Safe from Harm Protecting Our Parents

This programme contains some strong language

and some scenes which some viewers may find upsetting.

-Catherine. You should have gone to bed when you was offered it.

-Eh?

You should have gone to bed when you was given the opportunity to get in

-and the nurse to cover you up.

-Yeah.

And make you cosy.

The best thing I could've done was go through the door and go home.

You're not going anywhere. You're going into bed.

-You'll just have to sit again on your own.

-I don't care.

-All right, don't care.

-I don't care.

-All right, you've said it.

Now forget it and sit there and calm down.

-Oh, I'm going to give in.

-No, don't be silly.

-I am.

-Don't be silly.

-Just leave it.

-All right. OK. All right.

-Hello.

-Hello, sweet.

There are more pensioners than children living in Britain today.

As our population gets older,

its health needs are becoming more complex.

This is unfortunately a condition that does gradually get worse with time.

Two-thirds of hospital patients are over 65.

You are a bit black and blue, I'm afraid.

We need more support at home,

increasing pressure on carers and families.

Do you think we're going to leave you just like Gladys?

I just can't put up with this any more, I really can't.

As we live longer, how will we care for older people

and protect our own futures too?

I wonder when you get to my age, what you're going to do?

I wonder if someone is going to look after you like they're

looking after me.

We've been close for years, right from when I was first born.

Sadly, when Uncle Sid passed away I sort of took over helping Auntie Bet -

not looking after her, because she's fiercely independent.

Rhonda Bibb is on her way to meet her aunt, Betty Williams.

Like half a million older people each year,

Betty is in hospital, following a fall.

When I used to leave the house, I didn't know

whether I'd see her alive again.

And that's it, I mean she has to go upstairs for water

because she hasn't got a sink in the kitchen.

She sleeps in the kitchen on a stool, which you know, nobody should...

You wouldn't let a dog

or an animal live in conditions like that, you know, it's just not right.

Rhonda found Betty after her fall and called the emergency services.

She was on her own for 24 hours

because she couldn't get to anybody for help.

She just couldn't do it.

We had to get in with the police.

And I'd feared this, I really had, and so had she,

I know she had because we'd spoken about it but you know, as I say,

let's hope this is the wake-up call

and it's the beginning of the next chapter of her life for her.

Dr Peter Wallis is the lead elderly care consultant at Heartlands Hospital in Birmingham.

-Hello.

-It's OK.

-Hello, Betty.

He's been treating Betty since her admission.

-You've had a busy morning, haven't you?

-Yes, very.

You've got this ulcer on your foot.

-Yes.

-You've been on antibiotics now for some days.

-Yes, I have.

-Um...

Sister and I will need at some point, not now, to take the dressing down

and see whether the ulcer is getting better.

She's had a long period of having to look after her husband

when he was very poorly and sadly, he died some years ago and I think

she's never really sort of paid a lot of attention to her own needs.

How's Betty getting on on the ward? Is she needing a lot of help?

She's doing very well. She's quite independent.

I mean, we was trying to help her today,

but she's completely independent of her personal care.

Now, our goal is obviously to get you well enough to leave hospital.

With all due respect, I hear your house has got a bit cluttered.

-Very cluttered.

-Nobody wants to take away your independence, Betty.

-No, I realise that.

-And I respect that.

But at the same time we want to make sure that you're managing.

-That I'm safe and...

-Yes, exactly.

-I'm doing what I ought to.

Do you want to go in, Rhonda, and take a seat?

Helping patients plan for leaving hospital is

the responsibility of Social Services.

Student social worker Gemma is meeting Rhonda to discuss Betty's case.

Things at home have gradually got worse.

How bad are we talking?

Well, I had a bit of a shock this morning

because I had to go up the hall.

The last time I went up the hall, I could walk up the hall.

-I couldn't this morning.

-Really?

It's just, there's just stuff everywhere.

-What about, have you been upstairs?

-She won't let me upstairs, so...

-OK.

-I did go in the other morning and I cleared some away in the kitchen,

but it's a small dent in a very, very big...

So there isn't actually a kitchen, is there?

The oven doesn't work. She's got two hotplates that she uses.

She wears, like, a plastic apron

and all that was melted on the front.

That's when I really did have to say, "Look, you know, something has got to be done".

Yeah, it has. I think, yeah... well, it has.

She's not safe. I mean, I could just cry for her, I really could. Because she's...

-She's very, very independent.

-Oh, God, yeah.

That's... I was saying it was a good thing.

It's a good thing, because that's kept her going.

