Tag Archives: dementia

A life lived well before dementia

“Kites rise highest against the wind, not with it

She was born into a decent, honest and hard-working family.  A family that was neither rich nor poor; not blessed with an excess of good fortune but not unduly hard done-by either.  Just an average working family.

As far back as the mid 1700s her ancestors were a delightful mix of butchers and fishmongers, dressmakers and tailors, coal merchants and carpenters, tallow chandlers and umbrella makers.  With a few rogues along the way of course, two of whom served their sentences at Newgate Prison for minor misdemeanours.

So, you see, the most essential skills for survival ran through her bloodstream.  What more could she have asked for?  A coalfire to warm the living quarters, tailored clothes to wear, fresh food to eat while sat at a carefully crafted table, a light to read by and umbrellas galore to protect against the elements.  Umbrellas of protection; umbrellas with as many spokes as were needed to maintain that canopy of care.

More or less the Essential standards of quality and safety which made clear the outcomes her own family expected over centuries.  I’ve borrowed that phrase, of course, from our most esteemed (by some, but sadly not by me) regulator of care.  There’s one essential standard of quality and safety that she had, in abundance, that doesn’t seem to feature in today’s essential standards of care: basic common sense.  She inherited more than her full measure of that, and it kept her in good stead throughout her life, before dementia arrived and the need for caring care came into her life.  Honesty and decency coursed through her veins, alongside that basic common sense.  That’s three essential standards that seem to be missing from the caring care in the UK.

Her Dad was the first member of the family to benefit from an education.  He was the first on his side of the family to leave behind the umbrella making trade.  He became what today would be called an Insurance Executive – well, everyone’s an executive nowadays, but he was special.  “He was ever so clever, was my Dad” she used to say.  “He was ever so good with words.”  “There were no flies on my Dad!”  It was from her Mum and Dad that she took on such qualities that strengthened her backbone: she stood upright against all odds.

A happy childhood was enjoyed by all, with the usual gentle progress into adulthood being marred only by  World War II doing what WWII did to so many inner London families.  Then a working life in one of the trades of her ancestors, right through to her retirement.  Soon afterwards, she suddenly found herself living on her own.  But she coped.  She crumbled at first, as you do, but then picked herself up and put herself together again.  She’d played with the components of umbrellas as a child, so she knew how to reconstruct her own canopy.

Like so many of her generation, she worked hard, worked long, worked for every single thing she wanted in life.  She was never out of work and was never in receipt of benefits from the state; she had no debts and owed nothing.  She didn’t earn a fortune, but again, like so many of her generation, whatever she acquired, she gained through hard work and pride.  The pride she enjoyed was that she never needed to look over her shoulder.  She harmed nobody; she was gentle, decent, honest and solid.

Then dementia arrived just as she moved beyond her 80th birthday.

(To be continued)

“Kites rise highest against the wind, not with it

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Save the Cleveland Street Workhouse – we’re going to need it

What a depressing week last week was when considering care in the UK, and this week is heading in the same direction.

A short week ago, I was about to return to my obsession with the number 7 in the world of care, dementia care, political manipulation (aka demoliton) of the welfare state – and I had planned to start blogging my own personal ‘Seven Story’ of the lack of care in the UK as my family has experienced it.  I’ve decided to put that personal account on hold for now, because I have no wish to divert my attention away from the latest evolution of care in the UK.

1.  First, I came across a ‘seven’ :  Seven steps to driving down prescribing costs via Pulse and via the National Audit Office, but not necessarily in that order.  A saving of at least £200million is the estimate.  It’s not rocket science – so I’m somewhat amazed to discover that it needs a National Audit Office report to make seven ‘common sense’ suggestions.

2.  Then, I came across a variety of written answers to questions in Hansard – 10 February 2011 Written Answers detailing  meetings that  Ministers and senior officials in Andrew Lansley’s department  have had, since Lansley’s appointment, with independent sector organisations where Care UK representatives were in attendance.  There are only 5 listed, and there are more to come – but the latest written answers haven’t appeared yet.   But Grahame Morris did get a half-hearted answer from Simon Burns to his question as to how many health contracts had been awarded to Care UK in each month since May 2010 :

“We do not hold information centrally about local national health services and social care contracts. Primary care trusts and local authorities are responsible for their own contracting arrangements and decisions.

