Young and old

Over the years I have had carers as young as 17 and some into their 60s. You would have thought the older ones would be more mature. Not always. You can never tell who the best carers will be. I used to think young people would never be suitable, then I was proved wrong. Then I thought older people would be unsuitable for me, again I was shown to be wrong. In the end it’s the particular person and their character, not their age that makes a good carer. I have had brilliant carers of all ages.

I will tell you two true, but funny stories of Carers at both ends of the age range. Some time ago, I will give you no clues of when or where. I had an older carer who was just there to sit with me while Mary was out. I can’t safely be left alone for long. It’s a safety issue. As I am at risk on my own, I can’t get into the wheelchair or out of the house alone, I would be in danger from fire or problems. That’s while my muscles are working. In a collapse I am completely helpless. While the carer was there, she made my lunch and not untypical for me I had a collapse after lunch. That’s where my muscles go into a paralysis for a short while. It’s a kind of fit or seizure. I still call it a collapse because when I used to be able to walk, I fell over. I am fully awake in a collapse even though my eyes are closed. While I was in the collapse, the carer was sitting in a chair next to me, so I was waiting for my muscle function to return and I heard a light snoring sound from beside me. My carer had fallen asleep! During her stay with me I had 3 collapses and she fell asleep 3 times! Of course, she might say she wasn’t asleep. Anyone who has been alongside someone who snores would probably recognise that argument. You may not be surprised we haven’t used her services since.

At the other end of the age scale I had a 17-year-old carer straight from school. As part of her duties she needed to prepare my lunch. I asked for a fried egg. I had assumed this was a simple task, but apparently not one she had come across before. I guess still living at home, if you don’t get a chance to cook or are encouraged to do so you never learn. That was the case for her. I have had other young carers who are very capable.

I have noticed that certain agencies have higher proportions of younger carers and other agencies higher proportions of older carers. Probably because some agencies provide anything from 15 minutes upwards of care and so carers work solidly all day, every day. A young person looking for a job wants that kind of work, regular hours, plenty of them. Other agencies do a minimum of an hour. They often seem to employ those people returning to work after children or semi-retired. Sometimes these carers want more flexible hours and so doing a couple of hours with one client, having a gap and a couple of hours elsewhere suits them. These are just my observations. We have used both types of agencies. We have also used Micro providers, who are self-employed carers, and can be any age.

A final comment about age. Some of my family came to visit recently when one of my carers was around. All of them said to me afterwards, “Isn’t she a bit young to be doing care work.” She is 39. But she does look very young. I obviously told her and she said she often gets told that. Of course, I fully understand as I am often being mistaken for a teenager, or is that a pensioner, I forget.

Age is a funny thing; we make assumptions based on it both in terms of ability and maturity. We guess peoples age by how they look and act. Yet in reality we can’t always guess a person’s age nor can we tell how capable and mature they will be.

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Home is where the heart is (Update)

We all know the expression, “Home is where the heart is.” It expresses the idea that home is not a building but a place we connect to emotionally. Of course to connect to a place emotionally it has to offer something that touches us. That could be a memory about where we grew up, where our children were born, our first home, where our parents live or something that touches our feelings about our past. But emotions on their own don’t make up the complete human experience. We need physical things, comfort, warmth, convenience, accessibility, and other our practical needs meeting. A home has to fulfil those practical as well as emotional needs. Sorry to state the obvious.

For most people finding a place to live is a big issue, a major life decision and a mammoth task. When you are disabled, especially a wheelchair user, the issues are compounded. A suitable property has to have wider doors and corridors, more space in the rooms. It needs level access and a wet room. Ideally a ceiling hoist or a suitable room to fit one, from the bedroom to the wet room. The kitchen needs to be accessible if you are able to use it at all (I can’t, but other disabled people can). There often needs to be a call system to summon help. Parking, if any needs to be wider and nearby. These are just the more obvious aspects.

Think about your current home, look around you. How wide are your doors? Do you have a downstairs toilet, let alone a bathroom. Does your front door have any ridge or step? Even a 1” step is a bump for a wheelchair. How tight are the angles into your house? Think about your neighbours, friends, families houses. How many have level access, by that I mean no bumps at all. How many have wide doors and corridors? How many have downstairs toilets or showers?

Wheelchair by my bed while I am lowered back into bed by ceiling hoist.

You may think that I am asking irrelevant questions that don’t apply to you. If you are able bodied and fit. Why should you worry? Let me explain. First there is something that happens to us all, we grow old and become less able bodied. Most of us have relatives like that, don’t we want them to be able to visit? Even if you don’t want your relatives to visit, one day that will be you. Second there is accident and illness. All too common. I was 100% fit and well in my early 30’s when illness first struck me down. I have friends who have had serious accidents. Yes, it can happen to you, or a family member or a friend. Don’t you want them to visit. What if it happens to you, will you be able to stay where you are? What houses are there suitable?

