Archive for December, 2012

My Wishes For Elderly Care in 2013

As 2012 draws to a close I am saddened by what I see around me regarding the care of older people and wonder  where the humanity in caring has gone and why things so essential to the essence of humanity, as dignity and compassion cannot be managed in one of the richest societies in the world.

I frequently come across examples of neglect and institutional ageism in my work, such as an elderly person being discharged from hospital to a care home in only a hospital gown with bare feet, another with such a nasty bed sore they were unable to sit down. A nursing home resident who asked for the toilet and was told there was no need as he was wearing a pad, another who had her discharge from hospital delayed for a week so she could be rehydrated via a drip because staff hadn’t realised she had not been drinking enough. I could go on.

And so looking forward to a new year I find myself reflecting on the changes I would like to see in the way we care and support older people in 2013.

Here then are my New Year wishes for elderly care 

  • I wish national and local Government and the NHS would take responsibility for their gross failure to prioritise and resource basic standards of care for older people. The Government needs to stop sitting on the fence and make a decision about long term funding of elderly care. Putting the burden of rising costs of long term care on the taxation or National Insurance system must be considered as  the costs of care should surely be shared across society as a whole to provide the dignity we seek.
  • I wish commissioners would realise that older people, especially those with dementia, need longer to help them with daily living tasks and to make decisions. More staff are needed in hospital wards for older people, care homes and to support older people in their own homes and yes, it will cost more.
  • However, I believe dignity is only partly about money. It is also about heart and recruitment of staff at all levels working with older people needs to test attitudes and training needs to focus on basic standards, such as making sure older people are eating and drinking enough. We need to rely on health professionals and social care staff to be consistently kind.
  • I wish regulators would rate the care services they review with more precision than merely ‘meets or does not meet minimum care standards’ so informed choices can be made.
  • I wish management in local government would be honest about the reality of the funding shortage and stop pretending they deliver a person centred service. They have to put money before individual needs so stop the rhetoric that pretends otherwise.
  • I wish the bad care providers would learn about person centred care from the good ones or be driven out of the market.
  • I wish as a society we could prioritise the value we give to our carers, especially the thousands of unqualified staff who are paid little more than the minimum wage for skilled and demanding work. We pay more for people looking after our money than we do for people looking after our most vulnerable citizens.
  • I wish you my reader would consider the likelihood of yourself or family needing long term care, as 2 out of 3 of us surely will. Think about what kind of things would be important to you if you need care. Discuss it with those closest to you and encourage your elderly relatives to do the same. Decisions often have to be made during a time of crisis and it will be so much easier if loved ones know what the person would want.
  • Finally I wish we could all adopt zero tolerance towards poor care practice of older people. It is time to act , so complain, use social media to name and shame (honestly) change care providers if necessary, write to your MP, do whatever you have to do to stamp out unacceptable care standards.

Finally, I wish you a peaceful, healthy and purposeful New Year and compassionate, dignified care for your elderly loved ones and clients.

A Reply to A Crabbit Old Woman – By A Nurse

One day when I was clearing the staff room in the care home I was managing, I found a piece of paper had been pinned next to the copy of  A Crabbit Old Woman I used as part of staff induction training. It was posted on the staff board. This is what it said:

“What do you see?” you  ask, “What do you see?”

Yes we are thinking when looking at thee.

We may seem hard when we hurry and fuss,  but there’s many of you and too few of us.

We would like far more time to sit and talk.  To bath you and feed, you and help you to walk

To hear of your life and the things you have done, your childhood your husband, your daughter, your son.

But time is against us, there’s so much to do, patients too many and nurses too few.

We grieve when we see you so sad and alone, with nobody near you, no friends of your own.

We all feel your pain and know of your fear, that nobody cares now your end is so near.

But nurses are people with feelings as well, and when we’re together, you’ll often hear tell,

Of the dearest old Gran in the very end bed, and the lonely old dad and things that he said.

We speak with compassion and feel very sad, when we think of your life and the joys that you’ve had.

When the time has arrived for you to depart, you leave us behind with an ache in our heart.

When you sleep the long sleep, no more worry or care, there are other old people and we must be there.

So please understand when we worry and fuss. There are many of you, and too few of us.

Older People Excluded at Christmas

I was concerned about the findings from a recent survey of 2,000 adults, conducted by Friends of the Elderly, as it highlighted that many people admit to feeling burdened by older relatives at Christmas. Their research revealed that despite  87% of people feeling it is the responsibility of family to look after older relatives, worries about the financial burden (19%), being too busy (45%) and living too far away (36%) mean that families can’t take the strain.

In fact, almost half of those surveyed (47%) are dreading the day their  parents or grandparents need to be cared for.

This reluctance to spend time with older relatives was shown to be particularly poignant at Christmas, with 23% of people saying they have older relatives who are likely to spend Christmas alone. How awful is that!

However, only 32% of people plan to invite them over for Christmas, with the greatest reason for not inviting older relatives due to concerns about frailty (18%)

The  problem is not confined to Christmas as the survey found that while 31% would be happy to check in on ageing family members and visit regularly, they wouldn’t want them to move in with them. I can understand this as having your elderly loved one move in with you does not always work out when their needs and expectations increase.

