Tag Archives: Better Practise

Dementia: Looking Back: Looking Ahead (Week 23)

 

Maureen came back in a big way yesterday and confined Mrs Dementia to the dustbin until it was time to go to bed.  I wasn’t at all surprised that I was sent to the Boys Dorm at 1o.30 pm as she would have been exhausted after a very busy day.  Once we were upstairs she once again asked where the girls were so I took my cue and hot- footed it to the spare room.  This morning I heard Maureen crying out as she asked Denise, her daughter who has passed, if it was time to get up.  A quick cuddle and a cuppa did the trick and she was safely in the land of nod.

Today will be the first day for almost a week that Chloe has been on duty.  I have deliberately kept carers at bay so that we could get our home back for a while.  It’s not surprising that Maureen thinks it’s a Care Home with ‘ladies’ as she calls them here every weekday.

Some of my friends on Talking Point  have often questioned my judgement: quite rightly on occasions.  Certain members of my family have raised their eyebrows at my approach: one even suggesting ‘I haven’t got a clue’.  So take breath before you read this: we are now curtailing the amount of carer sits by terminating the presence of carers on Tuesday’s and Thursday’s.  Yes: we are reducing Local Authority funded carer sits by 6 hours a week.

Our Dementia Specialist Social Worker: Flexible Sue as I now  call her fully understands our strategy and she is never one whose sole concern is to manage budgets.  We have both finally understood Maureen’s plea to ‘want to get her home and  life back’.   It is possible that carer sits may be reduced even further as Maureen’s recovery from stroke continues.

Flexible Sue has kindly offered to support me as I try to ensure that Person Centred Care is applied across the board.  The Home Treatment Team provide daily mentorship as I try to get my own house in order.  They think my plan to continue an assessment of Maureen’s capabilities is sound and like my ideas about including carers in this process.  Once we have spent a week or so taking a look at Maureen in action I hope we can arrive at a consensus on the way forward.

The photo below puts some ‘meat in the sandwich’ of my thinking.  Actually it was cheese but no matter:

Maureen offered to make me a cheese sandwich yesterday afternoon.  I fell asleep as she had been in the kitchen rather a long time.  When I caught up with her it was clear she had struggled.  There were three sandwiches scattered around the kitchen I found the one above in the fridge. She had done her best: no harm had been done and nothing wasted – in fact plenty for another day.  Nevertheless, there had been purpose in her life for the last half an hour or so.  Our focus needs to be in helping Maureen to find more purpose than being tied to the kitchen sink.  I have every confidence that with the support I have at my disposal we are up for it!

 

Dementia: Two Good Men

I couldn’t let today pass without mentioning two good men.  Maureen and I both had fathers who were called Jack.  When I worked at the Morris, later to become British Leyland, I was always known as Jack’s son even though his name was John.  Maureen’s sister is still known as Union Jack’s lass whenever she bumps into those men who knew her of her dad’s activities in his days at the Raleigh.

I never had the pleasure of meeting Maureen’s dad as he had passed before we met. However from the stories she has told me he was a wonderful father just like mine.  The other thing they had in common is they were both active trade unionists.

Both of our fathers didn’t mince their words and were outspoken in their beliefs.  We are both proud to have had fathers who had no truck with liberal political correctness. 

Happy fathers’ day to two Jacks: we try to be chips off the old block.

I’m wondering if a change of scene would help us both on this sunny morning here in Cleethorpes.  Maureen has slept a lot in the last couple of days and hardly been out the door for more than the odd half an hour.  As you will see from my Niceness page I needed support yesterday to try to fathom what was going on here.

The warmer weather gives me a chance to see if Maureen will consider a day out.  As it is father’s day she might want to venture as far as Nottingham to see her brother and sister. Coventry might be a bridge too far so it’s unlikely I’ll be able to visit some familiar haunts to remind me of my dad.

We are fortunate that we only need to venture into Cleethorpes to reminisce about our respective fathers: Maureen lived here as a child for a couple of years and my dad came to see us here, along with my mum, on several occasions.  So a walk on the Prom would be nice and if we called in at Kew Road, where Maureen used to live, and the RAF Club to remind us of the Rear Gunner, we would both enjoy fond memories of two good men.