We can confirm that, as at the close of the last accounting period on 31 December 2010, the Department has not entered into any new contracts with Care UK since May 2010.”

John Trickett asked about the monetary value of the contract given to Care UK for the treatment of prisoners; and what assessment had been made of the compatibility of the award of that contract with  procedures and guidance on tendering – another non-answer followed from Paul Burstow.  It was the Hansard heading of Care UK: Prisoners that caught my eye.  But more on that one another day, and I’m sure I’ll come up with more than seven!!!  You can do the mathematics for yourself!  I’ve done my sums already.

There are still more written answers to come – eventually – so we will just have to hope that they are answered, rather than fudged.

3.  A serious case review found that residents of Summer Vale Care Centre, a Leicester care home for 26 people with dementia and mental illness had been “badly failed”.

“The report commissioned by Leicester City Council found patients were subjected to physical and sexual abuse from fellow residents. Summer Vale Care Centre in Mowmacre Hill closed in October 2009 after a whistle-blower alerted the authorities.  A police probe uncovered 65 “sexual or concerning” incidents at the home. The force said just seven incidents had been reported to them prior to their 2009 investigation, three of which had sexual connotations.  It is very clear to everyone involved with this review that all agencies badly failed the residents and their families.

“There were lots of incidents and concerns and even though there were around 60 professionals involved in making sense of this information, all of whom agreed that something should be done, no-one asked searching questions and no-one assumed the lead role“, added Dr Margaret Flynn, the report’s author.

No prosecutions so far due to insufficient evidence, but one still pending involving a senior member of staff.

26 vulnerable people with dementia and mental illness v. 60 professionals who failed them, but not one single prosecution thus far.

And the best that Minster Care can offer is “It is regrettable that the quality of care at Summer Vale Care Centre did not meet the high standards expected by ourselves and the local authority partners, and deserved by our residents.”  Note that the residents come last in that Minster Care statement.

4.  The Report of Ann Abraham, Health Service Ombudsman on ten investigations into NHS care of older people is incredibly hard to read – not because of its language but because of the distressing content.  It  carries the title ‘Care and Compassion?‘ – and if you get to the end of it, you will certainly be wondering where the care and compassion were, and whether the NHS still knows the meaning of either word.  The use of a question mark says it all.  Just ten stories of neglect – ten desperately sad stories – and probably just a brief snapshot of the way our so-called civilised society has decided to neglect a whole section of the population.

5.  Then, when you are trying to work out what the heck is going on, you read that “A Conservative MP and former GP who claims coalition Government whips attempted to gag her and prevent her from speaking out against the NHS reforms has warned health secretary Andrew Lansley he is ‘losing the profession’.

Dr Sarah Wollaston, the MP for Totnes in Devon, said she refused to sit on the committee of MPs considering the health bill after being told she could only take part if she agreed not to table any amendments and always voted with the Government.”

Gradually, it all becomes clearer.  They’ve all lost the plot!  And the only ones who will suffer are the older, vulnerable people in need of care.  There’s no sign that Cameron and Clegg care much about the real world; they just won’t listen to any comment or criticism.  I hope they open their eyes and ears and, more importantly, their hearts soon.  This destruction is not necessary.

6.  Today brings a report in the Daily Mail claiming that ‘Trespassing laws are to be used to evict elderly patients who ‘block’ hospital beds.   Pensioners reluctant to go home – often because they are too frail or confused to cope on their own – will be given 48 hours to leave. If they refuse, NHS trusts will seek a court order for possession of their bed.

The ‘bed-blockers’ could even be forced to pay the legal fees incurred.’

Not being a natural Daily Mail reader, I hesitated before mentioning this report – but I know for a fact that this kind of ugly threat is being carried out.

Frail and confused?  That normally means older people with dementia.  And that is precisely the situation that I have in mind: someone who has been in hospital now, waiting for the NHS and the PCT and the Local Authority to get their act together and carry out the required assessments so that one 87-year old can leave hospital.  The 87-year old can’t carry out those assessments himself, and neither can his family.  The 87-year old can’t care for himself, and neither can his family provide that care.  But that is precisely what the NHS and the PCT and the Local Authority are wanting.  Meanwhile, they are threatening eviction.  Well, bring it on!! Let it happen – and then we’ll name and shame you all.  Meanwhile, his family are complying with every single request that comes their way – but every question they ask is being ignored.  So perhaps we have arrived at a One-Way-Street of Care in the UK.

