Care

What is actually done, by whom, and at what hour

Written as if you were standing in the hall asking, because that is where these questions normally get asked and half-answered.

Three kinds of care

Residential, nursing and dementia support

The difference is not a marketing one. It decides who is in the building at three in the morning and what the fee is.

Residential care
For someone who can no longer manage alone at home but does not need a nurse. Help with washing, dressing, the lavatory, medicines, meals and getting about. Sixteen of our rooms.
From 00 a week
Nursing care
The same, plus care that legally requires a registered nurse: wound care, catheters, feeding tubes, injections, syringe drivers at the end of life. A nurse is on duty in the building twenty-four hours a day. Twelve of our rooms.
From 00 a week
Dementia support
Not a separate wing and not a locked one. Eleven of the people living here have a dementia diagnosis, in both parts of the house. Every carer has done the training, the corridors are laid out so that walking about goes somewhere rather than nowhere, and we do not move somebody at night because they are awake.
Included, not an extra

Staffing

Who is here, and when

These are the rostered numbers, not the minimum we are allowed. When somebody is off sick we use our own bank staff first and an agency only when we must; last month agency hours were four per cent of the total, and we will tell you this month's figure if you ask.

1 to 5: Carers to residents, mornings07:00 to 14:00, the busiest part of the day, plus the nurse, the manager and the kitchen.
1 to 7: Carers to residents, afternoons14:00 to 20:00, plus a registered nurse and the activities co-ordinator until six.
4: Staff awake all nightThree carers and one registered nurse, 20:00 to 08:00. Awake, not sleeping in. Nobody is alone in the building.
45 min: On-call manager, worst caseA senior is on call every night and lives close enough to be here inside three quarters of an hour.

The day

What an ordinary Tuesday looks like

From waking to night

Nobody is woken to fit this. If your mother has got up at eleven all her life, she gets up at eleven here.

From 06:30
Waking, when people wake
Night and morning staff
Tea in the room. The night staff hand over in person, at the bedside, not at a desk.
08:00
Breakfast
In the dining room or in bed. Cooked, if wanted, every day of the week.
09:30
Washing and dressing
Carers
In their own clothes, chosen by them where they can choose. A bath or shower when they want one, not on a rota of two a week.
10:30
The middle of the morning
Newspapers, the garden, the hairdresser on Wednesdays, visitors, or nothing at all. Doing nothing is allowed.
12:30
Lunch
The kitchen
Cooked here, two choices shown on a plate rather than read from a card. Relatives can eat with someone; tell the kitchen by eleven.
14:00
Afternoon
Activities co-ordinator
Something organised most days, and a sleep for the many who would rather. Nobody is made to join in.
16:30
The hardest hour
Late afternoon is when confusion and distress are worst for most people with dementia. We staff for it and we do not hide it from visitors.
17:30
Supper
Lighter. Sandwiches, soup, something on toast, and again at any hour after.
20:00
Night staff on
Night team
Four awake. Checks are agreed for each person, written down, and not a blanket hourly torch in the face.
Any hour
Awake at three in the morning
Then somebody sits up with them in the kitchen with tea. It happens most nights and it is not a problem.

The people

Who you will actually deal with

Four names worth knowing. There are thirty-eight of us in total, including the kitchen, the laundry and the cleaners, who are staff here and not a contract.

Ruth Anwar
Registered manager
Legally accountable for this house, and the person whose name is on the inspection report. Does the pre-admission assessment herself, in your mother's own home or ward, and answers complaints. Here since 2016, in the office or on the floor, Monday to Friday and on call one weekend in four.
Owen Mbeki
Clinical lead
Runs the nursing side: wounds, medicines, the relationship with the surgery and the district nurses, and the conversations about what somebody would want at the end of their life. He is the one who will telephone you at four in the morning if that is what has happened.
Sylvia Correia
Night senior
In charge of the building from eight at night until eight in the morning, five nights a week, and has been for eleven years. Knows who wakes, who is frightened of the dark, and who wants the door open exactly this far. If you ring at two in the morning, you will get her.
Derek Lowndes
Cook
Cooks for twenty-eight people twice a day, with eight sets of swallowing difficulties, four diabetics and one lifelong refusal to eat anything green. Comes out of the kitchen at lunch to see what came back on the plates, which tells him more than any survey.

The difficult part

Limits, moving on, dying here, and complaining

What we cannot do

We are registered for residential and nursing care for older people, including people living with dementia. That registration has edges, and they matter more than anything else on this page.

