Discussions

Effective Care or the Elderly - are we focusing on the wrong things?

Added by Pioneer513 under Evaluation & Measuring Impact

 

Eight years ago, I was tasked with creating  a template that would prevent an elderly lady ever requiring a Nursing Home.She had no relatives, had various disabilities, including profound deafness, but she had been a  Pediatric Consultant - and she knew that if you want something, you have to be specific!
SO, I was asked to plan for 
No Nursing Home - ever.
No Involvement with Social Services.
She wanted to remain at home with her dog -  her dog gave her constant companionship, that she could not always access with people due to her hearing difficulties..

I advertised originally for a cleaner/ companion at the local supermarket, once I had fully understood her needs(Around two years assessment time).
We took up references and Disclosure, and did the first interview in a public place - garden centre or supermarket cafe can be good places to meet potential employees.  It was then made clear that we were not the employers: that the lady herself would make the final decision.

Once all the checks had been passed,  and references taken up, we then escorted the applicant to meet the lady. We stayed for the first part of the interview, and left her for the more personal  second part.
We returned at the end of the interview.

The client was very clear about which candidate was suitable, and the staff in return have remained in position and very loyal for years. If she is having a bad day, for example, they will return at night and either cook her supper, or bring a plated meal.
When she had s second stroke, we needed to repeat the process, but now there was someone in place to do help with the training, etc.
As mobility  became more of a problem, and physical needs increased, we did it again.

The interesting thing is that many of her friends returned, when they saw that they were not going to be held responsible. With her care covered and working well, they started visiting more frequently. her house is always spotless, which is a great comfort to her, now that she vcan no longer do these things herself.
She now has a busier life than she did at one point, when she was almost totally alone.
Powers of attorney are set up - and everyone seems to be able to work together to provide a cohesive service.
Once it was set up, I kept regular contact for a further 2 years, and she knew that she could phone me at any time. 

For this to be effective and empowering,  the initial time has to be put in, where the client learns to trust you. 
It is not hugely demanding on time,  but requires frequent visits - say weekly.
The client has to understand the potential. There can be no  100% guarantee,(obviously), but it provides a goal, and I have no doubt that she is secure in the knowledge that we will have done our best.

 She is now very frail with a failing memory. I visit 6 monthly, and  laugh when I go to the house to see how meticulous her "girls" ( all mature women,  some retired, and grateful for something to do) are with the signage!  However, they will take her anywhere she wants to go: out for lunch - to the shops - to meet friends - to the doctors.
So she is very pleased indeed.

She is now in her 86th year, and remains at home, with the support of this loyal band.

The main tip is: consider these 4 years........
It is not more difficult than people believe, but it takes longer than people assume.

The relationships are crucial and should perhaps be the focal point.  The carer may be excellent, but if there is no relationship, it is a barrier to independence.
It is important to educate those that wish to go down this path to ask early enough to be able to make such relationships