-Yeah.

-It really has kept her going, but there comes a time where...

-You have to let people help.

-Yeah. And this is the time now.

Betty doesn't have children

and Rhonda is her closest relative.

But with her own family and mother to look after,

Rhonda can't care for Betty full-time.

-You've got a cup of tea.

-Yeah.

-Do you want any...?

No, I'm all right. I had a sandwich just before I came.

Oh, because there's chocolate digestives, your favourite.

They're now her favourites.

As long as she's...

-Going back.

-Yes.

You can't go home at the moment to how things are.

Why, what have you done?

I haven't done anything, I mean how they are.

-You mean me and the necessary?

-Yes.

-OK.

-Because if you do,

you will end up back in here, Auntie Bet,

and that's what I'm fright... what I'm afraid of.

Yes, it's all right.

We were afraid of what happened anyway, weren't we?

I understand, yeah.

In Betty's situation, you know, she is clearly very lucid

and quite capable of understanding the risks.

If somebody wishes to be at home and they want to run those risks

then, you know, we have to be careful about how much we intervene.

You know, on the one hand,

one can be too over-protective and too concerned about the risk.

Because if they are here long enough, they will lose those

vital skills that are needed to maintain independence at home.

Hospital-type complications will set in

and then someone loses the opportunity totally of getting home.

So one's got to try and strike a balance.

Like Betty, 80-year-old Jim Page has had a fall.

He's been in hospital for two months.

Jim, you know what's happening now, where you're going?

Home.

Who's going to be there now waiting for you?

-Daughter.

-That's it, that's it.

When the ambulance comes for you.

We're going to miss you.

-Oh, yeah?

-Yes, we are.

Getting Jim ready to go home is complicated by his dementia.

But his doctors and social workers

have decided it's in his best interest to leave.

Jim's son Mick and daughter Pauline are getting his house ready.

So what we're doing now is

for when he comes home,

we're bringing his bed down from his bedroom,

bring it down and hopefully they'll bring in, like a commode

and block off the staircase so he can't actually go upstairs.

Cos he will try.

Is that going to be too high for him?

It's just to make it more easier, more comfortable for him.

So that when we're not around,

we can be sure that he'll be more safer.

But I know he'd rather be at home in his own surroundings.

OK, James - come on, mate.

Jim's wife of 50 years died just before he went into hospital.

She'd been his main carer, but now he'll be at home alone.

It's just a bit raw at the moment.

All of a sudden,

within a couple of weeks everything has completely changed.

I mean, we found a photo of my mum that was, erm, was just over 12 months ago.

And the difference, you know, to looking at her

a couple of weeks back.

And then I look at my dad, the same thing.

And you're looking at him thinking

he can't change that much in 12 months.

But it's in the pictures, you can see it.

Want a cup of tea?

-Would you like a cup of tea, Dad?

-Eh?

-Would you like a cup of tea?

I know you don't have sugar.

Yes, I know. Oop.

I'll have a look.

Because Jim's savings are below £14,500,

he qualifies for full Social Services funding.

He gets the maximum four visits a day by carers.

Beyond that, it's down to Pauline and her brother

to help their father during the 20 hours a day he's on his own.

You're aware you're not allowed upstairs no more, don't ya? You can't go up the stairs no more.

-Why?

-They're blocked off.

-What?

-They're blocked off. Your toilet is there now.

Where?

Your toilet is there.

And you've got your bed down here.

Yeah. When?

When?

Now. You're home now.

So you're going to bed here at night-time.

And you go toilet there.

This comes off.

This is your home now.

This is where you lived before you fell and went in hospital.

I live too far to come over here and keep doing the everyday things.

And my daughter being still at school,

she's too young to leave on her own.

So I don't have much choice.

So somehow between me and my brother, we have to fit in what we can.

But he wants to come home,

so, better off in his own surroundings, I think.

We used to go out and have parties in the garden, didn't we?

-Uh-huh.

-In the summer.

Because their anniversary was in the summer, so it was always

a great excuse to have a drink, do you know what I mean?

Or everyone just come round for a chat.

We'd put the music on and everyone would be dancing in the garden.

Didn't care who was looking, who was watching, no-one bothered.

-Barbecues, weren't it?

-Yeah.

We miss all them, miss them laughs, don't we?

When we was younger and he was younger we used to go er,

he used to take us swimming.

Not just to our local pools.

-The lido.

-The lido, that's it.

-Open pool.

-Yeah.

He used to take us to...

In the summer, if he wasn't working, jump in the car, "C'mon, we'll go."

