A view on Care Homes from both business and residential perspectives
Presented as three fictitious interviews at Pelham Pastures Nursing Home, with the Proprietor (Paul Jackson), 92-year-old Resident (Harry Roode), and 88-year old Resident (Mary Dobbs), it serves to provide a fascinating insight into the financial and personal aspects of Care Homes.
________________________________________________________________________________________________________________________________________________________
Gina: I'd like to start by asking you, Harry, in general, do you think Care Homes are a good place to live, and is there anything that you think could be done to improve your standard of living?
Harry: Is this how it's going to be?
Gina: What do you mean?
Harry: The interview… tick boxes... are Care Homes a good place to live? What sort of question is that? Go and ask Gloria Swanson over there and, when she's stopped dribbling, she'll tell you they're the best thing since sliced bread. As long as she gets three square meals a day, nothing else in the world matters. On the other hand, Martha Crabtree in room 42 spends all her waking hours pleading to be taken home; and that, my dear, are two sides of the same coin.
Gina: But I'm not asking Ginny, nor Martha; I'm asking you. I want to know about your experiences at Pelham Pastures. Are you happy here?
Harry: Have you ever heard that song from the musical, ‘Funny Girl’; the one that goes, "people who need people, are the luckiest people in the world?" Well, whoever wrote that wants their head examining, I can tell you. I have arthritis in my left hand, arthritis in my right hand, I've had two minor strokes in the past twelve months and I've got a dodgy cherry tart that could call time on me at any moment. On top of all that, I now have my own personal stash of incontinence pads and religiously take a cocktail of drugs, morning, noon and night, that even Kate Moss would think twice about taking. Is it any wonder my son and his over-bearing wife couldn't wait to pack me off to this place! So you see, I need people more than most, yet somehow I don't feel in the slightest bit lucky.
Gina: Harry, I had no idea you felt like that.
Harry: When was the last time you asked? Sorry, I shouldn't take it out on you.
Gina: It's fine, really. If you don't tell me then I won't know, will I?
Harry: (chuckling) You know, the irony is, I've spent a good portion of my life dreaming of women in nurses uniforms and, now that I'm surrounded by them, there's bugger all I can do about it.
________________________________________________________________________________________________________________________________________________________
Gina: Thank you for taking the time out to be interviewed, Mr. Jackson.
Paul: Please, call me, Paul.
Gina: I'll cut to the chase if I may, Paul. You're obviously an astute businessman who's made a success out of Pelham Pastures; however, in order to become successful and to remain that way, do you have to separate the strategic element from the emotional aspects of your job?
Paul: By that, I take it you mean, do I see the residents as anything other than profit margins?
Gina: Well, do you?
Paul: My honest answer to that would be, no, probably not. It's not that I'm incapable of having feelings, far from it; but just like the Nurses, you have to prepare yourself for the inevitable in a place like this. If I had to get attached to our clients, I'd be an emotional wreck after a couple of months. After all, isn’t this what Care Homes are all about? We're here to provide a safe environment for the elderly, a place where they can be comfortable, happy and relaxed during their remaining time on this Earth. Think of it as a Premier Inn just outside London. You’ve spent what seems like forever driving down the M1 motorway and you need to stop off in a nice comfy hotel where you can take time out to de-stress, before making your way to…
Gina: The other side?
Paul: Actually, I was going to say Hammersmith, but you take my point.
Gina: And when they’ve finally arrived in Hammersmith, I suppose there's always someone else ready to take their place, yeah?
Paul: I note you said that disparagingly, but it's the way of the world, Gina. Mother Nature provides the need, and we provide the service. Of course it pains me to see people ebbing away, gradually losing their senses and their ability to communicate. I think it affects every single one of us in one way or another; but, if you strip it right back to the bare bones, discard the sentiment, the tears, and the fact that it might happen to you one day, then you're left with a conveyor belt of people waiting to be transported to wherever their journey takes them. My role is to provide that vehicle in a compassionate, yet cost-effective way. So I guess you could say that the profit margins are merely a by-product of that process. If, on the other hand, you’re suggesting that Pelham Pastures could be run as a non-profit organisation, then what would be the point of providing the service in the first place? Premier Inns don't operate on good will alone. It’d be breaking the first rule of capitalism.