Dear me I almost forgot this which I have added an hour after my intial post:

 

Dementia: Person Centred Care In Action

I have sent the following E Mail to relevant professionals this morning:

‘Hi Sue, Mel and Gilly

Person Centred Care

Who is able mentor me on helping me to make this happen see today’s Blog post https://memoryissues.wordpress.com/
Kind regards
Paul’
I have also received a call from the Home Treatment Team asking me how Maureen is.  You can’t get more Person Centred than the HTT.  They will continue to monitor how things are going.
Maureen is currently eating her breakfast prior to an appointement with her G P.  She slept most of yesterday and Dr Munjal wants to check her out following her fall on Monday.
Things are moving in a positive direction.

Dementia: Person Centred Thinking

I have been thinking for a while how we need to change the direction of our journey so Maureen is being enabled rather than looked after and kept safe.  This article from one of my Linkedin Networks is just what I have been looking for:

‘Simple changes make significant change for the person living with dementia.

One Page Profiles (1PP) are one of the Person Centred thinking tools that support the transition from people living with dementia being passive recipients of care to their being recognised as equal value members of society. They also herald a new progression, as services aspire to move beyond personhood towards citizenhood.

SCIE have a fabulous online tool that provides information, videos with Helen Sanderson and Michael Smull and a helpful step by step guide to completing you 1PP.

The 1PP is the visual outcome of semi-scripted meetings that are held with the person, their families and carers. But the real powerhouse of change and the arena for accomplishing that change is not the outcomes as much as the process undertaken to create that profile. The meetings offer a unique opportunity for relationships to deepen and flourish, with paid and family carers working in collaboration with the person to share understanding , skills and knowledge that might enhance the lived experience for the everyone involved.

One important difference between traditional person centred care and personalisation through 1PP is the inclusion of the experiences of the formal and informal carers. Not only do we seek to understand the experience of the person living with dementia, but we show equal respect to the qualities, aspirations and needs of members of too. In Dementia Reconsidered Kitwood reminded us that carers are people too. This sentiment seems not always to be present in all modern paid care roles with their minimal wages and maximum public scrutiny.

The 1PP process generates opportunity for real time problems solving that puts into action the previous rhetoric of the social model of disability. In short they offer a chance to develop solutions in a multi-focused forum to situations that cause challenge and concern to the person and those that support them.

I facilitated a meeting on one occasion for a gentleman who had lived in the care setting for just a few months. However, in all of that time the staff had been unable to successfully offer him any support to meet his personal care needs. Whenever they tried, no matter who amongst the staff, he would become increasing distressed. This distress was beginning to cast a shadow across all of his day. The initial remedy to this was that is daughter in law provided this support, much as she had at home for several years before he came to live in the home. At the meeting she said that, whilst she loved him dearly, she was hoping that she could start to withdraw this level of support so that she could visit and just enjoy his company, rather that feel responsible for his care.

We talked about how she was successful in supporting him and what she might do differently to the staff. She said that she didn’t know, but perhaps they sang the wrong songs. They sang songs together.

It is as simple as that.

They sang.

We asked what they sang together, and she said anything with bounce, Daisy Daisy was a good one, but be prepared to sing it over and over. The staff were skeptical at first, thinking that it was too simple, but as a team agreed to give it this a try. It worked immediately.

From that day on staff have been able to support this gentleman with all of his personal care needs. With staff providing this support his daughter in law has felt able to draw closer to him as he time is spent providing a deeper level of emotional support.

To achieve outstanding the CQC asks providers for evidence of a strong, visible person-centred culture where people are truly respected and valued as individuals and where they are empowered as partners in their care. The timely use of Dementia Care Mapping™ and Person Centred Thinking™ tools go some considerable way to providing that evidence.

Clover Care Consultants is able to support care teams and providers to evidence their practice and build on their successes’.

 Postscipt: I realise that this will take some working through but with my experience from a  Masters in Lifelong Learning and the Managing Change we’ve got a sporting chance

 

 

Dementia: You Can’t Kill The Spirit

Maureen is rather bruised at the moment but her spirit is still remarkable.  She was struggling on Tuesday after her late night visit to A&E at Grimsby Hospital and I needed to the support of the Home Treatment Team to help me pull through.  Yesterday Maureen was back at full throttle excelling as we worked through our busy day.

Our conversations early doors had been about living in this house: a place that has probably never felt like home.  We are both considering whether it is time to call time on 16 years on ‘holiday’ in Cleethorpes.  Maureen’s response has been exciting evidence that ‘she is still the full shilling’: urging caution and taking our time.

Melissa from the HTT called mid-morning and once again Maureen was in good form.  She had wondered if the HTT were checking up if I had caused the bruising on her face and was anxious to leave them in no doubt that I was not abusing her.  Maureen really enjoyed the stimulation of Melissa’s visit: another excellent professional from the HTT.

