THE TERRIBLE 92 – part 2

Advice to myself and carers

There is no fooling ma tante Salma, her senses are all there: with her eagle eyes she will notice any minor change you dare make in her surrounding, any change of expression in your face. Her nose will smell the cucumber being cut in the room next door or the tiniest drop of sweat you may harbour. And I swear she must have a 7th sense that allows her to guess people’s thoughts and their next move within a centimetre of precision.
Her memory is all there and my ears are going to explode with tales of money, success, status, past splendour: les soirees, les brilliants et les toilettes (the evening parties, diamonds and chic clothes) often repeated again and again…
And now what? With all her money, she is pacing round and round in her room and in her head, worrying about the next pipi. Worrying about millions of minor problems, not being able to abdicate her authority on her children, grandchildren and great grandchildren…after all I have done for them
She lives in anticipation of what will happen in the next days with great anxiety.
Are these common features of old age? Or is it the result of living in exile? Past traumas not digested?

After my three weeks’ stint caring for Salma, I made myself some observations about old age .
It is very important to explain to anxious older people when and how things will happen, even if it is not what they want, rather than being vague and letting them build scenarios in their head
We must not think that age diminishes the intellect or the senses and we must treat old people as normal adults
Do not contradict old people, they usually know best but sometimes when they don’t, let it pass, or you may get a tantrum, it is not worth it
It is vital not to forget who the person is and recognise all what they have achieved in their life when they are still alive, not only at their funerals
Old people still need touch, kisses, love and little gifts of the things they like

Reminders for myself:
Do your pelvic floor exercise on the hour every hour
Notice any obsessions that may develop, acknowledge them and try to move on
Ask for help and accept help graciously, don’t forget to say thank you
Do not expect people to communicate with you if I you do not put your hearing aid
Make sure you have a non-judgmental friend or two to whom you can lash out all your woes without being contradicted
What money you have, USE IT! for your comfort and amusement, what are you waiting for?

Someone should devise a course on growing old that is not only about how to eat well, how to stay active and warm, but about the behaviours we can develop, how to deal with psychological changes. The usual response from the near and dear is : ah! she needs antidepressant”, donnez lui un calmant…

ACTIVE, HEALTHY, SUCCESSFUL AGEING ?

http://www.theatlantic.com/business/archive/2015/04/unequal-until-the-end/389910/

Browsing vaguely in the early morning, I came across this article. It is about the US but the article looks at ageing from a different angle than the proselytising  “successful ageing”, “active ageing”, “healthy ageing” well-intentioned, money wasting, programmes that so infuriate me.

I will quote only a few lines from the article but Abramson’s book (The End Game .How Inequality Shapes Our Final Years. Corey M. Abramson. Harvard University Press) may be useful to the people engaged in social policy, and fund-raising endeavours.

For the affluent, old age has its challenges. For the impoverished, it’s only harder.

Perhaps the presence of shared challenges in later life explains why we’ve glossed over inequality’s effects among the elderly …  

Social circumstances affect not only how long we live, but how healthy we are when we become seniors.

Some of the elderly I encountered in my study aged with immense wealth, social support, and education. Others did so in poverty and isolation. The wealthiest people in my study had aged in or retired to communities with voluminous senior programs, while many of the poor became increasingly isolated as they struggled with piecemeal social services.

The ideal of “successful aging,” emblazoned in the collective consciousness by glossy magazine pictures of smiling senior couples watching sunsets from a beach, is more attainable for some of us than others. The reality is old age is not the end of inequality, but its end game.

I often argue that the choice given to old people between retirement/care homes and ending their lives on their own in their own homes is a false one. The rich old Americans must know what is good for them… Campaigning for a ‘healthy’ life for the old must include the demand for funds to establish structures to facilitate social life for the frail, the disabled, the financially deprived…

 

 

 

Live isolated in own home – this is what people say they want

Is it coincidence or what happened to a friend and a relative of mine more common than the general population imagines?

The two women, very different in all ways, over 80 both of them thought of themselves as coping living on their own. O loved her comfortable flat. Very independent she belonged to a few social groups, had many friends and family and at no time considered changing the situation. M on the other hand lives in badly managed sheltered accommodation after many moves, has no friends and only an elderly relative  as social contact.

O was found by a neighbour, unconscious. Nobody knew got to know how long she had been lying on her bed unable to contact anybody.  After a few weeks in hospital, she died. M was also found  nearly  unconscious and bruised on the floor where she had been lying for two days and nights.  The ambulance took over an hour to arrive and she was admitted to hospital. After 10 days as an inpatient she was declared medically fit and discharged with the promise of home care help as soon as she arrived home. She was still very confused, weak and unable to function. The relative was not informed of the situation, and not given any contact numbers.  The carers did not arrive that day, evening, or the next day. It transpired that she was discharged before a care plan was put in place by the council.