Gina: Fair enough, so how do you measure the importance of the level of provision on offer, against those profit margins; where do you strike a balance? And does it bother you how the Proprietor of a large establishment is perceived by those on the outside?
Paul: To answer your second question first, check out the car outside the front door and tell me what you see? Do you see an A-Class Mercedes owned by a wealthy Proprietor, or just another way of getting from A to B?
Gina: I see an extravagant possession that suggests more investment could be made into improving the home, rather than a way of advertising wealth.
Paul: And is that how you see me? As a money-grabbing fat cat lapping the cream off the working class milk? You really mustn’t think of profit as being a dirty word. Bear with me for a moment, would you, Gina? (leaving the room) I'll be straight back.
________________________________________________________________________________________________________________________________________________________
Mary: Do I get any freebies for doing this interview?
Gina: What would you like?
Mary: You can start with a few of those Jammy Dodgers you keep hidden in the staff room.
Gina: How do you know about those?
Mary: Being unable to walk doesn’t affect my eyesight, young lady. I clocked them as I was being carted to the toilet earlier this morning.
Gina: Yes, I suppose so, if you behave yourself, that is.
Mary: If, by that, you mean I have to give bog-standard answers to your questions, I’m afraid I can’t make any promises.
Gina: From what I hear, keeping the bad language to a minimum would be a start.
Mary: If you’re referring to yesterday afternoon, the Chiropodist should learn how to use a pair of nail clippers before practicing on me.
Gina: Hmm… What I would really like to know, Mary, is, are you happy living at Pelham Pastures?
Mary: Most of the time; the times when Billy visits and brings Marty along.
Gina: Billy’s your son and Marty’s your grandson, yes?
Mary: He’s a good boy, is Billy. He brings me mint imperials when he remembers. He has such a lot on his plate at the moment though, he hasn’t been to see me for the past few weeks.
Gina: He came yesterday, Mary. He brought Marty with him.
Mary: Marty? Oh, yeah, I remember now. When do I get my Jammy Dodgers?
Gina: I’ll get you them in a minute, don’t worry. Is there anything here that makes you unhappy, Mary?
Mary: Yes, yes there is.
Gina: And what’s that?
Mary: Some bastard keeps leaving mint imperials on my table. I hate mint imperials!
Gina: Ok, well I’m going to let you get some sleep now, Mary. I’ll be back a little later with the Jammy Dodgers and a nice cup of tea.
Mary: Thank you, dear. That would be lovely.
________________________________________________________________________________________________________________________________________________________
Harry: You won't remember my wife. She died in this very home four years prior to the day I moved in. She’d only been here for eight months. As long as I live, I will never forget that look on her face when I turned to leave on that first day. There’s no doubt in my mind she knew I was on my way back to the house where we had lived together for nigh on forty years, and… (weeping)
Gina: It’s ok, Harry. I know how much you loved your wife. You don’t have to relive it for the sake of this interview.
Harry: But I do. I was leaving without her. I was turning my back on the only woman I had ever loved in my entire life. I hope to God you never know what that feeling is like.
Gina: It’s clearly upsetting for you.
Harry: On the day she was brought in here, I followed behind the ambulance in my car. I couldn’t even leave the bloody car at home and share the ambulance with her (sobbing).
Gina: Please, Harry, don’t put yourself through this.
Harry: I sat at the side of her bed and she just stared at me, and a memory popped into my head. We’d been on a day-trip to Blackpool and I ended up with food poisoning. We put it down to a dodgy oyster. I don’t even like oysters, so I don’t know what made me buy one in the first place. Anyway, I was up half the night with stomach cramps. Did she complain? Not once; she held me all night long and, when I got out to be sick, she got out with me and held a damp cloth to my forehead. I was so thankful that she was there for me… so thankful. Then all of a sudden, there I was, sat by her side preparing to kiss her goodnight and walk away. I will always hate myself for that.
Gina: Maybe she understood why you had to do what you did.