7.  Meanwhile, the Cleveland Street Workhouse – originally built in 1775 and the likely inspiration for Charles Dickens’ Oliver Twist – is under threat.    ‘Complete redevelopment of the workhouse site has been proposed. If these plans go ahead, this important historical building will be totally demolished.  A very large-scale private residential development, quite out of character with the street and its historical surroundings, will take its place.

But if the thugs in the ConDemOlition Coalition get their way and demolish everything in sight, we may well see a return to the Workhouse.  So perhaps The Cleveland Street Workhouse needs to be preserved and renovated for future use.

Well, that was an unplanned Seven and certainly not a Magnificent Seven.

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How fair is Britain?

I’m half-way through reading “The Greatest Show on Earth” by Richard Dawkins.

I’m hooked!

Alongside, I’ve also been dipping into the first “Triennial Review “published today by the Equality and Human Rights Commission.  No, I haven’t read the full 750 pages yet, but I’ve read the transcript of the video overview, and a good few more pages too. 

Read more ….

I’m twice hooked!!

OK, I admit it was the word ‘triennial’ that grabbed me … for purely personal reasons.  I am approaching a first “Triennial Review” that is all my own.  Namely the Triennial Review that I promised myself I would conduct at the end of my 3rd year (yes, third year) into the circumstances of neglect that surrounded my own relative in need of caring care.  But neglect was all that came her way.  And she died a painful death, and an earlier than anticipated death, as a result of that neglect.

“It’s the job of the Equality and Human Rights Commission to help society make further progress.”  Would that be the Big Society that David Cameron keeps banging on about?  Or the other (only?)  Society that we all know of old?  And yes, I am quietly hoping it’s the second of those two options that the Equality and Human Rights Commission strives to help.

Can you help me also, EHRC?  Can you help me to achieve progress, as I work my way through the muck that is being delivered (almost daily now!!) from those who are supposed to care about ‘fairness’ and to care about ‘care’?  If you are able to do that, please get in touch and I will graciously accept your assistance.

Or are there two societies now?  One Big; one Small.  One where ‘fairness’ is defined by the Big Society backed by the ConDemNation, to the detriment of the Small Society comprising the little people?

“This October we are publishing our first ever such review, entitled ‘How Fair Is Britain’.

It describes the chances, choices and outcomes in life of people from all different groups.”  I’m still looking for a few words in the transcript: older, people, dementia, in care, but then I found some of them in the online summary.

Care and support:  (follow the link below if you care to read it all ….)

http://www.equalityhumanrights.com/key-projects/triennial-review/online-summary/care-and-support/

“As might be expected, we are more likely to need care as we grow older. We are also more likely to provide it later in life, as we have children and as our families and friends age with us.”

Don’t get me wrong, EHRC.  I applaud our past history of fairness, our well-known and well-recognised tradition of fairness and respect for other points of view, culture,  gender, race, sexuality,  religion and so on … that meaningful equality (as you call it) that we have achieved.  Historic prowess shouldn’t allow for complacency.

History is neither our present, nor our future. We must find the way to demonstrate today that we value and care enough about our history of fairness, our reliable traditions connected to our history of fairness, and our past celebrations of our ‘fairness’ to carry us forward to our today and to our tomorrow?

It is not enough though to express good intentions, what matters is making a practical tangible difference.  And you can’t hope to make change happen in the real world without looking hard at the facts.

I do appreciate that you’re also in a fragile state, EHRC, being – for want of a better phrase – currently under review.  But then again, I do wonder whether this fairness that we purport to attribute to this (as we would like to see it) fair nation of ours really does care, or even  whether the word ‘care’ may disappear from our vocabulary fairly soon, to be replaced by … neglect.

The spending review currently being imposed by our Married-by-Convenience Coalition Government may well demolish all of our hopes for ‘fairness’, especially fairness in old age.  If we allow everything that has become known as caring care to be scrapped without decent consultation and without decent consent, then the Older Person will be thrown out with the mucky bathwater.

