Monday, March 11, 2013


We wondered if you’d help us out on a slightly strange one. We took a call from an elderly female in a nursing home. She was obviously in a great deal of distress – in fact, the call taker said it sounded like she was being murdered. Then he said someone else came on the phone - a care worker or something - said everything was fine, not to worry, thank you very much, the line went dead. Obviously the call taker wasn’t happy with the way it ended, and didn’t feel a call-back would get to the bottom of it, so he said he’d be grateful if you wouldn’t mind swinging by and taking a look.

We’ve been to this nursing home any number of times. It’s a warm, well-managed place, comfy sofas in the lounge, bright artwork on the walls, a brisk and sunlit feel to all the rooms and corridors. Everyone who works there, from the cleaners and caterers to the nurses and health care assistants – they’ve always been friendly and helpful. If there was one nursing home in all the county less likely to be the scene of a grisly murder, it was this one.
We pull up outside, the driveway as empty and neatly swept as ever.
No police tape, CSI boiler suits, reporters.

Gus, the manager, is standing chatting to a nurse in the hallway.
‘Hello,’ I say as we step through the automatic doors. I wave a hand up in the air. Smiling. Slouching. The Peter Falk school of interrogation.
‘Sorry to trouble you. I wonder if I could have a word?’
Gus excuses himself to the nurse, unlocks his office.
‘I think I know what this might be about,’ he says, leading us inside.
‘Absolutely. I’m sorry to bother you.’
‘Not at all.’
He closes the door behind us and leans back against the desk.
‘How can I help?’
‘Our Control room took a call from one of your residents just a half hour ago or so. Apparently there was a lot of screaming and shouting, it didn’t seem to make a lot of sense, and then someone else came on the phone, said everything was fine, don’t worry, and hung up.’
Gus nods.
‘Yes. I thought so. What it is, you see, we have a woman of eighty-four who’s behaviour is extremely – erm – problematic. She’s come to us from her home address ...’
He mentions the flat number, the block, and before he’s even finished, a name pops out of my mouth.
Gus raises his eyebrows.
‘You know her?’
‘Too well. I couldn’t even begin to tell you how many times an ambulance has been out to Vera.’
‘I’m not surprised. She’s quite a handful.’ His glasses shine.
‘Vera came to us for a little respite, and almost immediately tried to self-discharge. I was concerned because she wanted to push her rolator down the road without adequate clothing, without showing any insight into her overall condition, personal safety etcetera, etcetera. So we enacted DOLS and ...’
‘Sorry – what’s that?’
‘DOLS. Deprivation of Liberty Safeguards. It’s an aspect of the Mental Capacity Act. You’ve not heard of it?’
‘No. But it sounds – great!’
‘Yes, well. It’s designed to help us give the care we need when the patient isn’t in a position to make the best choice for themselves, for whatever reason. Vera’s an odd case because she’s not been diagnosed with dementia, for example, which is often what this DOLS is brought in to cover, but she’s been assessed according to the guidelines and consequently detained here against her will for the last two months or so.’
It suddenly strikes me that it’s been quiet on the Vera front for some time. I could hug Gus. If I did, I’m sure he wouldn’t mind. He’d find a way to disengage at exactly the right moment, and everything would be properly documented.
‘Vera’s a challenging proposition, without question,’ he continues. ‘She spends an awful lot of time screaming for help, abusing my staff, making phone calls when she can, generally uncooperative, disruptive behaviour. And when she’s not doing that, she’s putting herself on the floor feigning injury, throwing things – you name it, really. I feel that our facility here is probably just an interim measure, but that’s in process.’ He adjusts his glasses. ‘You’ve never heard of the Deprivation of Liberty Safeguards?’
‘No. But I’ll definitely look them up.’
He turns and taps a password into the laptop behind him; with a few brisk keystrokes he brings up a Department of Health website.
‘A useful piece of legislation,’ he says.
‘I’ll read about it later, Gus. Thanks for your time. And good luck with Vera.’
‘She’ll be fine,’ he says, opening the door.

There’s a commotion in the lobby. A nurse is standing just in front of a tidily-dressed old woman in a red crocheted jacket and speckly brown skirt, who in turn is repeatedly ramming the front wheel of her rolator into the glass door and shouting Help! Help! in a plaintively thin voice I’ve come to know so well over the years.
‘Vera!’ I say, going over and touching her on the shoulder. ‘Vera! You’re looking so well!’
And she is. If you can ignore the fact that she’s shouting for help, she actually looks great, well-fed, her hair nicely cut.
She stops shouting and slowly turns to face me. She narrows her eyes a moment, then says in the lower, rasping voice she uses as an alternative to the scream: Do I know you?
‘Don’t you recognise me, Vera? I’ve been out to you hundreds of times.’
After a moment to think about that, she uses voice number three, the childlike whisper: Please help me! I have to get out of here. I have to get home.
‘But Vera – they’re obviously taking excellent care of you. I think you should stay here a while, rest up and get your strength back.’
Vera looks between all of us, then with a raise of her shoulders to build up her strength, charges her rolator at the door again, screaming Help! Help!

As the nurse tries to quieten her down, a young family emerges from one of the rooms behind us,  a man and his two young daughters, putting on their coats, ready to go. They stand in the background, unable to leave because of Vera at the door. The man puts his arms around the girls; they peer over his sleeves appalled, fascinated.
Help! Help!
‘Vera? Come on – you’re frightening those poor children.’
She stops. There’s a pause, then she starts to turn her rolator round to get a fix on them. But before she is even half-way through the manoeuvre, Gus has already politely and efficiently led them away to an alternative exit. 


jacksofbuxton said...

