The toast test

Care should be about dignity. Simples. I call it the toast test.

A nursing home in the Home Counties. A confused resident wakes late – nearly time for lunch. He requests toast. The care staff (Polish, Filipino, Indian, one Brit) are “toileting” everyone before their meal.

As activity coordinator I am on my break but fetch a piece of toast for him. It isn’t my job but it makes the resident happy. He is in control of very little but he has exercised a choice. I then get a mild telling off for spoiling his lunch. It is sometimes the resident’s  job to fit into the (admittedly benign) routine rather than for him to do what he likes in his own home.

Another resident “plays up” during the forthcoming lunch and the struggling staff wheel her back to the lounge and briefly leave her crying in front of the compulsory kilometre wide telly.

Another resident is in the last few days of his life. He doesn’t like the food (which to be fair is normally pretty good). He has a fancy for fruit cake. I sign myself out of the Fort Knox style world, keypad security on each floor, fingerprint recognition to get in and out of the building and traipse down the drive to purchase a fruit cake from a nearby shop and smuggle it back in.

The resident and I enjoy our subversive fruit cake together.

There is some lovely care at this home. One care assistant enjoys her break listening to music with a centenarian. Their rapport is touching.

A repetitive and stressed resident’s morale is transformed by a game of armchair balloon tennis.

One foreign care assistant is adored by staff and residents alike for her other worldly levels of radiance, goodness and patience. I only discover later that she has left her baby back home with family and is here to earn money to make a better life for them all.

I was lucky. At this point I was on £10 an hour and my household is headed by someone with a real salary. A few months before the current crisis I was offered a well-being co-ordinator post in a residential home at £8.21 an hour, 40 hour week, alternate weekends.

Knackered underpaid staff come as standard in this sector. Now add Covid. The woeful results are for all to see.


* Ruth Bright has been a councillor in Southwark and Parliamentary Candidate for Hampshire East

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  • David Warren 24th Apr '20 - 3:47pm

    Really good article Ruth.

    As someone who visited my late partner in a care home for four years I saw countless examples of what was both good and bad in the system. Fortunately the former was more common than the latter.

    The main issue was that staffing levels were to low to provide even the lowest basic level of care required. Staff were overworked, underpaid and often pretty stressed.

    As Liberal Democrats we urgently need to come up with a radical policy to reform social care.

  • Good on you, Ruth.Dignity and humanity should come first and always.

    If we ever do get a Social Care Green Paper – if ever – then there should be a rigorous look at the whole structure of both home visiting and residential social care. There should be a review of pay for carers and the whole private ownership contracting system with local authorities should be put under the microscope.

    It is now a helterskelter downward slide to the cheapest deal – hence low wages and mixed quality. Add the financial instability of the present for profit system and you have a pretty unhealthy brew.

  • robert sayer 24th Apr '20 - 5:38pm

    A wonderful tale. But as we have argued for the integration of social care into the general discussion of the NHS, surely this is a wonderful opportunity for us, as a party, to create a framework for this integration to take place plus mental health as well. We have policy papers on the subject and numerous party members who have expertise. Please get this arranged

  • A good starting point would be getting the Local Authorities to pay the market rate. We’d go bust if we filled our home with LA residents. As it is our self funders finance each LA resident to the tune of ca. £5’k p.a. Our LA funded are those who have run out of money.

  • @ Alex B Are you involved in the ‘business, Alex, ? If so, what are your profit margins and don’t you think you ought to declare an interest ?

    Do you really think elderly care should be on a ‘for profit basis’ for the vast majority of the population … any more than treatment for a broken leg should be on a for profit basis in the NHS ?

  • We budget to break even and are a charity. I work as a Trustee for nothing generally 2 days a week.

  • Katharine Pindar 24th Apr '20 - 9:12pm

    Ruth, I was very disturbed to read a Times report that in some nursing and care homes the poor souls who are dying of Corona virus are not given the drugs needed to ease their passing because those can only be prescribed by doctors, who are not visiting to prescribe them (or to sign death certificates, but that is not my present worry). I have been wondering what to do about it – I don’t know any doctors, but thought I would ask around locally – but is this something our party should take up nationally, do you think? (Thank you for your own caring work, and for this lovely account of it.)

