Dignity Stories Shared at Workshop Mostly positive dignity stories, but not all. They are stimulus for discussion. (names changed) Lewis was diagnosed with end stage dementia and had moved into a nursing home. However due to his challenging behaviour his family felt he was going to be asked to leave. One morning he had not slept and was very ‘anti-social’ in his behaviour. His care staff had asked that he accompany a group of other residents ‘to the farm’. The staff who were going had major anxieties, but Lewis was helped into the bus. He got in and was angelic! He interacted with the staff, spoke to the animals and even went to the pub and had a few glasses of wine. On returning home is wife was waiting in the car park – waiting to be told he had to leave. She was amazed at the calm, happy man that met her and the staff who had enjoyed his company. She had shared his care needs but hadn’t told the staff they had enjoyed many ‘bus’ holidays and he had worked part time on two farms. He went on to live happily at the home for three years – however he did ‘deadhead’ everything in the garden! And staff realised the importance of understanding a residents background Following a major stroke Mary went to live with her daughter and son-in- law. Her daughter photographed every item of clothing and each morning would present her mother with an album to help her choose her own outfit. We need to think about ways to empower people to have control over decisions and their lives whenever possible -key to dignity. Lucy wanted to make a cup of tea in the kitchen for her sister when she visited, but was not allowed in the kitchen. She felt frustrated and inadequate. Health and safety risk assessments sometimes stop residents doing normal everyday activities and things they love. Risk assessments should save lives not stop them – need person centred risk assessment. A gentleman didn’t communicate much at all. He sometimes seemed a bit short in the way he spoke. We realised his wife was in hospital having her hip replaced. When she was better she came to visit her husband - I’d never seen him so happy or animated. He jumped out of his chair. He was a different person because his wife was with him. We must recognise how important peoples family and friends are to them and how separation and contact can affect them. One lady said she would really like a cup of tea from a china mug instead of a mug. Staff brought in a range of china cups and saucers from home. The lady enjoyed her cup of tea so much it has developed into a regular tea party event that everyone now enjoys. It is so important to listen to residents needs and respond. It is often little things that have a big impact – Like retaining Everyday life ‘activities’ Debbie was 18 and new to care work. She recently accompanied a resident to A&E in the last days of his life. As I went to pick her up from the hospital (15 hours after she had started her shift because she didn’t want to leave him) the A&E consultant pulled me aside to praise Debbie for her compassion and dedication to this resident. A few weeks later I received a letter dictated by this consultant again praising Debbie and saying she should be given every encouragement to go into nurse training if that was her ambition. As her manager I was so proud of her. Respecting and showing dedication in this way treated this gentleman with dignity A young lady was born with spina bifida. In 2000 she was also registered blind. She was told that there were many things she would be able to do now. She had never been given the opportunity to learn braille and she felt no-one had the time to sort it out. But then someone did talk the time and now she is learning braille on a one to one basis each week and loving it. Staff thought they knew best, but it is never to late to learn new skills or make new memories. Albert came to access respite care. He was very unkempt and had poor personal hygiene. Staff attempted over several days to give him a bath, resulting in an escalation of aggressive behaviour. After several days of this, one staff member was chatting to Albert who said he would like a bath, but wanted a man to help. No one had considered this. His carer at home was his daughter and he didn’t feel this was appropriate and offers of help since had been from females. Once gender appropriate care was offered Albert became a very welcome visitor, who had tremendous personality and staff loved to see him. Afterwards staff said ‘well, if you always do what you always did, you’ll always get what you always got!’ It was an interesting lesson to always consult with the individual to identify what is important to them and thing of different solutions. A group of people with learning disabilities came to live together 5 years ago. The social workers assessment was that they had limited abilities and a local artist volunteered her services and came every Monday to develop their skills in art therapy. Now their 3D artwork sells for as much as £120 a piece, is widely respected and they have created work opportunities for other people. This gave them a sense of purpose and achievement. The word ‘respect’ is interesting as one of the ways people define what dignity means to them is – “Your respect gives me my dignity” Alison started her career in 1981 as a 16 year older care worker. One of her colleagues and friends who supported her in her early working life was a lady called Sheila. Alison’s career has now progressed and she has responsibility for 12 care homes. Sheila is now a resident in the care home that Alison started her career in. Alison asked her staff “Is Sheila one of ‘them’ or is she still one of ‘us’”. Shouldn’t she still be treated with the same courtesy and respect as when she