Do we really care?  If so, why don’t I believe you?  Why is our ‘caring care’ not visible?  Why have I spent 3 years of my life trying to establish whether or not we/you/they really do care?

Have we evolved enough to care?  Or are we in need of another “Blind Watchmaker”?

Will I be thrice hooked?  Ever?  Never?

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Intermittent connections in the world of dementia and care

There is what is known as a ‘major Service Outage’ in my part of the UK, and many of us are struggling with creepingly slow broadband connections – all are up the creek without a paddle for the foreseeable future, and no amount of troubleshooting has so far been able to sort us all out.  I’m told I have an intermittent connection, but no boffin has so far been able to create the constant connection that I need.  And as those strangely disconnected moments turned into hours, then days and now weeks, we have all been driven to distraction.  So, many micro filters have been changed, routers powered down and powered up, settings have all been checked, lines tested … and so on.  The systems have all had a thorough MOT.

But the brain behind the broadband can’t send the right signals to the right place at the right time for a meaningful, reliable and constant connection to be established.

Just like dementia.

When the brain’s working properly all those little electrical impulses work their way along the nerves to and from parts of your body and parts of your brain.  The neurotransmitters help those signals to jump across the gaps between the nerve cells.  And language, movement, problem solving and memory all work according to plan, according to the blueprint.  The connections remain constant.

But, with Alzheimer’s disease, the brain shrinks as the number of nerve cells in the brain reduces.  You can’t grow new nerve cells, so as more and more cells die away, the problems of dementia increase.  The neurotransmitters are reduced too so they can’t send the same signals.  The intermittent connections begin to surface.

The brain needs a good supply of blood – via blood vessels – for it to function, but if the vascular system in the brain becomes damaged, because of diabetes, high blood pressure or heart problems perhaps, or a stroke, the blood can’t reach the brain cells, so they eventually die.  And then along comes Vascular Dementia to wreak havoc.  More intermittent connections surface.

It’s 100 years since Alois Alzheimer first described Alzheimer’s.  Very little of Alzheimer’s teachings had to be revised and, though 100 years older today, they have not been corrected or amended but only confirmed.  Alois Alzheimer was apparently an optimist.

Dementia is the word we use to describe the symptoms that occur when the brain is damaged by disease, the most common being Alzheimer’s Disease.  Vascular Dementia is the second most common form of dementia.

Dementia is degenerative, and the speed of decline varies. A person will become repetitive both in speech and movement, will look in a mirror and fail to recognise their own image, will also fail to recognise their own family and friends, will lose the ability to carry out everyday tasks (the so-called activities of daily living or ADLs), will often become verbally and/or physically aggressive, will become agitated, may suffer hallucinations and delusions, will gradually suffer severe memory loss, will often lose their speech entirely and in the latter stages they will lose the ability to swallow, the ability to move, the ability to breathe.

Dementia leads to death.  There is no cure.

For some unexplained reason, Dementia is  seen at present as a problem requiring social care rather than health care.  And that is where the intermittent connections in the world of dementia and care really begin to show themselves.

Paul Burstow, Care Services Minister and Liberal Democrat MP, had a crack at local authorities for jumping the gun and making cuts in care support ahead of next month’s public spending review.  He also told Community Care that “Every local authority has a responsibility to do its best to make efficiencies and protect the frontline – there are better ways they can do this than salami-slicing and slash and burn.”    I can only agree with him when it comes to salami-slicing – if only because I can think of a few salamis that I’d like to slice, all currently involved in the care industry and in the dementia care industry.

Mr Burstow is also upset by the low uptake of personal budgets.

The Princess Royal Trust for Carers published the results of its survey of 800 carers, who care unpaid for a sick and disabled family member, and found that over half (53%) of all carers who work earn less than £10,000 a year, with three-fifths (60%) having to spend all of their savings to support the person they care for. 89% say that they are financially worse off as a result of caring and, consequently, almost two-fifths (39%) fear they will lose their home.  Broke and broken: Carers battle poverty and depression.

Read these Quotes from Carers – the intermittent connections in the world of care are clear to see.