I am writing this because I felt strongly that the general policy of keeping old people in their own home as long as possible ,’that is what they wish’, may in the long run be more destructive and costly that establishing good care homes. I have written about this in previous posts (search in this blog ‘Enrich your future, and  Protecting our parents) . Our culture is an individualistic one. The isolation figures are worrying and lead to the above incidents. Yet excellent care homes cater for rich people. We need to think outside the box, read Being Mortal by Atul Gawande, investigate OWCH. Ageing is a feminist issue and there is hope that the revival of feminist groups (london 70s sisters)   will yield similar projects.

http://www.theguardian.com/society/2015/feb/16/co-housing-people-things-common-live-together-older-people

PROTECTING OUR PARENTS episode 2

Episode 2 of ‘Protecting our Parents’ was called ‘Who Decides’. Yet another distressing programme that asks the wrong question. In Kathleen’s own words : “the system is all wrong”. Kathleen is the strong-willed bed-bound 80 years old woman who is a problem for the NHS and Social Services . She wants to die at home and not a care home but needs 24hrs care.  She also says: ‘The carers do their best but they are not here when you need them…make me feel like I am a nuisance …if I need help I need help. The carers are all right but they have no time …They should be paid properly.  I do not think it is fair that have to pay for private care.” But the psychiatrist declares that  her decision-making is impaired.

How can such an absurd situation arise? Urgent hospital admissions followed by discharges to the same inadequate situation. Hundreds of calls to the emergency ambulance, just to lift distressed Katherine up the bed. Official guidelines and personal wishes set in stone. Teams of well-meaning people and experts with their hands tied because of financial constraints and the conflicting interests of the diverse agencies involved.   The pretence that the whole problem is not a question of money.

Where was the son in this situation? Was nobody capable of thinking outside the box and find a solution for this woman to be comfortable in bed and prevent her from phoning emergency services costing over £57000 over a few months? A technical solution that would prevent her from sliding down the bed ? But do these hundred of calls to the emergency services express a deep sense of insecurity since the husband cannot lift her up the bed anymore?  what does this insistence of staying home with no quality of life and at all costs mean? The terror of the thought of the care home?   Did this isolated, symbiotic couple see other people apart from the rushed carers? Was there no other way to finance the extra help that Kathleen needed?

On a positive note and in the absence of family members,  it was good to see that the community social worker did work as an advocate for the couple against the medical experts’ assessment of Kathleen as being incapable of making decisions.

 

Thoughts on “Protecting Our Parents”

I may be unusual in not treasuring my possessions above social contacts. I have not read comments on the programme Protecting Our Parents broadcast on Thursday 17 April 2014 on BBC TWO, but it made me livid.

We were presented with three people at the end of their lives. They were in favourable circumstances with caring relatives, competent medical and social carers.  And yet what I witnessed on the TV screen is, near enough, torture. Yes, I feel that discharging from hospital vulnerable, dependent old people to their own home with no constant social contact is inhuman. The rationale for this is that this is the patient’s or relative’s choice and that staying in one’s own home is the most desirable option when people become vulnerable and at risk. This choice is a false choice. Attitudes are formed long before extreme disability has isolated the old person and in the grip of extreme fear of the care home.

If it was possible to establish excellent care homes where people can have human contact as much as they desire, where they are looked after by trained, well paid, unstressed staff, only then would the choice be a free one. This was so well demonstrated in the programme. The most independent and articulate old woman, Betty, who was so determined to keep her home and go back to it, soon forgot about it once she spent two months in a decent care home. She blossomed there.

Margaret Thatcher ends her life in the luxury of the Ritz hotel, ordinary people who cannot afford the price of good care homes are sent home to fall and break bones in solitary confinement.

 “There are worse things than care homes” Prof. Kirkwood

LACY, silver action, talking and doing.

It was expected that Lacy’s event at the Tate would trend on Twitter. It did not. But today two days after the event at last yes Growing Old Disgracefully were mentioned apparently interviewed by Lacy. I was not aware of their presence and neither were the people at my table or at the workshop. Anti-oil activism was the only activism mentioned on Twitter until today. It occurs to me that the problem of the whole project was  that it was focused on talking and being constrained to remain at our table limited in space and time.

Activism is doing. Old women are activists in  all spheres of political action, resistance, and fights for justice and in Art and Education. There are old women active and influential in the Peace movement, in the  Occupy movement, in the Green and Climate Change movements, in the education of young women and in the fight for the National Health Service, in Pensioners Forums  and other organisations that are fighting for a fair and just word.  And of course old women are volunteers in a host of charitable organisations. They are activist in the family too. All these women are invisible in real life because they are not considered as old but exceptional in their own activist group or else dismissed because they are in the caring field.  It is the ‘my best friend is Black, Jewish, Moslem, Old’ effect.