Accessible housing is a real issue for everyone, not just those of us in wheelchairs. It will increasingly become an issue with an ageing population. We need to be aware and think about these things.

There is a big problem in this country with availability of accessible properties. There are far more disabled and elderly people than disabled accessible homes being built, see the report from Habinteg:

We need to lobby for improvements in this situation. The Habinteg website has ways to do this

It also tells you a lot more about the problem than I have.

Update the government have responded to the report:

http://www.google.com/url?q=https://mailchi.mp/habinteg.org.uk/new-habinteg-research-released-whats-the-forecast-for-accessible-homes-1247221?e%3D7bbdcfa79a&source=gmail&ust=1562313550925000&usg=AFQjCNHynGHbnenXoBuGl85PvcGTeW7kaA

I have written a blog (Bedroom, dining room, lounge, toilet) about our own situation.

We want one with a bigger bottom next time

“We want one with a bigger bottom next time.” As I said it, I realised it could be taken the wrong way.

I wasn’t talking about carers, perish the thought. Nor as my wife suggested my own bottom being bigger. I’m sure you realise I meant aftershave bottles. We were in a shop and the said bottle was on offer. My current one seemed to fall over for a laugh. It sat and waited until the carers back was turned and them, bam, it fell on the floor. Every single day just after my carers had finished with it and the bottle was returned to its shelf on the trolley, there was a loud bang and we all knew what had happened.

“There goes the aftershave, it’s got too small a bottom.” One of us would say the obligatory words.

It’s as if the dark blue upright bottle of lotion waited silently for the right moment to catch us out. Always just as my carer is turning to do something else, yes it waits till her back is turned. It’s not a gentle thud when it falls to the floor either. Who would believe such a small plastic bottle could make so much noise hitting a carpeted flood. I suppose it does often hit the plastic protection I have around my bed, but that’s no excuse. So, as you can now understand I did not want a small bottomed bottle again, no matter how cheap it was. Even if the shop gave if away, I would give it back.

Today as I write this, we are at Cleve Spa coffee shop, no we don’t live there, well only every other day. Mary’s Dad is visiting and she is ordering him a hot chocolate. The lady serving offered it in a very nice glass mug. Mary said “can I have it in one with a bigger bottom?” She didn’t want it to tip over too easily. The glass mug offered had a very slender bottom. What is it with slender bottoms, is the world becoming obsessed with them. When I was a child mugs had big wide bottoms, as did everything and everyone else. Sturdy and wide were the standard, not slight and svelte. I suppose we are at a Spa and fitness centre so maybe slender is to be expected.

But why has crockery become so small and strange in the modern world. Slender bottom mugs, old pop bottles for water, milk bottles like I had at school for serving milk, gigantic wine glasses, you could fit a whole bottle in ones these days, and wooden platters. I know a wooden platter looks nice and it works OK with many things, a cheese dish looks great on it. But I was once served fish and chips on a wooden platter in a fancy pub. The peas just rolled on the floor, and I like peas. What next? Am I going to get a full roast dinner on a platter, where will my gravy go? It needs an edge, a barrier. I don’t want to have to start my meal by making potato walls around my plate.

Thinking again of small bottoms, as I am sure you weren’t. I fully understand the problem of small rear ends. I don’t have lots of fat on mine and the pressure of sitting long times can be a problem. This is not something that is covered sufficiently in the media. Shapely and fashionable posteriors are often covered, or uncovered. But the issues facing those of us with little fat on our rear ends just doesn’t see the light of day. I think it’s time we took a stand, not literally obviously. It’s a pain in the posterior, that is literally and I need to pad it out to make things more comfortable.

I do have a serious point to make, as odd as that may seem. Those of us who spend all our time sitting in chairs and lying in bed have to protect our skin. Pressure sores are a real danger and must be avoided. If you find yourself limited to bed or a chair for long periods of time (days or weeks) without being able to move, make sure you involve the relevant professionals in your care. In this case district nurses, who you contact via your GP. Prevention is better than cure with pressure sores. If you are concerned, chat to your GP.

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Slip, slide or stick

Last week I was taking bets on whether I would sink or swim at Wellington swimming pool. Today I was not able to find out. The existing owners are not wanting to spend money and the hoist is broken. So, I cannot transfer to the poolside chair that lowers you into the pool. Apparently, the new owners, who take over August 1st will prioritise sorting out accessibility.

