November 2014

The Nation Reviewed

The mystery bus

By Sarah Day

Choosing an aged-care home is not easy

On the other side of the glass doors, a dozen or so women with the same length neat, bobbed white hair are looking out like a welcoming committee. I pass through the doors, preparing to smile and offer greetings, but rather than meet my eye they look right through me. I keep walking and take a seat on the periphery. It is as if they are all in a trance.

“They’re waiting for the mystery bus tour.” A young nurse, my guide, shakes my hand and brightly introduces herself.

Together, we wend up the stairs. I look down at the silent gathering below. It is like a scene from Doctor Who. The nurse seems confident that a bus will arrive and the much-anticipated excursion will eventuate.

This is the fourth residential aged-care facility I have visited in Hobart in the past two weeks. I am a little more resilient this time than on the earlier visits. I have a rough idea of what to expect. This establishment is well lit by sunlight – a plus. It is modern and new. It smells of vinyl and paint. Our first stop is Marjory’s room – she has given her permission. She is downstairs awaiting the mystery tour. Her room, or “studio apartment”, is pleasant, spacious and equipped with en suite and kitchen sink. It is furnished with elegant antique furniture; original landscapes cover most of the wall space. The room has a well-lived-in, well-cared-for air.

“Residents are encouraged to bring their own furniture and objects of importance,” says the nurse. “Linen even.”

We walk along a broad corridor, past an open lounge-room in which a number of women are sitting in comfortable chairs, awake or sleeping, waiting for the start of “Cinema Hour”. This afternoon’s film stars Cary Grant and Myrna Loy. Nobody looks up as we pass by.

The nurse listens patiently to my barrage of questions: What are the ratios of carers to residents? The ratio of nurses to residents? The frequency of staff turnover? How many residents? How many level III nurses? What’s the best way to make friends as a newcomer here? How long might someone limited by disability be left alone in their room before being checked, and in the night time? How do you help settle someone into this new life? What if they don’t settle? Should a newcomer become distressed, disoriented alone in their room, day or night, how would anyone know? What if they don’t have the wherewithal to press the button to call for assistance? How would someone like my mother, in a bout of Parkinsonian panic, be comforted – given that a familiar face has been her only source of solace and distraction in recent times? If my father wished to visit every day, would that be possible? And for how long?

My mother and father have been married for 63 years. I am pleased to hear that, should he ever decide this is the best place for her, he could spend as much time here as he liked. He could eat in the dining room for $6 a meal; he could join in with activities, unlikely as it is that he would want to. But he could not stay the night.

We sidestep into a small, dimly lit chapel, ecumenical in theory but amply adorned with Marian iconography.

“What I’m really struggling with,” I say, “is whether my mother would receive a higher level of care here than at home with my father, who is 93, fit, lucid but nearly blind with macular degeneration.”

My mother is increasingly confused as a result of either Parkinson’s disease or the medication used to treat it – none of her specialists is able to ascertain which. It is difficult for my father to see well enough to choose her underwear, to tell whether her clothes are on back to front. It is difficult for him to apply her medication patches, which are flesh coloured and fiddly, like small round bandaids. It is difficult to see the one he is removing and the one he is replacing it with. He draws dots on the patches with black texta, so that he can see them more clearly against her skin. On evenings when my mother’s tremor is bad, he tries to help her with her fork, but he cannot assist easily. At the age of 90, he began to cook for the first time in his life and has made up for lost time with alacrity and aplomb. Their meals are colourful with vegetables, tasty and nutritious. He phones his granddaughters for new recipes and techniques. He is always searching for small ways to make easier the challenge that my mother’s life has become.

All day long he prompts her memory. She can seldom tell him what happened the day before, but she can recall street names from and directions through the villages of her English childhood, and the names and policies of pre-war prime ministers. Together, my mother and father trawl through shared experiences from 10, 30, 60 years ago, and the memories of people they once knew.

I reach for the tissue box beside the statue of Mary – her face, above her exposed and bleeding heart, is beatific – and lose my words.

“I’m sorry,” I say. “I hoped I might have stopped doing this by now.”

The nurse puts a kindly hand on my arm. “I know what it’s like. It’s terribly hard. I went through this with my father.”

We are now on our way to the “Well-being” room, which opens out to a courtyard, and feels like it belongs in a health resort. There is a small fountain, a set of parallel bars, more comfortable chairs arranged in a circle, and tables on which snowy-white face washers are displayed in fans. Footbaths, massages and meditation apparently happen in this room.

As with the other residential-care facilities (I never hear anyone use the word “home”, except my father, who makes the occasional dismissive comment about “old folks’ homes”), there is an activities centre, a choice between at least two dining rooms, the option of daily physiotherapy, and a varied daily program of events and diversions.

Physically, this establishment is pleasant, though the corridors are long. My mother might get lost. It is purpose-built. Two of the four I have visited are conversions of historic buildings. All of them are nice enough, the staff friendly and helpful. Each one has some element that appeals more than the other facilities. The not-for-profit charitable home has a buzz about it; there is more talk and interaction between residents. The fact that it prioritises those with disabilities or who are disadvantaged in some way endears me to the place, as does the fact that the in-house chef has won national awards. Another is lighter and brighter – there’s no underestimating the value of sunshine. Another is smaller, more intimate. One has a high staff turnover – not a good sign – and meals that are cooked off the premises – also discouraging. Its business manager, sizing me up, presents me with the price list before I’ve even looked around.

I’ve been conscious, throughout these tours, of the advice given to me by a friend – not to be beguiled by the physical attributes of the places. Appealing architecture, landscaped gardens, the newness of buildings and furniture are not paramount. The kindness factor is the most important.

Baby boomers shake their heads and imagine that they will do old age better than their parents. They plan on staying at home or establishing harmonious, mutually supportive sharehouses or co-housing communities reminiscent of those in their romanticised memories of the 1960s and ’70s. Good luck to them, if they can achieve either. The reality is that there will be a lot more of us than the present generation of old people. We will stretch the resources of the existing strained aged-care system beyond its limits. The first baby boomers are rapidly approaching 70. They better act quickly.

The nurse has led me in a full circle and we are now at the sliding doors again. She hands me a card on which the details of the business manager are printed. Costs. Daily rates. Bonds. No bonds. Since 1 July, fee scales have changed in aged care; the means test is more stringent, costs are higher.

It suddenly occurs to me why the residents’ hairstyles are so similar – they are all patrons of the in-house hairdresser. I wonder, briefly, where the women I saw when I first arrived are now: the summit of Mount Wellington, a local beach, the museum? Perhaps the journey of the mystery tours is more important than the destination, since, as Philip Larkin wrote: “Nothing, like something, happens anywhere.”

Sarah Day

Sarah Day is a writer and poet. Her most recent book is Tempo.

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