How Well Do You Know Someone After Working With Them For Four Months?

“You really do get upset at crap carers”, one of my station officers said to me.

We were sent to a young woman living in a group home. There are carers there as this woman has some severe mental health problems and there are a number of similar people living in this home.

Not that I would know as the carer opened the door and essentially pushed the patient at me.

All I could tell was that the patient was confused and uncommunicative. She reached out and took my hand and started walking towards the ambulance.

I explained to the carer that I'd settle her down in the back of the ambulance and then come back to get some information.

The patient sat in the ambulance, due to the way she was holding her head and breathing she was spraying spittle everywhere. The carer was nowhere to be seen.

I went back to the house and banged on the door.

“What happened?”, I asked.

“She wanted me to call an ambulance”, said the carer, “I don't know why”.

“Did something happen?”

“Her eyes rolled back in her head”.

“Did she shake at all?”, I asked.

“Oh… Yes”, said the carer, appearing a little dazed herself.

“What can you tell me about the patient's normal condition?”, I continued.

“I don't really know her”, she said. When I pressed her on how long our patient had been at the home she told me it was only “four or five months”.

Shaking my head in disbelief that in a small house like this the carers took so little interest in the people living there that they knew nothing about them after four months I asked what medicines she takes.

“Two little white pills in the morning, and two purple ones at night”.

I let the carer know that my psychic powers weren't that good and she'd have to be more specific than that. She couldn't.

The patient was unkempt, appeared to have someone else's underwear on and her hair hadn't been washed in some time. The 'carer' didn't know anything about her and refused to have anyone come to the hospital with the patient. By now the patient was starting to wander around the back of the ambulance and I wanted to get her to hospital.

On the way to hospital the patient kept standing up, so I had to hold her hand and get her to sit down again – I didn't want her falling over should my crewmate need to stop suddenly. While she was doing this she was unconsciously spraying spittle up my body, over my arms and in my face. She wouldn't keep an oxygen mask on, so I was getting covered.

By the time I got to the hospital I was fuming at the lack of care that this patient had been receiving from this 'care home', I was angry that no-one had travelled with her, I was angry that she had been 'dumped' on my with the carer not telling me anything about her and I was a little annoyed that I'd been covered in her drool.

Then I booked the patient in and discovered that she has 'open' tuberculosis, which means that I may be needing six months off work at some point in the future.

Again, this was a thing that the 'carer' had neglected to tell me.

So it was back to station for me for a long shower, followed by filling in paperwork for my risky exposure and a 'vulnerable adults' form to highlight what I considered neglect going on at that home. Someone higher up on the food chain than me will take on having a look at the home and seeing if my fears are justified.

As I reported it to my station officer he said to me, “You really do get upset at crap carers”.

“Yes”, I said, It's one of the few things that still fires my blood, that 'carers' can get away with doing such a shoddy job while I feel that us ambulance people are the only ones who still give a damn about people. I wish I met more people who were good carers.

A little time ago I met the private secretary for Ivan Lewis, the minister for social care – he told me that they don't have much to do with ambulances as we supposedly don't deal with that much social care. I put him right on that score, that around 80% of our jobs involve social care. This is what we see, this is what we deal with – we are that safety net that deals with everything when the other services throw up their hands and don't know what to do. When the sun goes down and everyone else goes home, we and the A&E departments must deal with everything and anything – and that is why we see the flaws in the system.

Looking at my list of future blog-posts I think that this week will have the failure of the care system as a bit of a theme, not for any real reason, just because that's what I've been getting of late.

19 thoughts on “How Well Do You Know Someone After Working With Them For Four Months?”

  1. I'm only a MOP, but you've touched a nerve here; something you often do in the course of your excellent blog. It seems to me that there is no such thing as a genuine 'carer' outside of an immediate family.When my Dad died, my wife and I gave up a good lifestyle, good money and rewarding careers to look after my 77 year old mother (advanced multiple myeloma sufferer), then my father in law (series of mini strokes) and now my mother in law (Parkinsons & a bunch of other stuff). Despite the financial loss I'm still glad that we did it; we were (and are) able to give some kind of love, affection and dignity at the end of their lives in addition to the bottom wiping, feeding & other practicalities. The best of the wartime generation, they never expected much, tended to be quite stoical and it has been a privilege to try and help them. Most of the welfare state was established on the back of their taxes and effort.