Not wanting to miss out on trying out the facilities I decided to try out stage one, the changing room. I am so glad I did; nothing is easy and simple when you are disabled. Mary and I got up at 6:15am, well I was awake at 4am as usual, but Mary brought me breakfast 6:15am. By 7:30am I was ready to head out to the Sports Centre. We arranged to meet one of my carers there, an experienced young lady who has used poolside changing equipment before. Arriving around 8am we headed into the changing room. Mary explored the sports centre.

Let me describe the changing room. It’s oblong and has a bench and two lockers along one of its short ends and a toilet and shower unit at the other. You enter on the right of one long wall with the bench to your right and toilet to your left. Ahead of you is a power up/down bed on the opposite side, it’s folded up against the wall. I say bed, really, it’s a metal frame with a strong plastic sheet stretched over it and holes in it. The plastic sheet has a dip to enable drainage, in theory. There is a lifting side to it, but this only comes up into place when the bed is up flat against the wall. When you lower the bed into place you either need to have the side already up or stay down. Which means that if it was up, you couldn’t then slide onto the bed. If it’s down, it doesn’t fulfil its purpose of keeping a user safe from sliding off. The whole bed raises and lowers electrically.

This is a similar changing room to give you an idea of how it looks

My wheelchair was lined up right next to the bed, with the side down. My wheelchair was then reclined, and the footrests raised. Making it almost bed like. The bed was raised to an inch below my seat height. The side support on my chair was removed and the arm swung up out of the way. The result of all this was a near continuous route from chair to bed. I then rolled onto the bed, simple. Not quite, because it was at that point, we discovered that the bed was designed either for children or shorter adults. I am 5’ 10” and my feet hung over the bottom. You may think so what? But I have delicate skin and the surrounding edge of the bed is a metal bar. Very hard and unforgiving, especially for delicate skin like mine. Later when I turned over there were red marks on the backs of my legs.

Clothing removal went OK, the plastic was still dry, so the material slipped alright. My carer discovered that the shower hose pipe was quite short when she was washing me. But the water pressure and heat were good. She was very glad to be wearing sandals as the floor completely flooded. Mary said the manager was mopping up floods coming from under the door while we used the shower. Why is it that no wet room is designed well? I have been in a few over the years and all of them flood. Can it be that hard to allow enough angle and sufficient drainage to prevent this?

The other place that flooded was the bed itself. The small drainage holes in the plastic were under where my body lay. I discovered that I am a great plug. When I turned over, to have my back washed we discovered a few things. First, there were no bars for me to hold onto to assist in turning, I had to use the side of the bed, not easy, because it’s too low to get hold of and has no grips. Second, the water was able to drain as I was not blocking the holes once I turned. Third, I had red marks perfectly matching the drain holes all over my back and bottom. Memories of the Amazon shower stool came back (see my blog “An odd request from Amazon.”) Fourth I slipped more easily when I had been soaped than after I was rinsed.

After I was washed, we had the problem of drying. My carer had already pointed out at the beginning, that the number of towels I had brought was woefully inadequate. I had asked Mary to pack three, thinking one more than my usual was ample. It wasn’t. As one was used to protect me from further marks after they were discovered on my back and one was used to dry the bed. Just one small towel was left to dry me. By this point the humidity in the room made drying hard going. But with amazing perseverance from my carer, I was dried and dressed.

Next my wheelchair was brought back to the bedside. I neglected to mention it had been moved while I was washed. The bed was positioned an inch above my chair seat, and I rolled back into the chair. A reversal of the earlier process.

It was great to have a shower, first one in a few months as I don’t have a wet room at home. I can only have a shower at other places. The last one being Revitalise in Southampton, where I also had a bath (see my blog “Shall we get in the bath?”). But I will not be repeating the experience until the new owners improve the facilities. We spoke to one of the representatives of the new owners afterwards and pointed out what needs changing and upgrading. Hopefully they will sort these things out and myself and other disabled users can benefit.

It’s disappointing when expectations of an experience fall so short. I did enjoy being able to get thoroughly soaked with water. But the difficulties of using the bed made the experience much harder than it needed to be. With a ceiling hoist, a replacement bed of adult size, a longer shower hose, and better drainage the experience would be so much better.

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Consequences

1995 Board game

Didn’t there used to be a game called consequences? Not sure I ever played it, I’m not really into board games. Too much time playing monopoly on Saturday mornings as a child, or rather losing monopoly. Mary was saying to me this morning how we sometimes forget there are consequences, we can’t just have fun and games, she was talking about my health. After three afternoons of going out in my wheelchair; today I have been awoken by a severe headache. When this happens, all too often, the headache literally drags me out of a deep sleep as it did this morning. The pain and nausea awaken me. This morning was most likely a migraine, but as I missed the aura, being asleep at the time, it’s hard to be sure. I do know that it seems to be responding, slowly, to the migraine medication, Zolmitripan. At least it is after the second one, which I had to wait two hours to take, then another hour to take effect.

