I am writing this in Arran where I am visiting an eighty-four year old aunt of mine who sadly now suffers from advanced dementia and for whom I hold a Lasting Power of Attorney.
‘Anne’ (not her real name but a very real aunt!) was the fourth of five siblings. The others all had children; Anne never did – but she has always been the favourite aunt of all eight of her nieces and nephews (and now of their children and grandchildren) so, whilst she is now widowed, Anne is not ‘alone’ in the sense of having family support. We all had wonderful holidays with Anne and her late husband in our childhood and in later years she visited all of us a good deal, too. Although spread across the globe we all still visit often and, despite the challenge of geography, have worked together to ensure that Anne has been able to stay in her own home for as long as possible.
But having held things together for Anne in this way for as long as we can we have reached the stage where we have to take the step of arranging residential care for her – a situation with which many of my clients will be familiar.
How does one know that ‘the time has come’? Well, in this case, although Anne is physically still spry and, with company, enjoys a brisk walk in the countryside, the scenery and wildlife in Arran having prompted her and her husband to move there, she is now so confused that she cannot retain new facts even for a few seconds. She cannot process information at all and is now entirely dependent upon others for her daily needs. Her brother and I are her Attorneys and we ensure that her home is kept clean and in good repair, bills are paid and she receives appropriate medical and personal care, but it is her emotional needs which have driven our decision.
Anne has a team of really lovely qualified carers (and they really do care) who visit her three times a day ensuring that she takes her medication and is properly washed, dressed and fed – but it is evident that ‘home’ is no longer ‘home’ for her. Home is, after all, the place where those you love most are to be found and/or where one feels safe and secure because of its familiarity and memories – and where one can enjoy a good laugh, as Anne always has.
None of these criteria applies now to her. She cannot judge, if left alone, how long she has been without company – and minutes seem like hours. Panic sets in. She does not know, unless told, whether it is day or night. Her bungalow has a slight familiarity, but she regularly mistakes the door to one room with the door to another. She cannot find things and panics about that, too (seven ‘searches’ for keys and/or handbag in one hour yesterday afternoon). She has a bee in her bonnet about switching off all electrical equipment at the wall to save money and be safe – a good basic rule, but in her case it includes the heating in the middle of the night. The house is freezing in the morning. She can no longer use the cooker since her way of testing if something is ‘done’ is to put the flat of her hand on the side of the pan.
If ‘home’ is no longer ‘home’ then it is time to find somewhere which is – where there is company, warmth, familiarity (one room not several cold ones to find one’s way around) stimulus, routine and security.
We have researched what will be exactly the right choice of care home for Anne and chosen one with qualified dementia specialists, friendly staff who will not talk down to her, ensuring that she feels valued and respected, comfortable (but not particularly grand) surroundings with accompanied country walks available, good, non-institutional food – and company – including the opportunity to reminisce with contemporaries (she still has a pretty good long-term memory). And of course somewhere where we can all continue to visit and laugh with ‘the old Anne’ again!