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LONDON, England / The Guardian / Society / Older People / July 14, 2009
Most of us will end our lives in an old people's home just like this one. The care is good; the staff are lovely. And yet it's hard not to be shocked by the reality of daily life here
By Amelia Gentleman
6-9am
The 26 residents at Raglan House can very crudely be grouped into the living and the dying. The dying remain in private rooms, in bed, barely aware of night and day, their dwindling existence regulated by four-hourly nursing checks, changes to their incontinence pads, a few kind words from the care assistants as they smooth the pillows.
The living start their day shortly after six when staff begin hoisting them from their beds with crane-like machines, remove their night clothes, wash them with a sponge, dress them, transfer them to their wheelchairs and push them into the day room.
The day room at Monmouth Court nursing home, Ipswich. Photograph: David Levene
One by one, six widows in their 80s and 90s arrive to sit together at the central table, rolling into the places they occupy every morning. Peggy Dunn drives herself in an electric wheelchair, a highly sought-after piece of equipment provided by the NHS wheelchair services to those deemed sufficiently mentally agile to be safe.
Elsie Stone, 89, who has had both legs amputated, wheels herself in, slowly, her chair creaking as she makes her way across the room. ("Come on Speedy," Peggy says. "I can't. My arms hurt this morning," Elsie replies.) Lois Kettly and Violet Grove arrive and wait for someone to bring them breakfast. No one says anything.
Sometime after 7.30, Peggy, who has been here for eight years, breaks the silence to ask: "What shall we do today?" Her companions do not reply.
"Let's do something different today," she persists. "Let's go on strike."
"On strike?" Elsie replies with a pale smile. "On strike from the monotony? It's the same every day. Every day."
Monmouth Court on the outskirts of Ipswich is a nursing home run by Bupa, with 150 beds shared out between four one-storey units, of which Raglan House is one. The gardens are lovely; the 1980s brick buildings are reminiscent of a Welcome Break motorway cafe. The home has two stars, which ranks it as good and makes it representative of the vast majority of Britain's care homes, where around 394,000 elderly people are currently housed. This is not a home for people who have paid for Bupa health insurance; 90% of the beds are paid for by the state rather than private contributions.
The government will today publish a long-awaited green paper into how care and support for the elderly should be reformed. It is not an area that the government has successfully focused on recently – there have been four ministers for care in the past five years – but it is a subject that requires urgent attention. Over the next 20 years, the number of people over 85 will double, the number over 100 will quadruple, and officials expect that 1.7 million people will need care and support. Funding is already thin and expected to get sparser still, as local authorities see their budgets slashed.
More of us will end our lives in these institutions, about which (unless we have admitted family members to one) we know so little. They remain shut away, forgotten about, only the focus of occasional media attention when something scandalous happens.
9.30am
A few newspapers arrive.
One of the frailer residents of the day room needs to go to the loo, so two care assistants fetch the electronic hoist and slip nylon straps beneath her bottom, fastening them into a sling between her legs, hiking her skirt down as she is winched up to stop her naked thighs being exposed to the scrutiny of her companions, at pains to ensure the clear plastic oxygen tube running from her nose does not get tangled in the mechanism.
She moans and cries out in fright throughout the process. "Ow ow. My left foot. My left foot. My left foot. Am I doing all right? I'm very uncomfortable. Sorry, sorry, sorry. Ow. It hurts. It hurts. Bless you, bless you. Sorry."
"You're no trouble at all," the carers reply. The staff are accustomed to her cries and they know the hoists feel awkward. "It's a horrible sensation. We've all tried it," the unit's senior nurse Chrstine Driscoll says.
To be fair to the valiant efforts of the home's staff, life here is not quite the same every day, given the constraints of looking after a group which includes many who are confused, immobile and incontinent (a triumvirate of conditions known in this sector as "the unholy trinity"). On Wednesdays, after breakfast is cleared away, there is bingo. On Thursdays, there are visits to the on-site hairdresser.
Everyone has a shower and a hair wash once a week. Once a year a few of the more physically able residents are taken for a trip to the market in nearby Bury St Edmunds. It is a highlight much anticipated.
The six widows spend their days at the central table where they eat their meals, grouped together because their physical and mental state is about the same. Three more women, in feebler condition, spend the day in armchairs pushed against the wall. Another woman, profoundly deaf, prefers to sit at a table by herself; she feels frustrated when people try to talk to her. There is also a separate table for a man whom nurses describe as a naturist. "He gets a bit upset that he can't sit here with no clothes on; I tell him it's fine to do that in his room with the door shut," a nurse says.
This morning he is sitting with his hand clapped to the right side of his face, as if he has just remembered some terrible news, but his hand stays there for five minutes, and after a while it becomes clear that he is not in shock but simply asleep. A nurse strokes his back to wake him up. "Have you got pain, my love?" she asks, and fetches him something from the medicine trolley.
Medicine is distributed four times a day. About a third of the residents are on antidepressants to help them cope with being here. One apparently cheerful and well-settled woman is on a heavy dose to counter her suicidal tendencies. Before she started taking them, she tried to hang herself using the assistance bell cord in her room.
If you ask them how they like it here, most of the six widows, born during the first world war or the 1920s, will insist that they are all right, that they can't complain, that the food is lovely and the nurses wonderful. It is hard to determine whether this is stoicism or a self-protective determination not to focus on the reality of their situation: that they have been sent here by their family or doctors because they can no longer look after themselves, and they are unlikely to go anywhere else before they die.
