Case study: community care & older people

Authors: Mel Cadman & Kathryn Cameron


Stage One: Background and referral - transcript

[phone rings]

Katherine McAllister

Hello, Katherine McAllister.

Mary MacDonald

Hello, this is Mary MacDonald from social work services at Argyle County Hospital. Has the hospital been in touch with you about Mrs. McAllister?


Yes, yes they phoned very early this morning. I am sorry; it's just, it was quite a shock.


I know, I know. You must have been worried.


Yes, we all were. It just, well, it sounds terrible, but I always thought that my dad would be the one to end up getting admitted to hospital. The darn thing is we were all worried about who would come for her if anything happened to him. I mean, the amount he drinks, I am surprised he is still functioning. But my mum, it just doesn't make sense.


I haven't heard the latest update from the ward. How is she doing?


They never really say, do they? They are still waiting for the results of the tests, but I think they are trying to prepare us for the worst. I'll know more after I visit tomorrow. I can't believe it.


I can quite understand. I am sorry to hear that. It's actually your dad I am phoning about. The paramedics have attended you mum last night, said they were quite worried about him. He seemed confused, and of course in the circumstances that's to be expected.


Oh. You mean he was dead drunk? That's just his normal state in the evening. It's just hellish for my mum, and he is not getting any younger either. His arthritis just gets worse and worse. Sometimes he's in so much pain, he can hardly move. I know it is difficult for him. I know that. But it's my mum I am worried about. It makes me so angry. It's so unfair. What kind of life has she had?


I understand, this must be very upsetting for you. But I wonder if we can discuss how we might be able to help both your parents. Going back to your dad, from what you say, it sounds like he'll need quite a lot of help if is to remain at home safely. I understand that a neighbor, Mrs. Burns, as she popped in briefly this morning to check on him, but she did make it clear that she wasn't prepared to do any more.


Exactly. And it's not just Mrs. Burns who thinks that. I know this is probably an awful thing to say, but he is a difficult, twisted old man. None of us will put up with him. I don't know how many times we have invited mum down to stay with us. But she wouldn't go anywhere without him. It's embarrassing to have to admit it, but I just couldn't bare the thought of him being here in my home. He made our childhood such a misery. I am going up to the hospital tomorrow to see mum. I will be staying with my brother in Ardcalloch. But I wouldn't be calling on dad.


It sounds like living with your dad was very difficult for you as a child. And I can understand why you feel the way you do.

Thanks for talking to me. You have been very helpful. It's part of my job to make sure your dad gets whatever help he needs. Oh, and one other thing. The paramedics thought your dad was quite forgetful. He wanted to know whether this was just to do with the drink, or whether there might be some other problem?


Well, my mum was used to say it was just his age. But I was beginning to wonder. He has been getting a little confused. But as far as I know he hasn't seen a doctor about it. That might be best for him and for everyone else, if he could be placed in a home right now. But I know he won't hear of it.


Thanks very much for all your help. I may contact your dad later today and see how we can best support him. As I'm your mum's social worker too, it would be good to meet you when you come up, so we can talk a wee a bit more about longer term plans for both of your parents.


Thank you. It's good to know there is someone there to help him. Mum is devoted to him. It will make a huge difference to her to know that he is being looked after. I find it hard to think about the future just now. I still can't take all in.


I quite understand. So just give me a call when you come up.


Yes, I will. And thanks again.


That's OK. Good bye.



Stage Two: Eight weeks later - transcript

Maddy Smith

He seems all right now. We've managed to settle him down. So we should get some peace for a while.

Maureen Phillip

Good. Thanks, Maddy.

It's hard to believe that Donald's been here for a few weeks. Feels a lot more.

We expect new residents to find it a wee bit hard to settle in. That's normal, but Donald? It's more than that. It's his attitude. He just doesn't see anything positive about being here. Staff have tried really hard to work with him. I mean they've tried talking to him about his feelings, any worries he has about his wife. We even tried to arrange for him to visit in the hospital but I get nothing back. Either he doesn't want to know or he can't respond.

The man is violent and abusive to my staff. I just don't see that there's any point in him being here.