I was woken at 4am, it’s now 8.05am and the pain is lifting, leaving me feeling, rung out and yuk. The plans for the whole day need to change because of this. I just need quiet and not too much light. The tablets are good, but not 100% effective. What they do is stop the agonising, head splitting headache in its tracks and leave a numb rung out feeling, that normally follows the day after a migraine. You feel like you have become very fragile, like a china doll.

Today family are visiting, and I’d hoped to join them at Weatherspoon’s for lunch. But instead we’ve had to hastily rearrange my care so that Mary is free to go with them on her own. That takes its toll on Mary. Changed plans are never easy and in this case mean moving things around in the house so that I can have a quiet space in my bedroom which is also our lounge (See my blog “Bedroom, dining room, lounge, toilet.”), plus organising care and changing other plans for the day. All before Mary’s breakfast. I feel useless, lying here with a cool bag on my head looking pathetic. Needing all the usual things done for me on top of this extra.

We should have learnt by now about consequences. But I find that my memory for suffering is very short and my memory for joy very long. So that when things go wrong and I end up in difficulty, feeling nauseous and in agony, I forget it soon after. That’s why I wrote this on the day it happened. I need to be feeling it to remember it. I’m not sure if it’s a protective thing, or just a very good strategy, but either way it works well. I am not a miserable person. I don’t focus on the bad days. Even during a bad day, I don’t have to be free of pain for many minutes before I move on. My tendency is always to be optimistic and positive. Anyone who knows me well will agree with that. That’s the real reason I never learn about consequences. I have a very short memory. I will also use distraction and adrenaline to override pain and difficulty. If anyone visits, I refuse to look sad and gloomy. This is a very common thing to do for those who are chronically sick. They will mask their real feeling behind a smile and laugh. It’s amazing how effective that is at making people say, “You look so well.”

We tend to judge the degree of illness someone is suffering on how miserable they look or on how white they are. Misery is easy to hide, and I would suggest desirable to do so. Who wants to visit a misery? Don’t misunderstand me here, there are times when the pain becomes so bad you can’t ‘put on a brave face,’ at those times I avoid seeing people. But I find those times come in waves for me. Pain, in my case is more often wearingly long term (chronic). But I realise there will be those who are suffering from severe, constant pain, don’t assume I am talking about them. I can only talk about myself and people in my situation. Whiteness commonly comes with iron deficiency anaemia and bouts of nausea. In fact, people can often look very ill when they have a minor cold and very well when they are dying. I have seen two friends on the day of their death, both looked better than ever. I never guessed it was the last day I would see them. If you have ever seen someone the day after a major heart attack, they can look bright and well. Yet they have not only nearly died, but still have major heart damage. Add into the picture all the major illnesses that show few external signs till the very end and its all very confusing. I always find it odd that a lot of cancers are invisible until treatment starts. The treatment makes people very ill, until it hopefully cures them. My point being that something as life threatening as cancer can sometimes be unseen until treatment starts. We cannot make a diagnosis of how well someone is by how they look. Certainly, a smiling red face tells us nothing. Again, I understand there are those who are severely ill and look it. I am talking of the many who are severely ill and don’t look it. (See my blog “You look so well.”)

I made the best of today, managed to see our visitors a couple of times during the day. Mary brought them in after each of their trips out. It was lovely to be included, but I needed the long breaks in between to recover.

I am writing this last section the next day. Migraine is gone and I am feeling that strange post migraine euphoria, that only migraine sufferers will understand fully. It’s like a weight has been lifted and you are left feeling a little lighter than usual as if gravity has reduced. I tend to get more ringing in my ears (tinnitus) but that may not be common. When I was still able to walk, I used to feel like going for a walk or even a run on a morning after a migraine. The freedom and joy of it having gone makes you want to rejoice. Now I run in my head, although I am always curious how my smart watch seems to find I have done some steps every day, in my bed! I don’t want to disappoint those of you with smart watches who assume every step on your watch you really took. Perhaps my watch counts the steps I take in my imagination? Don’t worry, I know that its based on arm movement so the few steps it counts are my arm moving.

There are consequences to everything we do. That applies whether you are ill or not, it’s just more obvious physically when you are ill. Activity takes a toll easily when your body is weaker. I so enjoy getting out of the house and this won’t stop me. I just need to pace it and allow recovery days. Today is a quiet day before I try out the swimming pool tomorrow (see my blog “Sink or swim.”) Let’s see if I can remember the lesson learnt.

