Neglected: physical needs and quality of life

Throughout my mum’s time at Ashlands we regularly came across examples of neglect of some pretty basic physical needs. Her physical independence was limited–and staff repeatedly made this problem worse by putting things she needed out of reach. The most worrying (and infuriating) aspect of these regular difficulties was that they were all completely avoidable: they didn’t require staff to have had any specialist training and they didn’t need any in-depth knowledge of my mum. As the manager commented when we raised concerns, it wasn’t difficult to sort many of these problems: It just needed a small amount of commonsense and an ability to look at the world from someone else’s viewpoint. Ashlands didn’t seem able to provide even this most basic level of care with any consistency. Here are a range of examples (though the list is by no means comprehensive):

• Sight and hearing. For much of her first fortnight at Ashlands we regularly found that staff had failed to put her glasses on. This did improve–but throughout her stay we routinely found that staff had not put her hearing aid in (my mum couldn’t cope with this fiddly job and was too proud to ask for help)
• Too hot. During the sunny, warm afternoons of September and October we regularly found that my mum’s chair had been pushed back by the window so that she was sitting in full, hot sunlight. On one occasion she was slumped forward and semi-conscious, and routinely complained of being too hot and thirsty. We mentioned this concern to staff and to the manager; we even put taped marks on the floor to remind staff of where the chair needed to go. In the end, the only way to solve the problem was for me to physically prevent the chair being moved under the window, by putting storage boxes in the corner behind it.
• Too thirsty. We regularly found my mum was unable to access drink (an issue that was identified in one of the CQC reports about Ashlands). A full jug of juice (containing roughly a litre) was usually placed on the unit next to my mother’s chair–but not a single member of staff seemed to realize that my mum was physically unable to lift and pour from such a heavy container. Even a full mug of tea was sometimes too much for her. We drew this to the attention of staff on several occasions–and for a short period smaller cups and a smaller jug appeared. In a way that we came to see as typical of Ashlands, this improvement was very short lived.
• In pain and discomfort. With hindsight, we realized that my mum’s wheel chair was too big and didn’t provide her with enough support. This, combined with her weak left side, meant that she struggled to sit upright and often ended up slumped over the left arm of her wheelchair. Since she was in this wheelchair whenever she was not in her own room, this was a major source of discomfort. We found that the situation could be improved by wedging a couple of cushions down the left side of her wheelchair. We left polite written reminders to staff to remember to use these cushions; we discussed the issue with the manager; we put our concern–and our suggestion to use these cushions–in writing. And still we regularly found her in her slumped position, or using her left arm to try to support herself. In the end, I had to resort to sewing tapes onto the cushion and tying it into the side of the chair! It is also worth pointing out that at no point did any member of staff either ‘diagnose’ the source of the problem (the chair being too wide) or explain that we could have her needs assessed by a specialist and be provided with a better wheelchair. This was done within a week of her moving to a different care home!
• Failure to spot the signs of a mini-stroke. One day my mum fell out of her chair and banged her head. Staff soon phoned me. There had been a lot of blood from a shallow wound and no loss of consciousness. They had phoned the GP: clean it up and monitor was the reasonable advice. Except that when I visited a couple of hours later my mum was sat in a queue for the hairdresser, caked blood on her face—and with every sign of a stroke. Speech unclear, left corner of her mouth drooping and left arm even more useless than usual. It was left up to me to spot the signs, draw them to staff attention and get them to call a paramedic. My mum was blue-lighted into A+E. The conclusion-a probable mini-stroke and a radical change of medication.
• No treatment-bad treatment. In her final weeks at Ashlands one of the carers getting my mother ready for bed, inflicted a one inch skin tear on her arm (one of a number she experienced). Twelve hours later, when I visited, this wound had still not been attended to. When the senior was informed about this she admitted having forgotten to carry out this task the previous day. She came to my mother’s room and applied an adhesive plaster–without either cleaning the wound or unrolling the flap of skin back over the wound.