Category Archives: Dementia

CARE HOME DIARIES PART 5: “I saw Mum. She didn’t see me”

I’ve blogged elsewhere about my Archers fetish.  I belong to a rather peculiar sub-group of ‘tune-in and tweet’ Archers fans spending seventy-five minutes every Sunday morning listening to the omnibus edition while tweeting affectionate mockery about everything from Bartleby the horse to Helen Archer’s organic yoghurt.

But the onset of 2014 brought one of those memorable moments when fiction genuinely touched real life and even the most acerbic of ‘tweetalongers’ paused briefly to dab at moist eyes with a sheet of kitchen roll.  But it wasn’t really the death of Jack Whoolley that had us shedding a tear or two. In truth, it was the story of Alzheimers disease and how dementia can kill even the brightest and strongest-willed among us long before the heart stops beating.

In a scene as beautifully written and acted as it was poignant, his wife Peggy visits her husband at The Laurels for what turns out to be the last time. By this stage Jack is in the final stages of what is in effect a terminal illness. Most sufferers will die from other conditions before Alzheimers itself can be listed as a cause of death, but by the time he dies Jack has clearly not been ‘alive’ in any real sense for several years. He no longer recognises Peggy, has lost the power of speech and shows little or no recognition of what is happening around him.

Those of us who know the real-life ferocity of end-stage dementia would recognise all too well a scene which is no less moving for it’s fictionality.  They would recognise Peggy’s attempts to sustain what is an entirely one-sided conversation with a husband who hasn’t spoken for several years and is almost certainly unaware of what is being said to him. They would be familiar with how Peggy reminds Jack of a funny story from the past, and how she notices the slightest of smiles from the corner of his mouth. Perhaps there is the slightest glimmer of awareness there just this once. Perhaps she imagines it.  In any case, she was just about to go but decides to sit down and spend just a little longer with her husband before she leaves.

As touching a drama as this was, these scenes are played out for real every day of the year. And for those of us who work with dementia, seeing friends and relatives struggling to connect with care home residents is a familiar, and sometimes slightly awkward reality.

Some listeners were a little perplexed that Peggy didn’t react more dramatically to that phone call from The Laurels.  But as she says herself: “Seeing Jack decline like he did, disappear in front of my eyes, it was awful… but it’s meant I had a lot of time to get used to the idea of losing him. Because really I lost him a long time ago.”

Thanks to a much greater awareness about dementia, most of us are now well enough informed to cite symptoms such as short-term memory loss or confusion as being fundamental to dementia. But for families of sufferers and those of us who work in the field, it’s the gradual deterioration of the all-round ‘human-ness’ of the person that is most striking. Dementia means the gradual inability to comprehend, to interact, or to hold anything but the simplest of conversations. At Jack’s stage of dementia, there is no conversation at all.

My colleagues and I at Hill View House* try our best to see even the most impaired of residents as real people who can hear and understand us as well as anyone else. In ‘Pictures on a Bedroom Wall‘ I wrote about the power of old photos** to allow staff like me to see the most disabled of our residents not as mute, immobile or vegetative, but as vibrant livers of life posing for holiday snaps and wearing fancy hats at weddings. To involve people at the end stages of dementia in choosing their clothes or deciding what they’d like for lunch isn’t easy. In some cases it isn’t possible at all.  But we try.

In The Archers it was that faintest flicker of a smile that tells Peggy she’s connected Jack with something resonant from the past. In real life it’s more likely to be a facial expression that says “you’ve forgotten to put sugar in my tea” or “pureed broccoli. Again?” It might even be an occasional “f*** off” after months of complete silence. Yes, that has happened.

But no matter how much and how well care home staff do care, there’s one thing we can’t affect. Some of our residents have visitors every day, or several times a week. Some have the odd visit from friends or children. And some have none at all.