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Science fiction or fact

“Pass me the proton gun”. That’s what I felt like saying after I heard that one of my tablets is called a Proton Pump Inhibitor. Surely it’s a laser gun, not a tablet, or at least an inter dimensional portal opening device.

It feels like medical science has shot on so fast in the last few years that the technology on my old favourite TV shows look like cave man tech in comparison. I used to think Star Trek had such amazing equipment. But in the early shows they just lay on a medical bed and a gigantic display read out heart rate and other vitals. You can now buy a ring on Amazon that will give you heart rate, oxygen and sleep patterns, a ring! Just about any smart watch does the same, well without the oxygen read out, unless you get an add on.

Sleep monitoring ring

A couple of years ago I bought an endoscope, to look behind a radiator. An actual endoscope. That’s a fibre optic cable that enables you to view into tiny holes and gaps. They use them in medicine to view down your throat and up the other end. My endoscope plugged into my laptop and enabled me to view a video feed on the laptop, now you can get Bluetooth ones that connect to your phone wirelessly and you view the feed on your phone. Of course they say, not for medical use. But they are effectively the same devices, available for a few quid. Don’t tell me no one is tempted to use them medically, hopefully none of my friends.

Then there’s the space age materials, around today. Pressure relieving gels made of silicone, breathable fabrics, super absorbent pads, and all the new polymers, plastics to you and I. Then what about the leap forward in electronic controls. I was looking at, well to be honest I was coveting, an amazing hospital bed on eBay. It was able to profile into a seat from a bed. The controls on it would not look out of place on a space ship. Multiple controls, read outs, even a colour LCD display. These days the simple controls on beds, chairs, wheelchairs and hoists are touch control. They use a circuit board level switches under the plastic cover. The more advanced even use the conducive type found on smart phone screens. These are technologies that didn’t exist when I was younger.

You can monitor most medical read outs via your smart phone and let’s face it a smart phone is one of the most incredible advances out. If you had told me when I was a teenager, much less a child, that I would be able to own a hand held computer that could: communicate with anyone on the planet with video and sound. Run so many applications the mind boggles. Track my location to a few metres. Speak to me and understand me. Translate most languages, well sort of. Be pointed at an object or place and tell me what it is. Take high definition photos and videos. Be a word processor, a desk top publisher, a portable power point device, an excel spread sheet, a complex calculation device, a drawing tablet, a video editor, a photo editor. I haven’t even scratched the surface. If you had said I could own one of these I would have laughed. Or I would have assumed it would be massive or cost thousands. But the vast majority of us now have and rely on smart phones.

My smart phone connects to my Hive heating, can check my cctv cameras, switch on my smart plugs and lights. It also links to my Amazon Alexa system. How much longer before we routinely get smart monitoring and medicine dispensing for dementia patients. I believe it already exists. Or how about a push button food preparation for people like me. Where a meal is taken from the fridge or freezer, heated and delivered to my bed robotically. Personally, although I could see that and even robotic care as possible in the future, I would never choose to replace human beings with machines. You would lose so much. Human contact is not replaceable by machines and it is vital to our wellbeing.

I like technology, it’s fun and helpful. But it has its place and its limits.

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Cutting through the red tape

(This is based on my experience, written as a personal guide, not an instruction manual.)

I’ve realised that for many people, including me, becoming ill is enough to cope with, without the hassles of ‘The System’ to navigate. So, I thought I would write a blog on cutting through all the red tape, aimed at helping anyone who has just become long term ill or disabled, or if you have family in that situation. I’m only writing from my personal experience. I do not claim to be an expert in this area. You need to check details of your particular circumstances with the DWP, NHS and/or local adult social care. I also highly recommend the CAB (Citizens Advice Bureau). This blog is designed to raise questions, not answer everything.

The first thing I discovered is that there are two separate systems when you are long term ill and about to be released from hospital. The NHS (hospital) and the community. Therefore, if you are in hospital and have a life limiting condition, the hospital have their own OT’s (Occupational Therapists) and Physio’s that are separate to the community ones. This might seem obvious, but it’s important. The significance being that the hospital team assess you and see if you are fit to return home and if so what equipment and care you need to return to your house. They put in place all the initial things you will need. Things like a bed, commode, carers, etc. But the care they setup is only temporary, a few weeks at most, whereas the equipment can be permanent. There is a problem though. They don’t sort out high spec wheelchairs (I believe they may loan push ones) and unless you already have a wheelchair or can get one, they don’t sort out ramps, temporary or otherwise. The reason that’s a problem is because ramps are not just needed for wheelchairs, but also for stretchers. I was returned home by stretcher, so the lack of a ramp was an issue. You’ll also need a ramp for any follow-on hospital visits if you, like me, need stretcher transport to hospital.

