0:00:02 > 0:00:05LINE RINGS
0:00:05 > 0:00:08'Ambulance service. Is the patient breathing?'
0:00:08 > 0:00:10'Hello. Is the patient breathing?'
0:00:17 > 0:00:19'Are you having trouble breathing?'
0:00:21 > 0:00:23'That's OK. Don't worry, don't worry.'
0:00:24 > 0:00:26'We know where you are. We know where we're coming to.'
0:00:30 > 0:00:34Kathleen and Leonard Price live in Birmingham
0:00:34 > 0:00:37in the house they've owned for 50 years.
0:00:37 > 0:00:38They want to stay there.
0:00:38 > 0:00:40LINE RINGS
0:00:40 > 0:00:43'Ambulance Service. Is the patient breathing?'
0:00:55 > 0:00:58Kathleen is permanently bed-bound.
0:00:58 > 0:01:02She receives social services' maximum home care package.
0:01:02 > 0:01:03But in the past three months,
0:01:03 > 0:01:09she's called 999 over 150 times asking for help.
0:01:09 > 0:01:11LINE RINGS
0:01:11 > 0:01:13'Ambulance Service. Is the patient breathing?'
0:01:19 > 0:01:22We had an e-mail yesterday, regarding Mr and Mrs Price.
0:01:22 > 0:01:24The elderly care system
0:01:24 > 0:01:27aims to keep us in our own homes for as long as possible.
0:01:27 > 0:01:30But as our population ages rapidly,
0:01:30 > 0:01:33the NHS and social services are struggling
0:01:33 > 0:01:35to work together to keep us there.
0:01:35 > 0:01:37I don't want to go into a care home.
0:01:39 > 0:01:40I've got my home here.
0:01:40 > 0:01:44Doctors and social workers have to balance stretched budgets
0:01:44 > 0:01:47against our needs and desires.
0:01:47 > 0:01:50It's a dilemma. I want them to be at home, together.
0:01:50 > 0:01:52But it's been explained to her
0:01:52 > 0:01:55that if it doesn't work at home it will be long-term care.
0:01:55 > 0:01:58I think at some point you're going to have to make the decision,
0:01:58 > 0:02:01with our help, that it's not possible any more
0:02:01 > 0:02:04and maybe we look at an alternative.
0:02:04 > 0:02:05We want to remain together.
0:02:07 > 0:02:10As we get older, who should make the decision
0:02:10 > 0:02:13that we can no longer be cared for in our own home?
0:02:15 > 0:02:17Well, we had a good life, really, didn't we?
0:02:17 > 0:02:18Yes.
0:02:20 > 0:02:22Happy days, though.
0:02:22 > 0:02:25- All memories.- Yeah.
0:02:25 > 0:02:27Memories.
0:02:43 > 0:02:45'Ambulance Service. Can I help you?'
0:02:45 > 0:02:50'Yes, we've got a female who's 80 years old who's unconscious.'
0:02:50 > 0:02:51'OK, and a name at all?'
0:02:51 > 0:02:54'Er, yes. She's called Kathleen Price.'
0:03:02 > 0:03:06Kathleen has been brought to Birmingham's Heartlands Hospital
0:03:06 > 0:03:08with a suspected kidney infection.
0:03:08 > 0:03:10OK, she'll be going into...
0:03:10 > 0:03:13I'll put her into bay one, actually.
0:03:13 > 0:03:16It's her fourth emergency admission in 18 months.
0:03:18 > 0:03:22Kathleen Price has been down in A&E for quite a few hours now.
0:03:22 > 0:03:24Probably looking at about seven or eight hours.
0:03:24 > 0:03:27She's not able to come up because we've got no bed space for her.
0:03:27 > 0:03:29So she's got to sit it down in A&E.
0:03:30 > 0:03:34A&E's quite full regularly in wintertime.
0:03:34 > 0:03:36There's a lot of pneumonias coming through,
0:03:36 > 0:03:39falls - it's a lot to do with the elderly, actually.
0:03:43 > 0:03:47Kathleen is stabilised, and after a nine-hour wait,
0:03:47 > 0:03:50she's moved to a bed on a renal ward for treatment.
0:04:07 > 0:04:08All right, I'll keep you in the loop...
0:04:08 > 0:04:12Birmingham Social Services' older adults team has been managing
0:04:12 > 0:04:15the Prices' case for over 18 months.
0:04:15 > 0:04:19They are a devoted couple who have been married, I think,
0:04:19 > 0:04:21about 60 years.
0:04:21 > 0:04:22They live for each other.
0:04:22 > 0:04:24It's a very symbiotic relationship, they live for each other.
0:04:25 > 0:04:30But he's not in good health himself, which has slowed him down.
0:04:30 > 0:04:34He's not sleeping in his bed now - he sort of sleeps downstairs.
0:04:36 > 0:04:39The Council pays for two carers to visit Leonard twice a day.