    After my Dad's death, a para-legal mentioned that she was also responsible for visiting elderly people in care homes for who her firm held power of attorney. As a result, she was 'part of the furniture' and saw those institutions as they really were. She seemed to be a really nice person who declared herself to be a Christian. I'm wary of organised religion, but as far as I could see she practised what she preached. She knew and visited just about every care home within a 15 mile radius and told me that if she knew she was going to be admitted to *any* of them then she would commit suicide. She didn't say this lightly. Given her religious belief, it spoke volumes to me.

    While taking our parents to various hospital clinics or visiting them on those occasions when they've had to be admitted, we have seen other families trying to do the same. Many were less fortunate in financial terms, but they still struggle on. It is very hard, but in talking with them, you learn more of the awful reality of the alternatives. It is hard though. There is virtually no financial support, tax relief or anything else: and when someobody dies, the taxman's clock starts ticking. I could write a book about how crap it all is to deal with, both financially and emotionally.

    Whenever I see Tony Robinson or Michael Parkinson or some other celeb wittering on about improving the standard of care for the elderly, I'm afraid I have a very cynical reaction. Is it done for the benefit of their own consciences, or as just another earning opportunity? We all make choices in life. They chose to walk away and have somebody else look after their parents. You can't contract out love, affection or genuine care. They should just live with what they have done & shut up IMO – they don't have to justify it to me.

    In our experience, the state (our taxes) always manifests itself in the end as a clip-board carrying jobsworth radiating the warmth and humanity of a brick. The past few years have turned me from being a bit of a pinko into preferring that the government cut our taxes, get out of our lives & leave us more to use as we see fit. On the positive side, I have lost all faith in the BBC and mainstream media 'reporting' and rely more on blogs like this for a feel as to what is actually happening on the various front lines.

    Sorry for rambling on. I'll stop now.

  2. Get a PPD test done now (unless you arent't already skin positive) and another one in a couple of months' time.If G_d forbids, you turn skin positive you may have your occupational exposure recognised.


  3. *Waves hand from back of room*I'm a good carer (I support people with learning disabilities, who are more likely than most to suffer from mental health problems). I've blown the whistle more than once on incompetent 'carers' or abysmal facilities. If I saw that level of neglect, I'd be seeking to have that numpty sacked.

  4. I'm not surprised you get upset with crap carers when they leave you open to exposure like that. Not to mention the blatent neglect of the patient.

  5. The only way you'll be having 6 months of will be for something other than TB. You're unlikely to have contracted it, in the short period you were with her. If shes been diagnosed and is in the community, she will have been treated – They still lock you up if you're non compliant with the treatment

  6. Although looking after a family member is the ideal, sometimes it is not possible to care for someone in the home. My mum was absolutely committed to looking after her parents (my grandmother lived for 20 years after a horrific stroke which left her paralysed on one side and unable to speak) but when my grandfather's dementia meant he was a danger to himself and violent to her, a care home was the only option. Many of the homes visited seemed to display the same level of “care” often written about in this fine blog, but – after persistence – a decent one was found. People often feel guilty that elderly relatives are being cared for in a home and Ray's comment only exacerbates this when sometimes there really are no alternatives.

  7. How utterly horrible for everyone, you and the patient.If you're in a professional capacity, as that “carer” is (was?), then isn't handling a TB case that way count as some kind of criminal negligence?

  8. So what is a carer? Is such a person medically trained? How can you take care of someone if you don't even know what kind of medication she or he takes?Body fluids…I think you're cursed!