Maureen came into her own as we dealt with the raised paving slab that had caused her accident.  In the Council Offices and the Solicitors she played her part in processing a potential negligence claim.

We both fell into bed around 9.30 exhausted after a long day.  I have been up early this morning sticking to my plan to improve my sleep pattern.

Yesterday convinces me we are on the right track here.  Thanks to my dear friend Kate Swaffer we are converts to the idea of neuroplasticity.  I am really grateful to Dominique Klotz for her introduction to Kate.  Perhaps one day Maureen and I might make it to Australia to thank our supportive friends in that neck of the woods.  How ironic that they have both been in the UK in the last week and we couldn’t get to meet them!

There is lots of evidence that Maureen continues to recover from stroke.  What we will never know is if we can minimise the consequences of further vascular damage:  I reckon with the team of people who are supporting us we can give it a run for its money.

 

Dementia: Respite With A Difference

Maureen is going into Respite: she is having a break from carers coming  into our house.  We are going to see how things go by getting our home back: one of her constant pleas; along with getting her life back.

We are going to do things as a couple again rather than me scarpering to do my own thing as soon as carers walk through the door. 

Maureen has been a revelation today boosted by contact from family and her husband at last understanding what she wants.  Tomorrow’s blog will paint a very positive picture of what we have been doing today.  I must dash to stop her washing up and putting her hands in water as they haven’t healed since that fall on Monday.

Dementia: Cometh The Hour Cometh The Woman

Four women gave us excellent support yesterday. Melissa from the Home Treatment Team met me and made practical suggestions to improve our lives. Sue our Social Worker provided sound support on the phone. Mel my Admiral Nurse kept herself in the loop throughout the day with contact via E Mail.  Kate my next door neighbour taxied us to the hospital at 10pm with Maureen streaming with blood after a fall.

Melissa made two salient points in response to my concerns about our situation.  Firstly, we need a Carers Log of Maureen’s presentation to monitor the progression of her condition.  Secondly, I need to address sleep deprivation as it put my mental health at risk. The immediate steps I am taking will be outlined on my Sorting Sleep page shortly.

I have to tread carefully over the log as any management of change is problematic.  How fortunate that my Masters’ Degree is in ‘Lifelong Learning and the Management of Change’. I know that  Tom Schuller  occasionally pops into my Blog and will continue to keep a watchful eye on his student.

Maureen’s car was out of action yesterday with a flat battery and I wouldn’t have been able to meet Melissa without Mike our next door neighbours help.   Kate, his wife, came to our rescue after Maureen had tripped on some uneven pavement.

The staff at Grimsby Hospital excelled in their approach to Maureen’s treatment. She was treated with dignity and respect by all.  Apparently she has friable skin so sutures could not be used.  The receptionist in A and E summoned a taxi for us around midnight and we were home shortly afterwards.

I have just taken Maureen her first cup of tea of the morning and she is bruised but far from broken by her fall.  She is concerned that I won’t be able to go to work today: how fortunate that my battles to keep order in the classroom, as a Supply Teacher, were concluded several years ago.

 

Dementia: Going Back Home

A couple of hours ago I  responded to Maureen’s constant plea to be ‘taken home’:

She was so happy to be back in familiar territory walking down the back ally of where she used to play as a child.  It was a pleasure to see her ‘back home’ and gaining a sense of belonging once again.

Then she met Roy the ‘Head Honcho’ who is in charge of decorating up the ally for the Queen’s Birthday:

When we came across a busker in the shopping area Maureen couldn’t resist singing along with this Willie Nelson look alike to my request of ‘Always On My Mind’:

 

I just had a sneaky feeling that taking her back just to her childhood home a few miles away in the centre of  Cleethorpes would do the trick.  She’s spark out on the sofa now after what she described as a ‘great morning’.   You have heard of Amazing Susan in previous posts but what about Marvellous Maureen from now on: that wife of mine is incredible.

Dementia: ‘Houston We Have A Problem’

I can’t remember who said it in the missions to get to the moon but we have a problem in Cleethorpes this morning.  In fact we have three problems Maureen’s current presentation, my well-being and a shortage of personnel at ‘Mission Control’.