However, we can all make a special effort at Christmas and it will make such a difference, not just with our relatives but with older people in our communities so give a thought to your neighbours and older people locally.

‘Friends of the Elderly are running a Christmas campaign which is focused on encouraging people to show a simple gesture to older people, such as simply checking in on an older neighbour regularly, popping a card through their door or having a chat with an older person at the shops.

This can be enjoyable for both younger and older people. It only takes a moment and can make a real difference.

Their campaign involves inviting isolated people in the community to join them for a festive lunch and inviting people to come and help decorate their homes. They have been encouraged by the wonderful response which confirms their survey findings that although people are concerned about making a big commitment, 64% of people are willing to open their doors to take a first step.

This is echoed in the survey results, which show that 47% of people feel local communities, should take more responsibility for looking after older people.

Almost half of those polled believe people in the UK should have a legal responsibility for looking after their parents in older age, as they are in France, while 27% of people think it is down to the Government to take care of the elderly.

The survey shockingly revealed the issues around visiting older relatives, with almost two thirds admitting they struggle to visit them at all, and one in five seeing them only a couple of times a year at most. I find this heartbreaking when I think of the older members of my own family surrounded by love. Too often I am asked by solicitors to find the right care solution for older people whose families have all but forgotten them.

Sadly, more than a quarter say an older relative has asked them to visit more often because they are lonely.

If you live far away or can’t afford to travel to see an older relative regularly, a phone call can really make the difference for those who live on their own and can’t get out as much as they would like. Human contact costs nothing yet means so much to an older person and will make you feel pretty good to! Click to enlarge  graphic. It shows some interesting information.


Putting the Person into Elderly Care

Many years ago when I managed a care home for the elderly, I included the following in my induction pack for staff. It was found by a nurse who was going through the belongings of an old woman who had died in Ashludie Hospital, near Dundee.

What do you see nurses what do you see? What  are you thinking when you are looking at me?

A crabbit old woman not very wise, uncertain of habit, with faraway eyes,

Who dribbles her food and makes no reply when you say in a loud voice “I do wish you’d try”

Who seems not to notice the things that you do, and forever is losing a stocking or shoe.

Who unresisting or not, lets you do as you will, with bathing and feeding the long day to fill.

Is that what you’re thinking, is that what you see? Then open your eyes, nurse you’re not looking at me.

I’ll tell you who I am as I sit here so still, as I do at your bidding, as I eat at your will.

I’m a small child of ten with a father and mother, brothers and sisters who love one another.

A young girl of sixteen with wings on her feet, dreaming that soon now a lover she’ll meet.

I bride soon at twenty my heart gives a leap,  remembering the vows that I promised to keep;

At twenty-five now I have young of my own, who  need me to build a secure, happy home.

A woman  of thirty, my young now grow fast, bound to each other with ties that should last.

At forty my youngest son’s have grown and are gone, but my man is beside me to see I don’t mourn;

At fifty once more babies play round my knee, again we know children my loved one and me.

Dark days are upon me, my husband is dead, I look at the future, I shudder with dread,

For my young are rearing young of their own,  and I think of the years and the love that I’ve known

I’m an old woman now and nature is cruel- tis her jest to make old-age look like a fool.

The body it crumbles grace and vigour depart,  there is now a stone where I once had a heart;

But inside  this old carcass a young girl still dwells, and now and again my battered heart swells,

I remember the joys, I remember the pain and I’m loving and living life over again

I think of the years all too few –  gone too fast,  and accept the stark fact that nothing can last.

So open your eyes nurses, open and see, not a crabbit old woman,  look closer – see ME

Nice eh! Reply coming soon!

Care of the Elderly at Home – Winter Warming Tips for Older People

Winter has now arrived and begun reeking havoc on the roads, depleting our bank balance with extortionate energy bills and generously spreading coughs and colds to innocent victims. Whilst Christmas provides diversion to these seasonal miseries it will soon be over and we will all be trying to loose the weight we have gained over the festive period and managing a financial hangover.

However, before we start  feeling too sorry for ourselves let’s spare a thought for older people and the family members who care for them, because no-one will feel the effects of winter more than they will. 

Older people’s circulation is less efficient than ours and they have less subcutaneous fat to keep them warm. Their income is usually much lower to pay for heating bills and their social and family networks reduced by the loss of friends and loved ones who have died or moved away. Icy pavements (real or imagined) and fear of falling, compounds the problem, as does the demise of small grocery shops and local post offices that gave older people a reason to go out for a short walk.

The result is that most older people do not go out much, if at all, in the winter and become prisoners within their own four walls. As a result their limbs get stiffer and more painful through inactivity and the lack of social interaction and human company makes them feel lonely, isolated and depressed  (Depression is under diagnosed for older people)  So what can we do?

