One afternoon in the secure dementia unit

Ian Anderson

ward doorsI punch in the code to get into work, and go to put my dinner in the office. Mrs O stands blocking the doorway. “Excuse me dear, I need to get in there for a minute.”

“Piss off, I’m not going anywhere with you.”

What a great start to my shift.

I’m ten minutes early so I’ll check my residents before handover. “Gidday Mrs H. How are you?”  She’s crying.  “What’s the matter?” I ask.

“I didn’t think you were coming back”.

“All’s well, my dear. I’m here.” A smile covers her face.  Success!

I walk into the dining room for handover. Bugger. We are a carer short this shift, so I have an extra in my group.  Otherwise, all seems business as usual: bowel movements, catheters, colostomy bags, walking frames, pureed food, doctor visits, strange rashes – the usual topics. Handover takes longer than usual because Mr I keeps wandering down the hallway without his frame, and members of our group keep needing to retrieve him and set him on the right path.

Okay, time to get into it. I have a word with lovely Mrs A. She is cackling and talking to herself as usual. I change the top half of her clothing, putting her in a nightie ready for bed later. I offer her a cup of orange juice. Her room is very warm and she drinks it down quickly. From past experience I know to hold the cup, as otherwise she will spill it all over herself and the floor.

I pop back to see Mrs O. She is cheerier now as a relative has come to say hello. I tidy her room, help her use her walker to get to the toilet and then take her to the dining room in a wheelchair. The other carers are assisting the more mobile residents to their seats. Some residents don’t come to the dining room, but eat in their rooms (with assistance). This prevents congestion and also stops arguments from breaking out. All our residents are either confused, agitated or in their own world. Two carers fetch the dinner trolleys and the rest of us assist with drinks, all the time working on persuading a couple of very active residents to stay in their seats and not to drink from other people’s cups.

The trolleys arrive and tea time begins. Many residents sit quietly eating by themselves but a fair number are fed by us. I go and feed Mrs A. She gobbles everything. I return her plates to the kitchen and then go to assist Mr T. He has puree only, as he has a swallowing difficulty, but he is always very grateful for our help. He worries me; he has become frail. He eats most of his dinner and then has thickened juice. “See you later mate. I must go. I have others to feed”. He raises his hand to say thanks and goodbye.

One more to feed. It’s Mr V. He sits quietly in his room. It’s easier to feed him on his own, as occasionally he has seizures, and sometimes also makes loud bellowing noises which frighten some of the other residents. With my assistance he eats all his puree and then two puddings. No bellowing tonight, so it’s relatively straightforward.

I’d better go and see if Mrs L is out of bed yet. So far we have tried four times to persuade her that dinner is ready.  She’s very confused and tells us she’s eaten and it’s time for bed. No joy again this time. I’ll put her food to one side and hope she gets up later. I go and check on Mrs U.  She’s in her room eating by herself.  “Hello” I say, “how are you?”

“Great” she says, smiling.

I ask if she’s had enough and she has. “I’ll take your clothing protector to the wash then,” I say.

“No you won’t. Fuck off you bastard. You’re always trying to steal my stuff”.

I leave her. I will get it later.

I walk down the hallway. There’s a yucky smell. I look in Mr L’s room. “Shit” is what I say, and shit is what I see. He’s clean but the mess is everywhere else. I call another carer to walk him away while I clean. It’s on the toilet seat, the floor, the bed linen, the pillow and the chair’s rug. The only place it’s not is the walls. It takes me forty five minutes to remake the bed, and clean the floor and toilet seat.

Dinner is well over by the time I finish, and the trolleys are back to the kitchen for dishwashing. It’s my tea break so I grab a coffee and speedily eat my dinner. Time is up, so it’s off for the supper run. It’s relatively uneventful tonight. Most residents enjoy a drink and a snack. Some politely refuse. One yells that it’s time for her to go outside for a cigarette. When everyone is fed and watered we each go with our respective residents to get them ready for bed.

All are washed, underwear changed, with night pads put on most. It takes considerable time. Of the group I’m responsible for, two have defecated and need a more thorough wash. All but one, who is self-toileting, have also urinated. Two have to be put in a standing hoist as they are completely unable to stand. Two are reasonably good at self-caring, so I mostly only have to supervise. Eventually everyone is in tucked in for the night.  Some residents have sensor mats which automatically alert us if they fall or get out of bed.

It’s time to write up my notes, a detailed record of eating, toileting, and anything else of note, including all interactions negative and positive. While I am writing I overhear an agitated relative in the hallway telling the nurse they are going to call the police because they don’t agree with decisions made by their power of attorney.  It’s not the nurse’s fault; it’s completely out of the staff’s hands. After ten minutes the resident storms away. The nurse is upset.

Time for me to go home.  As I’m leaving I hear a resident call out loudly: “Piss off you black bitch and go back to where you came from.”

That was an average shift. It can be a lot worse. We do it because we can make a positive difference to vulnerable people’s lives, and we do. We see the sadness of humanity on a regular basis. Since I first wrote this piece, there has been a pay increase. But why not a living wage? Why should many carers have to lead deprived lives because of poor remuneration? Are carers, and those we care for, really valued?


Ian Anderson works as a carer in a New Zealand secure dementia unit. (‘Ian Anderson’ is a pseudonym.)

4 thoughts on “One afternoon in the secure dementia unit”

  1. So often things of real importance go unnoticed and unappreciated. Without caring, hard-working people like yourself society would collapse.

    Please let me say a heartfelt thank you on behalf of those unable to do so. I heartily endorse your words and if it were within my power your value and wages would reflect your kindness. We need more people like you!

  2. Yeah, we lock these people away as if they were suffering from something like leprosy (Ref. Foucault’s books on “madness”), to be mainly unseen by society, and (if they are lucky) to be occasionally given the privilege of short visits by family and friends.

    When my father was locked up in one of these places, because of his serious “depression” and dementia, his incarceration became a death sentence, as the effects of being in a society of very sick people, many of them best-described as being “total nutters”, dragged him down and sapped his energy, and he just gave up on life and starved himself to death. The mental health system did their best for him, but ther “best” was an abysmal sick joke.

    And, somebody has to do the everyday hard yards of caring for these people, of making ther miserable and hopeless lives a little bit less degrading and a ltttle bit less humiliating. The least we can do for these white knights would be to pay them a decent living wage. But, their role is not seen by society as being either important enough or glamourous enough, so they too are locked away, slaving away doing shit work that most people would hate having to do, out of sight, out of mind.

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