Reflecting on her own mum’s care, Liz Deutsch realises that the role nurses can play in improving an older person’s quality of life is further reaching than it appears at first glance
What do we mean by care? It’s a rather large grey area.
In England, the recent social care manifesto is still in the process of being refined but its underpinning principle ‘to improve care for an ageing population and give people dignity in their older age’ remains.
Highlights of the manifesto include the personal capital ‘floor’ being increased to £100,000 while domically care costs for older people remaining at home may increase. Amongst this talk of money and retaining personal wealth I believe that the government is missing important elements.
The reality is, it is increasingly hard to find service providers with the capacity to provide care. Recently a 12-page list of private care providers was sent to my mum, who does not qualify for social services care. After receiving no response from most and no capacity to provide care from others, she soon exhausted of making calls.
“This made me realise care is not about formal care but networks”
It is hard to quantify what is meant by ‘care’. In fact ‘care’ is an all-encompassing word bridging health and social needs.
My mum is possibly in the worst-case scenario. She lives in relative social isolation with no established social network, leaving her vulnerable to hospital or care home admission, if all else fails. My mum has gradually contracted her activities of daily living, dealing with only the most urgent and necessary functions. This made me realise care is not about formal care but networks.
Only a small part of everyday care is provided by social services or private carers. As nurses, how can we help?
Through many difficult conversations I have encouraged my mum to think about what she needs – what is important to her? She has been through a plethora of assessments; she doesn’t need a ‘standard care package’. She doesn’t need or want an invasion of carers three times a day to help her get up, prepare meals and be put to bed.
“She doesn’t want to do online shopping, but for someone to accompany her to the grocery store and help carry the bags”
She is anxious and feels threatened.
She tells me housework is not high on her agenda. She doesn’t want to do online shopping, but for someone to accompany her to the grocery store and help carry the bags. She wants help to peg the washing out and ‘forget any ironing’. Personal care with a bath and hair wash, once a week would be appreciated.
What she most needs is companionship.
Mum is starting to build her social networks. The lady at the newsagents has agreed to deliver any ‘urgent supplies’ of food if she should run out between my visits. The lady who has a part time job in the garage will help to peg mum’s washing out. The ladies at the local co-op will carry her shopping to her car. There is a local paid carer who will help her take a bath.
“These support networks are established through personally identified needs”
I take care of her bulk shopping, some of her laundry and housework and I pay some of her bills online.
Very little of this is formal care and the majority does not incur much care cost.
These are the type of support networks that are informal, focused and established through personally identified needs.
Encouraging older people living at home to build social networks is pivotal to dignity, yet it is not even mentioned in the latest social care manifesto!
Liz Deutsch is clinical academic lead nurse and Heart of England NHS Foundation Trust honorary lecturer, University of Birmingham