Thursday 26 March 2015

CAREHOMES

You find yourself in strange company in care/nursing homes. Here, we have at least one suspected alcoholic and one who appears to be on the threshold of possibly her third nervous breakdown or personality realignment within two years. (Does one cause the other?) I'm talking about the care staff, not the residents and God knows how much worse it is going to get as more and more of them, particularly the agency carers, have communication difficulties with the natural English speakers -- nearly all the residents are English speakers but only around half the care staff. (For statistical reasons only, I'm classifying carers from Scotland and Yorkshire as English speakers. Oh yes, I can do controversial.)
To protest about the language and communication problems can be difficult. Nearly all those who demonstrate some difficulty in fully comprehending a particular request or statement are African and the prevailing political-correctness means you have to be very careful not to imply that we have an "African problem". When 99% of the residents are English-born and English-speaking, I think that fluency in English should be an absolute minimum requirement for working with individuals who are disabled, dependent on the carers for personal requirements, while they have their own communication or speech problems resulting from strokes or cerebral palsy. Hey, I can feel my testosterone kicking in here! I'd better go and have lunch before I lose my temper and ask one of the carers to throw something at the television for me.
Lunch.
Much better now, thank you for asking. The healing and therapeutic properties of chilli cannot be praised too highly.

GENERAL OBSERVATIONS IN CAREHOMES

OBSERVATIONS

You do notice the little things. In themselves, they might not be very important but it is what they represent that is significant. After strokes, MS is the most common disabling factor that has led to our residents needing this accommodation. In a peculiar way, it is like the way some people are just after they buy a new car: you suddenly notice every time you see another one on the road -- there's another -- there's another -- there's another etc. It's one of those conditions or diseases that causes you constantly to make comparisons between your situation and others'. Have you lost any sensation here/there? Do you have difficulty doing this/that? What were your first symptoms? How long have you had MS? What medication are you on? Does it work? Have you ever considered suicide? That's just the tip of the iceberg: there are always new questions you think of asking. We all have our own distinct variation on the theme which is why it is so frustrating -- especially for those of us with Type 'A' MS, a minority who present differently.

We do have a suicide prospect. I mean that the poor sod creates alarm and a search party is organised every time he goes wandering outside. Why? Because he might try and motor into the pond, trundle in front of a passing car or find access to a pair of scissors. Or something. Okay, he is utterly hacked off with living in a nursing home and often expresses himself in "I wish I was dead" terms. Sounds like a beacon of sanity to me. That, and the fact that he has encountered carers with questionable comprehension skills or basic empathy with disabled people. In nursing homes, that's a given. (Do you detect a general cynicism in these matters? Well done.)

HEALTH AND BLOODY SAFETY!

How, in the name of everything or anything that is holy, has the human race made it this far? Without the phalanx of health and safety experts, would we ever have known that hot things can cause burns, that sharp things can inflict skin damage, that balancing precariously on top of unsecured ladders or furniture might be dangerous and allow you to fall down with painful results? Dear (insert the name of your chosen deity, icon or favourite fetish), how lucky was my dad to survive without them to help him? He even managed to survive a world war!! Did nobody even bother to warn him about the dangers before he went?

 And today, the health and safety advice panel here tells me that I am not allowed to have control of my own medication! No, it must be issued to me by the designated carer in charge of medication! What's more, I'm only allowed things that have been specifically prescribed for me by the doctor. That ruling extends to a simple 75mg ('children's) aspirin and even to over-the-counter products like cough medicine! Apparently, I might overdose without realising it! On antibiotics! Aspirin! My very own Famel!

 It seems that I'm not permitted to ask one of the carers "would you give me two of those ampicillin or one of those aspirin please?" This is, apparently, to protect both me and the carers: I can't be trusted to be sufficiently aware of what I'm doing to be control of that request and that they cannot be trusted to respond appropriately. Look, I'm thinking, if they can't be trusted to do that, why the hell are you employing them in the first place? And in any case, how dare you take away my control of me? In my book, I am in control of me, as far as my mental functioning goes, even though I may need physical assistance to give effect to my wishes. Even having fun, however you define it, you need assistance from carers etc.