0:04:41 > 0:04:45With Kathleen in hospital, his case-worker Sam Iliffe
0:04:45 > 0:04:47is also checking up on him.
0:04:52 > 0:04:53Hiya, are you all right?
0:04:55 > 0:04:59Leonard and Kathleen have two sons - one estranged,
0:04:59 > 0:05:04and another who visits whenever he can, but lives over 120 miles away.
0:05:04 > 0:05:08Leonard, you know why I've come today, don't you?
0:05:08 > 0:05:10Remember I rang you yesterday?
0:05:10 > 0:05:14- Yeah.- I've just come today to check you're OK and see if you're coping
0:05:14 > 0:05:16while Kathleen's in hospital.
0:05:16 > 0:05:18- Yes, I'm all right. - You look very smart.
0:05:18 > 0:05:22- I've only just got up. - You've just got up?
0:05:22 > 0:05:24- Yeah, I sleep here. - You're still sleeping downstairs?
0:05:24 > 0:05:26- Yeah.- Even though Kathleen's not here?
0:05:26 > 0:05:31- No. I've got used to it now. - And you're coping OK at the moment?
0:05:31 > 0:05:35- Yes.- OK.- Feels a bit strange being on your own.
0:05:35 > 0:05:37I know.
0:05:37 > 0:05:38No-one to talk to?
0:05:38 > 0:05:42- Yeah. Nobody to row on, like. - No-one to row on!
0:05:42 > 0:05:46- At least you can watch what you want on the TV.- That's it.
0:05:46 > 0:05:49You've got the control over the remote control.
0:05:49 > 0:05:54Yeah. I like a good cowboy film, you know.
0:05:55 > 0:05:59A Western, like. I don't mean these silly things.
0:06:00 > 0:06:04But, um, she likes a love story.
0:06:04 > 0:06:07- Aah! The romantic stuff.- Romantic!
0:06:07 > 0:06:08You not romantic?
0:06:08 > 0:06:10HE LAUGHS
0:06:10 > 0:06:13She keeps slipping down that bed.
0:06:13 > 0:06:15I used to have to keep pulling her up.
0:06:15 > 0:06:18You'll end up hurting yourself lifting her.
0:06:18 > 0:06:20Yeah, well, I've been doing it, though.
0:06:20 > 0:06:22You shouldn't. You'll hurt yourself.
0:06:22 > 0:06:26We'll have to see what she's like when she comes home.
0:06:26 > 0:06:31Yes. She's hoping to be home next week.
0:06:31 > 0:06:32That's good.
0:06:32 > 0:06:33Hoping.
0:06:36 > 0:06:38She's been a good wife.
0:06:46 > 0:06:47LINE RINGS
0:06:49 > 0:06:51Hello, Kay, my name is Louise Graham, I'm a social worker
0:06:51 > 0:06:53here at Heartlands Hospital...
0:06:53 > 0:06:56While Kathleen recovers from her kidney infection,
0:06:56 > 0:06:58responsibility for planning her care
0:06:58 > 0:07:03when she leaves Heartlands is handed to the hospital social work team.
0:07:03 > 0:07:07I'm just trying to clarify what was happening in the community
0:07:07 > 0:07:10prior to her admission, you see.
0:07:14 > 0:07:16Do you know how many times she's called them?
0:07:24 > 0:07:2657...?
0:07:26 > 0:07:2757,000...?
0:07:38 > 0:07:40Like most local authorities,
0:07:40 > 0:07:44Birmingham doesn't pay for 24-hour care at home.
0:07:44 > 0:07:46And Kathleen doesn't have enough savings
0:07:46 > 0:07:48to fund her own care privately.
0:07:48 > 0:07:51- Hello, are you Mrs Price?- Yes.
0:07:51 > 0:07:53Hi. I'm Louise Graham.
0:07:53 > 0:07:55Social services' maximum care package
0:07:55 > 0:07:59provides four visits a day by two carers.
0:07:59 > 0:08:02But this doesn't appear to be meeting her needs.
0:08:02 > 0:08:05Obviously there's been meetings in the community
0:08:05 > 0:08:07and I know they've spoken to you before...
0:08:07 > 0:08:09- Yes, and I'd rather be at home. - ..and that you want to go home.
0:08:09 > 0:08:13- Yes.- I don't want you to worry that I'm pushing for anything else,
0:08:13 > 0:08:16I just want to make sure that that's what you want
0:08:16 > 0:08:19and that you understand that how things were
0:08:19 > 0:08:21before you came into hospital
0:08:21 > 0:08:24when you were calling, say, the emergency services,
0:08:24 > 0:08:26it can't really continue.
0:08:26 > 0:08:29But we need to make sure that, going forward,
0:08:29 > 0:08:32that you have the right support
0:08:32 > 0:08:37and that we can reduce those calls to the emergency services.
0:08:37 > 0:08:40How long will it be before I can go home?