There seems to be a fairly linear relationship between a residents cognitive ability and the amount of time they get from visitors.  Wives and husbands seem the best able to tolerate the ravages of what dementia has done to their loved ones, but for the most part we could plot on a graph how those least aware of other people and events are also the least likely to have contact with family and friends.

We staff frown upon the neglectful, ungrateful children who disappear from view once parents are safely dumped with us, only to pop up once again as soon as the popping of clogs seems imminent and an inheritance looms on the horizon.

In some cases this might well be true. But I suspect that for others the reluctance to visit is about something a little deeper. Perhaps the thought of sitting with a Mum or Dad or Nan or Grandad staring blankly, silently and unknowing into space is simply too painful to stomach after a lifetime of knowing them as the people who were once every bit as vibrant and alive as we are now. There’s always something else to do at weekends.

 

* If you haven’t read this blog before, Hill View House is a real care home with a made-up name. For obvious reasons.

** This now seems to have been adopted as good practice in NHS general hospitals. Thanks to @LauraDron for the link

CARE HOME DIARIES PART 4: Pictures on a Bedroom Wall

We can now see, read and hear about dementia more than ever before. But what does it really ‘look like’?

Edith stares up from the pillow as myself and another care assistant get her ready for bed. Her expression is blank and it’s difficult to know just how much she is actually aware of. The latter stages of Alzheimers have rendered Edith virtually immobile, and she has almost no ability to communicate beyond the facial expressions and eye movements only time and familiarity can translate.

Edith is not entirely silent, a fact I only found shortly after starting  at Hill View. One morning, apropos absolutely nothing, Edith lifted her head off the pillow, turned, and looked straight at my colleague Karen. “Get off me, you four-eyed bitch” she hissed. She then turned her gaze back at the ceiling, dropped her head back to the pillow and resumed her usual blank expression. This scared the crap out of me, but Karen simply laughed. “Okay my darling, that’s the last time I wear my specs to work.”

Edith’s room and ceiling are covered in photographs. There is Edith with her husband and family. Edith as the proud hat-wearing Mum at her daughter’s wedding. Edith as a fairly mature looking student in mortar board and gown receiving a degree. And on her chest of drawers sits a particularly striking black and white portrait of her as a young nurse. It looks like one of those old publicity shots for a Hollywood starlet. She was clearly a very striking young woman.

Hill View has given me some eye-burning images, but most vivid of all are those photos of residents long, or not so long, before they were struck by dementia. I try to equate those happy, animated faces with the staring eyes and haunted features of the person sat in front of me as I help them comb their hair or wash their face.

For this is a slow-burning, degenerative and ultimately terminal condition that will eventually kill the sufferer if other conditions don’t get there first. Early stage dementia allows sufferers some degree of independence and dignity. The latter stages, which can be many years down the line if the person is physically fit and well, require more and more supervision and support for people such as Edith, who needs help with just about every aspect of human existence. The expensively photographed young woman in the photo is now being fed puréed food and having her pads changed several times a day. Alzheimers has destroyed her..

Unlike Edith, Margaret doesn’t spend hours staring quietly into space. She can cover a hundred metres not very much slower than Ussain Bolt. Margaret still has the presence of the head teacher she once was, and talks ten to the dozen. She doesn’t always make sense but she makes use of a wide and educated vocabulary which sometimes stops me dead in my tracks wondering how words like ‘idiosyncrasy’ can still come from the mouth of someone with dementia as advanced as hers. Margaret will often come running up to me as if to tell me the most brilliant news I’ve ever heard, or to make some random statement which makes sense to nobody but her. But quicker than I can fashion an answer she’s staring through me as if I’m air. She then scurries off for another conversation with somebody else.

Margaret has pictures on her wall as well. Most of hers are more recent than Edith’s. She is retired and visiting far flung places with her late husband, a university lecturer. They are sipping cocktails on a hotel balcony overlooking the Med. In another photo, Margaret is proudly cradling a grandaughter. She looks eerily similar to how she looks now and is even wearing the same clothes. The Margaret in the snaps does not have a care assistant helping her put on her shoes.

