You don’t live here any more

John*, you don’t live here anymore.

28 days ago,

we served you notice –

wrote to your family,

your (90-year-old) wife

and advised that

we can no longer look after you.

You see,

your behaviour is

far too

challenging for us…

Again, you see,

There have been complaints.

The night you

accidentally,

we presume

entered Mrs P’s bedroom and

climbed into her bed;

peed on the floor,

or, the aspidistra,

That was not OK.

We know you don’t know at times

where you are or

what

you are doing.

Your capacity is, lacking;

and that

for us, is a problem.

And now

a problem for your family.

who must find somewhere for you to go;

Organise your relocation;

acclimatisation

and

adaptation to another place

Somewhere else,

just,

not here.

We have served you notice.

and

If you aren’t off very soon;

well…

we aren’t sure what we will do – but, it is unlikely to end well.

The next tiff or tantrum or angry spat where you appear to threaten

or hold too tightly

to someone’s fingers,

and we will likely

Call the doctor.

No… this is not a threat.

We wouldn’t threaten to have you admitted under a section of the mental health act

Secure accommodation

but,

that’s always an option.

Just, so you know.

Just so your family are aware

That the night-time antics;

Running around the garden,

Trying to climb through the window

over the wall

are just not something we can accept

and

nor can the other residents.

We may have offered you a home six months ago,

called this your

place of residence

since then,

but,

homes are moveable feasts

and

You now must relocate

to another place

In the borough.

Someplace else,

that is not here.

Change of address;

New carers or nurses or friends,

unfamiliarity within a vague space.

Dementia and struggling to form new memories,

you are

allocated a place

that is better suited to meet your needs.

John.

Yes,

That is your name.

We honestly, really, do, very much care

and

are totally interested in your

wellbeing.

But,

enough is enough;

Periods of notice relate to the correspondence sent to relatives and next-of-kin of those in our society living in nursing and residential homes, when, after a period of assessment and review, it is felt that care home can ‘no longer meet the needs’ of that individual.

The most frequent reasons relate to situations where the person, often an older man who has vascular or another dementia, following episodes of aggression, anger, fear or agitation is felt to be having a significantly detrimental effect on other residents.

Most care homes do not take this decision lightly, for they know the consequences, which can be disastrous for the older person – the trauma of relocation is huge.

In some areas, we have community psychiatric teams supporting older people, who are able to work with the care home and the resident, review what triggers certain behaviours – inadequate lighting and the resident can’t see where they are going, confusing way-markers and the bedroom of another is mistaken for theirs, fear, pain or anxiety and they cling to you for dear life, unaware that their grip is causing pain.

There is much unravelling that can be done to rationalise patterns of behaviour that seem complex and, are described by some as challenging.

Seeing the person, perceiving the world as best we can from their perspective, or point of view, can take us far. Recognising triggers – hunger, a need for the loo, fatigue, all require sensitivity which are hard to programme into the scheduled protocols of a CQC compliant residence. Some of this cannot be learned, it is innate – an internal sensitivity; emotional intelligence that allows for unspoken communication and understanding.

Sometimes what is needed is, slowing down. Pausing. Observing. Listening, reassuring, empathising.

The person who cares and the people who care and those who sit in the centre, who, belong in the caring professions, the mystical arts of empathy and compassion.

Call it mystic if you like.

*This narrative is a fictionalised composite.