0:08:40 > 0:08:44At the moment, I'm not sure, because I think we may need
0:08:44 > 0:08:47to get the community social work team involved
0:08:47 > 0:08:50with the planning of your discharge, you see,
0:08:50 > 0:08:53to make sure we have everything in place.
0:08:55 > 0:08:58I thought she was very coherent.
0:08:58 > 0:09:01I do believe she has got capacity to make the decision about going home.
0:09:01 > 0:09:05Obviously she's aware of the calls,
0:09:05 > 0:09:09but it's about, is she aware of the implication it has on others?
0:09:09 > 0:09:12That probably is questionable.
0:09:12 > 0:09:14And I know Mrs Price wants to go home soon,
0:09:14 > 0:09:18but I don't think it's going to be as soon as she would like.
0:09:18 > 0:09:21Kathleen is now well enough to leave hospital,
0:09:21 > 0:09:25but she can't go home until she has the right level of care in place.
0:09:26 > 0:09:31She's occupying a bed that costs the NHS £310 a day,
0:09:31 > 0:09:34and so for each day she remains on the ward,
0:09:34 > 0:09:39social services are liable for a £100 fine from the Hospital Trust.
0:09:39 > 0:09:41It's in their hands now.
0:09:41 > 0:09:45Yes. But I'd still like to go home.
0:09:45 > 0:09:47That sounds ungrateful, don't it?
0:09:47 > 0:09:49There's no place like home.
0:09:51 > 0:09:52No.
0:09:58 > 0:09:59I don't like leaving him.
0:10:01 > 0:10:04We're always together, you know.
0:10:04 > 0:10:09Married, and before that we was courting.
0:10:09 > 0:10:12He was in the forces, mind you.
0:10:12 > 0:10:16He didn't get married in uniform because he was already out,
0:10:16 > 0:10:20but he wore his de-mob suit, we called it.
0:10:21 > 0:10:22Yes.
0:10:25 > 0:10:28Yeah. Yes.
0:10:28 > 0:10:30Very nice.
0:10:30 > 0:10:32Seems a long time ago now.
0:10:39 > 0:10:44He's missing me more, I think. But he's coping.
0:10:44 > 0:10:48But he wouldn't strike out on his own, no.
0:10:48 > 0:10:50I don't bully him.
0:10:51 > 0:10:57He just, he takes the easy way out really, you know.
0:10:57 > 0:10:59Like most men!
0:10:59 > 0:11:00Yes.
0:11:06 > 0:11:08Any questions you have for me?
0:11:08 > 0:11:12Professor George Tadros is a consultant psychiatrist
0:11:12 > 0:11:14for the local mental health trust.
0:11:14 > 0:11:18So in December she called 999 80 times,
0:11:18 > 0:11:21and 80-plus times in February.
0:11:21 > 0:11:24While social services are trying to put in place a care package
0:11:24 > 0:11:26that will work for Kathleen,
0:11:26 > 0:11:28the hospital team wants to test her memory
0:11:28 > 0:11:32and her understanding of her needs at home.
0:11:32 > 0:11:39The law assumes that all of us above the age of 16 have mental capacity.
0:11:39 > 0:11:42So we can make decisions for ourselves.
0:11:42 > 0:11:45And the law specifies if we have mental capacity,
0:11:45 > 0:11:48we can make whatever decisions we want -
0:11:48 > 0:11:53even if those decisions are seen to be ridiculous or wrong,
0:11:53 > 0:11:54as we do sometimes.
0:11:54 > 0:11:57The difficulty in health care, especially with dementia,
0:11:57 > 0:12:00when the patient can't make those decisions,
0:12:00 > 0:12:03if the patient doesn't have capacity,
0:12:03 > 0:12:07that doesn't mean we take their lives away from them -
0:12:07 > 0:12:10no, that means we have to make decisions
0:12:10 > 0:12:12based on their best interest.
0:12:14 > 0:12:16Kathleen's doctors and social workers
0:12:16 > 0:12:20tested her mental capacity on two separate occasions
0:12:20 > 0:12:24before she came into hospital - with conflicting results.
0:12:24 > 0:12:27- How are you doing today? - Very well, thank you.
0:12:27 > 0:12:28Very good.
0:12:28 > 0:12:31Do you think the care package will work in the future for you?
0:12:31 > 0:12:33I'm sure it will. As soon as you get on your feet
0:12:33 > 0:12:37- then you soon get going, don't you? - Right, and you hope you'll be back
0:12:37 > 0:12:39on your feet and then things will...?
0:12:39 > 0:12:43Yes. Take it steady, you know. Take it steady.
0:12:43 > 0:12:45I have been looking into your records
0:12:45 > 0:12:48and it looks like you have been calling 999.
0:12:50 > 0:12:52- No, not necessarily. - Not necessarily, OK.
0:12:52 > 0:12:55- No.- Right.
0:12:55 > 0:12:57So, what are the situations
0:12:57 > 0:13:01when you would feel it is appropriate to call 999?
0:13:04 > 0:13:07I don't remember that I have called it that many times.