Mum didn't swim, so Mum would sit there with the food

and we'd all go on the diving boards and swimming pools

and Dad would be with us, joining us.

-We'd all have races, wouldn't we?

-Yeah.

My dad and my brother used to pick my sister up and me

and chuck us up in the air in the pool.

Obviously you can't do that now!

You don't expect it, though, do you, when they turn ill?

And only recently they've been giving him medication.

Cos you've got memory loss.

-Doctors at the hospital.

-Hah!

Do you know why you can't walk on your leg?

-No.

-Yes, they did!

Do you know how you hurt your leg before they put you in hospital?

No.

You wasn't walking, you was dragging your feet

and all of a sudden you kept falling.

I do find it difficult sometimes.

You get on the bus and go home and then you sit there

and think about it. And you get so upset.

Takes a toll on you sometimes, especially

when you're over here, if you come every day.

That's why I've stopped coming every day.

What do you fancy for your dinner? Hot dinner or a sandwich?

I don't want one.

-Will you have one tonight, then?

-Yeah.

Did you think I was going home now, is that what you thought?

No, I didn't. I wasn't listening to you.

Now, I don't want to appear rude.

It's ten days since Betty

was admitted to hospital following a fall.

Her social worker Gemma is concerned about the cluttered

state of the house Betty is planning to return to.

Betty currently is not willing to allow anybody into her home.

But I'm hoping that once some of its moved she'll allow us to help.

I still am independent if I go home without having strangers

more or less saying that ought to go there and this ought to go there.

That's not what I want.

And that's what I'm not going to have.

I'm sorry, but it's my home

and I'll have it and do it as I want to.

'I think the fact that she's got her independence is absolutely

'fantastic. Nobody wants to take that away from her, that's not what'

this is about, and I don't think by decluttering her house that's

going to take away her independence.

It's going to, if anything, give her more independence.

I just thought if we all sat down and talked together...

Uh-huh.

..because it's about what you want, your decisions...

-But we'd like to help as much as you'll let us.

-I know, I know.

I don't think, honestly speaking,

I don't want anyone to go in until I am there.

It's my home.

It might not be up to standard as it was 20 years ago, ten years ago.

But the basis is still there for me.

Even if we could just work on small goals of just clearing one

space at a time.

Rhonda, you've said you'll help, won't you?

Course I will.

But you've got to let us help you.

Until I've been home at least for two weeks,

I won't have settled into a routine.

What would you think about a temporary placement? Still going,

going home to sort out your home.

What I've got to sort out, yes.

Well, that sounds as though it needs looking into a bit further,

and that sounds all right.

So what do you want me to do now?

I don't want you to do anything.

Just think about it?

Yeah, yeah, let it sink in.

I'll get what information I can about a temporary placement

and see what sheltered accommodation's around.

Thank you very much indeed.

No, that's fine.

I do appreciate all the time you're giving me anyway.

We're going this way, down this way.

Oh, are we?

For those well enough to leave hospital,

Social Services has access to a limited

number of places in care homes for short-term, respite care.

Gemma's going away to see if there's anywhere that Auntie Bet

could have a temporary placement, so she's got somewhere to be

comfortable in and then go back to her house to try and get it sorted.

The only worry I've got is that Auntie Bet has said she doesn't want

any help for at least two to three weeks from any outside agencies.

I'm just hoping she will accept the help after this two to three weeks.

I've just got a feeling she might not, eventually,

get round to accepting help from anybody else.

That's my only concern.

We have done some further tests on your back,

and it does look like at some point when you fell you've injured one of

the bones at the bottom of the spine and it has crumpled slightly...

Henry Robinson is 82.

He came to Heartlands two weeks ago after falling downstairs.

You've got an infection on your lung, that does sometimes

happen when you're in hospital and not very mobile.

We'll get your chest better,

painkillers for the back ache,

and when your breathing is a little bit better in a day or so, we'll get

the physiotherapist to get you up and start moving you around again.

OK.

And our goal, keeping focused on it, is to get you home.

-OK.

-Is that what you want?

-Yeah.

-Good, OK.

Henry's daughter Pat has been helping him

since the death of his wife three years ago.

Hello, Dad.

How have you been?

-A bit better today.

-Oh, well, that's good. That's good.

Funny how just falling down the stairs gets you into a predicament.

Yes, well, it can't be helped, can it?

If you think positively, you'll be back home and normal again.

Yeah, but you'll just have a bit more help and it will make

life a lot easier than it...

-It obviously wasn't easy before, was it?

