph was accustomed to strangers being shown around the home, his home.’

  16. What is it about your care home that makes it feel homely for your residents?

  • Having personal items with you such as photographs, ornaments or a rocking chair.

  • Matching fabrics such as curtains, carpet and bedspread.

  • Meals that take into account your preferences.

  • Likes: brown bread, blue cheese, red cabbage, black pudding.

  • Dislikes: greens.

  • There are no unpleasant smells.

  • Feeling safe and secure.

  • Being allowed to go outside, or wheeled outside for a cigarette.

  • Having friends and family call and visit.

  • Being spoken to by your own name.

  • Having somewhere to lock away your valuables.

  • Being allowed to drink alcohol.

  17. Does your care home feel like a home or an institution?

  What’s the difference?

  • Your answer.

  My own opinion is that a care home is where the needs of an individual resident are put first whenever possible and practical. An institution is where the needs of individuals are largely ignored.

  Rather than the routine being planned around individuals, in an institution the individuals have to fit in with what is organised.

  ‘It should come as no surprise to learn that there were those amongst the home’s residents who were unaware of what time of year it was. Or what day of the week it was.’

  18. Autumn’s Colours highlights some of the ways in which dementia and confusion show themselves in the lives of our residents. List as many as you can find.

  • Dave talking to himself, planning an escape and seeing everyone as an enemy.

  • Residents unable to eat their food without getting into a mess.

  • Residents using knives and forks upside down.

  • Residents eating food with their fingers.

  • Some residents not recognising family and friends.

  • Residents not knowing what day of the week it is.

  • Dave walking into the rooms of other residents at night.

  • Vera wanting to get up and go shopping in the middle of the night.

  • Residents unable to have a sensible conversation.

  • Some residents not able to differentiate fact from fiction.

  • Old Rose never wanting a window open, even in summer.

  ‘The greater the mountain of paperwork, the less ‘accurate’ it was likely to be.’

  19. It’s a common complaint. Too much paperwork! List some of the paperwork that you think is unnecessary or a waste of time.

  • Your answer.

  My opinion is that the assumption, ‘If a task hasn’t been recorded, it hasn’t been done,’ is fundamentally flawed. It’s an unsafe assumption to think that a task has been completed simply because a tick or an initial suggests that it has. Care home managers, owners and inspectors should overhaul and review what paperwork is needed and what records are required to be kept, with a view to reducing it by fifty percent.

  CHAPTER THREE

  The care home

  You’ll find the Madding Crowd Care Home in the picturesque and atmospheric town of Dorchester in West Dorset, Thomas Hardy’s Casterbridge. From Dorchester it’s an interesting drive along the A35 to the shopaholic’s paradise known as Bournemouth, the destination of many a sun-seeking and beach-loving holidaymaker over the decades.

  In the past Dorchester had the dubious distinction of being the town with the highest ratio of three-car families. To the north-east is the uniquely beautiful and sacred city of Salisbury, its cathedral towering above neighbouring buildings. And only eight miles to the south, a short and exciting journey over the Ridgeway, lies the intimate town of Weymouth. From the Ridgeway is signposted the aptly named ‘Came Down Golf Course’. Resculptured in places for the 2012 Olympics, much of Weymouth looks the same as it did when King George the Third visited it some time ago.

  In bygone times Dorchester was a much smaller and more rural town. Parts of it still look rustic and unchanged from previous centuries and the days when Judge Jefferies sent the Tolpuddle Martyrs to a warmer climate. But despite its fascinating history, the local authority felt the need to earmark strategic sit
es for housing, retail and industrial development. Consequently, new housing estates appeared, one of which was the Castle Park Estate with its accompanying array of supermarket, post office, school, themed pub and garage. This part of the town, changed beyond recognition, lies in the shadow of Maiden Castle, a 6000-year-year old earthwork that remains unchanged and sentry like, surviving as a vast and grassy monument to earlier human settlements.