0:13:07 > 0:13:10No, all right, OK. And how's your memory?
0:13:10 > 0:13:13- Very good.- What day is it today?
0:13:13 > 0:13:16Erm...you've got me.
0:13:16 > 0:13:19Well, it's difficult when you are in hospital to keep track of days.
0:13:19 > 0:13:21But do you know what month is it?
0:13:21 > 0:13:23It's April.
0:13:23 > 0:13:28Kathleen, can I ask you to try to remember three objects for me?
0:13:28 > 0:13:30All right? I'm testing your memory now.
0:13:31 > 0:13:35Lemon, key, flag.
0:13:35 > 0:13:37Can you repeat them?
0:13:37 > 0:13:39Lemon, key, slag.
0:13:39 > 0:13:41- Flag.- Slug.
0:13:41 > 0:13:43No, flag, you know the flag?
0:13:43 > 0:13:44- Oh, flag!- Yes!
0:13:44 > 0:13:47Lemon, key, flag.
0:13:47 > 0:13:50Very good, OK. Keep them in your mind.
0:13:50 > 0:13:55Can you tell me the days of the week backwards, beginning from Sunday?
0:13:55 > 0:13:59Sunday, Saturday, Friday, Thursday,
0:13:59 > 0:14:03Wednesday, Tuesday...Monday.
0:14:03 > 0:14:08Very good. Do you remember the three objects you repeated after me?
0:14:10 > 0:14:11Er...
0:14:16 > 0:14:19- It's gone. - That's all right. That's all right.
0:14:19 > 0:14:23- I'm not doing very well, am I? - No, I think you're doing very well.
0:14:23 > 0:14:28I know your memory is not brilliant, but that's OK.
0:14:28 > 0:14:30Do you have any questions for me?
0:14:30 > 0:14:34Not really, apart from when am I going home?
0:14:34 > 0:14:37We're not ready for care homes and things like that.
0:14:37 > 0:14:38You're not ready for that?
0:14:38 > 0:14:41- No.- Do you think in the future you might consider that?
0:14:41 > 0:14:42Well, you don't know, do you?
0:14:42 > 0:14:45No. We'll certainly help you to go back to your home.
0:14:45 > 0:14:48Yes. Well, I hope so.
0:14:48 > 0:14:51- We'll do that.- Yes.- All right.
0:14:51 > 0:14:53Kathleen, good to see you.
0:14:53 > 0:14:55Lovely to meet you. Take care, bye-bye.
0:14:58 > 0:15:02I think in Kathleen's case, there is a genuine memory impairment,
0:15:02 > 0:15:07but also I think she underestimates her needs.
0:15:07 > 0:15:10She has been calling 999 very frequently,
0:15:10 > 0:15:12but as she was telling me,
0:15:12 > 0:15:16she can't remember that she called them that often at all.
0:15:16 > 0:15:18She can express herself,
0:15:18 > 0:15:21but she fails to comprehend what is going on around her.
0:15:23 > 0:15:25Kathleen lacks capacity.
0:15:25 > 0:15:29We will communicate that to the social services work team here
0:15:29 > 0:15:31and in the community,
0:15:31 > 0:15:35because the difficulty with elderly care, as you have seen -
0:15:35 > 0:15:37many people involved,
0:15:37 > 0:15:41and we need to keep them together working on the same plan.
0:15:54 > 0:15:57I understand where the medics are all coming from,
0:15:57 > 0:16:01the cost involved and manpower
0:16:01 > 0:16:04and she keeps ringing the ambulance service and it's inappropriate.
0:16:04 > 0:16:06It's horrendous. Who knows?
0:16:06 > 0:16:10One of these days that ambulance that she's called, I might need it.
0:16:10 > 0:16:14But every time I speak to her about it she says
0:16:14 > 0:16:16she knows it's wrong and she shouldn't do it.
0:16:18 > 0:16:20There's the assessment that you asked for.
0:16:20 > 0:16:24Senior social worker Anna Wilkie is Louise's manager.
0:16:25 > 0:16:28Seems to be lacking capacity.
0:16:28 > 0:16:33Social services has concerns about Professor Tadros's assessment.
0:16:33 > 0:16:36Denies that she has been calling 999...
0:16:36 > 0:16:40The decision that Kathleen lacks capacity means that in future
0:16:40 > 0:16:44she may not be allowed to choose where she lives.
0:16:44 > 0:16:45It's life-changing.
0:16:45 > 0:16:49We're making a decision that could change this person's life,
0:16:49 > 0:16:51and you have to weigh up everything
0:16:51 > 0:16:54and you have to keep going back and asking these questions.
0:16:54 > 0:16:58Because otherwise, if you get it wrong it might mean them
0:16:58 > 0:17:02having to be separated and you cannot undertake it lightly.
0:17:02 > 0:17:04You can't.
0:17:04 > 0:17:06Hello, Mrs Price.
0:17:08 > 0:17:12OK, then. So you know we're trying to arrange for you to go home
0:17:12 > 0:17:13with your package of care.