-Yeah.

He's had a urine infection, he's had this chest infection,

so he has been quite poorly.

Erm...

But hopefully, we're on the turn now and things will get better.

How are you feeling, though, in yourself?

Better than I was yesterday.

A bit better? You look better than I thought you would.

-Yep.

-Yeah.

Are you seeing the doctor about getting some fish? Cod.

-He wants...

-Did you say cod?

He wants you to get some scampi and chips.

THEY LAUGH

All right. We'll have a look, but I'm not sure.

'Well, I'd like to think that Social Services would be able to

'give him help at home.'

I mean, I go over there about three times a week anyway,

and I do his shopping and I clean the house.

Erm. I'm sure he'll be happier.

And it's his home, he's been there, ooh, lots and lots and lots of years.

So I wouldn't like to see him in a nursing home...

I saw my mum in a nursing home and I don't want to see my dad in one.

So hopefully he'll get a lot better and I'll keep more of an eye on him.

Social worker Gemma is also managing Henry's case.

She's called a meeting with his medical team.

We've started him on the appropriate antibiotics

and he is making some improvements.

That's what we're here for, is basically getting an appropriate

discharge destination and essentially a safe discharge,

so we are not going to rush him to be moved out of hospital

until he's ready, that's the main thing.

So it will be one step at a time.

How long is he likely to be in?

Not too long from now.

-Yeah.

-He's off the antibiotics through the drip,

-so he's back on tablet antibiotics now.

-Right.

And he's showing much more improved from the chest infection point of view.

We're looking at, upon discharge, a full package of care,

so it'll be morning, lunch, afternoon and then evening, service.

Very good. That sounds great.

-So we're not there yet.

-No, but we're getting there.

-But we've got a plan.

-Yeah.

Eat your sandwich nicely, please.

Sit down, Cath, please.

No, you eat that. It'll do you good.

-I don't want it.

-No, I don't want it.

After you've had your sandwich...

-Yeah, I'll have that.

-You have that.

-Right.

-That one.

-That one there.

BETTY: How, in all this world, have I

got my home into such a state of a mess?

Sid and I started our life together more or less, in that home

and we were perfectly happy.

I had hoped after my husband retired,

we could find somewhere smaller to live

and enjoy the rest of our lives together,

doing what we both enjoyed doing -

caravanning, going in the country.

We've always been cyclists in our young days.

I often speak to the good Lord,

although I may not visit church too often...

..and I do say, "Hope you don't mind,

"I'm not ready to go yet."

And with my little chats to my husband as well...

because to me, he's always there with me.

But as far as being ready, he's got to be patient for a little longer.

I never expected to age so quickly.

And I didn't feel that I'd aged so quickly.

It just got on top of me,

and I never thought that I would get into the state

that I've been living in.

I don't like even talking about now, I must be very honest.

I can't, Rob.

I'm so ashamed.

OK, see you soon, bye.

OK, she's 20 minutes away, so we'll just tell Dr Wallis.

Erm, Henry Robinson has deteriorated, he's quite unwell

at the moment, so we've actually rang the daughter to come in.

She's actually on her way and will be here in about 20 minutes.

It's ten days since the meeting to make plans for Henry to leave

hospital.

His daughter Pat is here with her best friend Sue.

-Excuse me.

-Dr Wallis is on his way.

I'm just finding it a bit difficult.

'He appears to have an infection on his lungs

'and possibly an infection in the urine as well.'

Um, we'd like to go to the bedside

and have another little look at him now and see how he's getting along.

You're welcome to come with us, would you like that?

Yes, but I just want to compose myself.

I don't want him to see me upset.

No, I understand, I understand that, I quite understand.

Are there any questions you want to ask us?

There's not going to be a lot you can do, is there?

Well, he's on the sort of maximum treatment that we can really

safely give on the ward here.

It's quite possible that he will pick up.

But hospital infections do tend to be quite virulent infections,

unfortunately.

Obviously if the treatments don't work

and he becomes more poorly, then, um, you know, he may well die.

And it...

it would be helpful to know from you, what sort of level,

what level of care you think Henry would want us to deploy.

Because the next step would probably mean moving up to an intensive

care unit.

But that would bring with it another lot of treatments that Henry

might find, er, quite burdensome.

I mean, if he...

If he's got a chance in intensive care then

I would go for that.

-Yeah, yeah.

-He's not the type of man to give up.

No, well that's exactly what I wanted to know from you.