Frank has a memory span of less than a minute. As a former chemical engineer he’s a clever man with a vast knowledge of local angling and science. He walks slowly with a frame but if you remind him to lift his feet “just like Neil Armstrong on the moon” he can speed up considerably. Frank has a quick wit. “By all means remove my jumper, young man, but please leave my head where it is” says Frank as we help him get undressed for a bath. His wife lives locally and phones him every evening. Frank is never really sure who she is but speaks to her as if he knows he ought to. 

His son lives far away but sends a word processed letter every week, often with an old photo or two scanned in. Frank will read the letter as if pretending to make sense of it’s contents, but enjoys staff reading his letters aloud to him. Every so often we’ll read out the name of a grandaughter or daughter-in-law and explain to Frank who this is. But the photos his son includes need no explanation. Frank can put names to faces of seemingly anyone from his past. A next door neighbour. A work colleague. The vice-secretary of the local angling association circa 1953.

Dementia is a convenient term but lacks descriptive power. As we can see from just a few brief stories, diagnoses such as Alzheimers have certain key features that exist on a long continuum stretching from slight memory loss and a little cognitive impairment to more or less wholesale destruction of the human being whose brain it invades. 

And every so often those of us paid to wash, dress and feed people no longer capable of doing it for themselves need to stop and look at the person in front of them. Because for every empty, burnt out shell of a human being left behind by dementia is a picture on a wall. A window through which we glimpse a moment in time of the real Michaels, Margarets and Ediths who lived, loved, brought up children, sipped cocktails, got degrees, posed with the vice-secretary of the angling society and wore posh hats at weddings.

Connor Kinsella
Lead Trainer, JCK Training

Next time: CARE HOME DIARIES PART 5: ‘Where have all the relatives gone?’

CARE HOME DIARIES PART 3: ‘Dementia and The Sound of Music’

If you missed Part Two of our dementia care series it’s here, but for Part Three we’re having a little musical interlude. How can someone with a memory span of 30 seconds know all the words to Love Me Tender?

The care home day is measured not so much in hours and minutes but by meals and periods in between breakfast, lunch and supper. We have an Activities Co-ordinator at Hill View House and staff who are on the whole very good at thinking up ways of entertaining and stimulating our residents. Even those with very severe dementia seem to register some sense of enjoyment in having their nails done, their hair put in rollers or having a book or letter read out to them.

But one Saturday afternoon we had a few residents who, for various reasons, were not in the best of moods and looked a little bored. Entertainment was required, and yours truly was nominated for the not particularly enviable task of thinking something up.

As a social care trainer I have fifteen years experience devising fun ways of engaging groups of people for several hours at a time, but looking around the rather bored, grumpy faces staring back at me from the lobby where our residents tend to congregate, I was running out of ideas for things we hadn’t done in a while. There are some good resources I’ve used before such as nostalgia quizzes on DVD, but in our particular home it’s difficult to get more than a small group around any of the TVs. I needed something we could do in a large area that would be entertaining enough not to have my audience wandering off, falling asleep or constantly asking “is it time for tea yet?”

Word games? A colleague had done a really good one the other day so it was too early to try again, even if we had only got to ‘Boys names beginning with C’. Panicking, I rooted around in a cupboard. Bingo? Popular with some of the residents, but bingo needs prizes and the help of other staff to help out the less able players. My colleagues were all busy elsewhere and besides, I know for a fact that if I was in a care home and staff suggested bingo I’d be telling them exactly where they could stick their two fat ladies.

I was just about to give up and tell the shift leader my time really would be better spent spell-checking the care plans when I came across a red plastic wallet with a CD and an A4 sheet with song titles on it. ‘The Musical Quiz’ didn’t look too promising at first, but I was grasping at straws here. I knew at least a few of our residents could belt out the big tunes from Calamity Jane or High Society whenever we put on the the DVDs, but would a session of ‘Name that Tune’ be a step too far for people who couldn’t remember what they’d had for lunch?

