White Christmas

The care home had given notice and were very clear on the telephone call that came through that in their opinion there was nothing more they could do. Betty was a problem. Wandering. Absent Without Leave. Absconding. Leaving other vulnerable people at risk whilst staff had to go find and recover her. She had been found in the launderette, in the local church and once in the local pub. All places of her old life. The life she had left behind when she had entered the care home. The duty logs carefully recorded and logged each successive incident of risk, using words which captured their increasing sense of frustration to describe Betty’s ‘behaviours’, which they had passed on to social services as they increased the number of telephone calls which they had made to check out how their referral was progressing through December.

By December 22nd things were reaching fever pitch and the Matron had got involved. As the Team Manager I handled a really difficult phone call with Matron insisting that I take action. I reminded her that this close to Christmas there were very few spaces in other care homes due to pressures from the hospital and given Betty had been with them so long could we not work together to help make things work? No. Was she sure the situation could not wait until the new year? Very sure. Matron was adamant that I needed to look into options for Betty as she was really very confused and more concerning, she rarely ‘did as she was told’. Betty was wondering all over the town after she had been told not to. Most alarming to Matron, last week Betty had ‘absconded’ and been found by staff wondering the streets of town looking for her late husband, Ronnie. When Betty had been told her husband had been dead for 10 years, she had become very distressed, crying, need a lot of calming down. Matron was concerned, upset even, she had Christmas to think about and this meant that she would be dealing with reduced staffing levels, a sickness bug and increasing number of relatives visiting the home. But it was really the staffing levels that concerned her. Two to one staffing was not cheap over Christmas, and whilst she would usually try to accommodate the increase if I would authorise an increase in fees to the home, it was unlikely that she could afford to commit that level of staffing to manage Betty and her behaviours.

On the afternoon of 24th December, two of us were the last ones in the building, running the Duty Social Work desk, when a panicked call came through from the home. Betty had gone missing during the night. She had been returned by police who had brought her back freezing cold and extremely confused. Matron was clear. The home was at their wits ends, Betty was a huge risk to herself, the GP agreed and the impact Betty was having on resources was leaving other vulnerable people at risk. Matron demanded that we arrange an emergency placement in a home which provided specialist support for people with dementia. Faced with the risk that Betty would end up in hospital if we did nothing, at risk of all sorts of harm from infection over the Christmas period, confused and alone, we rang Betty’s daughter in Tenerife and spoke to her about what may happen to Betty that afternoon. From the sunny shores of Tenerife ‘permission’ was granted to ‘move her somewhere nice’. DoLS sorted st the stroke of a pen. So a move that afternoon, Christmas Eve, was in the offing. All in time for Christmas.

Both of us went to the home, just in case we needed a driver and someone to chat to Betty. We knew we’d certainly need two to handle Matron. When we arrived at the home Betty was the first person we saw but neither of us recognised her. She watched us walk from the car down the snow-covered path to the home. Her gaze haunted, searching our faces as though looking for someone. We rang the door bell and waited to be let in by the matron, admiring the wreath on the front door, shivering from the cold.

The care worker who answered the door in her purple uniform had tinsel in her hair. She looked relieved when she saw us. “Oh, thank god you are here, follow me, Matron is expecting you”. We were ushered into the Matrons office before the door was slammed behind us before we had chance to say hello to Betty or anyone else. The Matron was ready for us “Do you want a cup of tea. We have mince pies, help yourself to Quality Streets”. “Thanks” we said and did as offered noting that the toffee ones were missing from the tin, presumably already eaten. Matron had her script and was not to be distracted or diverted “She is 89 but you probably know that. Been with us for about 5 years. Her daughter put her here for respite as she was at breaking point. We had to go back to Panel to make the decision permanent as she needed care. Was very underweight when she first arrived. We’ve sorted that out. She was self-funding for a year, her daughter sorted the finances. But once the money ran out and she moved onto your rates we had to move her as you wouldn’t match the amount we charge for the room she was in. She was no bother at first. Kept herself to herself. You could talk to her and that. Not now. All you hear is her talking about her husband Ronnie but as I say, it’s been ten years since he died. The photos are all over her room, they seemed devoted from what her daughter says…”. Matron paused to root round the Quality Streets. A moment of displeasure on her face as she realised that her favourites (the toffee??) weren’t there, then settling on a coffee cream. “The thing is, we cannot continue with her. It’s taking the girls all they can to stop her disappearing. I’m down to two staff from this afternoon. We just cannot keep her. Her meddies are there and I’ve spoken to the home where she’s going. It’s got a locked door, so you got that bit right. Is she going in your car? Could she go now? It’ll probably be for the best. I’ll get someone to fetch her”. My colleague and I exchanged glances, a mutual decision made, this is dreadful but let’s get this done, Betty needs to be somewhere where she is welcomed. We followed Matron bustling toward the lounge, rounding up a staff member who was tasked with gathering together Betty things. Within 10 minutes Betty’s whole life had been packed. 89 years reduced into fitting into a suitcase and a plastic bin bag.

Betty was compliant because in truth she didn’t know what she was complying with. Yes, she’d get in the car. It was the same colour as her daughter had. And Betty listened as we talked about driving her to the new home “My Pamela has got a car just like this. Do you know her?”. We asked Betty if she would consider a new place to live? Yes, she was ok with that too. “Until Pamela comes. She’s in Worksop. I’m going to live with Pamela”. Excitedly Betty climbed into the front seat and the one suitcase and half-filled black bin bag, a lifetime of experiences bundled in the boot. “Now then gentlemen. Just one thing. We need to pick up Ronnie on the way please”. We smiled and carried on and wished we were taking Betty back home to Ronnie.

The journey took about thirty minutes via two small market towns at the foot of the hills. Streets were quiet with the occasional shopper heading in and out of shops to grab a last-minute gift or jar of cranberry sauce. The radio in the car was playing in the background. And then, from no-where the radio DJ became the umpteenth that day to play White Christmas. Time stopped.

“Aww. This is a favourite of my Ronnies, is this one” Betty said. And started singing. Softly to herself.

Every traffic light we paused at Betty thought she saw Ronnie. She unbuckled her seatbelt as we stopped for a pedestrian crossing, she opened the door and leapt out shouting “He’s there! Ronnie love, I’m here, it’s me, it’s me Betty, get in”. A young man of about 20 pushing a pram and smoking a cigarette looked up with alarm and swerved to quickly get passed. Betty’s face fell, dejected. She looked confused and got back into the car. Moments later she turned to the social worker on the back seat and said, “That wasn’t Ronnie you know. He wouldn’t be pushing a pram nowadays and our Pamela wouldn’t fit in it, yer daft apeth.. And he never smoked”. Betty went back to singing. “Where the treetops glisten and children listen. To hear sleigh bells in the snow”. From my front drivers seat, in the rear view mirror I caught sight of my colleague in the back seat next to Betty, who was gently holding her hand, tears in his eyes.

The deal was concluded quickly enough. Within an hour Betty was literally signed, sealed and delivered. The new care home, a dementia specialist unit with lock doors a plenty, were very welcoming. She won’t be at risk here, we were reassured by the nurse, we have special key pads to keep residents safe. The nurse was most interested to hear about Ronnie and assured Betty, whilst leading her down a dimly lit corridor, that Ronnie would be there to see her soon. We said goodbye to Betty but by then she was already half way down the corridor towards the lounge. There was no transition for Betty, no endings, no time for her to adjust and realign to her new situation. Just a sharp new beginning in another room full of armchairs, forgotten lives and the unwatched television in the corner.

Dreaming of a White Christmas whilst living your last.