Today, Stephen Dorrell – the new Chairman of the House of Commons health committee – has urged politicians to face up to the way in which vulnerable elderly people are being forced to pay for medical care, health care, all because of the redrawing of the boundaries between health care and social care, without proper debate or scrutiny.

The debate surrounding NHS Continuing Healthcare – which is healthcare fully funded by the NHS, in any ‘setting’ so in hospital, in a care home, in one’s own home, in a caravan or even on a double-decker bus (privately owned, of course!) – is something that most people never need to come into close contact with, unless and until they or their relatives are old, and/or with health needs.  And especially, unless and until they develop dementia.  Then, for some strange reason, the connections of the professionals suddenly resemble our broadband problems: fully funded, but fully intermittent.

Many people are denied the human right to return from hospital to their home, by healthcare professionals and by social services.  They’re told they need ‘nursing care’ 24/7 in a care home.  They are then offered by the NHS £100 towards the cost of that nursing care, the Nursing Care Contribution.  But they are then also forced to pay £3500 per month or more for residential care, often shabby and sordid residential care.

All because they have health needs that are such that they can no longer live an independent life.  Residential care is the choice of last resort for so many people, because they can no longer be cared for at home.  And that applies especially to those with dementia.

They are often forced to sell their own homes – or rather their family is forced to sell the home, because by this time, the person needing 24/7 care is in no position to do so themselves – to pay the extraordinary costs of residential care.  Extraordinary costs, because nobody is ever given a breakdown of that cost, but it’s not normally a fair charge.  The quality of care provided is rubbish in many care homes, with enormously inflated charges, enormously inflated pre-admission promises of care, enormously low-paid workers, mostly immigrant workers, enormously low standards of training, especially dementia training.  But enormous profits for the care home industry.  (see the CQC announcement today today about some of the sordid care homes and agencies it has forced to close.  Many  other sordid care homes and agencies have survived the CQC axe – but only just, and only thanks to some very closely woven and constant connections.  There’s little chance of their connections becoming intermittent.)

The hoops and hurdles that have to be faced by those who challenge the decision-making process (also known as the National Framework for NHS Continuing Healthcare) are so complex and complicated that the so-called professionals can’t even work their way through them all.  And then the family members who find the inner strength to challenge it all are forced to spend years, and years and years being humiliated by the Primary Care Trust (PCT) and Social Services (SS).  It comes to resemble a game without rules, like Snakes & Ladders with venom-filled snakes hissing and spitting at the poor souls who try to climb the rungless ladders.

Except that there are rules.  There are legally binding rules that should not be broken.  But they are being wilfully broken, by the NHS, the PCTs, and the SS.  Aided and abetted by governments, one after the other.  They are all in it together, to paraphrase David Cameron.

“We are clear about what we must do … in a way that protects the poorest and the most vulnerable in our society, in a way that unites our country rather than divides it, and in a way that demonstrates that we are all in this together. Prime Minister David Cameron’s speech on the economy, Milton Keynes, 7 June 2010,

Dementia is an extraordinary disorder of the brain, a disease of the brain, a most devastating illness, for which there is no cure.  People die of and with dementia.  But dementia is not being acknowledged as a disease, an illness, a destructive force, removing from a previously capable and competent human being each and every single quality that defines a human being.

We as a civilised country ought by now to have found a way to create the constant, reliable connection between needs and service provision.  Dementia care still suffers from a ‘major service outage’ of a kind that paralyses those with dementia and their family members caring for and about them.

I am sick and tired of reading, hearing and watching our government, our ministers, our politicians, our healthcare professionals, our social care professionals and so on, all cry out in shock horror about the problems of caring for the elderly that we are facing, but they continue to do nothing to correct the ills of their ill-defined system.  Actions speak louder than words.  If we really are all in this together, then we should not be so lily-livered about sharing the responsibility for it together, via taxation.   All that is required is for the connection to be made, between health needs and care.  Between dementia and care.

After all, tomorrow it could be any one of us – even you – with dementia and needing care.

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The time has come ….. e’en though I’m no walrus!!!

I’ve ben fairly restrained thus far in my adulterated vitriol …. which otherwise would have been sent hurling and spitting towards those so-called support services that came my way over the last few years.