But also we have internalised this ageism. If we are energetic and healthy we say ” we are not old” even if we have to dye our hair and have plastic surgery and Botox injections.  If we are hard of hearing we do not raise our voice to ask for people to project their own.  We do not demand from the organisers of every demonstration to have special arrangements for old people who cannot walk or stand for hours. In feminist conferences there are old women on the panels but they do not mention that their expertise is due to age. There are  no workshops about what is like to be over 60. What is the journey from the age 60 to 90+ like? What is our contribution as older women to society, and what are our fears. Our past may be recognised but our present is not acknowledged.

I dream of an event in the tanks where old women would come and mill around with the audience showing placards of their field of action past and present local or universal. Where the walls would be plastered with photos of old women in protest. Where women in wheelchairs and their carers and grandmothers and grandchildren would mix with everybody else….

I dream… I dream …

BBC Newsnight Ageing population

Below a contribution from Kata  (63). I did not see the programme and am appalled by the BBC coverage of important issues and Newsnight choice of commentators. For Wolff’s care4care scheme see blog “Social Care in the home” that I posted in November 2011. 

With the news, according to a recent UN report that older people are the fastest growing age group of all, BBC Newsnight last week featured an item on the issue of how to manage old age in the 21st Century.

The UN Report estimated that worldwide there will be in excess of 1 billion 60 year olds by 2022, and 2 billion by 2050.
Whereas in most developing countries, young people are brought up knowing they will be expected to care for older family members, these days in developed countries, this is largely considered to be the responsibility of the State.

A studio discussion followed with Paxman in the chair, featuring Prof Heinz Wolff – founder of Care4Care scheme – George Monbiot, Environmentalist/political activist, with Prof Calestous Juma of Harvard University contributing via video link from the USA.

Care4Care is the ‘brainchild’ of Prof Wolff which he claims offers a solution to the challenge of caring for the increasingly elderly UK population. The rationale is that people should volunteer to care for others, for say 4/5/6 hours per week, in exchange for care when they themselves are older and require care. Care hours will be ‘banked’ to be used in the future. Evidently, there is currently a pilot scheme underway on the Isle of Wight and Wolff hopes that by 2015, there will be one million people doing this.

In response to Paxman’s query re who will ensure that the person now caring will receive it in the future, Wolff conceded that the next generation must be as keen as the present one to provide care. But what if they don’t WANT to, asked Paxman. The Professor expounded further that they simply MUST want to,or they will ‘die in the streets and won’t get there bottoms wiped!’ (The only reference in the discussion to the nitty-gritty of providing personal care!) Paxman looked pretty incredulous at this point!

Over at Harvard University, Prof Juna referred to technological innovations, such as robotics, being employed in the care of older people. Evidently in Denmark and Japan robots are being used to provide home care. So much for the human touch!

Monbiot argued that a whole raft of measures will be necessary regarding the provision of care, and that robots alone won’t suffice. According to him, we must face the pain and start planning now for the coming demographic downturn. Migration would be a factor, i.e. bringing in young carers from developing countries that would not be going through these demographic changes just yet.

Prof Wolff was emphatic that having young carers from overseas caring for older people in the UK would not work. He gave the example of a young Polish student caring for an ‘old lady’ could not work as there would be ‘no empathy’ and therefore it would not be viable. Paxman, quite rightly, pointed out that surely this was already happening with lots of workers from overseas providing care in the care sector in this country!

Young people will be required to supply the funds/care/labour that older people will require. Older people will be a ‘demographic burden’ which some people will have to service.

The issue of resentment of older people was raised. Wouldn’t young people resent older people, despite it not being their fault that they were living longer? According to Monbiot, young people will be required to supply the funds/care/labour that older people will require. Older people will be perceived as a ‘demographic burden’ which some people will have to service. Monbiot stated that he fully expects to be hated and seen as having not only ‘screwed up the planet’ but become a huge economic burden, should he survived long enough to be an ‘old crock’ ( it did not seem to occur to him that this was a very ageist and insulting term!) The situation will be very politically challenging, he concluded.

Wolff disagreed, he believes that many people will make provision for their old age, while others will be ‘feckless’ and will have a rough time of it. It did not seem to occur to him that contrary to being ‘feckless’, many people are not in a financial position to make provision for old age, they are living from day-to-day.
Further evidence, in my opinion, that he lives in a middle-class bubble which eschews class differentials. One point he made which I concur with is that as a society we need to put as much effort into providing for people towards the end of life as we do for the upbringing of children.