  9. I feel for your mum. We have often wondered what on earth we would have done (or, indeed, do) in the face of dementia. Probably the same as her for exactly the same reasons. The guilt wouldn't go away though. I still think about things I could have done better or differently when caring for my mum & she died four years ago. Guilt is a natural reaction for me, your mum & anybody else who cares, but it doesn't change things about care home quality. PR campaigns, training protocols & other forms of beaurocracy won't fix it. A care home is still second best, but the only thing to do in the circumstances. Your grandad at least has somebody who is probably going to be his advocate, doubtless visiting frequently and looking out for him. My sincere regards to your mother.

  10. Anonomous tip-off to CSCI in order? Will your vulnerable adults form trigger that anyway? It makes you wonder how they get through any inspection at all…

  11. I wouldnt ordinarily comment on a blog, however, this one is a subject which I am quite passionate about! I am a Tuberculosis service co-ordinator in an outer London hospital, and although in no way am I medically trained, I have been there long enough to get the general drift!The mere fact that the carer clearly had no idea as to the patients condition opens all sorts of questions with regards to the patients compliancy with the medication. We come across many patients who are given their medication, only to disappear a few weeks later (granted these are normally alcoholics). These patients tend to re-appear several months later with their persistent cough, weight loss and night sweats, having defaulted, and then have to start all over again, whilst in the meantime they have infected a whole number of people. Without the medical history, and of course some more detailed information from the carer you would have no way of knowing the patients status, and in fact whether they may have developed the drug resistant form of TB, or whether they were indeed suffering from infectious TB in the first place (although in most cases, they are normally deemed non-infectious after two weeks of medication). I have a tendency to waffle on the subject, so I will cut short now, but really I would speak to the TB nurse at the hospital at least they will be able to advise you as to the patients condition and adherence, as you may not require any screening at all, and it maybe just a case of institutions such as care homes (obviously not all of them) educating their staff about TB, and the way in which it affects people. Thank you for bringing up the subject of TB in your blog! From experience, there is a real ignorance surrounding it, and with an increasing rate of prevalence I think it is a fantastic way to start educating people!

  12. If you had to pick me up you would meet a good carer. I have severe mental health issues and my fianc, in addition to being a full-time law student and a part-time youth worker, looks after me at pretty much all hours of the day or night. I have in the past taken overdoses or self-harmed and had to go to hospital, and my partner has always come with me, been able to give a detailed account of my conditions and medication, explain any other relevant issues and also advocate for me.I know exactly how you feel about the fact that A&E are the port of call for everything that goes on after 5pm. The mental health centre where my psychiatrist and other professionals are based opens at 9am and closes at 4.30pm. If you ring them outside those times you may be able to get an appointment with an out-of-hours GP, who will either send you to hospital (see below) or dish out some Valium to knock you out until the world starts running again, but 9 times out of 10 they will say “wait until the next morning or go to A&E if it's serious”. You then have the frustration of sitting in A&E for 8 hours and then being told “there's nothing we can do, go and see your psychiatrist in the morning”. If you have mental health problems, going to A&E essentially just gives you a different place to sleep that night. The catch 22 of A&E is that if you know you are ill enough to need to be in hospital, you have insight and won't be admitted. If you have someone with you, they will be told to look after you until you can be seen by your normal psychiatrist.

    People with mental health problems are at the bottom of the NHS priority list – it often feels like we're at the bottom of everyone's priority list. It seems like most of the people who are paid to care don't, and the responsibility falls on friends and relatives, if you have any around who are willing to. I am lucky that I do, many more people don't. It is horrible to see people being mistreated or neglected by those with a duty of care to them, and it's those who can't or won't kick up a fuss who recieve the absolute worst treatment. I hope something can be done to help that woman and that you will come across some carers in the future who restore your faith in humanity.