Harry: No; they say the eyes are the window to the soul. Well I looked in her eyes that day and it was like I was inside her looking out. All the promises I had ever made, every single one, I broke on that day when I walked out of that front door. So if you really want to know what this place means to me, it’s a constant reminder of how I betrayed my Catherine… my beautiful wife, Catherine.
________________________________________________________________________________________________________________________________________________________
Paul: (returning with a file) Here we are. Behind what people see, i.e. the A-Class Mercedes, this is how I measure my contribution to society. I employ 10 qualified Nurses, 32 Carers, 6 Domiciliary Staff to do the cooking, laundry, cleaning, etc; a Hairdresser, an Accountant, a Handyman, a Gardener, occasional outside contractors like Builders, Roofers, Glaziers; a Health & Safety consultancy firm, a company that checks all our fire-fighting equipment, and an electrician to carry out our annual portable appliance testing and five-yearly fixed wiring inspection. Then, of course, we support local business by sourcing 70% of our food from local producers. We are also committed to the development of staff through training programs like the one you’re presently undertaking; we’ve also been accredited as an Investors in People organisation, which benchmarks our performance against world class standards. Is that enough for you, or would you like me to go on?
Gina: No, I think you’ve made your point. However, I still don’t think you’ve quite managed to answer my original question, that being the importance of the level of provision against the profit margin or, to put it another way, why buy a new chair when the old one will do. I know you won’t want to comment on individual cases, but we have a resident that’s been waiting for a replacement TV for the past twelve months. I keep telling her that there’s a fault with the picture, but she’s convinced she’s having blackouts.
Paul: Ah, now I have been made aware of this. You’re referring to Deirdre Cummings. Unfortunately, the TV is in her room and not one of the communal areas, so I’m afraid it’s down to her family to provide a replacement. Unfortunately, we rarely see them from one day to the next and they never seem to pick up the phone.
Gina: So what you’re saying is, if they can’t be bothered, then why should we?
Paul: No, I’m saying, as a business, we can’t afford to subsidise residents when the family of that resident can’t be bothered to put their hand in their pocket. It would be a dangerous precedent to set.
Gina: Thank you, Paul; I think that answers my question perfectly.
________________________________________________________________________________________________________________________________________________________
Gina: Mary, love, I’ve come to say goodnight and I’ve brought you a cup of tea and the Jammy Dodgers, just like I promised. Mary… Mary…
________________________________________________________________________________________________________________________________________________________
Gina: I'd like to start by asking you, Harry, in general, do you think Care Homes are a good place to live, and is there anything that you think could be done to improve your standard of living?
Harry: Is this how it's going to be?
Gina: What do you mean?
Harry: The interview… tick boxes... are Care Homes a good place to live? What sort of question is that? Go and ask Gloria Swanson over there and, when she's stopped dribbling, she'll tell you they're the best thing since sliced bread. As long as she gets three square meals a day, nothing else in the world matters. On the other hand, Martha Crabtree in room 42 spends all her waking hours pleading to be taken home; and that, my dear, are two sides of the same coin.
Gina: But I'm not asking Ginny, nor Martha; I'm asking you. I want to know about your experiences at Pelham Pastures. Are you happy here?
Harry: Have you ever heard that song from the musical, ‘Funny Girl’; the one that goes, "people who need people, are the luckiest people in the world?" Well, whoever wrote that wants their head examining, I can tell you. I have arthritis in my left hand, arthritis in my right hand, I've had two minor strokes in the past twelve months and I've got a dodgy cherry tart that could call time on me at any moment. On top of all that, I now have my own personal stash of incontinence pads and religiously take a cocktail of drugs, morning, noon and night, that even Kate Moss would think twice about taking. Is it any wonder my son and his over-bearing wife couldn't wait to pack me off to this place! So you see, I need people more than most, yet somehow I don't feel in the slightest bit lucky.
Gina: Harry, I had no idea you felt like that.
Harry: When was the last time you asked? Sorry, I shouldn't take it out on you.
Gina: It's fine, really. If you don't tell me then I won't know, will I?
Harry: (chuckling) You know, the irony is, I've spent a good portion of my life dreaming of women in nurses uniforms and, now that I'm surrounded by them, there's bugger all I can do about it.
________________________________________________________________________________________________________________________________________________________
Gina: Thank you for taking the time out to be interviewed, Mr. Jackson.