0:17:13 > 0:17:15Yes. OK.
0:17:15 > 0:17:21I know there were issues when you went home with you calling
0:17:21 > 0:17:26services at times when you needed to be lifted up the bed, or...
0:17:26 > 0:17:29I'm not trying to make you feel bad.
0:17:29 > 0:17:30I don't want you getting upset about this.
0:17:30 > 0:17:34- No, I won't.- I just need to know that you understand
0:17:34 > 0:17:36it's not a good thing to do.
0:17:36 > 0:17:39No, I thought it was settled, that point.
0:17:39 > 0:17:42You know, about calling in to 999.
0:17:42 > 0:17:46- So, you know it's not a good idea? - Well, obviously.
0:17:46 > 0:17:48So, what we were thinking,
0:17:48 > 0:17:52we've tried to come up with some extra support.
0:17:52 > 0:17:54So, what my manager has agreed to do,
0:17:54 > 0:17:57the person who holds the funding,
0:17:57 > 0:18:01she's agreed to give you an extra call...
0:18:01 > 0:18:06- Yes.- ..and hopefully it'll solve the problem
0:18:06 > 0:18:09and you won't need to be calling the ambulance service.
0:18:09 > 0:18:12- Yes.- So, do you think that's a good plan?
0:18:12 > 0:18:15- I think so. It's like an extra call. - Yeah.
0:18:15 > 0:18:19As I say, I would never call 999 unnecessarily.
0:18:19 > 0:18:22Great. We'll get you out of here as soon as we can.
0:18:22 > 0:18:26She fully understands that ringing the ambulance service
0:18:26 > 0:18:30to be lifted up the bed is not what you should do.
0:18:30 > 0:18:34But her need, to her, is very real and very apparent as well.
0:18:35 > 0:18:37She's been quite rational.
0:18:37 > 0:18:40- OFF CAMERA:- So, do you think that she has capacity?
0:18:40 > 0:18:42I do.
0:18:42 > 0:18:46She fully understood that it wasn't what she should be doing.
0:18:48 > 0:18:52As the question over her mental capacity remains unresolved,
0:18:52 > 0:18:55Kathleen can still make decisions about her own care.
0:18:56 > 0:19:01After five weeks in hospital, she will be allowed to return home,
0:19:01 > 0:19:05with an extra care visit in place - and two more for husband Leonard.
0:19:06 > 0:19:10Social services hope it will stop her calling 999 for help.
0:19:18 > 0:19:22So, do think we should phone him?
0:19:22 > 0:19:25You know, is he prepared for his wife to come home?
0:19:25 > 0:19:27I will go and ring him now.
0:19:27 > 0:19:29It's the day of Kathleen's discharge
0:19:29 > 0:19:33and the community social work team is planning for her return home.
0:19:36 > 0:19:37LINE RINGS
0:19:42 > 0:19:45It's answer machine, I'll ring back in a sec.
0:19:45 > 0:19:47LINE RINGS
0:19:56 > 0:19:59Still answer machine.
0:19:59 > 0:20:01LINE RINGS
0:20:01 > 0:20:03- I don't know where he is. - All right, OK...
0:20:10 > 0:20:11Is Leonard there, please?
0:20:11 > 0:20:14One of Leonard's carers picks up the phone.
0:20:16 > 0:20:17He's gone out?
0:20:19 > 0:20:21He's not in the house at all?
0:20:21 > 0:20:24Is he not in the garage?
0:20:24 > 0:20:27Back door's locked. He's nowhere in the garden at all?
0:20:27 > 0:20:29And all upstairs is totally clear?
0:20:30 > 0:20:32OK, do you want me to give you my number
0:20:32 > 0:20:34so you can give me a ring if you find him?
0:20:34 > 0:20:36OK, thanks. OK, thanks.
0:20:36 > 0:20:38Bye.
0:20:38 > 0:20:40- So how long has he been missing now? - Well...
0:20:42 > 0:20:44We've been ringing since half past ten.
0:20:46 > 0:20:50Nearly an hour. So has the carer been in today?
0:20:50 > 0:20:52- There is a carer there now. - PHONE RINGS
0:20:52 > 0:20:54Hello.
0:20:55 > 0:20:58He's gone to hospital. Which hospital is he in?
0:21:00 > 0:21:03Half six this morning. OK. Bye.
0:21:03 > 0:21:05He went his hospital this morning about half six.
0:21:05 > 0:21:09- Well, how can she be discharged? - Kath can't go home then, can she? - No.
0:21:13 > 0:21:16Hello, is that ward three? Hello, ward three. My name is Kaye Duhig,
0:21:16 > 0:21:18senior practitioner, Hodge Hill.
0:21:18 > 0:21:21You've got Kathleen Price with you, haven't you, at the moment?
0:21:21 > 0:21:23I know she was due for discharge today -
0:21:23 > 0:21:26her husband has been admitted now.