So ten minutes later I’d gathered a CD player, some cups, a jug of squash and a dozen people with a combined age of one thousand and a bit. And an hour and a half after that, we had, I think it’s fair to say, created a bit of a buzz. Yes, let’s repeat that. A buzz. In a care home. 

As resources go, The Musical Quiz was decidedly low-tech. Two discs each with thirty brief clips of well known tunes, each of which was numbered and announced, and repeated twice to help those who didn’t quite get it the first time. All I had to do was press the Play button, let the clip play once or twice, add a little showbiz-lite, crack some woeful jokes and wait for my makeshift choir to burst into song. Well, it wasn’t quite as easy as that, and that’s why the session worked so well. Some of the tunes were instantly familiar and picked up in seconds. Others needed a little more work. “Hang on, hang on – it’s on the tip of my tongue!” said Bert, as Mary would ‘la-la-la’ the tune until yet another of the group would suddenly grasp the first line as if retrieving the words from a radio show she’d last heard in 1945.

These were people whose dementia normally taunted and frustrated them for not being able to remember words and phrases that could and should trip off the tongue. But for this afternoon at least the effort of trawling deep-seated archives of memory (stored well away from those parts of the brain most damaged by dementia) was a pleasure, not a pain. It’s been well known for years how regular and frequent brain ‘exercise’ can slow down the progression of dementias such as Alzheimers Disease, but this wasn’t really therapy. This was fun.

Among the group were people for whom getting dressed is impossible without the help of staff. Some need constant reminders that meals don’t need paying for, or that they now live at Hill View and their daughter isn’t coming to take them home. Some have short-term memories so brief they forget the answer to a question within a few moments and have to ask the same question again. And again. And again.

But somewhere in each of those minds was a jukebox of songs. Songs that had perhaps lain dormant for decades but brought back to life by a few seconds of playback on a CD player. Occasionally I asked “When was the last time you sung this?’” or “Anyone remember who had a hit with that?” but nobody seemed to know. It didn’t matter. It’s the sheer joy of a good tune that had our early hominid ancestors building flutes out of deer antlers, me bouncing around the mosh pit to Bauhaus in 1979, and care home residents belting out songs in 2013 that were loved and sung by them, their families and friends long before I was born.

Now that’s what I call music.

Connor Kinsella
Lead Trainer, JCK Training

Next time: CARE HOME DIARIES PART 4: ‘Pictures on a Bedroom Wall’ where dementia makes my jaw drop

 

For further information on Dementia training and services, contact JCK Training at enquiries@jcktraining.co.uk or call 0208 133 9458

CARE HOME DIARIES PART 1 ‘Unfashionable, Unseen, Unmentionable’

Introducing a series of posts from the front-line of dementia care

It had been twenty years since I’d last dealt with bodily fluids that didn’t belong to either small children or one of the dogs. But here I was at 7am on a Saturday morning helping to wash and dress a chap called Ted. Ted has severe Alzheimer’s Disease. He cannot walk or talk, and needs constant assistance to do just about everything.

Before this, my last encounter with Alzheimer’s had been twenty years ago. I was training to be a Registered Mental Nurse and what was then known as ‘Psychogeriatrics’ really wasn’t the most popular placement for students. Hardly surprising for a specialty sounding like a David Lynch movie and promising little more than a seven hour shift full of old people’s bits and an ocean of human waste.  But I finished my placement through gritted teeth and carried on toward a career with mentally disordered offenders and far, far away from the ravages of dementia.

So wiping Ted’s bum on a Saturday morning while normal people were having a lie-in could reasonably be described as a culture shock for one who normally earns a living travelling up and down the country running courses, or sitting at home bashing away at a laptop. But in six months as a relief care assistant I’ve learnt an incredible amount.  About life. About death. About people. And a lot about dementia.