When I was last in hospital and due for discharge, the longest delay in getting home were access issues. The hospital transport service sent out an assessor to check access at my home. As an aside I should explain this was in January 2018 at the end of the period of time I was able to walk (look at my other blogs for details). So, we were in a house with normal access. In our case we have a step. How many houses don’t? The assessor said we needed a ramp; he also reckoned our inside access was too tight. It is tight, but I have had stretcher transport several times since too and from. He was prepared to have the crew try the internal access but would not authorise my return without a ramp. The hospital would not supply a ramp as I had no wheelchair at that time. A circular argument. We had returned my previous wheelchairs as I had been able to walk for nearly three years. After my wife had many fruitless phone calls to the hospital OT, a friend of ours assembled a temporary ramp, enabling my return home.

This is where I am really grateful to a wonderful friend for that ramp, and a fantastic ambulance crew, three of them (an extra one joined them at our house). They persevered even though the temporary ramp was not ideal for my weight on a stretcher. This enabled me to get home. Our friend did a lot more than the ramp. He helped Mary prepare the front room for my community profiling bed.

A word about the temporary care package from the hospital. They put your care requirements on a system that gets bid on by a few care companies. The lowest bid wins! The trouble is companies that bid don’t necessarily have enough capacity. They just want any extra business; it seems they bid first and see if they have capacity second. The company that won me in auction, it feels that way, did not have capacity for the hours I was supposed to get. Which meant that I was given less care each day than I needed, even though they had bid on it and accepted the contract for those hours. The other problem is that the care company who accepts the contract has that contract with the NHS. So, they don’t feel they need to meet your wishes, the NHS is their customer. Every problem I had first had to be authorised by the NHS.

Next step Adult Social Care, that’s community, they take over your care and therefore the payment and authorisation of the care package. This still means you are not directly the client of the care company. But it’s a step towards things changing. You start to get choice. Adult Social Care do an assessment of your needs. They decide how many hours care per week you need. If you have a partner caring for you, they look at respite weeks for them and extra hours care that will help them if they have needs. Looking after someone who is long term ill and needs 24/7 care takes its toll on your health and respite breaks help to prevent burn out. If your partner/carer becomes ill, then the state will end up looking after you full time. They want to prevent that.

Once care is granted by Adult Social Care, you have two choices. First you can let Adult Social Care get you those hours exactly, but from a supplier of their choice. You will not be the client directly. So, it will be like the hospital package with all the control out of your hands. Or you can take direct payments which are less money per hour than any care company charges, yes you heard right, than any care company charges. The council get special rates on everything, so a couple of companies have negotiated prices with them that are at the rate they pay if you let Adult Social Care organise your care. But those care companies treat those contracts as second class. That is my opinion, I cannot claim it as fact, it’s how it feels. They send whoever they want at whatever time suits them. So, if you have a problem with smokers, or loud people or if you don’t want male carers or have any special requirement, tough. If you want to get up at a set time each morning, you’ll be lucky. The cheap rate for the council comes at a cost. Yet some of the staff I have spoken to at Adult Social Care seem unaware of this. They are convinced there are agencies that charge the adult social care rates to individuals, I can’t find them. Either they are as rare as hens’ teeth or like Scotch mist.

I just want to say a word of praise for our main Social Worker, she is brilliant and does understand these limitations. She just has no power to change it. She did a fantastic job organising my care and setting everything up. In fact, most social workers we have dealt with are great, they just lack the power to change the system. The current system means you no longer get a permanent social worker. One sets everything up for you, then you just call the ‘hub’ and speak to the duty social worker for any changes. I am always pleased when the social worker who I know is on duty. For some unknown reason three departments organise Direct Payments. Adult Social Care authorise it, a department at the council pay it and a non-governmental charity, in my case Enham, administer it. Three different lots of staff are being paid to sort out one lot of money. Is that efficient? Cost effective and or does it waste the money that would otherwise go to care? You decide, I have my own opinion.

Direct payments buy you less hours than you are assessed for, but you have choice and can get consistency of carers. They buy less hours because of the difference between the amount per hour paid by adult social care and the amount per hour charged by care companies. Normally at least £2-3 per hour different. I think counsellors and politicians who setup the system should be forced to have the council run system of carers provide them care for a few months. Or try to buy care at the amount provided under direct payments. It’s a nonsense to say you need a certain number of hours then give you insufficient funds to buy those hours from any care agency. Even micro providers charge more than the amount given and they are self employed individuals. The system would soon change if politicians had to use it themselves. One other thing, you receive a different rate of Direct Payments if you use an agency than if you use a micro provider. A little higher for an agency as they are CQC registered and have lots of extra paperwork.

