Helen Martin: Homes are where the heart is

Abbotsford Care Home'. 'Pic: Roberto Cavieres
Abbotsford Care Home'. 'Pic: Roberto Cavieres
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MANY people might assume that the elderly with dementia would be better looked after in a hospital, including a psychiatric hospital, than a nursing or care home. Actually nothing could be further from the truth.

The Royal Edinburgh Hospital has been criticised for sedating elderly patients, leaving them in bed until lunch-time, failing to provide suitable activities, losing patients’ clothes, and failing to move them on quickly enough to care packages or homes. (The last is hardly their fault as there’s a chronic shortage of community care and places.) Other hospitals stand accused of adding to patient distress by transferring them unnecessarily from ward to ward.

That, I’m afraid to say, is pretty much par for the course. Hospitals are busy, hurried and nightmare places for the elderly, so much so that most good care homes will move heaven and earth to have as much hospital treatment as possible delivered to their residents on an out-patient or day basis so that they can return to the care home at night. Most will also try to send a familiar care assistant with the resident because they know hospitals are woeful at dealing with those who have dementia.

Nursing and care homes are just that – homes. Hospitals are a different beastie altogether with a completely different culture and ethos, based on the idea of making patients well or better, or just giving them a diagnosis, and sending them on their way.

Despite the occasional horror story and perceptions of “neglect”, the fact is that most care homes have an almost impossible job to do and do it very well.

They have to select staff displaying patience, care, understanding and respect towards people with dementia who can be unresponsive, sweetly bewildered, confused or obstructive, noisy, difficult, verbally and sometimes physically aggressive or destructive. Until you have tried to entertain and stimulate those with advanced dementia, you cannot imagine how difficult it can be, especially as each individual might require an activity specially devised for them.

Many need assistance at meal times 
. . . that’s politically-correct speak for “spoon feeding”. Double incontinence is common. Calm reason doesn’t always work. Diversionary tactics are usually better.

Staff must search for opportunities for residents to exercise choice and free will. That in itself can be hugely challenging considering their inability to do so is the main reason they are there in the first place. Overall it has to become a real home, and despite everything, a happy one; somewhere the demented can feel they belong and exercise their individuality, while also providing all the services of a hotel from chef and kitchen to laundry and cleaning team and regular maintenance, as well as nursing and care, hairdressing, podiatry and spiritual sustenance. Some also have to be a hospice.

A care home manager has multiple “bosses” to please . . . the resident, the relatives, their own company hierarchy, the council social work department and the inspectorate, all with different expectations. Despite conflicting demands, they must keep focused on the residents’ comfort and happiness.

We fail to recognise and value the expertise that exists in good dementia care homes, which may be one reason why hospitals feel they have no-one to learn from when it comes to care.

Ticketmaster won’t win any medals

IF there is one excuse I loathe it is “technical difficulties”. Forget apologies when things go wrong, services fail or you’re stuck at the other end of the country unable to get your cash from an auto-teller. Instead, you will be told it is a “technical” issue, in the same helpless tone someone might employ to refer to “an act of God”, something beyond their control for which they have no responsibility.

It happens increasingly as banks, medical services and everything else becomes reliant on technical systems despite overwhelming evidence that they break down.

Edinburgh’s Commonwealth Games in 1970 and 1986 may have had their problems, but being able to buy tickets wasn’t one of them. Folk bought them . . . in shops . . . with cash.

Now Carphone Warehouse and the vast Dixons empire are merging, apparently because the next big thing is the ability to control household devices, heating, cooking etc from a mobile phone. When your house burns down with the dog or grandad in it, you will be told it was a “technical issue” and not that some greedy geek couldn’t wait to sell you technology that was still experimental.

Which brings us back to Ticketmaster, a fine system, I’m sure, that could have been a great addition to Commonwealth ticket sales options, but was never capable of sole delivery.

If fuel companies, banks, military forces and governments continue to ignore the old advice against putting all eggs in one basket, the world will end not with a war, global warming, a deadly virus or an ice age, but with a “technical difficulty”.

Branson’s your man

RICHARD Branson has refused to rule out Virgin taking over Edinburgh’s trams in future if the opportunity arose. What a pity no-one thought of inviting him to run the whole thing from the start.