Who cares enough to care for the elderly?

There is an article in today’s Times 2, written by a pseudonymous Liz Penny, entitled “Who cares?”.

This article makes me angry. Very angry.

“When Liz Penny’s elderly father had a fall and her mother developed dementia, it was the beginning of a nightmare journey through hospitals, care homes and red tape that took her and her close-knit family to the brink of despair”

In a long article (here) Liz catalogues the unrelenting decline of her once fit elderly parents. Dementia, alcohol abuse, broken bones, frustration and depression.

“In December 2004 they seemed fit and well, living comfortably and independently in their home of 40 years in the Midlands. We are a close and loving family and spend a lot of time together; I had noticed nothing seriously amiss. Then Dad fell over and cracked his head on a windowsill. There was a lot of blood.”

The NHS is far from perfect and there are inadequate resources to look after feeble, elderly patients existing in the hinterland between so called “genuine” illness and “mere” frailty due to old age. And there is a regiment of non-medically trained commissars with clip boards tasked with over-ruling doctors and declaring elderly patients' “problems” as not falling within the ambit of the NHS.

I return to this topic frequently and touched upon it recently when I described Mollie Jones .

But that is not what gets me angry about “Who cares?”.

What gets me angry is the attitude of the author, Liz Penny. For, you see, it is people like Liz Penny who are bringing the NHS to it’s knees. Liz would say she is well-meaning, and maybe she is. But she lacks insight. In reality, Liz is a Welfare State scrounger. She is presumptuous, hypocritical and uncaring. All GPs know Liz Penny. “Liz Penny” is a pseudonym, but is also a collective noun. All GPs get phone calls from Liz Pennys and they always say the same thing.

“Something must be done, doctor, but I am not going to do it.”

Let us look at the Liz Penny story in more detail:

“Dad had a chest infection and was very confused. He was also going through alcohol withdrawal – it turned out that his GP had known for a year that he was alcohol-dependent, but had been unable to convince him to get help.”

Why did you not know, Liz? How often did you really visit?

“We moved Mum in with me, 15 miles from her own home in the opposite direction from the hospital, while we all got over the shock. Another was to follow. Her forgetfulness was dementia. She asked the same question six times in 30 minutes. I had to label my kitchen cupboards and write out for her every night where she was and what was happening the next day. My sister Pam and I juggled our jobs with caring for Mum and visiting Dad, a two-hour round trip.”

How had you managed to miss that Mum was dementing, Liz? How often did you really visit?

“Complete strangers to the welfare state, Pam and I turned to the internet to try to establish what financial help might be available. The answer seemed to be none, if my parents had substantial savings, which they did – Dad had astutely, or so he thought, raised £50,000 recently via an equity release on their house and put it in the building society for their future care needs.”

£50,000 is a lot of money. More than most can lay their hands on. Why should Dad not contribute to his own living costs? Unlike his daughter, Dad is attempting to provide for his own care. Why shouldn't he? Why should this burden fall on the taxpayer.

“Winter turned to spring. We moved Mum back to her own home, got her a referral to a memory consultant and, after much phoning, form-filling and investigating, found an agency to supply carers to visit her three times a day.”

Why did you do that, Liz? Why did you not keep her with you?

“Mum’s daily carers were variable and the agency was unreliable. Mum lost a lot of weight. My sister and I rang her every day; she was tearful and confused. We rang each other eight times a day: Have you seen Dad? Can you get to Mum – the agency can’t find anyone to visit tonight. Have you phoned their solicitor? Can you get to their building society? Have you rung Mum’s GP to organise a medicines box from the pharmacy (a friend of a friend told us about this)? Can you buy Dad more pyjamas? Who’s collecting Mum on Saturday? Have you rung social services? Can you look for a gardener and cleaner for Mum? Have you paid her chiropodist’s bill? Can we get together to fill out these funding forms tonight? Who’s taking a day off work this week to get her to the memory clinic?”

Heavens, it is hard work, isn’t it Liz. Let’s hand it over to the tax payer. Do you really suggest that the NHS should be looking for gardeners?

“We put our own lives and families on hold and irritated our work colleagues with the long list of phone calls we had to make day in, day out. It was relentless, depressing and utterly exhausting – and that was with two of us to share the load.”

Sharing the load? Liz means sharing her guilt of passing on the load to someone else.

“Fit from years of tennis, Mum recovered physically and returned home. But spring turned to summer and her memory worsened. We went back to the internet and found another agency to supply live-in carers – mainly wonderful South African women who cooked her fresh food and played Scrabble with her. She put weight back on (but not before her own mother’s engagement ring slipped off her thin finger and was lost) and I felt confident enough to skip some weeknight visits, although I still phoned her every day.”