'This is often a situation with older and frailer patients that

'when an infection supervenes, there isn't a lot of reserve -

'there's not a lot of physiological reserve

'and so patients can quickly become very unwell very quickly.'

Obviously the family are quite upset, that's understandable because

we've swung from discussions about going home to discussions about

whether he can survive and that's a lot for them to take on board.

Grandad, it's Hannah, can you hear me?

Can you hear me, Grandad?

Dad?

-Dad?

-Laura, can you come here a minute?

Laura! Can you come here a minute?

Laura! Excuse us for a second.

Check his thing is seven. The resus.

-No...

-Just excuse us for a bit.

ALARM BEEPS

SHOUTING

-Lucy!

-We've got someone helping out with chest compressions, please?

ALL TALK AT ONCE

Lucy, make sure the family are sitting...

-Keep going.

-OK.

Ready to jump in on the next one, yeah?

OK. Pulse is 32, can I just check the air entry?

-Wait a second, guys.

-Breathe!

-Breathe! Yeah, we got some air entry...

-OK.

Keep going then, lovely.

Who's giving drugs...?

'In this sort of setting patients are incredibly vulnerable and coming

'into hospital is swapping one set of risks for another set of risks.

'At home, there's a risk of him being on his own and falling, etc.'

In hospital there is another set of risks,

and those are obviously hospital-acquired infections.

So again, one's always trading one thing off against another.

Henry was resuscitated.

But three days later, he died with his family at his bedside.

'Stability in a frail older patient is really quite capricious.

'It's difficult to know how long it's going to last

'and how it's going to become de-stabilised.

'The trick is, I suppose, if one can call it that, is to get

'somebody back on their feet quickly,

'get everything organised and

'get them moved to the next, safest care setting as quickly as possible.

'Because the longer one delays in an environment where

'there are hazards, the more likely you are to fall victim to them.

'However, you know, if you manage to get somebody home quickly,

'there might have been another set of problems there.'

OK. Here you are, James.

'It's difficult to know, this is not an easy territory to predict

'and to chart.

'I think, you know, getting moved through

'the system as quickly as possible is the best way to try

'and avoid these sorts of problems happening.'

OK then, James, I'm going now. The calls.

OK, mate. Thanks for coming round.

There'll be somebody along for your next call at five o'clock for your tea call.

-OK, mate.

-Have a good day, see you soon. Bye.

TV COMMENTARY OF RUGBY

So, have you got any expectations, Betty,

of what it's going to be like?

Erm. I think it's going to be large,

spacious, friendly.

I should have maybe put that first!

When I walk in that door I shall know whether it's me, or it's not.

A month after her fall, Betty is taking

a look at one of several nursing homes suggested by Gemma.

It's the one closest to her niece Rhonda.

And you've got to remember it's not permanent.

No, that's right, that's what it isn't.

It's got to be better than the hospital ward.

You're right.

-OK, go in here and turn left.

-That's lovely.

-OK?

-Yes, fine.

If Betty likes it here,

her local authority will fund a place for a month.

It's nice and warm in here as well.

This is nice, Betty.

Yes, it is nice.

-Much better than the wards.

-What do you think?

-Is this going to be my room?

-This will be your room, yes.

Ooh, it's beautiful.

-There you go.

-Oh, that's lovely.

All right, can you see all right?

Oh, yes, and the big tree, the large tree,

they're huge aren't they? Oh, many years of growth on those.

What do you think Betty?

-Oh, it's lovely.

-Do you like the room?

-Oh, yes, I do.

-That's good then.

Thank you very much indeed.

I'm a happy lady at the moment.

I can see that.

I'm a happy lady, thank you.

'I'm really positive about Betty. I think it went really, really well.

'It's a hospital-to-home bed.

'So it's always with a view of going home.

'It's never, ever to be long-term.'

Cos that is the aim, for her to go home

and to have her independence back, so that is what we want.

And the house has got to be de-cluttered either way,

so I'd rather Betty be part of that.

Let me have a look at the bathroom.

Social Services pay a reduced rate of £525 per week

for Betty's temporary place.

Long-term residents who don't qualify for council funds

can pay twice that.

-It's been nice to get out.

-Mm, it has.

I bet you're looking forward to going back to have a cup of tea.

That's what I would like now, a nice cup of tea.

A nice cup of tea.

No, you haven't, Dad. You've not even been here an hour.

-Who ain't?

-You ain't!

-I have!

-No, you haven't.

Slippers.

Four weeks after returning home,

Jim Page is back at Heartlands A&E, following another suspected fall.

It doesn't seem five minutes

since he was in here and back out again, does it?

