I am so relieved that I was able to keep my 98 year old mother after a long spell of illnesses resulting in organ failure, in a residential home and out of hospital which are often dangerous places for older people . The staff at the time did not want to countenance my mother’s impending death. She had moderate dementia and a great humour and wit. She was close to several in the team. I was happy with this as I recognised that she had formed a necessary attachment for her sense of security and wellbeing. Although care homes are places where people die, many are not emotionally equipped or have the learning or know what to expect and how to manage their feelings when they become attached to a resident. This is very human territory. We are seeing this now with Covid-19.
Now it has become apparent that care staff need support and emotional debriefing. The amount of very frail older people with health complexities need specialist care and the staff and relatives’ person centred outcomes also need to be addressed as part of the ‘Relationship Triangle’
Saying goodbye is so important for families and the dying person. I was pleased to be with my mother at the end- she was 98 years old and waited for me to come before she lifted her head of the pillow in acknowledgement after which she took her last breath. She had refused food and drink for 10 days and clearly did not want any intervention. She was surrounded by familiar things, people and sensory cues that enabled her to have a peaceful end. I fought hard for her not to go into hospital. These are the last places a very old person with or without complex needs should go if they are in their last days. The ambulance trip alone would have been enough to kill her due to her frailty.
Hospice staff preparation is second-to-none and enough time and space for more in-depth training must also be given to staff, using the best blended learning methods to ensure a good result. I hope that this end of life holistic person-centred approach which prevail with resident centred outcomes that go beyond process driven ‘tick box’ systems. It costs money and valuing in other ways.
Hopefully society will wake up to the value of the carer, both paid and unpaid. We need to grow our own, nurture our own and recognise the important health needs within ‘social care’. This is a structural anomaly since the demise of long stay NHS provision. Older people have been parked in a system that has had insufficient attention to develop a sector that grew fast out of Mrs Thatcher’s pot of gold given to doctors and dentists to set up care homes in 1980’s. This new hybrid never saw the need for multi-disciplinary gerontological practice to provide a socio-health more specialist and holistic approach, needed after the effects of increased complexity resulting from the Care in the Community Act. Many care homes have more recently been viewed as businesses with easy profit gains in relation some larger care home groups, squeezing the value-added quality by indifferent finance houses profit machines. This will all have to change.
Social Care needs to be put onto a more substantial footing with parity and acknowledgement that requires a socio-health integrated approach and model and one that focuses on delivering this care to meet the person centred outcomes that older people themselves recognise as the primary hallmarks of good care.
Many jobs will be replaced by AI but not the human focused roles in care settings. It is the human touch and closeness people need at the end of their days. I am relieved that a more humane approach is being considered by the government at this time for families. I hope it will also say goodbye to the old and challenge a new model of care and caring that is diamond in status and second to none in the rest of the world, as was the aspiration of the former health minister, Jeremy Hunt. This sector cannot be airbrushed out and the government need to address the whole area of health and social care funding as soon as this is over. It is now in everyone’s faces.