The last few years, that is,  of my own life when I forded the shallow waters between an otherwise normal life and the abnormal life across the shallow water of someone needing care and support.  The indescribable chasm ‘twixt the normal world of most of us and the abnormal world of dementia.     So different are those two ‘worlds’ that I cannot even begin to find the words to talk about it all.   Yet.   
But I am hoping to find a way, a route map, the Ordinance Survey Map, if you will, of my own personal walkings through the world of dementia and dementia-care.

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The homecare companies that couldn’t care less

UNISON, the UK’s leading public sector union, today slammed private homecare companies for exploiting staff and leaving elderly people without the care and support they need.

Private care companies routinely employ staff on zero hours contracts, that often means huge swings in paid hours for staff. By refusing to pay for travel time between visits, many home carers are effectively paid below the minimum wage.

They are not offered even basic training, including how to administer medicines, despite having to give them out as a part of their work.

Some companies book back-to-back calls with no travel time at all. This forces carers to shave minutes off already packed care slots, and means elderly people are short-changed, missing out on vital support.

Out of their low wages, many care workers have to pay for their own transport, mobile phones and uniforms – all essential to do the job.

And as I sit here writing this, You & Yours on BBC Radio 4 is discussing the very same problems.  With continuing talk of reverse auctions, call cramming, lousy training.  “There’s a gap between what’s in the Standards and what’s actually happening” are very true words that I’ve just heard from Helga Pile, UNISON’S from National Officer for Social Services.

And yet there is another contributor Colin Angel, Head of Policy & Communications at UK Homecare Association, who almost denies there is a problem and suggests that everything is regulated by the Care Quality Commission.  He’s a provider of domiciliary care, of course.

An anonymous contributor to the programme became so disillusioned, exasperated and thoroughly fed up with the careless carefree homecare that she was able to access for her 94 year old mother with dementia that she placed her mother into a care home.  I will keep my fingers crossed and hope that she has been able to find a genuinely careful and caring care home.   The scenes she described are not a one-off.  The cultural differences between cared for and caregiver resulted in extremely odd combinations of food being served.  Smoked haddock and gravy!  Communication made impossible because of the lack of English in the caregiver.  Problems with time schedules.

Money, money, money! That’s what far too many care providers care about.  With their shares in the company, enormous salaries, bonuses and so on, it’s not likely they would consider working for £5.80 per hour (a measly 5p above the minimum wage), a mileage rate of 17p per mile and on a zero hours contract.  So why are they prepared to exploit their staff and the very people they purport to care for?

But nobody really cares about those on the receiving end of careless carefree care – who are, in the main, elderly people without the inner resources to question it all.  The vulnerable elderly people in need of care often have elderly relatives trying to do their best for them, so their elderly supporters are often also challenged.

Pamela Wells called on care homes to up their game, when her own report was published last week.

Caroline Bernard – Counsel & Care’s Policy and Communication’s Manager – suggested that the homecare companies ought to be monitoring the work of their staff.  Cultural differences were again discussed, and the need for dementia training.  For the second time Paul Burstow Minister of State for Care Services declined to appear on the programme and said that everyone ‘should’ receive a good standard of care and that many agencies are rated good or above.

Should receive a good standard of care – yes, of course they should.

But the fact is, Mr Burstow, that it is not a reality in many cases.

My own relative had something like 14 different homecare workers visiting her in any one week; she came to resent that.  They mostly had a very poor command of English which was a huge problem for an elderly person with dementia.  They filled in the ‘daily contact’ record book with many untruths, giving the impression they had understood and carried out the task required of them when that was far from the case.  (That must be one ability they are trained for!)  Meals were not prepared – “she said she’d already eaten”.   She may well have said that, but she has dementia and she has diabetes too.

Medications were incorrectly ‘prompted’, at the wrong time of day, or on an empty stomach.  Or just left on the table in a plastic pot – “for you to take later”.  Result: my relative stored those meds up.  Who would have carried the responsibility if she had taken them all in one go?

I complained about the appalling homecare service.  I asked for continuity of care worker – the Manager told me that the staff preferred to have maximum variety in their work.  The Manager suggested to me that I should not complain “because some of the workers are now refusing to visit”.  That’s what I call mis-management.  Tail wagging dog?