was a senior colleague? When did she loss the ‘right’ to respect. How does the power balance feel here ? Equal? Interesting stimulus for discussing of use of ‘language’ Did Alison mean to be disrespectful? Extract from - A letter from a daughter of a deceased service user… I am writing to thank your exceptional staff for the difference they made to my fathers life over the last 4 years. Dad looked forward to their visits and the humour they brought. They are exceptional (and I don’t use that word lightly) people who sprinkled their magic in Dad’s life. I’m sure they are now having a similar effect on the lives of other vulnerable people Yours forever grateful The staff obviously understood the gentleman and his sense of humour. James is 29, he has just moved into a house with two other men, both of whom have learning disabilities too. They have a small team of support workers who assist them to live independently in the community. James is an only child who lived Mum until she died last month. The two tenants are initially suspicious of James, especially when he is reluctant to help with the housework and does not understand their house rules. This leads to friction in the house and an atmosphere that disturbs everyone and makes life difficult for the support staff. Staff are concerned about James’ behaviour. They discuss his care plan with the information about his routines. It identifies that James showers every day following a long three stage process, he must have a full set of clean clothes every morning and he needs a new toothbrush every Friday. It is decided that these behaviours are as a result of years of ‘spoiling’ by his mother and a programme of positive behaviour management will help him settle more easily into the routine of the home. On the first morning that James does not have clean clothes available he washes the worn ones in the sink and puts them back on - wet through. His support worker cannot persuade him to change so he decides it will be a lesson for him to wear them all day. When he is told he must use his toothbrush for a month, James will not clean his teeth at all because he is so distressed. One of the support worker’s makes jokes about his showering routine, the others laugh at him. James becomes withdrawn, his notes indicate he is not mixing with the others and not settling, he is either aggressive or curled on his bed, it is thought to be because of his resistance to change. An 80 year old man came to us from hospital late one Saturday night. There was very little information about him, he did not appear to have any relations or friends, he was very disorientated and agitated. All the information we had was basic DoB, brief medical history, previous address etc. Very brief notes - he had dementia, was aggressive but was fairly local. After several weeks, it came to a point where we had to call in the CPN to help, he looked at his medication and we were considering whether we were able to keep him, it was difficult for staff and the other residents. He lashed out at anyone who tried to get him to do something – he refused baths and getting him dressed in the morning was a nightmare because he fought, shouted, struggled and hit staff - Nothing really helped, he was abusive for no reason and our staff are not paid enough to put up with that. Just after he came, we employed a new member of staff, she had stopped work whilst her family were young, she hadn’t worked in care before but she was local. She came in for a trial and even before she started her initial training she seemed to have a rapport with him. He would go with her when she asked, he would be more relaxed when she was with him. We asked her how she did it, but she didn’t know. Later she told us she recognised him straight away, he had been a headmaster at the local school. She said he didn’t know her and she hadn’t said anything to him because it seemed wrong for her to be washing and dressing him when he had taught her. ‘He was well respected, very strict but always fair he taught me Welsh, he was a good teacher’ She hadn’t even finished her training and she was able to work more effectively that even the most experienced members of staff with this man. Mair lives in her own home, because of a recent diagnosis of dementia and some issues with dressing, her son has persuaded her to have support at home. Care Workers let themselves into the house every morning at 8.30 to wake her, help her shower, dress and get breakfast. They make a quick call at lunchtime then come back at 6pm to help her get her tea, medication and then ready for bed. Mair says the women are all nice, she likes their company and they make sure she has her clothes on in the right order and takes her pills but she is uneasy about personal support in the bathroom, she thinks they are a bit too ‘familiar’. She knows she needs help to remember and do some things but she was very embarrassed the first time when the care worker stayed in the wet room and opened the shower curtain to help her wash herself. She didn’t like to say anything though. Now she is slowly getting used to it, but it’s not nice. Often on cold morning she would prefer to stay in bed a bit longer, it takes her a long time to pull round, but they won’t let her, she smiles and says they ‘torment and tease her until she gets up’ she supposes it is good for her. She used to go to town but she doesn’t have time between visits now. She has stopped making meals because it was suggested she ordered frozen prepared meals and they heat them in the new microwave her son bought. One day one made her throw away the fish she was having for lunch because they said it was out of date. She had bread and jam instead. She knows she is lucky to have so much support.