From large bin to small bucket

I was about to post a further reply to Mental Nurse’s post Diary Of The Demented but my replies get so lengthy I thought I’d be better just creating a new post.

When our old Victorian asylum was starting to wind down, many people were full of optimism, looking forward to waving goodbye to the long, dim, corridors with high ceilings. Farewell to the stains, the smells and the memories of a dubious history. They envisaged a brave new world of shiny purpose built units. These new state of the art environments would benefit and uplift all of us, reducing stress and promoting well being. Oh, everything was going to be so much better.

Looking back now it’s hard to believe that we were so naive to really believe that the NHS trust were going to spend millions of pounds on the mentally ill. Nope, they had just built a new district general hospital here in Ruralshire so the purse was empty when they closed the bin. But every cloud has a silver lining and sure enough the new district general was a blessing in disguise. As the district general opened it’s doors, so the small cottage hospitals closed theirs. Suddenly the trust had vacant community units dotted around Ruralshire. These small units were heralded as the new community care units for the mentally ill. Hurrah!!!

Unfortunately, these units were also of Victorian build albeit on a smaller scale and were certainly not fit for purpose. The one I worked on was like a rabbit warren, making observation impossible and bathing/toileting a nightmare (usually like three adults having a fight in a phonebox). Emptying the asylum was like taking everyone out of the bin and putting them into small buckets. The buckets were mostly situated way out on the outskirts of the towns, so no real community access either.

Now I’ll try and relate this to dementia care which is what I started out writing about (about an hour ago!). In the bin there was a hierarchy of dementia wards. There were wards for a variety of needs, from those wards for the physically active with severe behavioural problems to those who wards for the virtually moribund who required total nursing care.

When the bin closed, patients were allocated to units in their own community. So if Mr Bloggs came from Hicksville, he was transferred to Hicksville community unit. All sounds eminently sensible. Isn’t it great, instead of being in that asylum 30 miles away he is now back in his home town. Although it might have seemed a great idea, I don’t think anyone had really appreciated how difficult caring for such a diverse group of patients could be. Reflecting on the bad old days at the bin, managing a large group of people with similar problems now seems relatively easy.

Caring for folks of mixed dependency was always a huge juggling act. Things could be chaotic in the evening with people fighting, stripping and screaming. This was when frail patients often missed out on care. Conversely, most of the morning was spent on physical care for the frail folks when you knew there were people anxiously trying the door handles, crying, looking for family and desperate to get home. Try as you might to allocate care proportionally it was often impossible. No matter how determined you might be to spend some time with someone who was ill in bed, often another patient would suddenly burst into the room demanding you get out of their house, things would escalate and you would have to leave to help calm the irate “householder”. While this sort of incident is probably not that uncommon anywhere, we just seemed to be overwhelmed with it after the split. In the middle of the two extreme groups are the passive little ladies who sit quietly on wet pads, left uncomplaining until the smell gets picked up. As they don’t scream for attention they are inevitably always last in the line.

Anyway, a couple of formal letters of complaint about us failing to meet basic standards of care resulted in the trust suddenly being concerned about these forgotten people and their action was swift. Not the action I anticipated however. Only patients whose behavioural problems were so severe that they could not be managed in any other setting would be allowed to remain on the unit. All others were to be discharged ASAP to private nursing homes. So, even though you may have exactly the same illness, depending on your presentation you can be cared for by the state or mosey on over to the Twilight Nursing Home and wave bye-bye to your life savings. (But I guess that’s another 3000 words at least, so I’ll shut up).

I’m not sure if this experience is confined to remote places like Ruralshire or if urban units face similar problems? Oh and I should say in response to previous stuff, it’s always encouraging to hear things are better elsewhere and also seem to be better in general everywhere these days.