  13. I've only been a Healthcare Assistant for about 2 months all told (I'm a University student and work at a local Care Home over the holidays) and so I am obviously not the highest authority on this subject – BUT – I believe that HCAs don't have any medical training in medication and so on and so forth until they reach the level of Senior Healthcare Assistant. Perhaps someone with more understanding of this will help. I do know that we are taught about abuse, moving and handling (something which I am training in tomorrow actually) and so on. But this post has left me SEETHING with anger – even I as a new Healthcare Assistant would have been able to give you a hell of a lot more information about the patient than this idiot. Although when I first started I wasn't informed that I needed to read the Care Plans and that the chap in Room 40 was HIV positive. Picture me with new cut on my hand rubbing E45 onto his skin without gloves…Despite this, the Care Home I work at is one of the better ones, I promise you. We actually give a damn about the patients, their welfare, their state of mind etc. We have a few residents with bedsores but for the most part they are caused by stints in hospital rather than a lack of airflow mattresses or a turning chart on our part. We are all genuinely upset when a resident passes on, gets ill or is in serious pain. We never ever leave patients unwashed, in dirty clothes, wearing a t-shirt as an incontinence pad (as Tom once witnessed I believe) or without food. We get hauled up in front of Matron for forgetting to fill in fluid charts on time, so I can imagine she would take a very dim view of anyone as frankly dense as this girl.

    I personally try to chatter as much as I can to residents as many of them have no stimulation at all, especially if they are bedridden, as do many of my colleagues. They tend to have interesting stories to tell from their lives (a road near where I live used to be a storage place for bombs and tanks, and an unexploded Doodlebug is still resting in the hill near Grange Farm) if only people would take the time to listen. But the problem is we don't have the time to listen for very long, as we're so understaffed that we have to run around like headless chickens trying to keep the residents comfortable and well looked after as is their right.

    My point is that some Carers and some Care Homes are not as bad as this. Some of us do care!! 🙂

  14. Its disgraceful situation and its really only blogs such as this and the odd report in the media that make the public aware of this.I have seen many bad care homes and carers who need to reassess their job title it very sad and all we can do as ambulance crew is quietly seeth and write the appropriate report hoping that someone will take noticee.

  15. I have experienced the same thing here in America. Our nursing homes area joke. They hire inexperienced Nursing Assistants who care more about

    getting their nails done then they do about the medication that the

    patients are taking.

    Patients are always being abused, mistreated, its truly disgusting.

    Sorry to hear that you were close to TB. I did a shave biopsy on a man

    who we later found out had leprosy. All I was wearing was a pair of

    “clean” gloves. I was scared but it turned out to be ok. 🙂 I think you

    will be ok too!

    By the way I saw your book (that's how I got to this blog) and I bought

    it. I absolutely love it. Please never stop writing!

  16. Beg to differ,as pointed out below by another poster, and from my personal experience of a few years in a TB clinic, given the kind of “care” this patient was receiving I wouldn't be surprised if her compliance with the therapy would be close to nil, and, furthermore. if she developed an MDR-TB.

    Uh, and a Local Health Authority epidemiologic team (or whatever is called on your side of the Channel) should pay a visit to the “CAREless” home because I wouldn't be surprised if an outbreak occurs….

    Respectfully submitted

    Andrea (MD, formerly EMT from Italy – One of this days I should really register on the site

  17. Dementia in an otherwise healthy former athletics teacher was the reason some of my relatives had to put a dearly loved father into a care home. Once he became violent, he was a big danger to himself and everyone else. One of his children had been a social worker for decades, and happened to know every care facility in the area. So they managed to find a good one for him, but that's what it took. Scary.

  18. I am a carer. And I believe, though I am not one to blow my own trumpet, that I am a good carer. I love my residents, and I know them inside out.However we are not trained to do their medication, and are allowed nothing to do with it. Why this carer didn't find someone else like a nurse or senior carer to explain to you what had happened and medical history etc is beyond me. I wouldn't dream of sending a resident away without giving any information.

    Caring is one of the easiest jobs to get with little to no qualifications, and the turnover of carers is astonishing, we go through them like hot cakes.

    The company where I work stopped doing working interviews years ago which in my opinion is stupid, how can you tell if someone with no qualifications is going to be a good carer in a 15 minute interview?!

    I must admit a few carers in my work could do with a kick up the bum, but there are a few brilliant ones who really do love and enjoy their work.

    Why else would anyone stay in a job that pays 10 000 a year for 40+ hours a week and only time and 1/2 for christmas?!

    Louise 🙂

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