Tuesday, 15 December 2009

A Sharp Reminder

I write this with tears in my eyes.
I have just watched the second half of the very moving "Can Gerry Robinson Save Dementia Care Homes?" [BBC iPlayer]. I feel so much for the residents of these homes, having spent most of last year seaching for somewhere suitable for my Nan before she died*.

I have also seen care of this sort, as it is often "the norm". People don't realise the capabilites of those with dementia. I had a placement on a ward, which I felt was generally good, but which certainly failed its usual standards in the early morning. Once staff had come on shift, following the handover, there was around 45 minutes for 6 staff to assist the clients to shower, dry and dress. Some where able to do this with little assistance, but normally there were around 18 people to assist. Most needed two or even three staff members to assist, mainly due to mobility issues, or because they could become aggressive**.
Older people have fragile skin, and often need much more care. A quick rub down is not sufficient to dry them, and they will often need to be assisted to apply cream etc. You need to check for pressure sores, bruising, soreness or damaged skin. You need to respect them as a person, assist them to change into their clothing, assist them to chose colours and textures whenever possible. I could easily spend a hour with someone, longer even, enabling them to wash themselves and choose their outfit, do their hair. 18 people, 45 minutes, staff working in pairs. Thats 7.5 minutes per person. It seems quicker to many staff to just do it for their clients to get the task done, because you simply don't have the time to take.
When I worked on a adult ward, I worked with a lovely lady who was very confused. I spent over an hour assisting her with showering, even washing and applying cream my own face to show her what to do, as she found it easier to copy than to follow verbal directions. Just spending time choosing her shower gel, enjoying the smell of it, or the feeling of having her hair done.

We need more staff, particually more regular staff. Bank staff simply do not know the clients and the clients do not know them. Staff need more training, and we need to have the time to spend with clients and families to find out the important things. What is your mother's routine? Does she shower or bath, morning or evening? What products do they use, lots of bubbles or just unscented soap and a soft flannel? Do they like to read books, or the morning paper? Do they take sugar in their tea?

How can we provide personalised, patient centred care, when we don't really know our clients?

I'm tired. I'll continue something along this line another evening, because the guinea pigs need their hutch cleaned out.

*On this note, I read each of the homes' reports in depth, for the past few years. I had whittled a long list down to just four which I planned to pay several visits to with my mum, in order to find somewhere that I was happy with. I forwarded this list to my uncle, to keep him informed, and he replied with the ones he had looked at. It was a list of every home in the area, including the ones I had sent him, with no attention paid to ratings or inspections.

**And why shouldn't they be aggressive? They've awoken in what may seem to them a strange place with people they do not know. They have been assisted half-asleep into a wheelchair, taken to one of several bathrooms, and these strangers are removong their clothing and putting them in water?

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