‘Matthew’s Book’ is a small project but it has generated a big response. The book is on an iPad. It provides a multi-media guide to Matthew and his needs. The book will follow Matthew wherever he goes, including hospital, to ensure that all staff working with him can quickly find out about the essential aspects of his care .. and what good practice means for him. Continue reading
Choices about how we live our lives are nearly always made in a social context. When we make a choice we have others in mind. We are affected by what others want and need, what others think about what we’re doing, and how others will react. Continue reading
There’s a part of our welfare system that is almost invisible, at least as far as the literature is concerned: the day centre. Day centres are the poor relation of welfare, given little regard and seen by many as a relic of the old days of institutional care. They are deeply unfashionable. In some areas they’re seen as ripe for abolition. And yet, among the people who rely on day centres, there is still strong support for them. Those people, however, rarely have any choice about whether the centre stays or goes. When is comes to choice and control, choosing to keep the local day centre open (when the financial pressure is for closure) is so outside the prevailing orthodoxy that it’s usually ignored. Continue reading
New Scientist reports in its January 11th issue that, at an individual level, our chances of succumbing to dementia have decreased. This is not enough to stop the total number of people with dementia rising, but it does give us reason to re-consider previous assumptions. The article looks at two recent studies in the Lancet involving thousands of people. One study, based on survey evidence, showed that expected numbers of people with dementia were far lower than predicted taking account of the increase in the average age of the populationover a 20 year period. The other noted an increase in the cognitive ability in their mid 90’s of a group born in 1915 in comparison with a group born in 1905. The hypothesis (summed up as ‘cognitive reserve’) is that ‘intellectual activities’ create a resilience to age-related decline across brain networks. So what creates this ‘cognitive reserve’ among older people? Examples suggested include:
- playing bridge
- playing a musical instrument
- having a full social life
Backed up by good health measures (don’t smoke, exercise, watch your blood pressure and cholesterol, eat a healthy diet), there is a basis for individuals to adopt a sound preventative strategy. (As the article says “.. we do have some control over how we live”.)
Also, there are a number of promising strands of research that are looking to identify the causes of Alzheimer’s and measures to counter the disease, for example, the work by Susanne de la Monte and colleagues suggesting that Alzheimer’s might be caused by a type of brain diabetes.
When 1 in 3 of us can expect to suffer from dementia at some stage and when the number with type 2 diabetes is expected to nearly double by 2035 these might not be ‘reasons to be cheerful’ .. but they might just be reasons to suppose that this is a health and social issue that we can do more about than we thought.
People making choices about how they are supported is at the centre of the personalisation project. It seems such an obvious and simple idea: of course people are going to know more about what they want to get out of life than a public official, no matter how sympathetic or qualified. While ‘client self-determination’ has been part of the post-war social work tradition, it was often qualified by the caveat that the ‘client’ may not always know what was in their own interests. The disabled people’s movement, however, challenged the prerogative of state welfare to define both the problem and the remedy. Continue reading
This is not a welcome retreat of the state from people’s personal and family life, or some assertion of choice and control. Instead, it means:
- someone losing precious friendships since the day centre closed
- someone having to fall back on already depleted personal and family resources
- someone continuing to live in a house that hasn’t been cleaned for weeks
- someone going without the regular advice they need on keeping warm and well
- someone who doesn’t get the help they need to take a shower or a bath
- someone who’s fear and loneliness is greater now that no one calls by
- someone who loses the advocate and friend who fought for them
- someone whose carers have had to give up work and friends
- someone who is much more vulnerable to exploitation and abuse.
What does it mean to you?
Well it looks like Florence Nightingale was right after all when she subjected her patients to a regime of sunshine and fresh air. An item in this week’s New Scientist cites research confirming the bacteria-killing qualities of these two commodities. The value of sunshine and fresh air is receiving greater attention at a time when the classic antibiotics are becoming less effective. As the article says, “.. perhaps we can prepare for the looming post-antibiotic era by taking some lessons from the pre-antibiotic age.” One of the researchers writes, “Hospitals of the future should be designed to allow windows to be opened and perhaps patients to be pushed outside in their beds.”
The reality for thousands of people in care homes, nursing homes and hospitals is something rather different. Thousands of older people in particular spend most of their days in stuffy, stale, airless environments. It seems to show up a lack of interest in the quality of the physical environment once a person finds themselves ‘in care’. CQC’s Essential Standards of Quality and Safety runs to 274 pages but says little about environments that support physical and mental health. Perhaps it’s time to look at the scientific evidence and revise our view of ‘good care’.