0:21:26 > 0:21:30Well, I want to make sure that this patient is not discharged.
0:21:31 > 0:21:36Leonard has been brought into Heartlands with a twisted bowel.
0:21:37 > 0:21:43I was expecting to go home, but fortunately or unfortunately,
0:21:43 > 0:21:47my husband has had to come back in
0:21:47 > 0:21:51and so there was nobody there to receive me.
0:21:54 > 0:21:57I am glad that I have stayed here.
0:21:57 > 0:22:00I don't think I would be capable for the time being.
0:22:05 > 0:22:09It was very frustrating to find out that after all our hard work
0:22:09 > 0:22:12that the area social worker had rung ward three
0:22:12 > 0:22:15and had cancelled the discharge of Mrs Price
0:22:15 > 0:22:19because Mr Price had come into hospital.
0:22:19 > 0:22:22Well, you know, as far as the hospital is concerned,
0:22:22 > 0:22:24that doesn't matter.
0:22:26 > 0:22:28I know it sounds very hard and very callous,
0:22:28 > 0:22:29but it doesn't matter.
0:22:29 > 0:22:35She shouldn't be on an acute hospital ward,
0:22:35 > 0:22:39not when everything is in place for her to go home.
0:22:39 > 0:22:42- Kathleen.- Yes.
0:22:42 > 0:22:46We have spoken to the social worker and you are going home today.
0:22:47 > 0:22:48I am going home today?
0:22:48 > 0:22:53Yes, yes. There will be a carer at home at six o'clock.
0:22:53 > 0:22:55I see. OK?
0:22:55 > 0:22:56But Len is staying in?
0:22:56 > 0:23:01- Leonard, yes - just for overnight monitoring, OK?- All right.
0:23:01 > 0:23:02Yes, thank you.
0:23:10 > 0:23:13The decision that Kathleen can return home safely
0:23:13 > 0:23:16has been taken by the social workers' managers
0:23:16 > 0:23:18and the Hospital Trust.
0:23:18 > 0:23:20I have had a call from the hospital
0:23:20 > 0:23:23and the ward want to discharge her home.
0:23:23 > 0:23:26I said, "Well, he's not going to be there."
0:23:26 > 0:23:30You know, she's been in hospital coming up to five weeks.
0:23:30 > 0:23:31She is going to be lonely, isolated.
0:23:31 > 0:23:33She'll be on the phone to the ambulance
0:23:33 > 0:23:36because she will feel, you know, there is nobody there.
0:23:36 > 0:23:38So it's starting the problem again.
0:23:40 > 0:23:44You do see the Trust's side of it.
0:23:44 > 0:23:47I understand both sides and you feel like piggy in the middle.
0:23:49 > 0:23:51And part of me wanted to be able to say,
0:23:51 > 0:23:55"Oh, no, she can stay here until he goes home."
0:23:55 > 0:23:57Because that would be lovely in an ideal world -
0:23:57 > 0:23:59but that's not the real world,
0:23:59 > 0:24:02because we have got no beds for people who are really ill.
0:24:04 > 0:24:06I didn't think they would let me.
0:24:11 > 0:24:14There'll be a carer there for six o'clock.
0:24:20 > 0:24:22There is a reason for everything.
0:24:34 > 0:24:37- All the best. Look after yourself. - Thank you.
0:24:37 > 0:24:40No problem.
0:24:43 > 0:24:48Sad though it is, there are hundreds of people in the community
0:24:48 > 0:24:50who have nobody else living with them,
0:24:50 > 0:24:54who are bed-bound and who rely on carers going in,
0:24:54 > 0:24:57and that's the only contact they have, day in, day out.
0:25:17 > 0:25:19The carers should have been here.
0:25:19 > 0:25:20And we don't know what the carers do.
0:25:20 > 0:25:22Is that where you're going - into your bed?
0:25:22 > 0:25:26- Sorry?- Is that where you wanted to go, into your bed?
0:25:26 > 0:25:28I ain't fussy. Whichever is easiest.
0:25:28 > 0:25:33Do you sit here, sometimes? We can put you there all right.
0:25:33 > 0:25:37- All right, Kath?- Yeah. - Have you got her?- Yeah.
0:25:37 > 0:25:40Have I got her?
0:25:40 > 0:25:43- You better have! - THEY LAUGH
0:25:43 > 0:25:45Are you ready, Kath? Same as we done in the ambulance, ready?
0:25:45 > 0:25:46One, two, three...
0:25:49 > 0:25:52- Ta.- Comfy?- Yeah. - Is that all right?
0:25:52 > 0:25:56We want to leave you so you feel comfortable and safe.
0:25:56 > 0:25:59- You should have gone straight into bed, really.- Oh...
0:25:59 > 0:26:01Oh, God.
0:26:01 > 0:26:04- Are you comfortable like that, Kath?- Not really.
0:26:04 > 0:26:06Not really, no.
0:26:06 > 0:26:08I am a nuisance.
