There is a little old lady.  She sits alone in her house.  Mainly she stays in one room – there is no radio, there is no television.

She sits at her table and shuffles paper.

She has a mild form of dementia.

Some carers arrive, they give her some medication.  They change her incontinence pad, they get her dressed and washed.

Meals on wheels arrive, she has something to eat.

In the evening there are more carers, they change her incontinence pads and give her some night medication.  They put her to bed.

She lives, isolated in her house.

Her carers don’t like her because she shouts and she repeats herself.


One day she falls over.  She is found by her carers.

So the ambulance service is called.  We pick her up, but she doesn’t want to go to hospital.

We watch the carers bully her so that they can change her soiled incontinence pad.  The carers are aggressive.  Their tone of voice and the words that they use are harsh.

Our patient tells us that the carers that visit in the morning have hit her.  Given the attitude and actions of the carers that I have seen this doesn’t surprise me.

We contact her daughter – this isn’t the first time that she has made this claim, her daughter has reported it to the social services.

We leave the patient, we cannot kidnap her.  We return to station where we fill out a ‘vulnerable adult form’ – this goes off to our Control where it is dealt with by a specialist team.

A week later I’m asked to phone the social services person dealing with the case.

They ask me what I’ve seen, what I’ve heard.

Explaining over the phone it feels that trying to express the atmosphere in the house is impossible.

But for once I have faith in the social worker, I don’t know why but I do.

I don’t know yet how this story ends.

The little old lady needs people to not hit her, she needs company, she needs care.

Maybe our attendance will be the tipping point that will start that care.  Maybe the social services needed to hear from someone else the reports of abuse?  Maybe the carers tip-toe around the daughter when she is there, maybe something will get done.

I hope so.




Right – that’s it, I’m out of ambulance stories and I have a week off work.  I’m going to try and post every day – but I just don’t know what about.  Regular service will soon be resumed. You have been warned.

21 thoughts on “Maybe”

  1. Thanks for this post Tom.I truly hope that it will be the start of turning the corner of awareness of this issue.

    There are so many people in the self-same situation, young and old.


  2. You are so right with you views in this thread about people who are vunerable. More needs to be done. More help in society and better help for us ambulance plebs! to be able to refer to the right teams! It's coming slowly.Gotta take task on your previous blog though.

    Whats the difference between someone with dementia and someone with and alcohol problem?

    I agree. I'm the same when going to a known alco/regular. Same comments as you've made. But is theirs not another social failing? It's easy to dismiss certain groups of people. It wasn't that long ago that people with dementia were just deemed as batty!

    Keep up the good work though. Just trying to give my perspective

  3. Nothing will change. There are far too many demented vunerable old people out there, and 90% of the voters don't give a monkeys anyway. What can you do? Take a smelly batty old lady home with you at the end of the shift? I don't think so.Take one, take 'em all. And where would you put them? And did I mention the smell?

    'Old age is a shipwreck' as some sage once said.

    The shape of things to come? Just cheered myself right up, thanks Tom!

  4. Eloquently Put.The amount of times I have seen exactly what you are talking about, and it just continues, with no sign of slowing.

    Fair Play to you for raising this issue mate.

    All the best.


  5. The impact of this story is enhanced by your use of a short and simple sentence structure in this particular post. It is a very powerful picture and one I have seen a few times too. Sometimes a catalyst such as your visit is enough to bust open the truth and allow change to happen. Still plays on your mind though, doesn't it?

  6. As someone who works as a carer, I must have had better training than these shams. I would never dream of bullying a patient/service user/client (delete as appropriate). My training taught me to be alert for signs of abuse, and to never force a patient to do something they didn't want, even if it was in their best interests. I've seen it happen on wards though – I was told to be more forceful than I would like with a patient and a continence pad – but all I can do is be persuasive – dementia or not.

  7. I read this post with the smell of my grandfathers nursing home in my nostrils. We all hated the place (my grandfather included) but he had Multiple Sclerosis and we couldn't look after him properly. I went to see him everyday, and I never saw any abuse, but it wouldn't have supprised me.

  8. Thanks for this post, Tom. As a dispatcher I see this every day and sometimes have to beg, wheedle or threaten police and EMS officials to write a damned report about it. On our end we don't have to see this in person, but many times we end up being these poor souls confidants, friends and mental health therapists on the phone. I can't help but wonder and worry about what happens when we hang up the phone and go on to some drunken sod who's ruining his life and everyone around him. Social services in this country (US) is (if possible) worse than in the UK. Children are ignored, let alone the elderly. Keep on trying and I will too.

  9. Tom, can you contact me urgently, I've developed a nasty rash since the last time I saw youMwa!! Love you!

  10. someone with an alcohol problem has CHOSEN to drink, despite knowing there is a risk of dependency, has started drinking more and more without checking the issue, and then has been surprised (or then again maybe not) when dependency has developed.someone with dementia made no such choice, or had any chance to put the brakes on before it became an issue, it just happened and there was nothing they could have done to avoid it.

    Someone with an alcohol problem can seek help and, with enough effort and willpower, can get on the wagon and stay on it.

    Someone with dementia has no such option.

  11. Err, you seem to have missed the point there.Alcoholics are ill and vulnerable, it's very sad that society can't be arsed to treat them (or the elderly) properly.

    I don't think many people want their lives to revolve around drinking, riding in ambulances and sitting in hospital waiting rooms.

