A little lost...

A lot of the residents at the Care Home have some form of memory loss, be it short-term (ie. they forget that they have sent their favourite blouse to the wash and thus can’t find it) or full-on Alzheimer’s Disease (AD), consisting of mood swings, aggressive behaviour, serious confusion and ultimately loss of bodily functions and death. We fortunately have no residents with AD this severe as they would need more care than we can give them but we do have some residents with progressive memory loss. It can be very upsetting for these people; imagine not being able to remember the last time you ate, drank, washed, or went to the toilet. Imagine this combined with a constantly changing group of HCAs who whisk in and out of your room like small tornadoes with meals, tablets, washing and bedding, saying ‘Do you want to go on the commode?’, and ‘Would you like to have a wash before we put you in your nightie?’ even though you don’t even remember having lunch and is it really 7:30pm already?

It must be very distressing at times and with the best will in the world, we HCAs are not always as understanding as perhaps we should be. I try to see things from their point of view and listen closely to what they are saying so I can help them if I can but when you’ve people to feed, wash and dress in the morning for example, trying to explain patiently to an angry resident who can’t find their favourite blouse that they asked for it to be washed the day before can be a very frustrating task.

I have compiled a few incidents from the last few days and weeks which prompted me to write this post below.

#1. Stealing

Some of the residents with more severe memory loss misplace items and cannot remember where they put them, as you would expect. The trouble starts, however, when they begin to believe that someone has stolen whatever it is they are looking for. For example there is Gerry in room 12 downstairs. He refuses all care from the staff – he always refuses a wash and help with changing his clothes which means he can end up staying in one set of clothes 24 hours a day over a period of days until the District Nurse and one of the SHCAs manage when changing the dressings on his legs to distract him with their chatter for long enough to give him a good scrub and change his clothes. Despite this, he is generally courteous to the staff and a happy person. However, a few days ago I went to ask if he would like to come to the dining room for lunch (sometimes he does, other times he doesn’t) and I found him grumbling to himself. On asking him what the matter was, he said he couldn’t find his best slippers – one of ‘you lot’ (meaning the staff) had pinched them and nothing I could say would change his mind. In the end I had to leave him turning his wardrobe out as I was afraid that if I tried to convince him of our innocence any further he would file a complaint against me for either bullying or stealing.

Another time I heard one of the residents, Joan, saying to another that money was being stolen from her room – you could see the ears of every HCA in the vicinity perk up as that is the kind of thing which makes us extremely wary of going into a resident’s room alone – but the other resident gave her short shrift and told her to make absolutely certain that she hadn’t just misplaced it before she started pointing the finger. As it happened she had put her money in her knicker drawer so it would be kept safe and had forgotten. You could hear the sigh of relief whistle around the staff room when this was announced.

#2. ‘Visions’

A strange title but an apt one. The above mentioned lady, Joan, charged me with abuse in a roundabout way last week because I had apparently gone into her room and told her that I could see into the future and that she was going to die soon. Obviously this was complete nonsense; firstly, I have never claimed to have second sight (nor would I want it if it were ever a possibility) and secondly, I would never ever tell anyone that I had foreseen their death (even if I had been so unfortunate as to foresee such a thing). Despite the obvious ludicrousness of it all, I was called into the Matron’s office and asked about it. I was utterly speechless at first; I must admit I wondered for a moment if she was playing a joke on me. But when she called the secretary in as a witness to what I said, I realised she was being completely serious and I found myself having to explain that I had never told Joan anything of the sort and even if I could see into the future I was hardly going to tell people when they were going to die soon. However, I did track down what the source of the problem was; as I had been getting Joan ready for bed, there was a programme about ghosts and haunted houses on the TV. There was a man on who could supposedly speak with the ‘spirit world’ and we began talking about that and foreseeing the future, etcetera etcetera. Her memory loss and frequent depressive episodes as a result of a brain haemorrhage meant that she had forgotten the TV programme entirely and had pieced together what she remembered of our conversation into something which had no resemblance to it at all in my eyes, but which to her was the absolute truth. I could tell Matron put little stock by this but had to follow it though as the HCA she had told HAD to report it. Abuse is a very grey area within Care but even the merest whiff of it must be reported just in case. It reminded me that you have to be very careful what you say and how you say it with people.

#3. Losing yourself

One of the most upsetting aspects of memory loss for the staff especially is seeing residents lose all memory of themselves. Seeing someone who only needed assistance with putting on their socks and shoes of a morning deteriorate to a bedridden shell of their former self can be disheartening and distressing. Ina is a good example of this; last summer I remember her as a quietly spoken but interesting woman in an electric wheelchair who needed assistance with the commode and that was pretty much it. Now, after 5 TIAs, she is almost entirely bedridden and can do very little, if nothing, for herself. She has an ulcer on her right heel, another one burgeoning on her left heel and is on a 2 hour tilt chart. Her legs are contracting and her neck is stiffening in one position. She is often very sleepy and slow; doing her menus takes 20 minutes at least and feeding her some soup and sandwiches can take up to an hour which is obviously very problematic when it comes to caring for the other residents. I find dealing with her quite saddening; I remember her when her mobility was her only setback. That quiet but kind person is still in there; she is just a little lost.

Fred was another example of this; he had AD but it progressed very slowly; last summer he could get around in his wheelchair and was a very nice chap to talk to, although he kept himself to himself. A week before I returned to the Care Home he took 3 tumbles in 2 days. He was put in bed with cotsides and went from lucid but bedridden to palliative care within 3 weeks. Feeding him became increasingly difficult – initially he would forget to chew but would do when prompted by the HCA. In the last week or two when asked to open his mouth, he would just purse his lips and suck up miniscule amounts of food off the tip of the spoon. Giving him a drink was nigh on impossible as you couldn’t get him to loosen his jaw enough to get even a straw in. One teatime I was trying to feed him and in between little sucks off the tip of the spoon, he murmured in a surprised tone that he had never been in a room with a woman alone before and he didn’t know what to do. It occurred to me that possibly the only woman he had ever been ‘alone in a room with’ in that way (ie. in a bedroom) was his late wife; maybe he was, as his memory deteriorated, fusing that memory with the fact that I was a lone female voice chattering to him whilst giving him his tea in his bedroom. I found this quite upsetting. Once again the person he had been was obviously still in there as he was piecing together memories from decades back, but he was also losing his grip on life. He died only a few days later of pneumonia.

Until next time,

Liv xxx