You see, Liz, a bit of tender-loving-care and Scrabble, even from a South African woman, worked wonders. Think how much better it might have been if you had had the time to play Scrabble.

Then mum has more medical problems and needs a prolonged hospital admission. Eventually, she stabilises and the time is reached at which it is no longer appropriate for her to be in an acute medical ward:

“Then the hospital started to ask what our plans for her were; they couldn’t do any more for her and she was bed-blocking. We had to decide between a nursing home and herown home.”

Liz still ignores the obvious solution. It does not occur to her. Instead, Liz is now openly wishing her parents dead.

Why is Dr Crippen angered by Liz Penny?

Because, like all Liz Penny’s, she will do anything except that one thing that would really help. Why did you not give mum and dad a home, Liz? Bit inconvenient? Other commitments? House too small? Who knows. You could have sold Mum and Dad’s house and put a granny flat on yours, or bought a bigger house and used the residual funds to pay for carers to come in as and when necessary. And you would have been supported by the district nurses, and the family doctor.

God, it would have been hard, wouldn’t it Liz? It would have interfered with your social life, and your skiing holiday, and maybe you would have had to reduce your hours at work. But they are your mum and dad, Liz.

So OK, you couldn’t hack it. But pleeese don’t come all this crap about

“We are a close and loving family and spend a lot of time together.”

You may think you are, but you are not. If you were, you would have picked up on the drinking and dementia yourself.

“We are therefore still topping up the care package to the tune of £130 a week…”

Oh tush. Tush tush. You and your sister are having to pay £130 a week to ensure mum and dad have decent care. You are a middle class family. How much did mum and dad fork out over the years for clothes, shoes, music lessons, swimming lessons, allowances, extra clothes, birthday presents, a little financial help here and there, presents for the grandchildren, holidays and riding lessons?

“I am so angry that we have arrived here. I am angry with Dad for not telling us about Mum’s dementia. I am angry with Mum for not telling us about Dad’s drinking. I am angry with myself for being powerless to make it all better for them with a wave of a magic wand.”

Not a magic wand Liz. And no, you could not make it “all better”. But you could have improved on a game of Scrabble with a South African nurse.

You could have made mum and dad welcome in your own home.

“I am angry with the NHS for the disgraceful treatment of both my parents in two large hospitals. I am angry with the Government for its callous underfunding of care for the elderly.”

The care of the elderly is underfunded. But Liz, your Dad is rich. He was, in your own words a “globe-trotting businessman father” and has, as one would expect, considerable financial resources; a state pension, two small occupational pensions, and £50,000 in the bank. And his own house, not a council house. Most people just have a state pension.

What are you really worried about? That you are going to have to spend your inheritance?

I agree that the care of the elderly in NHS hospitals is appalling. But that is not the most important issue here.

“I am angry with social services for the apathy, the lack of help, the misleading or contradictory information that repeatedly dribbled our way.”

They are not apathetic. Social workers are overworked, underpaid and jaded. And yes, they do become a little cynical about the middle-class Liz Penny brigade saying “something must be done” but meaning “something must be done by someone else.”

"I am angry with God for drawing out their end in this demeaning way. If He does it to me, I shall sue.”

I like the last sentence, Liz. If you have an address, there are a few writs I would like to send to Her too.

But the preceding sentence is a tad naïve. Even with optimal medical care, being frail and elderly with multiple medical problems is a bugger.

We may all hope for a long, peaceful and untroubled old age but in reality it is rarely like that.

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Some of you will think I am being harsh to Liz Penny. I am not. There is no God given right to a peaceful old age. Life is not like that.

The NHS was set up and funded to deal with illness, not old age. The problem in the UK is that the Welfare State mentality has turned us into a nation of welfare payment scroungers. Why do families in this country not take responsibility for their own elderly? Why should the taxpayer pick up the bill for the social care of elderly, wealthy businessmen?

Liz Penny's article should have been entitled "Who cares enough to look after the elderly?".

Not Liz, it seems.

Why do we not care for our own elderly relatives? It can be done. Some British families do it. Families of Indian and Pakistani origin. I have never, in all the time I have been practising medicine, heard an Indian or Pakistani say “We cannot look after mother because we have jobs and families of our own” Somehow, they manage.

My practice looks after three large old people’s homes and an EMI unit.

There is not a single patient of Indian or Pakistani origin in any of the old peoples’ homes. There is one hopelessly demented elderly Pakistani lady in the EMI unit. She probably gets more visits than the rest of the patients put together.

There must be moral in this