The carer that come this morning to dress you.

He's all right when someone's there, but they can't be there 24/7.

I assumed he was safe, being as it's been a while now.

But obviously not.

The A&E team and consultant Dr Sally Jones have to weigh up

the risk of sending Jim home.

Mr Page, you may or may not remember me.

My name's Dr Jones and I saw you before Christmas

when you were on ward 21.

Have you been managing OK or has it been a struggle?

-No, it's been all right.

-OK.

OK. Can you stand up for me now? Give it a try.

I want to see how difficult it is for you.

Oh, no, if I stand up my leg will hurt. I can't.

Give it a try. I want to see. I need to see how difficult it is

so we know what sort of help you need.

Argh. It's this leg.

OK. Try not to lean on that cos it's on wheels, all right?

If you stand up straight, how does that feel?

Oh, well, achy.

Achy. All right. You sit back down again.

OK.

-Oh, no.

-OK.

-Argh!

-OK.

'At some point, you know, we can't stop him falling completely,'

and I think he is always going to be at risk of falls.

If he was to go to a care home he would still be at risk of falls,

'but he'd be unhappy cos where he wants to be is home.'

We'll get our therapy team to come and see you

once you've had some more painkillers.

See if we can get you on your feet.

And, if you're well enough, we'll try and get you home.

-Is that what you would like?

-Yeah.

OK. We'll see what we can do to help you. OK?

-OK, love.

-All right.

'You know, this is the first blip we've had

'since all these extra things have been put in place.'

So I think it's worth another go. If it keeps happening,

we're just going to have to see where we go from here.

INDISTINCT

Oh! Sorry!

You know I'm tender!

I know you're tender.

It's also Betty's last day at Heartlands

and it's a special one.

'I've reached another year of my life.'

I believe in telling the truth.

'I wondered where I'd be,'

what I might be doing, anything wonderful or not.

Well, I think it's got to come under the heading of "not"!

Is this bag done, Betty? The next bag?

You can probably get a little bit more in that

cos it's got a stronger handle.

'It is still a big day

'because I am going to Arden Lea for approximately four weeks.'

I'll leave your bags with smelly stuff in there. That's all you need.

As I said to the manageress, "You never, never know. You might

"have to put up with me for longer than you think."

Be good. Mind what you're up to.

And it's been lovely meeting you.

And I'll give you a...

Oh, dear, I can't get at you! Your nose is in the way!

Oh, dear, I can't get at you. I can't bend down.

Never mind, here. That's done it, hasn't it?

Look, sit down for five minutes.

Now, I'm going to pull those curtains back and you'll see me.

All right? Take care.

-Bye.

-You mind how you go.

-I will.

The arm, I can't get it round.

There you go. Do you want it doing up?

No, no, I might have it.

-Bye!

-It's been lovely knowing you! Bye, Catherine! Bye. Bye, Catherine.

Jim is going straight home from A&E with the same care

package as before - four visits a day, paid for by the council.

I've been spoilt.

We have to spoil you, don't we?

-And it's your birthday today.

-And it's your birthday.

Beautiful. It's just how I like it.

Just how I like it.

-This is the menu for today. We've got beef casserole.

-Yes.

Cabbage, peas.

I won't see you tomorrow.

Oh, you're not on my programme to come tomorrow,

so I'll see you when I can.

-Is that Tuesday?

-I probably might see you Tuesday.

-Oh, yeah?

-Yeah.

-Are you done now?

-Yeah.

ALL: # Happy birthday, dear Betty

# Happy birthday to you. #

Oh, that's beautiful, Thank you so much.

Now we're directed to keep people independent at home.

He's by himself in that house now.

So we have to make sure that he's as safe as he feasibly can be.

With Jim back at home, community social worker Dave Sharp

picks up the case from his colleagues at the hospital.

How you doing?

-The leg.

-The leg?

-Yeah. Playing up.

-Playing up? Your knee or your leg.

-My knee.

And how's your mood? Are you in a good mood?

Are you chipper or are you feeling a bit low?

How are you feeling?

-Half and half.

-Half and half?

-Yeah.

-So up and down?

-Yeah.

OK. Do you ever feel lonely during the day, James?

Yeah, nobody sees me.

Nobody comes round and sees me.

So the carers occasionally come in and make you a drink and some food.

-That's it, yeah.

-Your daughter comes occasionally?

Now and again.

Are you invested in the process of keeping James here? Health pending.

-As far as we can. As far as we can, yeah.

-As much as you can. OK.

There's something called telecare when you can actually monitor

James' movements during the day, for a temporary period of time,

just to see if...what risk he's at.

Anything to keep him safe.

-Then if I can't get over then I know it's OK.

-Yes.

-Or at night-time.

That's what I'm suggesting.

I mean, you can be contacted in an emergency,

but it means that he retains some level of autonomy.

Independence. Stays here.

For as long as we can manage that and it's safe,

which is what he seems to want.

-All right. Thank you for your time.

-Yeah.

He's existing at this point, he's not really living.

But that's an enduring problem for older adult social work, really,

in the community.

Oh, dear.

In terms of your quality of life when you're isolated, it's possibly

limited when we're pushing down that road of keeping someone at home.

There should be more to life than just being safe.

ICE CREAM VAN JINGLE PLAYS

Would you like to push me back in? Oh, that looks nice.

"Thanking you, sir," she said.

Betty's month of convalescence at the nursing home

is coming to an end.

Social Services has been paying for her stay,

to give her time to make her house safe to return to.

-Hello, Betty, how are you?

-Better than I was when I first came here.

Yeah.

Gemma and her manager, David,

are here to discuss her plans for leaving.

You're looking so well.

The difference, seeing you today, is quite shocking.

Oh, I'm sorry if... You ought to have asked me.

I didn't know it was you. I nearly knocked on the door next door.

-Her eyes are brighter as well.

-Yes, very.

Do you feel better in yourself?

Yes, yeah. I'll be truthful - I don't feel I'm quite ready to go home.

I dread putting the key in and opening it first time.

So you haven't been home at all?

-Pardon?

-You haven't been home?

-No.

-No.

To be honest, I never felt well enough to...

SHE COUGHS Excuse me. ..go out.

Do you think you'd not go back? Who would sort out...?

I haven't even thought about it, Gemma.

Because obviously we were funding the placement for the four weeks.

-Yes.

-We're coming up to the end of the four weeks.

It's coming up to the end.

Not that it's rush, you've got to go.

Oh, yes.

But we do need to make plans.

That's fine.

I think what we're saying is that you need a bit more time,

and I think we're all agreed here that the best place for you

to stay at the moment is the place that you've improved

fantastically over the past, sort of, four weeks.

-I see.

-Enjoy your lunch.

Rather than risking her safety by letting her return home,

Social Services extends its funding by another month to give

Betty more time to declutter her house.

Auntie Bet is a very determined lady.

But I think because she's comfortable at Arden Lea, that pressure to get it

done has gone away because she's got a bit of respite from it.

I think that's what it is. I'm hoping that's what it is.

And facing up to going home will be even harder for Betty.

Gemma's student placement is coming to an end

and she'll have a new social worker.

If Betty had been more settled, I think it would

have been easier to leave.

It's difficult cos obviously I'm going to have to pass...

Somebody else will take over,

and Betty will have to build up that rapport again.

For the third time in five months, Jim Page is back in hospital.

When did you fall? A long time ago before the carer come?

-Just stay there and rest.

-Eh?

-Just lay there and rest.

He must have lain on the floor for a long time this time cos he's

got signs in his blood that he's been on the floor for quite a while.

That's probably contributing to him being quite poorly this time.

Mr Page. Are you having a snooze?

You're usually a little bit brighter than this.

Can we have a bit of a chat?

How are you feeling, anyway?

Half and half.

Yeah.

'I just wonder whether he's somebody that would actually do quite well'

in a residential home, in terms of not being quite so lonely,

having somebody to chat to, somebody to keep an eye on him, such that

if he was to fall he's not going to lie on the floor for many

hours undiscovered, which is what's happened this time.

I just wonder if we're approaching that point,

but it's a very difficult decision to make.

You know, even telling somebody that they've got cancer, in one

sense, is much easier than potentially making a decision

that somebody doesn't want that's really going to change their life.

Have you got somewhere we can have a private conversation, with a family?

Yes, let me just check... just check the room.

Hospital social worker Dolores has taken over Jim's case

from her community colleagues.

I mean, what we're getting at the moment is approximately

a maximum package of care. OK?

So what we would be looking at now is

whether or not that is going to continue to meet his needs

when he goes home or do we need to look at something else for him?

Would you consider him going into a placement?

-At a very last resort.

-Yeah.

If he was to go into a placement, chances are it'd probably be

a nursing home, based on where he is now.

They would be able to provide him with all the care

and support he needs, 24 hours a day.

You could sort of breathe easy, when you know you can't be with him,

that you know he's being looked after properly.