  • Dilettante Eye 24th Apr '20 - 9:13pm

    I don’t know if its true that Eskimos once put their elderly on the ice to die, but its both a cruel and yet intriguing mental image. We on the other hand put our elderly in care homes where they can and s..t themselves towards oblivion in the safe, warm and dry conditions, of a £700 per week loving environment.

    I think maybe I need some ice?

    I finish off the breakfast dishes, as I watch my 94 y.o. dad do circuits of my garden. He shuffles through the kitchen door in his padded gilet, his Thinsulate hat that makes him look like a smurf, and his Roy Orbison dark glasses.

    ‘I’ve done six’ he says.
    I counted five, but I don’t intend to crush his enthusiasm at this late stage.

    At 66 this wasn’t the retirement I’d planned, but its the retirement that I got. For 94, dad’s in fairly good condition. He’s shuffling-ly mobile, and thankfully continent, but his sight and hearing and memory are drifting, but the good news is that he has retained the taste buds of a 20 y.o., and enjoys his food. Indeed whilst no-one would relish the idea of a heart, lung, or liver transplant from a 94 y. o. I can assure any willing recipient of a a taste bud transplant, that dad’s taste buds are still ‘in the room’?

    Like many I reflect on the aging process with a mild sense of trepidation. I’d like to think that my future expectations are more about a drive to Lytham with a flask of tea and a meditative view over sands, whilst hoping that regular bowels are more of a background concern.

    I’ve given myself disease willing! a target of 88, after which I’ll do a serious re-calibration of what is and isn’t worth []

    I’ll make sure that my dad’s remaining life is as event free as I can make it. I also feel personally, resilient enough to deal with anything that a shy God or Gaia can throw at me.

    My worry goes to my two daughters, who I feel will have to meet realities that we never had to. I suspect as a boomer, we had the very best of Planet Earth, and I am both grateful and ashamed.


  • I’m fortunate in having limited experience of relatives in care homes, at least since I’ve been old enough to understand, but I have friends of friends who work in them, and it’s apparent that they are not earning enough. Overall, the system needs much more investment, and as a society we need to get over the idea that care in old age is something that can or should be funded cheaply.

    I’m amazed how even fairly left leaning friends of mine still talk with horror at the idea of elderly relatives having to sell their home to help fund their own living expenses, even when it’s absolutely certain they will never return to their own home. There are other knock on impacts of having so many properties left empty for prolonged periods, often in need of a lot of work done by the time the family is ready to sell.

    The same goes for inheritance tax. People who might criticise the tax dodgers, and bemoan greedy bankers, become blind to the benefits to society of taxing these large sums of unearned wealth that only a minority of society benefit from. They’ve somehow convinced themselves that their parents really did work hard for it, and that because they were taxed on it (often not the case, especially for money gained through the increase in house prices), it must never be taxed again. But the truth is that the threshold for inheritance tax is set at a level that means any recipient of an estate that does have to pay it is still getting a lot of ‘free’ money that they didn’t earn.

    I think the fundamental problem is that most of us are ignorant of and in denial about the realities of end of life. IMO it often comes from a place of squeamishness, not because we don’t care, but the net effect is that we collectively appear to underestimate just how much it costs to treat the kind of disease people who live long lives often have only after they’ve retired, or stop to think of how much it costs to look after the elderly properly in a care home setting.

  • David Warren 25th Apr '20 - 10:10am

    I took part in a Social Liberal Forum meeting yesterday and adult social care was discussed.

    One of the things that came up was the idea that there could be a role for the voluntary sector in the sector which is something that I hadn’t previously considered.

    Trying to run care to make a profit is one of the main problems. When it was delivered by local authorities prior to privatisation it wasn’t perfect but it was vastly superior to what we have now.

  • Richard Underhill 25th Apr '20 - 11:17am

    Boyhood hero Billy Bunter liked toast with butter dripping through the holes, as I did today, stopping the toaster early. Dragons Den had a Polish bread (on sale in Waitrose).

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