Here are my top tips for helping your elderly loved ones during winter:

  • If the older person has friends or neighbours ask them to pop round. Older people often don’t like to bother people but love it once company arrives (you don’t need to tell them you initiated it)
  • Make sure the person keeps warm. Thermal vests, leggings and socks make good Christmas presents.
  • Make a bulk supply of nutritious homemade soup and divide it into ‘pour and store’ freezer bags so all they have to do is get it out of the freezer and reheat.
  • Make sure they have  a supply of salt or de-icer products. These are often hard to get hold of once the snow and ice arrives.
  • A good supply of books, magazines, games and crosswords will keep their ‘little grey cells’ exercised.
  • Pop in to see them as often as you can. I know it’s a busy time but you will feel hugely uplifted by giving  pleasure to an older person and you don’t have to stay long. Little and often is better than a longer visit every few weeks.
  • Contact their local Age UK office and find out what clubs and day centres there are for the older person to go to. Most provide transport.
  • If you live a distance away buy them a cheap or second hand computer and set up Skype so you can keep in regular contact. It can also be used for shopping, playing games and reminiscence. Their carer or neighbour may be able to help them. If they don’t have either, recruit a local volunteer from their local college or advertise in a shop.
  • If there are other older people living in the same street why not see if you can invite them over for a cuppa and a mince pie? The festive season provides a good opportunity to start the ball rolling.
  • Finally, if you are taking care of an elderly loved one, make sure you look after yourself too. Have regular breaks and use on-line forums such as the Carers UK Forum to maintain social contact.

Christmas Present Ideas for Elderly Loved Ones

I remember the difficulty I had thinking of Christmas presents for my grandparents and more recently my elderly parents. What I tried to do is the same as I do for every individual I buy Christmas presents for. I think about the person and seek inspiration using the following questions: What do they enjoy doing? What would they like to do? How do they spend their time? Where do they spend most of their time? What do they like to eat/drink?

You can probably think of others.

One of the most important things you can give an elderly person is our time. Why not pop round with some home-made mince pies or a Christmas cake? You will make their day!  If money is tight or the older person doesn’t like asking for help, what about printing some gift tokens offering an hour of your time so they can choose what they want to use you for? You can share your skills such as baking, sewing, shopping, gardening, driving and give your loved one pleasure at the same time.

Here are some more ideas that I hope you will find helpful.

  1. An iPod with their favourite songs/books
  2. Large print calendar/birthday & anniversary book/diary/ telephone index book* (available from the Partially Sighted Society)
  3. Digital photo frame and subscription to Mindings
  4. Large print stationary pack*
  5. Pot pouri and refresher oils
  6. Jumbo playing cards*
  7. Thermal underwear
  8. Large piece jigsaw*
  9. Box of their favourite goodies (food or toiletries)
  10. Gift token for their local theatre

* Can be purchased from the Partially Sighted Society

I wish you and your elderly loved one a happy and peaceful Christmas



How Do You Know if Care is Person Centred?

You will know by now that I am passionate about care for older people being person-centred. But how do you know if the care your elderly loved one receives is person-centred or not?

Knowing what person-centred care actually means for older people provides us with a good start. It’s about treating people as an individual, treating them with dignity and respect, enabling them to make choices about their care, joining things up, with them at the centre and focusing on what is important to them from their own perspective as well as professionals deciding what is important for them.

We recently reviewed the care of one of our clients who lives in a nursing home and the feedback we gave the Manager provides a good example of person-centred care. Here are some of the things we highlighted:

  • Residents were not ignored or given platitudes when calling out. I watched a carer leave what she was doing to reduce a resident’s anxiety. She sat next to her; made eye contact, held her hand, spoke calmly, ensuring she was comfortable before returning to the task in hand.
  • A resident asked if she could go to the toilet and the carer was with another resident. She was reassuring and told the resident she would be back. It was said with confidence and the resident appeared to trust it would happen and it did.
  • I have often witnessed carers telling visitors and residents how long they have been on shift, how busy they are etc.- I did not hear this kind of conversation
  • Carers were confident in moving and handling and kept residents at the centre by gently explaining what they were doing.
  • Carers were respectful and treated residents with dignity.
  • Care plans lacked the depth of person centred planning, and were scant with some details. They had the medical details but lacked what was important to the person and information about their life that enables carers to personalise care even more. Its not just the end result such as ‘pain relief’ needed, but  – Why? When? and How?

Some of the questions that need to be asked to answer these questions and ensure care is person-centred are:

  1. I prefer to be known as:
  2. I have lived in these places during my life:
  3. During my life I have held the following roles (include work, home and voluntary)
  4. The skills I have gained during my life are:
  5. The things I enjoy doing most are:
  6. The person who knows me best is:
  7. Family and friendsI care about are:
  8. This is how I would describe how I usually am:
  9. The most important thing you need to know about me is:
  10. In order for me to feel happy and content I need:
  11. In order for me to sleep well I need:
  12. This is what is most likely to upset me:
  13. When I am upset I tend to:
  14. What may help me relax is:
  15. When I am not well I need:
  16. When I am in pain I need:
  17. To help me understand what you are saying I need:
  18. The most important thing you can do for me is: