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  • 19th February 2018 | By David Jolley

    Next month will see the second anniversary of our Dementia Conversations group. This month we met on Shrove Tuesday but did not brave the hazards of pancake making. It was the day before Valentine’s Day – so we did touch on romance with red felt hearts and the biggest heart-shaped chocolate cake.

    As people gather we make sure the room is warm and welcoming. There is tea, coffee or juice. This week the warm drinks were particularly welcome as the temperature outside was barely above freezing. Ros Watson opens and encourages people to share their thoughts and stories. This week we were joined by Louise and Liz from TIDE: http://tide.uk.net/

    We learned that TIDE has evolved from the carers’ part of Dementia UK. It now has a life of its own and is supporting carers and providing training so that they can speak about their experiences with confidence. This is good for the carers and provides education in various settings and informed representation in committees and lobbying opportunities. Their presence released powerful stories from people who have been encountering crises in their care situations. We learn how services can be contacted and respond. We see how reorganisation of services has meant they address extensive areas of Greater Manchester and seem to believe that when a bed is needed, one which is 15 miles away is just as appropriate as on nearby. These experiences also bring us to the realities and practical application of the Mental Health Act.

    Revision of the Mental Health Act is underway, as is consideration of a better legal and service framework for people who lack capacity by virtue of being ‘of unsound mind’, but for now we have Section 2 and Section 3 of the Mental Health Act and DoLS. There is nothing like using things for gaining an understanding of them.

    Tasked with advising on what to say to general hospital wards about the needs of carers when individuals with dementia are admitted, we were able to draw on personal, sometimes painful, experiences. These were the key points raised: Empathy. To be fully consulted – Daily updates. All aspects of discharge. Definite dates. Flexible visiting. ‘This is me’ https://www.alzheimers.org.uk/downloads/download/399/this_is_me_tool

    Safety first. Correct information. Respect. To be heard. Own clothes and possessions. Staff to have an understanding of mental health conditions including delirium.

    Clear communication with the patient. Mirrors, crockery, cutlery, routines.

    Carers to be asked how much they wish to be involved.

    A culture of kindness. A link worker for carers.

    Carers are concerned for their loved one: What have they been admitted for? Will their dementia needs be met? Continuity. Individual likes and dislikes. Not one-size-fits all. Respect. Dignity. Maintain well-being not just treatment of a medical condition. Decent food and hydration. Time to gain and give understanding and reassurance. A Dementia Friendly Ward. Trained nurses. Good signage. Someone for family to talk with. Occupational Therapy.

    • Respect
    • Information
    • To be listened to
    • To be involved
    • To be understood
    • To be offered help with stress and illness
    • To be offered education and maybe training

    Much to be said for asking the people who are living with these challenges – threats to their very being and sense of self – It is a good way of learning.

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    Limits 14 February 2018 | Comments (0)

    My friend Roger is in hospital in North Wales. He has a broken dislocated ankle having fallen whilst out on a regular Thursday walk with other friends, all in their seventies or eighties. The weather was bad and the terrain treacherous. Roger’s eyesight is not so good and he has been having falls. He fractured a patella in one such only a few months ago. Medication may also be making his balance less certain.

    The little group waited and shivered for over two hours before the mountain rescue team could get to them. Roger was shivering most and enduring dreadful pain. It is a relief that he has become safe in hospital and we hope surgical interventions will bring him back toward the state he was.

    Tomorrow we will be walking with a group of ten or more on our local park and maybe onto roads and green spaces nearby. There is walking and talking and time for more talk for an hour, followed by simple refreshments and more talk and chuckles. It is just to get out and to enjoy the pleasure of the air and what is to be seen and how your body feels to be used. We hear of one lady’s friend and neighbour who has not been out of her flat for more than a year. She spends her time with food and drink to either hand, TV before her – her legs have become weaker, her weight is increasing. Movement even within the flat is becoming an adventure, and hazardous.

    Somehow we have to steer a course which keeps people safe but lets people keep moving.

    As a teenager in the 1950s and 1960s, a hike in the countryside of Shropshire or Derbyshire was a treat to be experienced on Bank Holidays. Transport was a commissioned, ancient double-decker bus in blue livery. We went slowly along the roads, making heavy of any incline. All passengers were willing the engine to keep pulling so that we could get there – and hopefully get back. We had packed lunches, no alcohol, but easy sing-songs: just the wonder of the air and the scenery and the spiritual buzz to be close to the earth that God made.

    Roger’s group is the ‘graduate’ outcome of weekly hikes of young families from the 1980s. Can you have too much of a good thing? The children of the families have found other things to take their time. It is the senior men who have clung on to a routine which has obvious attractions, but dangers now as bodies and sensory apparatus are less flexible and less reliable.

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    6th February 2018 | By David Jolley

    This is just me musing – no statistics or web links – but maybe they will follow.

    I am on the small side, so maybe I am prejudiced. It starts with my seeing a huge/very big refuse vehicle riding up a small road just below our park this morning. It comes every day. Through the day many more very big, very heavy vehicles will come to and fro along that little road which has a slight incline. Most are taking and fetching materials to a building site where hundreds of new homes are being built on land which was, until recently, a neglected post-industrial wilderness. New Homes: Good. Damaged Roads: Bad.

    I wonder why the contractors don’t use smaller vehicles.

    I wonder if we could legislate for maximum size and weight of vehicles on our roads.

    Many of us have an inner mantra: ‘Small is beautiful’. Most of us are comfortable within a network of the relatively few people that we know and love best, straying beyond it for interest and additional experience, but returning to put the new knowledge into context.

    Hospitals become bigger and bigger. Cardiac surgery for children cannot be provided in Manchester – because the expertise and training is congregated in Liverpool. Specialist beds are declared to be insufficient for the need. People are inconvenienced, disappointed and left fearful.

    When the pattern of services for the mentally ill and older people was changing from institutional care towards care in local communities through the 1970s, mental health was included as a component of District General Hospitals, servicing populations of about 200,000. There were four such hospital in Manchester and at least one for all the towns clustered round it: Stockport, Ashton under Lyne, Oldham, Rochdale, Bury etc. The big advantage was being near to where people live, liaising easily with families, faith communities, Social Services, Primary Health Care – and other hospital specialties.

    Homes for older people were provided mostly by the Local Authority with a mix of purpose-built and converted property. There may have been some limitations to their structures, but they were OK and better than what came before. The encouragement of the private sector and punitive discouragement of direct Local Authority provision saw, at first, a plethora of small homes run as family businesses. They may have had their limitations but many were loved. Most have now disappeared and have been supplanted by bigger homes, some owned by chains run by international organisations. The average size of nursing homes is 40+ beds, care homes 30+ beds. Even at these levels companies find it difficult to provide quality care within the budgets supported by Local Authorities. The number of homes has reduced and so the availability and affordability within communities have been reduced. A smaller home has the virtues of residents, staff and families getting to know each other. Local homes make it easier for friends and family to visit and to contribute to the life of the home.

    I am still in favour of a return to small.

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    Dilos-kcor 29 January 2018 | Comments (0)

    29th January 2018 | By David Jolley

    The new shape and organisation of the Guardian has drawn me into reading more attentively. The Saturday Review section has often been whipped away to the Big Green Recycle bin before I even scan it; but the January 20th issue in the new format included an article which caught and held my eyes:

    ‘Made in Accrington’. Jeanette Winterstone gives an appreciation of the town where she grew up and found her early education: ‘Prose A-Z on the shelves of the Accrington public library’, supplemented by lectures and weekend courses at the Mechanics’ Institute.

    There is a photograph of the most ordinary of streets which features an original version of VW Beetle driving away from us, and a double decker coming toward us, while people walk the pavements or linger at shop windows. We know that street because we drove down it on the mission which brought us Tilly, our brindle whippet, from a strong lady who posts letters by morning and walks whippets the rest of her day.

    Professor Winterstone lists Accrington’s finest: cotton mills, engineering works and the Nori brickworks. Accrington Brick is the best you can get. Our house has Accrington Brick for its front wall and the corners. The house is 110 years old and the bricks remain untouched by the time – perfect. She smiles in letting us see that ‘Nori’ is ‘iron’ spelled backwards. Was this a mistake – or a branding brainwave? Surely it has to be the latter.

    ‘The idea that things could be backwards or upside down and still rock-solid appealed to me’.

    Absolutely and it appeals to me too. Something about honest-to-goodness strength in shape and constitution just has to be right despite its modesty. Contrast the nonsense revealed by the collapse of the fantasy world which Carillion had built and the extraordinary story given to me this week of services for people with addiction problems who live in Manchester but have to travel to North Wales if they require inpatient care.

    How on earth did we allow these crazy arrangements? How can we get a grip and return to back sense which will work, be economic and will go on working?

    Nori – Bricks as hard as iron. There used to be an organisation which called itself ‘RATS’ – a self-inflicted putdown for its members who were all STAR performers in comedy, magic, the theatre or films. RATS put on shows to raise money for deserving causes, the stars taking no fees. Great stuff.

    I hear there is talk of changing the name of the specialty of Old Age Psychiatry (OAP – see!). OAPs (Old Age Psychiatrists) have been with us since the specialty was established 1989. The name succeeds various alternatives which were used by individual psychiatrists working with older people, ‘psychogeriatician’ being perhaps the most popular. I do know that some people feel unhappy about being referred to an expert whose title includes the word ‘old’ or ‘geriatric’ – but this is all stigma. Accrington Brick and Professor Winterstone tell us to put a hard face on it and own what’s ours.

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