 Don't you believe everything the pro-lifers tell you -- quadriplegia isn't always fun.(and this is one of the better-renowned care home groups!)

Friday 11 November 2011

A passing observation of the way things are.

Must get my priorities firmly established. The fight against stupidity and idiocy needs to be unrelenting. Certainly, there's plenty to fight and not all the targets are institutional, although this place is seriously institutionalised. Okay, many residents can't tell the difference and the staff don't understand what that means. Actually, quite a few of the staff don't understand lots of things and I'm constantly having to monitor my responses so as not to appear particularly condescending. Fair enough, if your first language is Polish, Lithuanian, Scouse or Geordie, you can be forgiven some gaps in your vocabulary. But come on, there are limits!

Tuesday 5 October 2010

Having a job to do

Some things really hack me off. Occasionally, in the middle of a relatively sedate and otherwise unremarkable conversation -- or even a meal time, someone in the room finds an opportunity to deliberately misunderstand something somebody else said. Not just that, they deliberately choose to make their own apparent understanding of what they heard distinctly unsavoury, do it in a way that the rest of the room can hear their 'take' on the conversation, even when it is grotesquely inappropriate to the subject and the setting. They seem to think that the guffaws and bursts of laughter that follow somehow justify their behaviour. There always has to be somebody doesn't there? What really hacks me off is -- why, why on earth is it always left to me to be the one who does it? Why can't they take that responsibility for themselves? Honestly, I don't know how they would survive without me voluntarily shouldering that burden.

Sadly, a couple of the residents with intriguing attention spans and/or cognitive quirks seem to have a slightly erroneous understanding of what the original laugh was all about but, because people laughed, it was obviously funny, so they will mention one of the words used at odd intervals, not always the same word, waiting for the response that never comes. Except, of course, from one or more of those other, similarly mis-oriented residents. Surreal? It is to this resident but I keep that thought myself. I don't think they're ready for me to try and explain that to them.

Monday 13 September 2010

Is it that time already?

Good grief -- still only September but already they are talking about Christmas arrangements. They will be hard put to top last year. We had a Christmas lunch to remember. In groups of 10 or so, the residents go to a local restaurant for the Christmas "special". I sat at a table where my fellow diners included David and John (the drunkards!). I've always thought of myself as more of a gourmand than a gourmet, though the odd pretension is not beyond me. We contrived to cause chaos when we arrived at the restaurant -- six wheelchairs, one powered and under the control of a half blind fat man with a poor sense of direction (David), two pushed and two self-propelled -- but very slowly and uncertainly. Several badly-bruised tables later, David ended up facing John, who was sitting next to me. Thanks to a stroke, John has limited vocabulary and patience when faced with delays, obstructions or failure to understand him. Oh how the waiters enjoyed dealing with him! (Fortunately, either they were familiar with the situation or had been briefed in advance, so they did not respond badly as he very colourfully expressed himself). The obligatory stupid paper hats emerged from the crackers: only David decided to wear it.
During the meal, which fell rather short of Come Dine With Me standard, David and John got through two bottles of wine before they started on the port. They are known for this, which is why they are referred to as the drunkards. By this time, David needed waking up every two forkfuls/spoonfuls, as his hand continually lost momentum and came to a halt on its journey, halfway between plate and mouth. I thought it would have been fun not to have woken him at all but simply left him alone at the table and wait for him to surface, then watch as he attempted to rationalise his situation. John didn't think that was very funny and he told me. "That's not very funny", he told me. "It's just not... you're very... no..no. Well, it's just not funny. It's not. Okay? Okay?" John used to be a schoolteacher.