There was a time when dementia was, as it seemed to us student nurses, the unfashionable, unseen and unmentionable of health care. But more recently the blogosphere, social media, a smattering of telly and a renewed interest in the harm that can come to a group of people who are just about as vulnerable as it’s possible to be has made dementia a great deal more visible than it has been in the past. It is now something most people are aware of, even where they haven’t been touched by it themselves.

But there remains one perspective pretty much invisible to the dementia story. Not those of the sons and daughters of sufferers, many of whom have provided moving and hugely educational accounts of Alzheimers, Vascular, Lewy Body and all the other conditions which form the umbrella of ‘dementia’.

There are around 18000 nursing and residential care homes in the UK. They will be staffed by a team of mainly unqualified care assistants, primarily female and paid minimum or near minimum wage, In many cases they will have had just about enough training to tick a box and satisfy the CQC inspector, and may often have little command of English.

Theirs is pretty much a silence broken only by the odd hidden camera expose of physical abuse, verbal hostility or theft, or the ever growing focus on care home scandals where residents are left starving, dehydrated and rotting in their own excrement. If they work in people’s own homes as domiciliary carers, they don’t turn up, or when they do, spend barely any of the allotted (and paid for) time with their clients. We hear some pretty terrible stuff, but how often do we hear the care assistants’ side of the story?

Most people working on the front line of dementia care aren’t big on talking about what they do. From my own experience, this certainly isn’t because they’re inarticulate or have nothing to say. They’re just too busy putting in enough minimum wage hours to pay the gas bill. So this is a carers-eye view of a degenerative brain condition which ranges from the mild early-stage to the severe, terminal condition we rather clumsily lump into the term ‘dementia.’  It won’t always be easy reading and there will be mention of things we British would never normally mention, but I’m lucky to work in the sort of home where good things happen as well.

Connor Kinsella
JCK Training

Next Time: CARE HOME DIARIES PART 2: ‘The Good, the Bad and the Ugly’ where I get a job at Hill View House just as I start to think of social care as the new slave trade. Well, I still do. A bit.

The CQC and Embarrassing Toilet Incidents

So the Care Quality Commission (CQC) is once again left feeling like the bloke who leaves a giant stool in his in-laws loo just as the flush stops working. They’re not just flapping around in a panic with their trousers around their ankles. They’re tripping over, hitting their head on the bath and suffering the acute embarrassment of the in-laws calling the ambulance out. 


I’d seen the trailers for last night’s Panorama so knew what to expect. Fiona Phillips flashing her Jimmy Choo’s as the celebrity face of Alzheimer’s and doing a bit of crying. Sorry Fiona, perhaps a little harsh but I do have issues with slebs doing ‘issues’. That’s for another blog.


It was of course revolting television and very hard to watch, even when forewarned is forearmed. The online world is rampant with a thousand calls for action, more respect for elderly people, and Telegraph readers demanding instant dismissal of all care home staff not carrying a Surrey passport. 


But while it’s good and right to howl loudly from the rooftops, we also need to take a step back and ask how we as a society put a stop to this. It would be lovely to think that the extended family will take over when Grandad starts leaving the gas ring on and tries to make toast with a chocolate digestive.


But the nuclear family is long gone in this corner of the world, and those care industry shareholders won’t be giving up their yachts and racehorses anytime soon. So for now at least we’re left with bodies like the CQC and our Safeguarding Panels to protect vulnerable people from the living nightmares we seem to be seeing and reading about every other day.


Still emerging battered and bruised from the ashes of Winterborne View, the CQC now have their old friends Panorama to thank for yet another death by spycam. They didn’t emerge with a lot of credit last night. It would be all too easy to point the finger and join in with a bit of quango-bashing, but in fact I come to praise Caesar, not to stick a knife in his guts.