0:26:08 > 0:26:10No, it's not your fault, Kath.
0:26:10 > 0:26:14If the carers had been here there wouldn't be any problem
0:26:14 > 0:26:17because they can hoist her straight onto the bed.
0:26:17 > 0:26:20So we can just do what we can.
0:26:20 > 0:26:23- Hello.- Help yourself!
0:26:23 > 0:26:27Hello, Kath. Long time no see!
0:26:27 > 0:26:31Hello, welcome home, how are you, Kath?
0:26:31 > 0:26:33Not too bad.
0:26:33 > 0:26:35It's good to see you home, anyway, Kath.
0:26:35 > 0:26:37I'll go and get the stuff for the bed.
0:26:44 > 0:26:46Glad to be home?
0:26:46 > 0:26:49Oh, yes. Mind you, the house looks as though a bomb has hit it.
0:27:06 > 0:27:08You'll be all right, Kath.
0:27:08 > 0:27:10When you settle back in you'll be all right.
0:27:18 > 0:27:21Right. So, Kath, we'll be in later on, then, all right?
0:27:21 > 0:27:24We shouldn't be much later than nine o'clock.
0:27:24 > 0:27:25Don't leave me too long.
0:27:25 > 0:27:30No, we'll be here by about nine-ish. So we'll see you a bit later.
0:27:30 > 0:27:32See you later. All right, Kath?
0:27:39 > 0:27:44- See you in a bit, Kath. - You're OK. Mind how you go.
0:27:44 > 0:27:46Bye, Kath. See you later.
0:27:48 > 0:27:49Put that kitchen light on.
0:27:53 > 0:27:56When Len was admitted, I thought they wouldn't let me out
0:27:56 > 0:28:00but they did, so...
0:28:00 > 0:28:07But I was sad because I expected him to be here, you know.
0:28:07 > 0:28:09But it's just one of them things.
0:28:28 > 0:28:31Are you listening, Len? Can you hear me?
0:28:35 > 0:28:37I don't want to shout loud.
0:28:40 > 0:28:45After his overnight stay in hospital, Leonard is back home too.
0:28:45 > 0:28:49I was glad he was home safe and sound.
0:28:51 > 0:28:55We've had a few tiffs.
0:28:55 > 0:28:57SHE CHUCKLES
0:29:26 > 0:29:30But he was going with another girl at the time.
0:29:31 > 0:29:34And I met him at a dance...
0:29:37 > 0:29:38..and...
0:29:39 > 0:29:40..he took me home.
0:29:41 > 0:29:45And it went from there, didn't it, Len?
0:30:02 > 0:30:04HE MUTTERS
0:30:04 > 0:30:05What's that, Len?
0:30:11 > 0:30:12Oh, yeah.
0:30:24 > 0:30:26HE CHUCKLES
0:30:44 > 0:30:45Must be 60 years.
0:30:50 > 0:30:54It's got to be - I was 20 and I am 80 now.
0:30:57 > 0:31:00THEY CHUCKLE
0:31:04 > 0:31:08As I say, I always worked evenings.
0:31:08 > 0:31:11I never left the children.
0:31:11 > 0:31:14Mostly factory work.
0:31:14 > 0:31:16My God, they worked you to death.
0:31:17 > 0:31:20But it was a job.
0:31:20 > 0:31:22We never had a lot to squander.
0:31:25 > 0:31:30No. There was no such thing as old people's homes.
0:31:33 > 0:31:36It was a last resort, you know.
0:31:39 > 0:31:43I don't think I would like to give my home up
0:31:43 > 0:31:45to go into a care home,
0:31:45 > 0:31:49but you don't know what's around the corner, do you, you know?
0:32:37 > 0:32:39LINE RINGS
0:32:39 > 0:32:41'Ambulance Service, is the patient breathing?'
0:32:53 > 0:32:55It's a month since Kathleen left hospital
0:32:55 > 0:32:58with her new package of care.
0:32:58 > 0:33:01'Don't worry, we're going to get the right help for you.'
0:33:08 > 0:33:12The Prices have called 999 40 more times.
0:33:18 > 0:33:20My understanding is that she was OK at night.
0:33:20 > 0:33:23She's been ringing all hours of the day.
0:33:23 > 0:33:25The police have been out to the house,
0:33:25 > 0:33:28the ambulance have still been out to her.
0:33:28 > 0:33:30It just seems that the package, at the moment,
0:33:30 > 0:33:31is just not working whatsoever.
0:33:31 > 0:33:35The carers are saying that Leonard looked really poorly.
0:33:35 > 0:33:38But Kath's saying she wants 24-hour care.
0:33:38 > 0:33:40Well, she can have 24-hour care in a care home...
0:33:40 > 0:33:45- But not in her home. - ..not at home, no.
0:33:50 > 0:33:55Hello, I am Liza Armstrong, I'm your new social worker.
0:33:55 > 0:33:58How are you getting on with the carers?
0:33:58 > 0:34:00They're all right.