  After a series of planning applications and appeals, another housing estate was nearing completion. Spreading to the dual carriageway that separates the twenty first century from the remnants of a fourth century temple that our Roman friends built on Maiden Castle, was the Maiden’s View Estate. It was here that the Hindmarshes had a detached house at the end of a cul de sac, far from the madding crowd.

  * * * * * *

  The Hindmarsh’s care home was not a new, purpose-built structure. It was a converted building. Most visitors agreed that a reasonable job had been made of the conversion. Doorways were widened for wheelchair access, ramps with handrails replaced steps at the front and back of the building and three lounges were provided, one on each floor. Other rooms were turned into an office and a staff room, the latter, thankfully, some distance from the residents’ areas. A spacious laundry was created and the old lift replaced with a new model. The kitchen and the main dining room had been placed next to one another, something that might seem obvious, but which is evidently not obvious to all architects.

  In former days Dorchester had enjoyed its own small hospital, Dorset County Hospital in Princes Street, a solid-looking stone structure with blue metal fire escapes scarring the exterior. Other small hospital units were spread around the town. With the town’s expanding population these facilities were initially enhanced by putting Portakabins on the Princes Street site as a temporary measure.

  These had formed the Children’s Unit and the Geriatric Unit, as it was then called. Eventually, to the relief of almost everyone, it was decided that money would be better spent building a completely new hospital for Dorchester and the surrounding villages on a new site away from the town centre, so the old hospital was closed and sold off to developers. One of the satellite units sold off at the same time was a geriatric unit in Damers Road. It was this unit that Mr and Mrs Hindmarsh purchased and converted into their 40-bed care home.

  The Trumpeting Major Care Home for the Elderly and Infirm of Casterbridge therefore looked grand and elegant. Stone walls merged with double glazing. The main entrance was right of centre and led into a foyer. This has been designed to serve as a reception area with an administrative office, but it was found that there was no need for a receptionist, so it became a store for resident records and other documents, alongside zimmerframes.

  Primrose Jenkins managed the day-to-day running of the home from her office down the corridor. A large photograph of Brian and Jill Hindmarsh was displayed ostentatiously in the foyer and a small spotlight in the ceiling highlighted the smiling couple.

  On the whole, the Hindmarshes were reasonable proprietors and employers. Little was known about their background, since they sought to keep their personal lives well away from their business activities, but they appeared to be a normal middle-aged couple. They chose not to interfere with the running of the home, since neither of them had any nursing or medical experience. It was said, however, that they had once had a female relative in a nursing home who had died in tragic and mysterious circumstances. The passage of time and the absence of hard facts had allowed the details of this dark episode to be embellished. Was there any truth in the story that the old lady had been murdered by another resident?

  When the Hindmarshes came into money from somewhere they decided to buy their own care home. The rumour that they were big national lottery winners was doubted, but could not be altogether dismissed.

  The couple generally visited the home at least once a month, usually by prior arrangement with Mrs Jenkins, staying for an hour and discussing matters of the moment. They would introduce themselves to any new residents and members of staff. Brian would also call in each Saturday morning to collect any residents’ fees, sign cheques and, as he said, to make sure that all was well.

  Alas, the home had little in the way of lawns or gardens. It could only boast a couple of very small flower beds and several concrete troughs. Some of these had daffodil bulbs planted in them, forgotten all year round until they made a welcome display each spring. The others had various bits and pieces growing in them, planted by an elderly bow-legged man who was employed to do the gardens.

  In fact old Frank was not actually paid for his labours. His frail old wife had died at the home after a long illness some three years back. Having been a regular visitor during Beryl’s slow demise, he had missed his visits when she eventually died. With time on his hands, he had volunteered to look after the flower beds, which had until then been woefully neglected. And so, from time to time old Frank would appear in his green apron and wellies to ‘do the gardens’.

  * * * * * *

  Mealtimes were often hard work at The Mince and Mash Care Home for the Masticatorially Challenged. Breakfast was the easiest meal of the day, because it arrived in several stages. Folks had their porridge or Weetabix, their tea and toast. They seemed to want none of the alternatives. Perhaps there weren’t any. But dinner time was different.