So it might be something you would like to consider.

I know it's difficult.

It's always difficult for families to make this decision.

At the nursing home,

Betty's period of funded respite care is once again nearing its end.

But she still hasn't been home to declutter her house.

After several meetings with Social Services managers, the pressure

is on Betty, and her new social worker Trish, to find a solution.

'We have very limited resources we have available to us.

'So normally a person can remain there for a period of four weeks,'

so I have to have that discussion with

Betty now that we need to be making a decision.

As Betty owns her own home and has some savings,

from now on she'll have to pay for her temporary place.

To stay here permanently, Betty may have to sell her house.

-Are you comfy and ready?

-Yes, I'm comfy.

-OK, OK.

Go on, then, Trish.

Really, the bed, it won't be funded much more than from Monday onwards.

I don't think that you've been home yet, have you?

No, I haven't.

Have you made a decision?

Oh, yes, I am going to go home.

-OK. Well, we've tried.

-Yes, you have.

-And you've made your decision.

-Mm.

You know the risks of going home.

I know every risk that's going.

OK.

What I will need to explain now,

I'll need to get in touch with the environmental health people.

What for?

In terms of... My understanding is you've gathered a lot of things.

Yes, yes.

Well, they would really like to come in just to

assess in terms of fire, risks to neighbours.

-I think you have to be there when they attend...

-Shall I tell you?

-It's not something that...

-I shall be there.

No-one goes in that house other than Rhonda and myself.

Yeah, absolutely. They're aware of that.

What possessions I have saved for my own pleasure at home,

it's nothing at all to do with anyone.

I needn't have told you anything about those possessions.

It was just my story.

Look. You're going to upset me, Trish, and I'm not having it.

So I suggest you either go or you don't talk to me

any more about home.

Betty, I had to be open and honest.

It's not for them to go in and poke around your possessions.

I'm not saying anything more, and that's final.

Now, do you mind? I've had enough already today.

I'll leave you to it. I do appreciate that.

I'm just not well.

I don't want to hear the words Social Services ever again in my life.

She won't let us in.

If she was to give a little bit,

we could have helped her a bit more, I think.

But that's it. She's made her decision and I think it will be

back to Rhonda now to be picking up the pieces.

And I think, for us, we'll just have to wait to see

if Betty does reach a point where she does feel she

would work with us.

I don't know if that will ever happen.

HE COUGHS

Hiya, Dad. Hiya.

Hiya.

-Are you all right?

-Yeah.

-Yeah?

-Yeah.

You're moving to another place.

They're going to move you into another place soon.

Why?

Well, there's nurses there.

You'll be looked after again, still the same.

It's just another building.

Like a nursing building, nursing home

and they can keep an eye on you better.

I'm not saying these are not keeping an eye on you,

but they've more time for you.

'I just wish my dad would respond to me telling him

'he's got to go into a nursing home how he did last time he responded,'

by telling us all to do one.

Screaming, shouting.

That would be my dad and I'd prefer that.

At least he can talk to me then, he's got something to say to me.

Whereas now he just don't say anything.

All right then. See you tomorrow sometime.

Bye. All the kids send their love to you, OK?

Bye.

-HE COUGHS

-Ta-ra.

-Bye.

'It was wonderful at Arden Lea.

'I was happy.

'But I will not go into a home just to get out of doing

'what needs to be done at my home.'

-Hello.

-Oh, hello. Oh, food, food, food.

Yes. Are you hungry?

What we having nice for pudding? You don't know?

Listen. It's like lemon jelly, full fat yoghurt, light yoghurt.

-No ricey pudding?

-No rice pudding today.

-I can ask for ice cream.

-Ice cream, yes, please.

-Would you like some ice cream?

-Yes, I would today, thank you.

-Thank you.

-Thank you, my dear. Mind how you go. Don't you fall!

God, we've got everybody falling round here.

-I'm going to do some work.

-OK, all right.

'It's still a draw to go home, even now.

'It always will be.

'Because Sid and I started our life together in that home.

'And even though I'm on my own now, it still draws me

'because it's part of me.'

It's peace, perfect peace in this dark world of sin.

Why don't you open the door and let me come in?

I don't want to go into a care home.

I've got my home here.

I think, at some point, you're going to have to make the decision,

with our help, that it's not possible any more

and that maybe we look at an alternative.

We want to remain together.

What judgments do we make about people older than us?

Should we be challenging ageism?

Join the Open University debate around ageing by going to

bbc.co.uk/protecting our parents

and follow the links to The Open University.