It's Saturday morning. Deep joy is on ration but I do the best I can. This morning it is Liz, accompanied by Deepak, a slightly apprehensive Indian guy of about 18. The morning rituals involve carers necessarily having fairly intimate access to residents' bodies: in some cases they give them a bath or assist them in their toileting requirements. I was their last resident before breakfast. Trying to be chatty and put him at his ease in his obvious discomfort, I asked him how long he'd been involved in caring. This, he told me, was his first experience ever! Well give the lad his due, I thought -- he may be finding it challenging but he is trying to get it right. Still, he did look shellshocked by this short, sharp introduction to the nitty-gritty of caring. Why, I wondered to myself, had he been teamed up with Liz, one of the long-serving carers here but still one of the least capable of taking a lead, making decisions or, depressingly often, being able to do things properly anyway. Why, I wondered aloud, had he not been been given any basic training first? He smiled weakly and apologetically and shrugged his shoulders. Not because that was the only way he could answer that question though. No, he answered that way because his English is so poor he didn't understand the question I asked, along with a lot of the conversation that we had thought we were having with him!

He disappeared from sight sometime during the morning and he didn't reappear. Mind you, that is not really surprising. He had been sent at short notice by the agency to assist the kitchen staff!! Fully expecting to be preparing vegetables, cleaning kitchen utensils and equipment and cooking under the supervision of a trained cook, he had driven here from East Ham. On arrival at 7 a.m., he was greeted by the care team: they simply assumed he was one of the agency carers and allocated him accordingly. Inside 10 minutes, the poor lad found himself in an apron and wearing latex gloves, helping to give a bath to easily-confused and not infrequently incontinent Philip, then potty-mouthed and not mad, just slightly-unhinged Katy (a sample, just to give you some idea: "Hello darling, you're very nice! Are you married darling? I love you darling -- who are you? Well you can f-off, just effing F-off!" This bonhomie is extended to all and sundry. They love her at her local Pentecostal Church. No, really, they do! I suppose Pentecostalists need a laugh a more than most.)

I think he is now reviewing his career options.

Saturday 21 August 2010

Meet some of the gang.

Meantime, my fellow inmates continue to be themselves. Morgan is an alcoholic, diabetic, 5'5'' Welshman with what I can only describe as a weathered face, blue eyes and crinkly, grey-streaked black hair. He must be around 70. Some 30 years ago while on holiday in Greece, he lost both legs just below the knee in a drunken accident when he somehow managed to waterski into a motorboat at full throttle.  Sadly (touchingly? quaintly?) – well you can't laugh, can you -- he wears his trousers, usually jeans, with the  empty legs dangling down at the front of his wheelchair, perfectly pressed and placed  precisely where his legs ordinarily would have been, stopping just short of the footplates.
He’s generally quiet and polite and when having his pints – Guinness preferred -- in the fresh-air part, sits apparently in  a world of his own, smoking one cigarette after another. That is, unless he’s had a few –  given his depleted body-mass, two pints is enough  and he doesn’t like to stop there.  He can get recklessly bad-tempered and has a builder’s vocabulary. His refusal to accept the limitations imposed by his loss  means that, in a rage or trying to pick his cigarettes up from the floor, he frequently pitches head-first out of his chair, which doesn’t cheer him up at all. Shamefully, it's happened often enough now to produce an ironic cheer or round of applause from some quite unsympathetic fellow residents – as if he'd done it on purpose for their entertainment.(It's Showtime!!!) No, not Morgan.

A striking woman, Elaine, occasionally drops in to chat to some staff and residents.  Tallish, greying hair secured in a ponytail, a little too much lipstick, flat shoes and a so-so bust. My instincts had cut in and my reservations were noisily shouting for my attention just as I noticed the Adam’s apple. I looked around the dining room, checking people’s reactions.  Clearly, they were familiar with  Elaine but there was a studied neutrality in several faces, including staff, some of whom were themselves watching others’ reactions  and it was clear that those reactions ranged from grudging acknowledgement, through uncomfortable to openly cheerful and welcoming.