Paul: Please, call me, Paul.
Gina: I'll cut to the chase if I may, Paul. You're obviously an astute businessman who's made a success out of Pelham Pastures; however, in order to become successful and to remain that way, do you have to separate the strategic element from the emotional aspects of your job?
Paul: By that, I take it you mean, do I see the residents as anything other than profit margins?
Gina: Well, do you?
Paul: My honest answer to that would be, no, probably not. It's not that I'm incapable of having feelings, far from it; but just like the Nurses, you have to prepare yourself for the inevitable in a place like this. If I had to get attached to our clients, I'd be an emotional wreck after a couple of months. After all, isn’t this what Care Homes are all about? We're here to provide a safe environment for the elderly, a place where they can be comfortable, happy and relaxed during their remaining time on this Earth. Think of it as a Premier Inn just outside London. You’ve spent what seems like forever driving down the M1 motorway and you need to stop off in a nice comfy hotel where you can take time out to de-stress, before making your way to…
Gina: The other side?
Paul: Actually, I was going to say Hammersmith, but you take my point.
Gina: And when they’ve finally arrived in Hammersmith, I suppose there's always someone else ready to take their place, yeah?
Paul: I note you said that disparagingly, but it's the way of the world, Gina. Mother Nature provides the need, and we provide the service. Of course it pains me to see people ebbing away, gradually losing their senses and their ability to communicate. I think it affects every single one of us in one way or another; but, if you strip it right back to the bare bones, discard the sentiment, the tears, and the fact that it might happen to you one day, then you're left with a conveyor belt of people waiting to be transported to wherever their journey takes them. My role is to provide that vehicle in a compassionate, yet cost-effective way. So I guess you could say that the profit margins are merely a by-product of that process. If, on the other hand, you’re suggesting that Pelham Pastures could be run as a non-profit organisation, then what would be the point of providing the service in the first place? Premier Inns don't operate on good will alone. It’d be breaking the first rule of capitalism.
Gina: Fair enough, so how do you measure the importance of the level of provision on offer, against those profit margins; where do you strike a balance? And does it bother you how the Proprietor of a large establishment is perceived by those on the outside?
Paul: To answer your second question first, check out the car outside the front door and tell me what you see? Do you see an A-Class Mercedes owned by a wealthy Proprietor, or just another way of getting from A to B?
Gina: I see an extravagant possession that suggests more investment could be made into improving the home, rather than a way of advertising wealth.
Paul: And is that how you see me? As a money-grabbing fat cat lapping the cream off the working class milk? You really mustn’t think of profit as being a dirty word. Bear with me for a moment, would you, Gina? (leaving the room) I'll be straight back.
________________________________________________________________________________________________________________________________________________________
Mary: Do I get any freebies for doing this interview?
Gina: What would you like?
Mary: You can start with a few of those Jammy Dodgers you keep hidden in the staff room.
Gina: How do you know about those?
Mary: Being unable to walk doesn’t affect my eyesight, young lady. I clocked them as I was being carted to the toilet earlier this morning.
Gina: Yes, I suppose so, if you behave yourself, that is.
Mary: If, by that, you mean I have to give bog-standard answers to your questions, I’m afraid I can’t make any promises.
Gina: From what I hear, keeping the bad language to a minimum would be a start.
Mary: If you’re referring to yesterday afternoon, the Chiropodist should learn how to use a pair of nail clippers before practicing on me.
Gina: Hmm… What I would really like to know, Mary, is, are you happy living at Pelham Pastures?
Mary: Most of the time; the times when Billy visits and brings Marty along.
Gina: Billy’s your son and Marty’s your grandson, yes?
Mary: He’s a good boy, is Billy. He brings me mint imperials when he remembers. He has such a lot on his plate at the moment though, he hasn’t been to see me for the past few weeks.
Gina: He came yesterday, Mary. He brought Marty with him.
Mary: Marty? Oh, yeah, I remember now. When do I get my Jammy Dodgers?
Gina: I’ll get you them in a minute, don’t worry. Is there anything here that makes you unhappy, Mary?
Mary: Yes, yes there is.