They have the unenviable task of inspecting just about anywhere in the country that has a roof, paid staff and vulnerable people sitting indoors. They deserve to be cut some slack for that at least, but what concerned me last night was the sheer panic in the face of what was bound to be another incendiary device going ‘BANG!’ in the face of a horrified public.

They declined to appear on camera with Fiona Phillips. Now Fi is hardly Jeremy Paxman in a designer two-piece so why the reluctance? Our national care inspectorate reduced at once to the status of dodgy car dealer chased around by that bald bloke in a parka who makes shows about dodgy car dealers. 


But perhaps with the benefit of past experience, their ‘Panorama Statement’ was robust, reasonable and said all that needed to be said. A media-trained representative could and should have offered that content to the Panorama cameras. More dignity, more transparency, and much less cowboy builder.  


And then there was their slightly embarrassing Twitter campaign emerging almost as soon as the credits were rolling. Their output of Tweets is normally so rare I’d forgotten I even follow them, but last night? A slightly embarrassing flurry of ‘It Wasn’t Me Guv’ postings, and a link to their most recent report on Ash Court


To paraphrase the report: “Ash Court is lovely. I’d send my Gran there.” It contained enough typos to suggest the authorship of a chimp with a bad caffeine habit. Unprofessional, but let’s put that down to the inspector’s report-writing fatigue and almost certain overwork. More importantly, why the apparent whitewash? Well there is that notorious tendency of care homes to get the decorators in as soon as they have a whiff of an ‘unannounced’ inspection, and would we really expect care staff to be stood in front of a clipboard-wielding inspector abusing a frail, elderly woman while chatting away in Spanish and watching Corrie? You can’t punish what you can’t see. 


I don’t write public statements for the CQC or for anyone else other than myself and my business. But I might have asked this of those who will invariably point the finger at the inspoectors: “Did anyone from the CQC actually abuse vulnerable people at Winterbourne View or Ash Court? No. Did anyone at CQC have anything to do with building 60-bed three-tier monstrosities which are more about battery farming than any semblance of residential care? No.”


Their management of the latest care industry furore was undoubtedly poor and unnecessarily defensive. They need to learn lessons. They almost certainly need more inspectors on the ground, and less twonks in suits. But there’s a whole heap of reasons why we’ll keep on hearing, reading and seeing these horrors, and the answers won’t come anytime soon. So for now we need a care inspectorate thrusting it’s face into dark corners shouting “Oi! You!” and not running around panicking over an obstinate plop.


If you can’t be bothered reading his profile, Connor Kinsella is Lead Trainer with JCK Training and writes about himself in the third-person. 

Deaf, Daft and Demented: Improving Attitudes to Elderly Care

The woman on the radio sounded distraught. She was calling a phone-in show from the hospital where her frail, elderly Dad was being treated. Treated perhaps, but not being cared for. The caller described a ward full of elderly, infirm patients marooned in their beds trying to reach water jugs across the Grand Canyon of space between them and an impossibly far away bedside cabinet. Others pressed the call button repeatedly for commodes or help with moving up in the bed. Nobody came. 


The presenter Shelagh Fogarty suggested a shortage of staff. Apparently not. The caller described a large group of ward staff lolling around the Nurses Station chatting about Facebook. The phone-in took place on the back of a recent RCN report calling for minimum staff levels on elderly care wards. The RCN survey was itself a response to a catalogue of horror stories surrounding the care of older people. In the same week a Which? Magazine ‘secretshopper’ sting highlighted (yet again) serious failings in domiciliary care. It makes sad if not unfamiliar reading. Missed medication. Missed food and drink. Soiled beds. That sort of thing.

So what are the reasons for this constant torrent of bad news? There are plenty of ‘big picture’ factors involved, and others more eloquent than I have written about some of them elsewhere with the precision of front-line experience. But let’s look at one specific and rather uncomfortable area from my own perspective as a trainer.

It’s one of those elephants in the room that doesn’t get much of a public airing, and goes something like this. 