The basis of how much, if any you pay is assessed by the council based on your income and savings. I understand we live in hard pressed times and I realise that I am fortunate to live in a country that provides free care to people like myself without other means. But my point is that either the correct amount per hour should be supplied or at least it should be acknowledged that it is impossible to meet the hours assessed with the amount given. To pretend that the hours assessed and payment given match or can ever match is a folly.

The other very odd part of the system is for respite care. That whole system is very upside down. The way it works makes no sense to me. But it’s too complex to explain here.

A lot of things run in parallel when you come out of hospital. An OT and Physio from the community should be assessing you. A district nurse will no doubt call on you and if you need it, your GP. Depending on your level of limitation you can get almost everything done at home. There is a dental access centre in Taunton you can register with, they do home visits. The same rules apply as with visiting a dentist in terms of payment. If you had free treatment before, you still do. The GP can visit you. Even opticians can test your eyes at home. Again, the free treatment rules apply. But, dental and optician visits at home are second best to going into a practice. They travel with very limited equipment and can’t do everything. So, if you can travel, then do.

With hospital appointments if you have no transport of your own, need to travel by stretcher or wheelchair on public transport would be impossible (buses with a large power wheelchair are a nonstarter). There is hospital transport. They question you closely about why you can’t travel by another method. Hospital transport is also a very inconvenient method of transport. You must be ready 2 hours before your appointment time and can wait an hour or more after.

It’s the OT who assesses you for aids. The hospital OT will have supplied initial equipment, but things like hoists, slings, chairs and other more specialised equipment will come from the community OT or they will advise where to buy them. On the subject of hoists, if you are unable to stand or weight bear, the standard type supplied will be a push portable one. Ceiling hoists are only supplied if they are deemed necessary in your circumstances, as they are in ours.

Just recently we have been made aware that there is a specialist OT who deals with housing, both modification and allocation. No one told us about that when I was sent home from hospital into my front room without access to a bathroom and with difficult access to our house. That’s why I am writing this blog for others. Information is vital, we should have been told advise was available about housing. If in doubt, ask.

Wheelchairs are a whole area in themselves. You need a GP referral for a wheelchair. That referral goes to Millbrook Healthcare. They send out an assessor, eventually. It took 8 months for me and apparently, I was marked very urgent. It seems to me that the new privatised system for wheelchairs is slower than the old system through Exeter Wheelchair Services. In Hartlepool, the NHS wheelchair service assessed me and built me a custom wheelchair within 3 months. The way it works with wheelchairs is that you are assessed for the minimum type that meets your need. In most cases that is a push wheelchair. If you need a power wheelchair because of your needs, then you will only be allocated one if you can use it inside and outside your house. Years ago, when I was first allocated a large high-backed reclining wheelchair, it was still a push wheelchair. See my blog ‘Keep on rolling’. You only get a ramp supplied in your house once you have a wheelchair. Some Church friends bought me a second-hand power wheelchair while we awaited the NHS chair, this meant a temporary suitcase ramp was then supplied. But we were fortunate, friends from Church paid for and other Church friends built an even better concrete ramp outside our house. It accesses our front door and back garden.

Me using the concrete ramp outside our house last year, in wheelchair our friends bought while we waited for NHS one.

I hope my experiences have cast a little light on a complex area. You can see there are many anachronisms and it’s frustrating to navigate. Without Mary sorting all this out over the last few years I don’t know where I would be. She has had many a stressful phone call with different departments. I realise this blog may make it sound like I sorted things out. In reality most things were sorted by my wife Mary. I have only really got involved more recently as things have been easier.

May your journey through the red tape be a simpler one than ours.

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Not so public convenience (Updated)

(This blog designed to advise and help, it is humorous, but also factual. It may cause you to blush)

Wheelchairs are brilliant machines for transport. Power wheelchairs in particular have transformed my life. But a wheelchair is after all still a chair. Think about a chair, you sit on it, it has a solid seat, and no hole in it. So, imagine that you are a man and you need a wee. I guess it may be worse for a woman. You may not want to imagine it, you might prefer to think of something else, I am trying to help for those who would find this useful. These are everyday realities of being disabled. Let’s forget for a moment if you need to do anything more than a wee, that’s a whole other area.