We cannot nurse someone who needs a ventilator, renal dialysis on site, or continuous intravenous treatment.
We cannot hold someone who is trying to leave unless a lawful authorisation is in place, applied for by us and decided by somebody outside this house.
We cannot keep someone safe here if they are repeatedly violent towards other residents and no medical review changes it.
We are not a mental health unit and we are not a hospice, although most people here do die here, with the district nurses alongside us.

When someone would have to move

It happens, and it is the part families are least prepared for. Two things bring it about.

The first is that needs grow beyond our registration, as in the list above. If that looks likely, we will tell you weeks before it is urgent, not on the day. We will take part in the assessment, we will write what we know, and we will not simply hand you a notice.

The second is money, and it is dealt with on the visiting and fees page.

Either way you have twenty-eight days' notice in writing, and in the same letter the name of the person at the local authority whose job it is to help you find somewhere. If a move is genuinely in progress we do not enforce the date.

When somebody dies here

Most people who come to live at Elmswood House die here. We would rather write that down than let you discover it.

When someone is dying we telephone the family at once, at any hour, and we do not wait until the morning to be kind. The room becomes the family's: you may stay overnight, bring in whoever you want, bring food, bring a dog, bring a priest or nobody. We put a chair bed in. There is no charge for any of it and no limit on how many of you come.

We ask everybody, while they are well enough to say, what they would want at the end: whether they would want to go to hospital, who should be called first, whether they want to be alone or not. We write it down, we review it every year, and we give you a copy. Nothing in it is binding on anybody.

After a death the room is not cleared in a hurry. The fee stops seven days after, and you may take that week or not.

If we get something wrong

Say so to whoever is nearest, or to the registered manager, on any day. If it is not resolved on the spot you will have an acknowledgement in writing within three working days and an answer within twenty-eight, in writing, saying what happened and what we have changed.

If our answer does not satisfy you, the inspectorate and the local authority both take complaints about this house directly, and their addresses are on a card in the hall and in the front of every resident's file. You do not need our permission and we are not told first.

The last inspection

The inspectorate came unannounced in March. The report is on the table in the hall and we will post you a copy. The house was rated good overall and good in four of the five areas inspected.

There was one requirement: our records of medicines given at night were not consistently signed. We changed the night handover in April and the pharmacist now audits it monthly. Ask to see the audits; they are not confidential.

The questions people ask in the car park, not in the office

Will she think I have abandoned her?
Possibly, at first, and she may say so to you and to us. It is the commonest thing sons and daughters hear in the first month and it is not evidence that you were wrong. It usually settles somewhere between three weeks and three months, and sometimes it does not settle and you carry that. We will tell you honestly how she is when you are not here, including on the days that are bad.
Is she restrained, or sedated, when she is difficult at night?
No bed rails, lap belts or chairs anyone cannot get out of unless a specific risk assessment says otherwise and you have been told. Medicine to calm somebody is prescribed by a doctor, reviewed at least every twelve weeks, and used for distress, not for staffing convenience. You may ask at any time what your mother is taking and why, and we will print the list.
What happens when she falls?
She will fall; almost everybody here does at some point, and a place where nobody falls is a place where nobody is allowed to walk. We do not lift someone off the floor until they have been checked, we telephone you the same day whether or not it was serious, and the falls of every month go to the manager and to the inspectorate.
Can I take her out, or home for Christmas?
Yes, for an afternoon or a fortnight. No permission is needed, only telling us so that the medicines go with her. The fee continues while she is away, which is the part nobody likes.
What if I do not like what I see one day?
Say it that day, to whoever is in front of you. The complaints route is set out above and it does not go through us if you would rather it did not. Nobody's care has ever been worse here because their family complained, and if you believe otherwise, that is itself a complaint the inspectorate wants to hear.
Am I doing the right thing at all?
We cannot tell you that. What we can say is that almost every family arriving here has already kept somebody at home for a year longer than was safe, and has arrived exhausted and convinced that is a failure. It is not. Come and look at three houses and decide with your eyes.

Ask us the thing you have not written down

Telephone and ask for Ruth or Owen. If they are on the floor they will ring back the same day, and neither of them will pretend a hard question is a simple one.

Contact Visiting and fees

What is actually done, by whom, and at what hour

Residential care

Nursing care

Dementia support

From waking to night

Waking, when people wake

Breakfast

Washing and dressing

The middle of the morning

Lunch

Afternoon

The hardest hour

Supper

Night staff on

Awake at three in the morning

Ruth Anwar

Owen Mbeki