Care of the elderly is far and away the least popular of the health and social care specialities, and attracts the sort of staff who might just as well be earning a Gold Star for assembling Big Macs.

For as flawed as the bigger picture may be, it is still individual care staff leaving patients to dessicate or care home residents to sit in their own faeces. Whenever I hear one of these reports I imagine myself visited by The Ghost of Christmas Yet to Come, aged by forty years and placed in a nursing home by a family who have ignored my Living Will request to be shot at the merest suggestion of double incontinence. I have a memory span of thirty seconds, and I’m muttering to myself, probably because nobody else will listen. My Inco Pad fills with the end result of my soft diet lunch. A couple of care assistants haul me into a wheelchair and whisk me off to the nearest shower hose, deep in conversation over Kate Middleton’s choice in shoes. 

So in this Dickensian nightmare I’m quite literally at the arse end of the care sector, but back in the real world does it really follow that elderly care attracts the bottom of the pile in terms of it’s staff?

Speaking as a trainer working with hundreds of care staff over the years, most certainly not. But I do often see a demoralised workforce working long hours for poor pay and even poorer conditions. With the best will in the world it’s not hard to see how patients or clients eventually come to be seen not as valued individuals but as names on a job sheet spiralling ever downward  toward ever-increasing neediness and ultimate death.

So what do we do? Do we throw more centralised funding at our local authorities and privatised care providers?  Even if such fanciful thoughts had the slimmest of chances of becoming reality, I suspect this would achieve little in terms of progress beyond a healthier shareholding for their employers.

What about better training for care staff? For as long as I’ve been in the business training has been a luxury expense in an industry long governed by the bottom line of the profit/loss equation. ‘Stack it High, Sell it Cheap’ used to be the mission statement for Tesco but is now the essential business model for elderly care, where training is often seen as a costly irrelevance to short term profit. But could more and better quality training really improve the care and attitudes toward our vulnerable elderly? 
A few years ago I collaborated with some local colleagues on designing and facilitating a BTEC Short Course Award: Caring for the Older Person with Mental Health Problems. It was a fairly simple programme consisting of three classroom-based modules focussed on Dementia, Depression and Challenging Behaviour. We worked with a varied collection of staff from both nursing home, residential and domiciliary settings. Some of our candidates were managers, while most were front-line carers. Almost all were terrified at the prospect of taking a test at the end of each day although Exam Phobia faded quickly once our candidates realised how much they already knew and what they were capable of.

We looked at how depression, so endemically common among older people in care and yet so seldom tackled, can be quite easily identified by care staff using the sort of rapport and person skills that comes inevitably when helping a resident put on their socks every morning.  We looked at magnified images of protein plaques and discussed how these lead to memory loss. We looked at how awareness of the sensory and cognitive deficits of dementia can help us communicate much more effectively and reduce distress. Not only did our candidates earn a recognised qualification but challenged, examined and re-evaluated  how they worked with older people. Now let’s not pretend this was Dead Poets Society but the fact I’m talking about this award it in the past tense irks me more than Robin Williams. And that’s a lot of irk.

We were able to deliver the award only with the help of a generous funding pot from the now defunct Business Link Dorset. Once the funding dried up, so did the course, and we certainly didn’t have the resources to evaluate the shop-floor efficacy of the training. But on anecdotal evidence at least, investment in a reasonably cheap and effective project yielded greatly improved levels of care and support inspired by more positive attitudes and a greatly enhanced sense of self-worth among our groups. With potentially business-ruining CQC reports easily available online and a traditionally high turnover of staff, you don’t really need a degree in health economics to work it out. It’s just good business to have better trained staff.

In the meantime we’ll continue to hear an unending tide of bad news stories and radio phone-ins about staff who have become demoralised and dispirited when they could, with a little time and effort, be taking a fresh look at the work they do as something which is as skilled and satisfying as any of the ‘sexier’ areas of the care and support industry.  

It could certainly beat flipping a burger.