It is only when they move away from the group, and talk quietly with a care assistant or a visitor, that the guard begins to come down. [
rc]
Click here to continue reading
© Guardian News and Media Limited 2009
Most of us will end our lives in an old people's home just like this one. The care is good; the staff are lovely. And yet it's hard not to be shocked by the reality of daily life here
By Amelia Gentleman
6-9am
The 26 residents at Raglan House can very crudely be grouped into the living and the dying. The dying remain in private rooms, in bed, barely aware of night and day, their dwindling existence regulated by four-hourly nursing checks, changes to their incontinence pads, a few kind words from the care assistants as they smooth the pillows.
The living start their day shortly after six when staff begin hoisting them from their beds with crane-like machines, remove their night clothes, wash them with a sponge, dress them, transfer them to their wheelchairs and push them into the day room.
The day room at Monmouth Court nursing home, Ipswich. Photograph: David Levene
One by one, six widows in their 80s and 90s arrive to sit together at the central table, rolling into the places they occupy every morning. Peggy Dunn drives herself in an electric wheelchair, a highly sought-after piece of equipment provided by the NHS wheelchair services to those deemed sufficiently mentally agile to be safe.
Elsie Stone, 89, who has had both legs amputated, wheels herself in, slowly, her chair creaking as she makes her way across the room. ("Come on Speedy," Peggy says. "I can't. My arms hurt this morning," Elsie replies.) Lois Kettly and Violet Grove arrive and wait for someone to bring them breakfast. No one says anything.
Sometime after 7.30, Peggy, who has been here for eight years, breaks the silence to ask: "What shall we do today?" Her companions do not reply.
"Let's do something different today," she persists. "Let's go on strike."
"On strike?" Elsie replies with a pale smile. "On strike from the monotony? It's the same every day. Every day."
Monmouth Court on the outskirts of Ipswich is a nursing home run by Bupa, with 150 beds shared out between four one-storey units, of which Raglan House is one. The gardens are lovely; the 1980s brick buildings are reminiscent of a Welcome Break motorway cafe. The home has two stars, which ranks it as good and makes it representative of the vast majority of Britain's care homes, where around 394,000 elderly people are currently housed. This is not a home for people who have paid for Bupa health insurance; 90% of the beds are paid for by the state rather than private contributions.
The government will today publish a long-awaited green paper into how care and support for the elderly should be reformed. It is not an area that the government has successfully focused on recently – there have been four ministers for care in the past five years – but it is a subject that requires urgent attention. Over the next 20 years, the number of people over 85 will double, the number over 100 will quadruple, and officials expect that 1.7 million people will need care and support. Funding is already thin and expected to get sparser still, as local authorities see their budgets slashed.
More of us will end our lives in these institutions, about which (unless we have admitted family members to one) we know so little. They remain shut away, forgotten about, only the focus of occasional media attention when something scandalous happens.
9.30am
A few newspapers arrive.
One of the frailer residents of the day room needs to go to the loo, so two care assistants fetch the electronic hoist and slip nylon straps beneath her bottom, fastening them into a sling between her legs, hiking her skirt down as she is winched up to stop her naked thighs being exposed to the scrutiny of her companions, at pains to ensure the clear plastic oxygen tube running from her nose does not get tangled in the mechanism.
She moans and cries out in fright throughout the process. "Ow ow. My left foot. My left foot. My left foot. Am I doing all right? I'm very uncomfortable. Sorry, sorry, sorry. Ow. It hurts. It hurts. Bless you, bless you. Sorry."
"You're no trouble at all," the carers reply. The staff are accustomed to her cries and they know the hoists feel awkward. "It's a horrible sensation. We've all tried it," the unit's senior nurse Chrstine Driscoll says.
To be fair to the valiant efforts of the home's staff, life here is not quite the same every day, given the constraints of looking after a group which includes many who are confused, immobile and incontinent (a triumvirate of conditions known in this sector as "the unholy trinity"). On Wednesdays, after breakfast is cleared away, there is bingo. On Thursdays, there are visits to the on-site hairdresser.
Everyone has a shower and a hair wash once a week. Once a year a few of the more physically able residents are taken for a trip to the market in nearby Bury St Edmunds. It is a highlight much anticipated.
The six widows spend their days at the central table where they eat their meals, grouped together because their physical and mental state is about the same. Three more women, in feebler condition, spend the day in armchairs pushed against the wall. Another woman, profoundly deaf, prefers to sit at a table by herself; she feels frustrated when people try to talk to her. There is also a separate table for a man whom nurses describe as a naturist. "He gets a bit upset that he can't sit here with no clothes on; I tell him it's fine to do that in his room with the door shut," a nurse says.
This morning he is sitting with his hand clapped to the right side of his face, as if he has just remembered some terrible news, but his hand stays there for five minutes, and after a while it becomes clear that he is not in shock but simply asleep. A nurse strokes his back to wake him up. "Have you got pain, my love?" she asks, and fetches him something from the medicine trolley.
Medicine is distributed four times a day. About a third of the residents are on antidepressants to help them cope with being here. One apparently cheerful and well-settled woman is on a heavy dose to counter her suicidal tendencies. Before she started taking them, she tried to hang herself using the assistance bell cord in her room.
If you ask them how they like it here, most of the six widows, born during the first world war or the 1920s, will insist that they are all right, that they can't complain, that the food is lovely and the nurses wonderful. It is hard to determine whether this is stoicism or a self-protective determination not to focus on the reality of their situation: that they have been sent here by their family or doctors because they can no longer look after themselves, and they are unlikely to go anywhere else before they die.
It is only when they move away from the group, and talk quietly with a care assistant or a visitor, that the guard begins to come down. [rc]
Click here to continue reading
© Guardian News and Media Limited 2009