At 2pm Maureen became concerned about her car again: she is fixated that someone else is using it and not taking her out when they are enjoying the luxury of her motor.  She went off on her own hunting for children who had been playing in her car yesterday and returned half an hour later having forgotten why she had gone out for a walk.  I’m extremely grateful to Susan Macaulay for helping me to reconsider my position on ‘wandering’.  Sue our social worker has also gave me live telephone support on this matter yesterday.  I have no intention of locking Maureen in and will support her right to go for a walk on her own whenever I feel she is in the right mode to be safe.

A secondary problem is that I am racked with pain this morning and needed a hot shower to ease the pain in my shoulders and legs.   The further problem is that Mission Control is depleted this morning as two key personnel have gone AWOL today (not really).

I have now arrived at a point in this Blog where I started yesterday when I pressed the wrong button and released an early draft: I’m spoiled for choice with the level of support that is available to me as a Care Partner this morning.  Sue our social worker never works on Wednesday’s and Mel my Admiral Nurse is on a course in London.  Despite the unavailability of such key personnel I still have a number of professional staff I can turn to if  to chat over my next move.

Just by chance I have an appointment with Paul Martin my counsellor this morning and I will arrange to see Dr Munjal while I’m at Clee Medical Centre.  I need to chat through with them my ‘cunning plan’ to deal with Maureen’s car , wanting to go home and being reluctant to take medication..  If they had not been available I know I could have chatted to staff at the Home Treatment Team or walked a few streets away to be with with Yvonna the chemist at Lloyds.  I could also contact Angie a Carers’ Support Worker and take up an offer of meeting her to discuss how things are going.

When Maureen and I decided to move to Cleethorpes lots of people questioned our sanity.  In retrospect it may well have been a reckless decision to move away from all immediate family who all live over a 100 miles away.  What they, and we, didn’t realise at the time was the range of services here is exemplary and I would be surprised if any Care Partner enjoys the options for support that I have at my disposal this morning.  I had hoped to praise the set-up to support carers here through the channels of the  Academy of NHS Fabulous Stuff and the  Huffington Post  but I fear that may not happen as Maureen doesn’t want me out of her sight at the moment.

I have a number of ideas on how to try to resolve Maureen’s fixation on her car, wanting to go home and being deserted.  It is fortunate that we have a slow puncture in the front near side tyre.  I bet those wheel nuts will be so tight it will not be possible to put the spare on this morning.  How convenient the car can be immobilised for a few days.

Bob Marco asserts that accepting the ’emotional glue’ is a prerequisite to becoming a supportive Care Partner.  He argues that once you accept this sticky solution life returns for those who are on this unforgiving journey: simple solutions all round then!

Today’s Tasks

  • Immobilise Maureen’s car
  • Seek advice on Maureen’s presentation
  • Make dental appointments
  • Encourage Maureen and carer to empty the ironing basket
  • Continue de-cluttering the house
  • Refer family members to Blog for an update
  • Continue to explore moving home with Maureen
  • Potter in the garden
  • Fast during the day to address pain in limbs

Footnote:  I will forward this Blog to the Academy of Fabulous NHS Stuff and Huffington Post and hope  they spread the word of excellent support for carers in Cleethorpes.

 

Dementia: Getting Carried Away Again!

I’ve done it again got carried away and paid the price with a very challenging night resulting in little sleep.  I have already confessed to a silly mistake last week when I strayed into repairing a fence rather than calling a man in.  This week it’s a side-effect of the Learning The Fundamentals course that has led me to err and stray from my ways as a Care Partner.

Yesterday I spent a far too much time revising my blog and frequently checking if my modifications had been well received. This continual popping upstairs has to stop as my blog already serves me well as a therapeutic tool with the added benefit of an excellent place to seek and receive support.

My focus needs to shift to yesterday’s bewitching experience with once again someone switching Maureen’s reality at the drop of a hat (more on this in a later blog).  From around 9pm last night I was the ‘other Paul’ who emerged in Maureen’s reality without warning.  It was 4 hours later before I dared to leave her downstairs ‘waiting for her husband to pick her up’.

As always I slept fitfully in the spare room until around 4 am when I was awoken by a deafening scream.  I raced downstairs and couldn’t find Maureen anywhere and suddenly realised she had gone to bed.  My hug was well received as Maureen told me ‘she had been frightened’ and promptly drifted back to sleep..

I will continue with the Fundamentals and make minor changes to my blog but not at the expense of seeking to minimise Maureen’s distress.   My blog has already exceeded my wildest expectations as a therapeutic tool and an essential part of my support network. Sincere thanks to all who continue to help us find our own way on this hazardous journey.