Gina: And what’s that?
Mary: Some bastard keeps leaving mint imperials on my table. I hate mint imperials!
Gina: Ok, well I’m going to let you get some sleep now, Mary. I’ll be back a little later with the Jammy Dodgers and a nice cup of tea.
Mary: Thank you, dear. That would be lovely.
________________________________________________________________________________________________________________________________________________________
Harry: You won't remember my wife. She died in this very home four years prior to the day I moved in. She’d only been here for eight months. As long as I live, I will never forget that look on her face when I turned to leave on that first day. There’s no doubt in my mind she knew I was on my way back to the house where we had lived together for nigh on forty years, and… (weeping)
Gina: It’s ok, Harry. I know how much you loved your wife. You don’t have to relive it for the sake of this interview.
Harry: But I do. I was leaving without her. I was turning my back on the only woman I had ever loved in my entire life. I hope to God you never know what that feeling is like.
Gina: It’s clearly upsetting for you.
Harry: On the day she was brought in here, I followed behind the ambulance in my car. I couldn’t even leave the bloody car at home and share the ambulance with her (sobbing).
Gina: Please, Harry, don’t put yourself through this.
Harry: I sat at the side of her bed and she just stared at me, and a memory popped into my head. We’d been on a day-trip to Blackpool and I ended up with food poisoning. We put it down to a dodgy oyster. I don’t even like oysters, so I don’t know what made me buy one in the first place. Anyway, I was up half the night with stomach cramps. Did she complain? Not once; she held me all night long and, when I got out to be sick, she got out with me and held a damp cloth to my forehead. I was so thankful that she was there for me… so thankful. Then all of a sudden, there I was, sat by her side preparing to kiss her goodnight and walk away. I will always hate myself for that.
Gina: Maybe she understood why you had to do what you did.
Harry: No; they say the eyes are the window to the soul. Well I looked in her eyes that day and it was like I was inside her looking out. All the promises I had ever made, every single one, I broke on that day when I walked out of that front door. So if you really want to know what this place means to me, it’s a constant reminder of how I betrayed my Catherine… my beautiful wife, Catherine.
________________________________________________________________________________________________________________________________________________________
Paul: (returning with a file) Here we are. Behind what people see, i.e. the A-Class Mercedes, this is how I measure my contribution to society. I employ 10 qualified Nurses, 32 Carers, 6 Domiciliary Staff to do the cooking, laundry, cleaning, etc; a Hairdresser, an Accountant, a Handyman, a Gardener, occasional outside contractors like Builders, Roofers, Glaziers; a Health & Safety consultancy firm, a company that checks all our fire-fighting equipment, and an electrician to carry out our annual portable appliance testing and five-yearly fixed wiring inspection. Then, of course, we support local business by sourcing 70% of our food from local producers. We are also committed to the development of staff through training programs like the one you’re presently undertaking; we’ve also been accredited as an Investors in People organisation, which benchmarks our performance against world class standards. Is that enough for you, or would you like me to go on?
Gina: No, I think you’ve made your point. However, I still don’t think you’ve quite managed to answer my original question, that being the importance of the level of provision against the profit margin or, to put it another way, why buy a new chair when the old one will do. I know you won’t want to comment on individual cases, but we have a resident that’s been waiting for a replacement TV for the past twelve months. I keep telling her that there’s a fault with the picture, but she’s convinced she’s having blackouts.
Paul: Ah, now I have been made aware of this. You’re referring to Deirdre Cummings. Unfortunately, the TV is in her room and not one of the communal areas, so I’m afraid it’s down to her family to provide a replacement. Unfortunately, we rarely see them from one day to the next and they never seem to pick up the phone.
Gina: So what you’re saying is, if they can’t be bothered, then why should we?
Paul: No, I’m saying, as a business, we can’t afford to subsidise residents when the family of that resident can’t be bothered to put their hand in their pocket. It would be a dangerous precedent to set.
Gina: Thank you, Paul; I think that answers my question perfectly.
________________________________________________________________________________________________________________________________________________________
Gina: Mary, love, I’ve come to say goodnight and I’ve brought you a cup of tea and the Jammy Dodgers, just like I promised. Mary… Mary…