I’m often told by both staff and some residents that the place lacks proper management.  There’s a reluctance to make decisions and there’s no managerial hierarchy where you can identify someone who can impose discipline, knowing that their authority would be accepted and endorsed by senior management.  I’ve certainly noticed that and apparently it’s only become a problem over the past year. There’s nostalgia for the firm hand of management that meant staff were quickly brought into line and followed correct procedures.  The last manager of this house was Neil, who made it function efficiently and cheerfully; he was in charge and you did things properly.  Not only that, he was, apparently, a first-class carer as well and led by example.  It was almost a family occupation, since Wendy, his ‘partner’ (oh how I hate the way that designation is becoming prevalent) also works here.  She’s now one of the senior care officers and deputy manager, a position for which she signally lacks the judgement and decisiveness.

  Neil is now 'Elaine'  and it was Wendy he came to talk to. Well,  I’m sorry: you can dip me in chocolate and call me a penguin but if Neil has an Adam’s apple, stands up to pee, doesn’t get PMS and can reverse into a parking space, I’m damned if I’ll call him ‘her’.  I’m not alone in not celebrating: it’s also obvious that Wendy isn’t over the moon at his presence here.  The regular sight of Neil, now Elaine and in a dress, often with a padded bra in her company in view of many residents, is an agonising embarrassment for her and her relief when he leaves is obvious.  There’s nothing remotely feminine about him. I understand that she’d love him to bugger off, in a non-technical way, but  her  lingering – but fading – affection for the man he once was allows the situation to continue. God knows what their poor bloody kids make of it.

Tommy remains the man who brings the sun out (“It’s what I do.  I tell it to come out.”) but he’s not been well and refused to go to the doctor.  No-one was prepared to try and make him because that would only produce a pretty heated confrontation and he can put up one hell of a fight if they attempt to get him into a taxi against his will, becoming what Americans refer to as “an ornery cuss”.   It’s been tried before  and it wasn’t nice. He’d probably have a major fit anyway.  It’s very unsettling though, when a 60-something baldy with a manic laugh/giggle, badly-stained graveyard teeth and wide-open eyes made rather alarming by very thick lenses on his glasses, keeps calling me  ‘m’dear’, frequently using the word “darling”and patting me on the shoulder while not sounding or looking remotely like Noel Coward or Stephen Fry. Fortunately for both of us, I don’t think  that, hormonally, he’s even remotely Freddie Mercury, never mind Graham Norton. In its wisdom, nature has ensured that he will always been no more than eight years old and he is a bigger danger to himself than he is to anybody else. Just don't upset him.

Yesterday evening about 8.45, I went to the Social Club for a pint: it's about 100 yards away from our entrance, about 35 seconds pushing for my carer.  Sometimes, we all have to do things we dislike. I sat opposite Trevor, who was on his second  pint of Guinness. Morgan was in his accustomed position, doing what Morgan does.  As I finished my Director’s Bitter (recommended), he  was reordering and invited me to another, duly accepted.  That finished, he accepted my offer of another, opting for a Wood’s rum although I decided enough was enough at that stage. That’s 10-ish, when I returned. The bar shuts at 10.30. About 10.55, Graham, on duty from 10pm, was interrupted while he was talking to me.  He returned about 25 minutes later, explaining that Trevor had had problems getting back from the club, Big surprise! He’d needed assistance covering the last 90 yards or so and then in getting to bed.  This morning at breakfast, he was obviously fully recovered, since he ate half next year’s  UN Ethiopian breakfast food allocation.
It’s 11pm. I had a Bishop’s Finger about half an hour ago. (That’s a beer, you pervert.) Within the hour, bed and a giant whisky await. Oh, sod it. I can’t wait that long.
Graham! Graham! GRAHAM!