It seems as though Vera should be somewhere a little more secure than a nursing home.Dear old Gus seemed to have things under control though.

I'm fairly sure you've written about Vera a few times before?

Spence Kennedy said...
This comment has been removed by the author.
Spence Kennedy said...

(Note: I tried to write in a neat little hyperlink in that last comment, but it made the site go haywire...)

Jacks - I did write about Vera before (you'll find it in Sept 2012 - 'Vera, first to last'). She's a prolific frequent flyer that no-one seemed able to address - until Gus, that is!

I must admit I ended up describing Gus along the lines of Gus Frink in 'Breaking Bad'... ;)

Anonymous said...

It seemed to me this is a nursing home to recommend. The manager knows his stuff and I am left wondering if Vera could of just walked out of others.

Did you look up DOLS? Can control add notes regarding Vera to this new address?

tpals said...

Hooray for Gus! All the ambulance staff should go out and celebrate. It may even call for a national holiday.

Travelhun said...

Wow - so glad for you that Vera is finally starting to get the care she needs, as opposed to the care she wants.

Spence Kennedy said...

anon - Def one of the best. The manager was great - really calm, authoritative, knowledgeable. And when Vera was kicking off in the lobby, he was still able to look around and see what effect she might be having on others. I did look up DOLS, and I have to say I'm absolutely amazed it wasn't invoked for Vera a long time ago! I can only think it's not widely known about; most people I've talked were surprised when I told them what had happened.

tpals - Gus the Great from now on! A statue in the marketplace at the very least, with garlands of flowers lain by grateful paramedics, carers, neighbours &c &c. Vera was so difficult, and such a drain on resources, I think he qualifies for some kind of bonus payment...

travelhun - Absolutely. That's the other thing - she'd fallen in to a pattern of behaviour that couldn't possibly have been making her happy. I was amazed to see how well she looked in the home. Shame her behaviour was no different, but then maybe it has some organic cause that just hasn't been identified yet. But she's definitely safer and better cared for now than when she was in her own flat.

Cheers for all the comments.
At last - some closure on one of these stories!

Anonymous said...

My Great-Grandmother was a difficult patient in her age with a few Vera-like qualities. She was removed from the penultimate care home for fighting over sticks with the old ladies. When she left the resident parrot had to be sent for behavioural therapy as she had taught it to curse (in a Swansea accent) when the manager walked by.
Unfortunately, they knew her so well in A&E that some of the nursing staff came to her funeral.
Excellent as always :) Verity

Spence Kennedy said...

She sounds quite a handful. I had a 'Kill Bill' type image of your Gt-Grandmother in a yellow jumpsuit (let out a bit here and there) fighting over sticks in the lounge against a hundred other old women / zimmer frames & rolators flying &c. The final care home must've been considerably tougher. Crewed by retired Shaolin masters.

Love the parrot story, too. Was it only the manager who copped an earful? (Didn't help her case, I expect).

Anonymous said...

Make that jumpsuit lavender haha (she did go through the patio doors of the day room at one point). She was never one for dailing 999 though, at age 90 she was too deaf to speak on the phone. Due to dementia she also believed that ambulances were sent to pick up dead people who had been bombed so you can imagine the fight she put up every time she had to get in one haha.

The managers office opened directly into the visiting room (which was where, incidently, the parrot was kept) so unfortunately most visitors also benefitted from a vocab lesson too :)

Spence Kennedy said...

When you say she went through the patio doors, I hope you mean they were open at the time.

I think I'd have enjoyed meeting your Gt Grandma - and the parrot, come to that. There's a really old one in a local pet shop, who says grumpy things now and again (although he always talks when you're not looking, so maybe it's actually the pet shop owner pulling our leg...)

Anonymous said...

Yes they were open, she had a soft landing in the ornamental grass border. *touch wood*

If I was a pet shop owner and thought I could get away with it ... I would

:D Verity

Becca said...

There's a few "If you... then" jokes floating around at the moment that I rather like the format of.

The following is, I think, my favourite.

If you own a parrot and you haven't taught it to shout "Help, they've turned me into a parrot!" then you're wasting everybody's time.

DOLS are an intriguing bit of legislation, mostly because they are grotesquely overused and abused by people struggling to cope, or who simply no longer have the best interests of the 'client' at heart - but Vera sounds like a true example of when it's really been applied correctly. Gus does indeed sound like a gem - if I were you I'd seriously be considering sending a note thanking him for the good care Vera's clearly receiving, and emphasising how much better she looks, and how much better things have been for you, since she has been living there.

It's terribly hard though - she clearly doesn't want to be there, and until/unless it actually gets to the Court of Protection, nobody will have the job of representing Vera's point of view in the decision making without also being influenced by the various other issues which must be considered.

Spence Kennedy said...

It's odd that no-one round here seems to have heard of DOLS, esp. when it seems to be an extremely useful / expedient piece of legislation. I have no doubt at all that it's right for Vera, but I take your point that it could be abused. So much depends on the appointment of an effective patient advocate - but as that's often a family member, there's a risk that self-interest might play a part. From what little I've read about DOLS, it doesn't seem as complicated to enact as a MH Section, with only one GP involved. Still, I have to say it was a huge relief to see that Vera had finally been made safe after all these years of frequent flying / abusing careworkers &c.

That's a good idea to send Gus a card or something. I'll see what I can do.

I love that parrot idea! Genius! :)