100 BLOGS
NUMBER 41






REVISED CARE PLAN
December 9, 2011



Mabel is sitting on the seat in what is her little corner of the world these days. Unless I’ve asked for her to be dressed in her coat ready to be taken out, this is where I find her when I visit now. Often she is sitting with her head bowed, occasionally she is collapsed to the right, today she is upright but staring vacantly. I crouch down and say hello. She looks at me but otherwise there is no response. I don’t think she recognises me. Though recognition comes and goes, and on a good day I will still be known. I doubt if she’s said my name for the last time yet. But that day is coming.

There is a glass with juice of some sort on the little table beside her, the table that does her at mealtime and for cups of tea in between meals. I lift up the glass and offer Mabel a teaspoonful of the pink liquid. She opens her mouth for it. Inded she must be thirsty because she takes several mouthfulls before losing interest.

After a few vain attempts to engage her attention with small talk, she pushes me away. She gets irritated when people persist in trying to communicate things she can’t understand. Which is fair enough. I sit on the floor. It’s 8.30pm and there is no-one else in the lounge. After a minute or two, I take her hand and she squeezes my fingers. Perhaps she would be squeezing the fingers of anyone who put their hand in hers. But that’s OK. I squeeze back so as to let her know that someone is here for her, someone who doesn’t require anything back.

This morning, with Mum sat where she is now, I went with Marion, a senior carer, to Mabel’s room and we talked through a care plan review. Marion sat on Mabel’s bed spreading out some files and notes. I sat on Mum’s comfy chair. I’m sure Mum wouldn’t have minded our being in her space, we were only looking out for her interests after all.

The care plan reviews happen every six months but this was the most important one yet as Mabel has changed so much recently. For a start, she can no longer stand up. And just as I use a transfer board to get her from wheelchair to front passenger seat in the car, there is now a hoist in her room which I’m told is used to help get Mabel to the toilet. Marion enquires how I get on with taking Mabel to the loo when we’re out. Well, of course that hasn’t arisen for months now. We had a couple of awkward experiences in the spring, but what curtailed me taking Mum to the toilet was the difficulty in getting her in and out of the car. So several months ago the taking-Mum-out-for-four-hours-on-a-Saturday-afternoon came to an end. I now lunch with her at the home and Dad and I take her out in the car for two hours maximum. But I shouldn’t to be talking about what I already know, I should be asking about this hoist business.

After discussing the use of the machine, Marion reports that Mabel has been signed up for the more substantial incontinence pads within the last few weeks. Rather than disturb Mabel in the night, she is seen to in the morning. We don’t go into details, though I like to think I would do that if I felt it was necessary. As it is, I’m on the way to being satisfied that Mabel’s combined toilet and sleep needs are being dealt with sensibly and humanely, because there is a system in place and because the quality of the individual carers is high. I had more reservations about the home when Mabel was healthier and in need of stimulation in between my visits. Now she has very basic personal care needs that I think are being met. Though I’m suspending judgement on the hoist until I’ve seen it in action. Mabel used to visit her sister in another care home and objected to the use of the hoist, saying that it made Jean look like a piece of meat.

We go through every aspect of Mabel’s welfare. Because she’s lost weight recently, the food that she takes in is being closely monitored and noted down. For the time being, the home is going to use its own initiative in order to try and get Mabel to eat and drink. This morning, Marion herself tried Mabel with a bowl of porridge and that was a success. Only if her weight has continued to go down when its recorded again in a week’s time will they consult the dietician and move Mabel over to special formulations. At least that is Marion’s recommendation. She wants to know if I agree with it. I do: let Mabel eat porridge and cake while she still has any appetite for them.

From time to time Marion’s own mother is mentioned. She is dying of cancer in the local cottage hospital and there are aspects of her care that have parallels to Mabel’s own. Marion has a tough life just now, seeing to the needs of frail elderly people when she’s not visiting her own mother. On several occasions she’s been called to the hospital because it was mistakenly thought her mother’s death was imminent. This reminds me that I need to put on record that I want to be called if Mabel seems to be failing fast. The last time I was asked about this I said something about not needing to be called until the morning. Well, I don’t know what I was thinking about when I said that. That’s not what I want. I want to be on hand for Mum at the end.

Are things coming to an end for her? I ask myself this question as we sit together in the lounge of the care home. Well, the dementia has taken a firmer hold recently, that’s for sure. I call Mum’s attention to my presence and she looks at me blankly. Through how many layers of broken circuits? I stroke her brow in what I like to think is a consoling way. “Stop it,” she says, firmly. The rebuke takes me back to childhood when I occasionally drove my mother to telling me in no uncertain terms to, ‘shut it,’. Well, I’m quite happy to stop it, to shut it, whatever.

When she seems settled again I tell her I must go, and I ask for a kiss to see me on my way. I push my face up to hers, so its pretty obvious what’s required of her. She gives the kiss with good grace. And that’s that.

“Back tomorrow,” I announce with a cheerful wave from the door. But the wave isn’t acknowledged. Perhaps she thinks she’s done enough to support her son for one day. Perhaps she’s wondering if there is never to be an end to the emotional needs of this child of hers. Which, once again, is fair enough.


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