  12. you've missed my point too. I think we're agreeing a bit but disagreeing a bit.Yes, alcoholics need help, proper help, the sort of help that isn't widely available, to dry out and get some sort of order back in their lives.

    And yes, alcoholism is an illness which renders sufferers vulnerable.

    However, no one forced the alcoholic to have their first drink. The alcoholic chose to drink, and then chose to drink more frequently, and greater amounts, and it got out of hand. This could have been avoided had the person made a decision to not drink or to limit their drinking before alcohol dependency became an issue.

    We all know perfectly well that alcohol can easily lead to problems like dependency, liver trouble and so on. If we make the conscious decision to use it we must be prepared to accept at least some responsibility for the consequences of that decision, rather than expecting everyone else to pick up the pieces so we can go smash it to bits again.

    Whereas dementia, alzheimers disease and the suchlike are forced upon their sufferers. There is no element of “they brought it on themselves”. They are blameless victims of an illness that could strike any one of us without rhyme nor reason.

    That's the moral side, now the practical side.

    An alcoholic does have the chance to dry out. They can get better. They are not a lost cause. It will take hard work and willpower and dedication and, dare I say it, luck, but they can recover and get back a life worth living.

    A person with dementia doesn't have that chance. The best we can do for them is try and make the remainder of their lives comfortable.

    An alcoholic can dry out and step up in life again, but a person with dementia is stuck with their symptoms and needs constant, prolonged treatment – not with a view to making those symptoms go away or get better, or with a view to changing their behaviour patterns, which is how the treatment of an alcoholic might be approached, but simply with a view to taking their symptoms into account and trying to make their lives bearable.

  13. I think most experts believe there is some sort of genetic / biological component which plays a role in alcoholism. The external factors which seem to be associated with it aren't a barrel of laughs either (correct me if things have moved on, I studied this very briefly 5 years ago!). I don't think people like you or me who are lucky enough not to have problems with alcohol can really understand how someone with a problem reacts to drink.In practical terms (and I'm being deliberately callous!) if an alcoholic is cared for and recuperates then there's a chance we can get them contributing back to society, fat chance of same happening to a batty old dear.

    Finally, and please remember I'm being flippant here, by your logic you wouldn't treat someone with AIDS because they probably had sex without a condom or treat a broken leg because they went out and fell over when they didn't really need to leave the house at all – Except you wouldn't say that because you don't have the same sorts of prejudices against the people suffering from those illnesses.

    PS – I know we really agree that everyone should be treated in an ideal world!

  14. A genetic or biological contributing factor in alcoholism is all the more reason for individuals to exercise a great deal of caution when it comes to trying addictive substances, whether it's alcohol or drugs, illegal or prescribed.The viewpoint I come from is that of the child of an alcoholic father, my problem with alcohol is the other side of the bottle. My reaction has been to not drink as I refuse to put myself at risk.

    If someone got AIDS/HIV because they had been sharing needles or had sex without a condom (and told me as much, because there is a chance of breaking condoms, etc, and the benefit of the doubt should be given) then I'd certainly treat them, but I'd think they were a damn fool. The trouble comes in when the problem is recurring – when they keep on doing it, hurting other people by doing it, and pushing away any help.

    Leaving the house is something you have to do. You can't live your life without taking some reasonable risks. But things like taking hard drugs, drinking excessive alcohol, sleeping around without using condoms, wandering across roads without looking both ways for traffic, perching dodgy electrical radios on the side of the bathtub… they're risks that you don't have to take, erring on stupitidy.

    Unfortunately I get ranty about stupidity.

    My views are probably also coloured by my having one of the “it's not your fault, but there's nothing we can do about it, have some painkillers, long term physiotherapy would be better for you and might even enable you to get back to having a part-time job again, but we can't afford to give you that” illnesses.

  15. For someone with an alcoholic father, you don't seem to have a very good understanding of the nature of addiction, although I suppose it's understandable.And for someone who is probably quite dependant on the support (insufficient as it may be) provided to you, you are very unsympathetic towards the needs of others.

    Anyway, enough about you, what about me?

  16. Ugh, sorry, but I find the notion that alcoholism is a choice, in part or wholly, crass and unfeeling. I'm also an adult child of an alcoholic and I agree that it is “a mental obsession that causes a physical compulsion to drink” as described by some charity or other in the States. It's a disease that can progress with incredible stealth and subtlety from normal social use to the point where the capacity to make healthier choices is destroyed. That's the nature of addiction.

  17. my understanding of addiction is that addictive substances should be avoided because of the trauma they cause to views on the needs of others is that in an ideal world everyone would be provided with what they need – in a lot of cases that's education from an early age, about things like “alcohol wrecks lives” and in some cases it's a good round of having heads banged together.

    enough about me, what about you? please, what about you?

  18. Some social workers deserve your faith, limited though resources are they do have to comply with the law; by the very act of calling you, you can know that the matter will be investigated.There are brilliant advocacy services, often employed by social services, who do a great job of ascertaining the wishes of even the most demented. Be reassured that this lady is probably not being hit, but she is afraid and that could be a result of her dementia or her carers. She may even be remembering being hit by someone else; long term memories can be very active in such cases.

    Carers vary, and while I have never seen abuse, I have seen behaviours I would view as inappropriate. They are also paid peanuts for dealing with some difficult people, situations and incontinence pads. They should be paid more and most are wonderful.

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