  It’s time for your rations, Dave. What do you have to do, Dave? I have to eat it all. I have to eat it all. All of it. You need your strength, Dave. Remember the escape. You’ll need your strength. The situation is grave, Dave. Be brave, Dave!

  ‘Dave, use your knife and fork!’

  Wendy took a paper napkin from the nearby trolley and wiped Dave’s gravy-covered fingers. She put the knife and fork in his hands.

  ‘Now try to eat properly.’

  Be brave, Dave.

  * * * * * *

  Dinner was served at one for most residents. The ‘feeders’, who couldn’t manage to feed themselves and needed various levels of assistance, were served earlier. Twisted arthritic fingers might be a problem for some, while for others it was remembering what to do with a knife and fork. For both care and kitchen staff it was easier to cope with lunch by having two sittings. The other residents appreciated this, since sitting next to the likes of Peggy or Dave and watching them eat could be enough to destroy the heartiest of appetites.

  The dining room was furnished with eight square tables, each accommodating four people. On each was a tablecloth of some description, four plastic place mats and a small vase of silk flowers. The tablecloths didn’t match one another these days. The green chequered ones had been brought in by ‘laundry Clare’ who had bought them in a car boot sale.

  And so Dave and Peggy sat at one table with Wendy attempting to stay in charge of proceedings while Eve was sitting at another with Tracey to help her. Tony had cooked chicken and mushroom pie, carrots, broccoli and potato, which he’d pureed for Eve.

  ‘There you are, you lucky people! Get that down you!’

  Wendy’s task was to ensure that the equally muddled Peggy and Dave didn’t try to eat each others’ meals, which they constantly seemed to find more appetising than their own, that they didn’t use their fingers to eat with and that the food went more or less straight from plate to mouth. Each wore a plastic apron to minimise collateral damage. Salt and pepper pots, vinegar bottle, sugar bowl and silk flowers were all put out of harm’s way.

  ‘If ever the expression ‘second childhood’ was applicable to old people, it’s at mealtimes’ said Wendy out loud.

  She could remember the day when, not long after Peggy had moved into the home, her family had decided to take their mother home for the afternoon and return her after tea. This, they had announced with evident self congratulation, was going to be a regular thing. It turned out to be an isolated event and the experience was never repeated. What caused the change of mind was never disclosed, but it wasn’t hard to guess.

  It’s an unfortunate fact of life that eve
n the best food, when it has been pureed, seems to imitate other substances with disgusting accuracy and manages to look quite inedible. But, for Eve there was no viable alternative. Semi-solid food was difficult for her to swallow, so Tony would puree her meals. She was also encouraged to drink nutritionally-fortified drinks. Soup, yoghurt and pureed meals were regularly offered to her and though she would attempt to eat something, she didn’t manage very much. Tracey patiently tried a few teaspoons of pie, then a couple of yoghurt, followed by a sip or two of tea from a spouted drinking cup. This took all of twenty minutes.

  Eve was then returned to the secure familiarity of her room. She was suffering from a malignant growth somewhere in her bowel. This would eventually be the death of her, but in the meantime it caused her to tire easily and she needed a lie-down in the afternoon. With the aid of a hoist the ever-capable Tracey lifted the ever-delicate Eve on to the protected bed, covered her in a crocheted blanket, drew the curtains, raised the cot-sides, put her buzzer and a drink within reach and left her to enjoy some rest. Dave and Peggy walked back to the lounge with Wendy. The dining room could now be made ready for the remaining residents to enjoy the fruits of Tony’s labours.

  As was the case in the lounges, so it was in the dining room. There were no set places and residents were free to sit where they pleased, but most residents had their chosen or allotted place and woe betide anyone who dared to sit in it. Some of the most spiteful exchanges between residents occurred as a result of someone sitting in the wrong seat.

  With thoughtfulness and imagination Tony had compiled three seven-day menus. He had put these into clear plastic A4 envelopes and pinned copies on the back of the kitchen door and stuck copies on the dining room wall. They were supposed to be followed in rotation. The residents had no say in the compiling of these menus. They ate what they were given. Cost was the governing factor, not resident’s choice or preference.