You are sitting down, and you need to wee. Well you might think, there are urine bottles you can use. True, there are. Think then about Wheelchairs, they are narrow, the width of your bottom typically, so your legs are together. Still with me? Maybe you need to act this out in your head. Where does the urine bottle go? If you can put it in the right place how do you ensure, no leaks at a 90-degree angle without injury to yourself. Perhaps you are beginning to see the issue. It is possible but not easy, after all it can be done. Then imagine you are on a train in the disabled space. The train companies give much more space these days for wheelchairs. But typically wheelchair spaces face the rest of the seats. That is also true on many buses. Perhaps we are expected to entertain the crowds while we are there. Getting back to relieving oneself, I don’t really fancy entertaining the other passengers by using a urine bottle in front of them, or under a blanket with everyone wondering what I am doing. It would be a little off putting. Talk about performance anxiety. Fortunately, there is an alternative and I found out about it after I had struggled with urine bottles in wheelchairs for years.

You might think how can Mike share such intimate details publicly. But, if I do maybe I can help others. I didn’t know about these things. I have had to struggle finding out. If my embarrassment can speed up the help for others, then so be it.

The alternative is a Conveen. I believe there are various makes, but I only know about the one I have used. Coloplast Conveens. They are external catheters. Normally catheters go inside the urinary tube in either a man or woman. Conveens, which I think are only available for men, fit on the outside. They look like a condom, but they have an open end with a fitting for a tube to go to a urine bag. They are adhesive, I will come back to that as it causes some fun fitting them. The bags come in two types, ones that attach to your leg and ones that attach to your bed or directly to your wheelchair.

Remember I said Conveens are adhesive, so they must stick all around to prevent leaks. Obviously, you need the right size. Yes, they send you a device to measure the diameter of your manhood. After you have recovered from the disappointment of the fact you are average, boasted in the fact you are large or wept over the fact you are small. You can order them. When I phoned the surgery to give them my size, I had a very funny conversation.

Prescription line lady, “what size do you need?”

Me, “30mm”

Prescription line lady, “is that length.”

Amazed silence from me, then “no, that’s diameter.”

I feel like I should wait a few minutes at this point while all the guys reading this, finish measuring. By the way the diameter range available is 21 to 40mm. Who knew such things eh? Or who wanted to.

There is a special measuring device (See picture below):

Fitting a Conveen, is, let’s say tricky. Think adhesive, hair, preparation adhesive, yes they give you a preparation wipe of extra adhesive. So, everything is sticky. You really need the two pairs of hands you have with a carer to fit it successfully. If you get it right and don’t catch all your hairs in it. Then connect the tube right, it works great. Much better than any urine bottle.

I would say if you are someone who needs to use a Conveen, read the instructions carefully and follow the advice of the rep to the letter. I ignored one bit of advice and realised afterwards why it was important.

Below is a picture of a Conveen sheath, the part that fits over your manhood. It’s rolled up in its package so you can only see the top that connects to the tube, that then goes to the urine bag (see photo below the Conveen) the ribbed part is a strain relief or air gap. This is where I went wrong. It’s important to flatten all this part with your thumb and fingers when fitting so none of your manhood goes into any of it. If it does, then that strain relief part, with the ribbing just acts as a pinching device, not nice. The only bit that goes over your manhood can’t be seen in the photo, it’s all rolled up and sticky. It unrolls as applied. Glue on glue, very sticky. Hence no leaks. So long as you apply it right and have the size right, no boasting. (Also note, there are two lengths available, so check you get the appropriate length, no comment).

Next step you connect the tube from the urine bag and attach it by straps to your leg. Make sure when attaching it to allow for expansion, after all it will get filled up. The urine bags come in different sizes and will need emptying, so leave the drain tap accessible and check it’s closed. It’s easy to accidentally knock it open if your carer pushes it back under your trouser leg after draining. By which you will realise they have a drain tap at the bottom and your carer or partner has the enjoyable job of draining it, see photo below.

Conveen sheath in its package. Note the ribbed section, avoid inserting your manhood into this bit by squashing the top of sheath when putting it on.

Leg bag, pipe at top connects to the sheath, see below for close up of the drainage tap

Note, make sure tap is closed after draining.

At the end of the day you may be thinking, but how do you remove a sticky rubber thing from such a delicate area. Your eyes may be watering in anticipation. Don’t panic, they thought of that. There is a non stinging release spray that is amazingly effective at removing the glue. It’s a pain free process.

This is the glue remover spray.

Have I freaked everyone out sufficiently and caused everyone to need a lie down or at the very least some counselling? Seriously, I hope I have helped to explain and clarify some things and point you in a helpful direction.

Let me just emphasise these Conveens have been life changing for me. I can only recommend the Coloplast ones as they are the only ones I have tried. They sent me samples to try first. They work brilliantly, the only failure I had was when I applied it wrongly the first time. Every other time since I have had no issues. So follow the instructions carefully.

I read this blog our at a writers group in Wellington and one big issue that became apparent was, what about women? There are internal personal catheters for women, but that is not as easy or convenient.

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Tell your friends and do use the share buttons.
There is a button on the right if you want to follow me.
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