Paul Burstow, I welcomed your appointment recently.  I look forward to being able to continue to welcome your appointment.  But only if you understand the numerous meanings of TLC.  Not just tender loving care.  Work out your own permutations, Mr Burstow.  A few suggestions for you to play with: training; care; trustworthy; lasting; careful; loyal; compassion; tested; long-lasting; life; controlled; considerate; … … … over to you!

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The Seven Stages of Dementia

Seven Stages of Dementia


Stage 1:
No cognitive impairment

* Unimpaired individuals experience no memory problems and none are evident to a health care professional during a medical interview.

Stage 2:
Very mild cognitive decline

* Individuals at this stage feel as if they have memory lapses, especially in forgetting words or names or the location of keys, eyeglasses, or other everyday objects.  But these problems are not evident during a medical examination or apparent to friends, family or co-workers.

Stage 3:
Mild cognitive decline

* Friends, family or co-workers begin to notice deficiencies.
Problems with memory or concentration may be measurable in clinical testing or discernible during a detailed medical interview. Common difficulties include:
*Word- or name-finding problems noticeable to family or close associates
*Decreased ability to remember names when introduced to new people
*Performance issues in social or work settings noticeable to family, friends or co-workers
*Reading a passage and retaining little material
*Losing or misplacing a valuable object
*Decline in ability to plan or organize

Stage 4:
Moderate cognitive decline
At this stage, a careful medical interview detects clear-cut
deficiencies in the following areas
:
*Decreased knowledge of recent occasions or current events
*Impaired ability to perform challenging mental arithmetic-for example, to count backward from 100 by 7s
*Decreased capacity to perform complex tasks, such as marketing, planning dinner for guests or paying bills and managing finances
*Reduced memory of personal history
*The affected individual may seem subdued and withdrawn, especially in socially or mentally challenging situations

Stage 5:
Moderately severe cognitive decline
Major gaps in memory and deficits in cognitive function emerge.
Some assistance with day-to-day activities becomes essential.

At this stage, individuals may:
*Be unable during a medical interview to recall such important details as their current address, their telephone number or the name of the college or high school from which they graduated
*Become confused about where they are or about the date, day of the week, or season
*Have trouble with less challenging mental arithmetic; for example, counting backward from 40 by 4s or from 20 by 2s
*Need help choosing proper clothing for the season or the occasion
*Usually retain substantial knowledge about themselves and know their own name and the names of their spouse or children
*Usually require no assistance with eating or using the toilet

Stage 6:
Severe cognitive decline
Memory difficulties continue to worsen, significant personality
changes may emerge and affected individuals need extensive help with customary daily activities
.

At this stage, individuals may:
*Lose most awareness of recent experiences and events as well as of their surroundings
*Recollect their personal history imperfectly, although they generally recall their own name
*Occasionally forget the name of their spouse or primary caregiver but generally can distinguish familiar from unfamiliar faces
*Need help getting dressed properly; without supervision, may make such errors as putting pyjamas over daytime clothes or shoes on wrong feet
*Experience disruption of their normal sleep/waking cycle
*Need help with handling details of toileting (flushing toilet, wiping and disposing of tissue properly)
*Have increasing episodes of urinary or fecal incontinence
*Experience significant personality changes and behavioral symptoms, including suspiciousness and delusions (for example, believing that their caregiver is an impostor); hallucinations (seeing or hearing things that are not really there); or compulsive, repetitive behaviors such as hand-wringing or tissue shredding
*Tend to wander and become lost

Stage 7:
Very severe cognitive decline

This is the final stage of the disease when individuals lose the ability to respond to their environment, the ability to speak and, ultimately, the ability to control movement.
*Frequently individuals lose their capacity for recognizable speech, although words or phrases may occasionally be uttered
*Individuals need help with eating and toileting and there is general incontinence of urine
*Individuals lose the ability to walk without assistance, then the ability to sit without support, the ability to smile, and the ability to hold their head up. Reflexes become abnormal and muscles grow rigid. Swallowing is impaired.

Taken from: http://www.simplesite.com/MotherMary/2926945

Other versions are available, but I like the simplicity of this version.

From the Seven Ages of Man to the Seven Stages of Dementia.   To be continued.

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