I mean take a look at his record. Monday the 5th. Donald asked Laura Smith, his key worker, where his f'ing money was. And when she said she would find out for him in a minute, he hit her in the back of the calf with his walking stick. He hit her so badly she fell over then shouted, "Serves you bloody right!" And that he hates everyone in this f'ing prison.

And Laura is now sick. She won't be back for some time.

Tuesday, the 6th. Donald demands a drink from the bar and when Sheila Baird, one of our care officers, says, "You can't serve him alcohol," he lashes out at her. Calling her for... The usual torrent of filthy abuse. He tried to hit her with his stick but somehow she managed to get away.

Then later the same day, one of our lady residents asked Donald if he wanted to watch TV. He replied with some sexually explicit remark. We only found out about that because she was in tears at bedtime.

Wednesday the 7th. In the morning he refuses to come down for breakfast and shouts abuse at the member of staff that woke him up. When the deputy tries to talk to him, he's even more foul mouthed.

Thursday the 8th. For the umpteenth time Donald's asked if he'd like a shower or a bath. He responds with swearing and abuse. The member of staff on the receiving end of this told me she wouldn't work with him again and that she would be speaking to a union rep.

The catalog continues. Verbal abuse, assault, refusal to cooperate, it goes on. I mean, I know there might be something else going on here. He's definitely gotten a lot more forgetful even the short time he's been here but he's got no inclination to visit or talk about his wife. I'm beginning to wonder if he even realizes he's got one.

We have arranged for a GP to visit him and I wouldn't be surprised if he diagnosed some form of dementia. Maybe the GP can give him some medication, but so time. It all takes time.

The thing is I'm really worried that he's not able to be cared for in an open setting. Even in a nursing home. And as for the hospital, well, he's never going to be top priority is he?

I mean, we've tried our best. We really have. I've got one member of staff who's off sick. Two who are refusing to work with him and the rest are scared to turn their backs on him.

And as for the residents, well, they're complaining about his hygiene, his aggression and his language. I really don't think this is the right place for him. But where is?

Stage Three: Twenty weeks later - transcript


You just wait here for a moment Mr. McAllister, one of the nurses will be out to see you as soon as we've finished the test. I'm sure your mother will be really pleased to see you, we're delighted with the progress she's made so far and fully expect she'll be able to go home in the next week or two.

David McAllister

Thank you very much Doctor!


You just take a seat, OK?


It's a great relief, thank you.


I feel like I've been living in hospitals these last few months. Seeing Mum here and visiting Dad on the other side of town, it's been hellish! We didn't think Mum would pull through, right? But she's a tough old bird, thank God! The one good thing that's come out of it though is that the family seems to have pulled together a bit better.

And then there's Dad. Across town, in a locked ward. I was quite shocked when I saw him at first. He seemed to have changed, to have grown smaller and defeated. As if he'd given up. Mind you, he hadn't lost any of his anger, the way he was cursing and swearing at the medical staff! He said that: "Oh they've been hitting me!" And right enough there were bruises on his arms. Oh I didn't believe him, really. But I made a complaint. Well, I had to.

And there was the problem of getting Mum across to visit him because she's so fragile. Oh she's been fretting to see him and desperate, and when we did take her over she was so pleased and happy! I think it actually helped her recovery. And you could see that she still loved him. Ah, even my sister could see that, and she didn't understand why.

But when she comes out, she wants to go home; and there's no way that can happen. So, we've been trying to sort of fix up the extension to the cottage, and she knows that she's more than welcome to come and stay with us. If it's OK with everybody else. We thought the hospital would have made that decision, but no, they said it was entirely our own choice.

How are we going to pay for it? And how is she going to pay for all the support she's going to need, I don't know. Mind you, I did read in the newspaper somewhere about free personal care, whatever that means. And then we've also got the problem of Dad. He's responding very well to his medication and should be coming out soon and Mum wants him to come out and the two of them to go home and live together.

But what worries me is things will just go back to square one. And anyway, his social worker has said that he's not able to make decisions for himself. And said that he might even have some legal way of making sure that he doesn't. So, I think I've got my time cut out for me, looking after the finances, the accommodation and the support.

Maybe if I had a word with Mum's social worker. She's been very good so far. It could be a good day.