As you may know I started a new job a week ago. It’s a care home for people with dementia. I had my interview quite a while ago, over the phone, so I didn’t see how it looked inside and I’m really glad it happened this way because I would have rejected the offer.
On my first day of work I quickly realised that I’m in a place called, in care jargon ‘an institution’. I learned over the years that care home should be a home, institutions are bad. And what is meant by home is: en suite toilets, or better yet bathrooms, large living area for all the residents and building designed like a maze where, after the second shift I still didn’t know how to get to the closest toilet. I did question sometimes whether those buildings are suitable for people with dementia but I never knew any better.
Also, just between me and you, the ensuite bathrooms are very often used as storage space for furniture or moving and handling equipment and it’s difficult to even get to the sink.
Those places operate something called ‘toilet hour’ – usually around 11 and 15, where everyone needs to go for a wee. That creates chaos as staff has no easy way of communicating between themselves regarding who’s already been and who hasn’t and there is a toilet queue in hallways. Staff sometimes had to shout the question across the room because we didn’t even have time to find out otherwise. And the online system called Nourish doesn’t offer a quick check on that – everyone’s record needs to be checked separately to find out. I presume this is to show that residents are ‘being treated like individuals’. Here you are.
Anyway, I was initially thinking not to disclose on my blog where I work, because I was worried I may get a stalker (lol!) but the problem here is that people reading this post won’t believe I’m telling the truth. So I need to reveal that: it is Fessey House run by Swindon Borough Council and it is easily the best care home I’ve ever worked in. Something I’d never expected – the ‘institution’ approach really works for residents. I presume they don’t care about having en suite toilet; they want toilet that is easily accessible and they don’t want to get lost.
The building is divided into units (where access is controlled by fobs) that are basically corridors with medium size rooms (big enough to perform manual handling though), without unnecessary clutter; toilets are located throughout the corridor so there’s never too far to get to one, and – what I’ve never seen before, I now wonder why – the door to toilets open both inside and outside and only require minimal force to move so it’s ideal for a person using walking frame to get in and out.
There is also living room connected with a dining room and a kitchenette – all in the same room, which I think is ideal.
It was always my understanding that being combative and refusing care are feature of a person with dementia. That’s even part of every employment training! Mind you, I also worked with two clients with dementia in their own home when I was live in carer and that wasn’t much different – I mean the chaos of taking care for 30+ people was certainly not there, but fights to get the clients to wash, dress and use the toilet were the same as everywhere else.
When I first started in Fessey, I am sorry but I thought the residents are severely medicated as they were so chilled out. I did see some people going to the toilet by themselves but I thought they must have ended up there by accident while mindlessly wandering because, you know, people with dementia so severe that they need to be in a care home, don’t go to the toilet by themselves.
On the second day I realised that although chilled out, they’re certainly not spaced out like what you’d expect from people who are severely medicated. I also started noticing that they smile, wave to staff and give them thumbs up, one resident even winks! I finally asked somebody how they were and they said ‘I’m well, thank you’. They did not ask how I was, but if I’d ask the same question somewhere else I’d most likely be told it’s not my business.
Residents eat with knives and forks and in a very tidy manner (they don’t need a bib), they are also very easy to convince to go to different areas, if needed.
I don’t think I ever witnessed staff being impolite to an elderly resident in any care home (I did witness that in learning disability care homes, unfortunately) but only now I realised that being polite and being kind is not the same thing.
To be kind one really needs to focus on another person and it’s not possible to do that when you’re stressed because all of that running around that you have to do if environment is not suitable for the task.
In other places we often had to drag people to toilets – but we had no choice because otherwise they’d sit in their feaces forever. But I thought that’s what dementia is like.
But then, did anybody ever think how those people feel if they witness staff running around like headless chickens the entire day? Maybe they think we’re predators who are trying to abduct them?
Also almost every care home seems to have a problem when residents get stains on their clothes – they are being dragged to their bedroom or the closest toilet to change.
Or even if the stain was big, does that really matter? It will go to the wash at the end of the day anyway.
But we had to that because ‘someone may come, see the stain and think we don’t take care of them’. Like if they were products that we put on shelves to show off and get more business.
Today I tried to be even kinder to everyone – and it is so easy when everything works well – and they started saying thank you and I’m sorry to me.
I am now starting to think differently about those visits to mum’s care home when I could have stayed longer with her if we were in the garden (coving regulations), the weather was beautiful but she didn’t want to go outside. Even when I was there the last time. I thought at the time that possibly it’s the sign of her dementia progressing and she didn’t understand I live abroad.
But now I wonder that possibly her needs changed and she was more focused on meeting the basic ones rather than investing in personal relationships.
I was of course informed that sometimes residents may have challenging behaviours but so far, during my week there I didn’t notice any.
What I realised though was that there are forms, expected by the regulatory body CQC, where we have to record every challenging behaviour but there are no forms to record when they were happy and kind to us. Does that seem fair?