Having spent my first few shifts at the one nursing home I’ve been writing about, the last couple of weeks have given me the chance to experience work at two other homes in the area.
I should say at the outset that it’s difficult to know quite how to evaluate residential care – one home may be slightly dated in its decor and equipment, yet have a wonderful team of compassionate, dedicated staff, whereas another may be ultra-clean and well-equipped, yet have apathetic or uncaring staff. Fortunately I haven’t come across such extreme either/or situations, but I am very aware that it is this combination of hygiene/equipment standards and staff compassion that forms the core of my reaction to different homes.
I have worked one shift in a sparkling new extension of an existing care facility housed in an old mansion that backs onto fields. The whole place is spotless (you can detect it from the moment you walk in) and is equipped with cutting edge conveniences including a hoist that attaches to a permanent fixture above certain residents’ beds and a spacious sluice room that includes a separate macerator for soiled pads (as opposed to just a bin). I got the impression that no expense is spared in the running of this home – from the swish equipment, right down to tiny details such as the labels on laundry baskets being typed and laminated, rather than just scrawled straight onto the plastic lids with a marker pen, and the disposable aprons being of superior quality plastic to most. When the essence of the job is so demanding, these details make a big difference: if the staff are less stressed about a lack of supplies or malfunctioning equipment they naturally retain greater patience and are consequently better able to do their job. I was especially impressed by the way some of the rooms have French doors that open onto their own small patio area decorated with pot plants. It’s still unmistakeably a care facility, but small touches like that make it feel so much closer to a Home.
The other place I’ve worked in also manages to feel somewhat homely, by virtue of it being a big old Georgian house on a hill. Many of the upstairs bedrooms have lovely bay windows with views across a valley that has been particularly beautiful this autumn. The home overall has something of a hotpotch feel to it, which in some ways is quite endearing – there’s certainly nothing of the clinical air that renders some newer places a touch atmospherically sterile – but I don’t find it a very comfortable environment in which to work and I don’t think I’ll be going back.
I don’t have a problem with the staff – on the whole they are friendly and caring towards the residents. They spend more time with them than I’ve seen in other homes – primarily because the work is less time-consuming, the staff enjoy longer impromptu breaks which one c/a who I worked with chooses to spend in the lounge with the residents. She doesn’t engage with them particularly, but even her presence is a reassurance compared with most c/a’s who scurry off out of sight the first chance they get.
My discomfort stems primarily from the sense of benign neglect that pervades the home. Not of the residents – I haven’t seen any deliberate ill-treatment per se – but of the facility in general. Apparently this home was once well-respected in the area, but it suffers from a blindingly obvious lack of funding (it is part of the Blanchworth Care Group, whose profit margin I would be interested to know of), which manifests itself through less than adequate standards of cleanliness, inadequate provision of supplies, and underfunctioning equipment. One thing I appreciate about the BUPA home is that every resident has a set of supplies (pads, wipes, rubbish bags, cream, gloves, etc.) that is generally kept in the same place in every room. This allows staff to find the things they need quickly and easily, which is essential when you’re cleaning somebody up and trying to minimise discomfort. In this other home, however, there isn’t such a system – supplies appear to differ from room to room – and one thing that particularly irks me is the lack of special wipes for cleaning bums. Most homes provide specifically designed large fibrous wipes which can be used either wet or dry, with water or cream, without falling apart. This place however, relies purely on standard toilet paper, which is useless – it’s scratchy, the sheets are small, it falls apart very easily and is essentially no match whatsoever for the surprisingly copious amounts of poo that people continue to produce well into old age. Of course there’s a comedic element – but that’s on reflection, in the telling – in the instance itself it’s distressing and frustrating having to unwind metres of paper to do a job that there is a much more effective product designed to do.
Other aspects – the lack of pans for the commodes, which means waiting as they go individually through the sluice, and then enduring the frustration of finding that the sluice isn’t working effectively enough to clean the pan sufficiently; the fact that there are no bins for soiled pads in the sluice room itself; the fact that the sluice can’t cope with solid waste matter, which means tipping it down the toilet in a separate bathroom before returning to the sluice; the strained plumbing system which means flushing away waste is not always as straightforward as you’d imagine. The fact that the smell of stale vinegarised urine from E’s clothes as I got her ready for bed was so overpowering I had to hold my breath…and could only suggest that she had been sat in wet clothes for hours without being changed.
This was all compounded during my last shift by the time I spent with A. A is a 94 year old man, built like a Weeble (“they wobble, but they won’t fall down!”), completely blind in his right eye and virtually so through his left; he suffered a stroke in 2003 (or “twenty-oh-three” as he put it), which left him unable to lift his arms above his shoulders and thus too immobile to continue living alone in his flat, which he had been doing since his wife died in 1996. He is also, he informed me as he got into bed, a born again Christian and has been since he “accepted the Lord as [his] saviour” at age twenty. While his beliefs are removed from my own (there’s nothing like being reassured that we’re all sinners as you tuck an old man into bed), I nevertheless take comfort from the fact that he has a comfort of his own to accompany him as his body begins to wain.
A gets a bit confused about things (such as unbuttoning his pajama top just after I’d helped him put it on), but is well aware of where he’s living, and of his physical condition. Early in my shift he rang his buzzer and I was asked to help him off the commode. When I got there A was concerned to know whether his urine was clear or bloody – I had been given no warning of this by the nurse who asked me to see to him, despite what transpired as her full awareness of an ongoing infection A has been prescribed antibiotics for. When I asked A to stand up, the contents of the pan showed no trace of urine – only blood. Dark ruby, thick, sticky, incredibly pungent blood, which also hung in a coagulated glob from the tip of A’s penis. Had I not known, I would never have thought that such an amount of blood could be the product of urination. It was, shall we say, a bit of a shock. I replied to A’s mild enquiry as to the composition of his urine by informing him that there was quite a lot of blood (though I was relieved to know he felt no discomfort…and also, in a sense, to know that he couldn’t see for himself the product of his body’s dis-ease) – his pad was also saturated a dark red. Much of my shift was thus dominated by blood and shit – two substances which it turns out, particularly in combination, are really quite exhausting, particularly when you’re working in an under-resourced environment with substandard equipment.
Though you don’t realise that until later. I’m acutely aware of how rapidly I become institutionalised at work, in the sense that my world shrinks to the dimensions of the building, and the human beings who live within it – including their bodily excretions, which I deal with calmly and efficiently, aware that I am there to ease the discomfort of others, and to maintain their dignity as best I can while cleaning and inspecting the most intimate parts of their bodies. And so far I’ve been able to leave the uncomfortable sights and smells behind me when I leave, because they are so far outweighed by the pleasure of the human contact I enjoy with residents (and also because I’m not squeamish – a condition I have my own theories about that I’ll save for a later date). But perhaps the experience with A was a bit much to expect myself to process and let go of so quickly. As I drove home I felt a heaviness, a quiet numbness, as opposed to the happiness I wrote about before. I wasn’t at home long before dissolving into sobs and sleeping for twelve hours. I think this time I needed to feel the shock.