0:34:00 > 0:34:03They're good girls? They're looking after you?
0:34:03 > 0:34:04They are good girls. Yes.
0:34:04 > 0:34:09But one of the other things that I receive, you know,
0:34:09 > 0:34:13the feedback, is also that the ambulance came, didn't they?
0:34:13 > 0:34:16Can you remember why did you call them?
0:34:16 > 0:34:18Because I needed help.
0:34:18 > 0:34:22- Right.- And your carers could do a lot more, and they would do a lot more
0:34:22 > 0:34:26if they had the time and was paid properly.
0:34:26 > 0:34:28How else could we help you?
0:34:28 > 0:34:31They should pay them more, give them more time.
0:34:31 > 0:34:35They're allowed - how many minutes is it? I can't run on minutes.
0:34:35 > 0:34:38They do care. But they haven't got the time.
0:34:38 > 0:34:40That's what I'm trying to say.
0:34:40 > 0:34:42If we could get more carers, would you physically pay for them?
0:34:42 > 0:34:44I can't afford to pay.
0:34:44 > 0:34:48I might be lying here now, but I've paid into the system.
0:34:48 > 0:34:50What we are here to talk about
0:34:50 > 0:34:55is whether you really do understand how much care you really need.
0:34:55 > 0:34:58You can't have the carers 24 hours in your home,
0:34:58 > 0:35:00unless you can pay for it.
0:35:00 > 0:35:02I know that you do need care
0:35:02 > 0:35:07and I do think you would get a lot more, better care in a nursing home.
0:35:07 > 0:35:10- I know you're not going to agree with that.- Well, I'm not going, no way.
0:35:10 > 0:35:11- Forget it.- I know that.
0:35:35 > 0:35:38Please don't. Yeah?
0:35:38 > 0:35:40Unless it's really an emergency,
0:35:40 > 0:35:44really something happens, something wrong.
0:35:44 > 0:35:45Yes?
0:35:46 > 0:35:48You have to wait for the carer to come.
0:35:56 > 0:35:58I don't want to go into a care home.
0:36:00 > 0:36:01I've got my home here.
0:36:03 > 0:36:05I'm very disappointed.
0:36:05 > 0:36:08Not in being old - in the treatment.
0:36:08 > 0:36:12You know, as if you're a kid,
0:36:12 > 0:36:14as if you're asking for help unnecessarily.
0:36:14 > 0:36:16I wouldn't do that.
0:36:16 > 0:36:21I didn't realise that it was so costly dialling the 999,
0:36:21 > 0:36:23so what do I do from there?
0:36:28 > 0:36:32They are using a large amount of the health resource.
0:36:32 > 0:36:34I haven't had that conversation about resource.
0:36:34 > 0:36:36I worry that if I do with patients,
0:36:36 > 0:36:37if I'm honest,
0:36:37 > 0:36:38if I raise that discussion
0:36:38 > 0:36:41that this is how much it costs,
0:36:41 > 0:36:45that people will think I'm making decisions on the basis of cost.
0:36:45 > 0:36:48In a sense, it would feel as if we're saying you're not deserving.
0:36:48 > 0:36:49Sit down.
0:36:51 > 0:36:54The cost of the 999 calls, and Kathleen and Leonard's
0:36:54 > 0:36:59hospital admissions, is charged to the local health budget.
0:36:59 > 0:37:03Under the new NHS funding structure, this is run by Dr Chitnis,
0:37:03 > 0:37:06who has been the Price's GP for 20 years.
0:37:06 > 0:37:08I would feel very uncomfortable
0:37:08 > 0:37:11that we were making the most important decisions
0:37:11 > 0:37:12solely because of money.
0:37:12 > 0:37:15But actually, what do we do as a society,
0:37:15 > 0:37:19when their ultimate wish to stay at home is just not affordable?
0:37:21 > 0:37:23That's a very uncomfortable place,
0:37:23 > 0:37:27to be saying it is money that's going to drive the decisions
0:37:27 > 0:37:29around this couple's care.
0:37:29 > 0:37:33I'm sad to say it might end up at that place,
0:37:33 > 0:37:37and we're going to have to make some very difficult choices.
0:37:37 > 0:37:40Hello? It's Dr Chitnis.
0:37:41 > 0:37:42Oh, hello...
0:37:44 > 0:37:47Dr Chitnis and community psychiatrist Dr Dhariwal
0:37:47 > 0:37:50are here to review the Price's case.
0:37:50 > 0:37:53- How are you?- Still here.
0:37:53 > 0:37:57- You're still here, OK?- Yeah.
0:37:57 > 0:38:00- How's your chest feeling? - Not too bad.
0:38:00 > 0:38:04'Ultimately, I would love to keep this couple at home.'
0:38:04 > 0:38:07But her situation of being bed-bound with the pressure
0:38:07 > 0:38:10sores on her feet, the incontinence,
0:38:10 > 0:38:13the, at times, being in a pad that is damp
0:38:13 > 0:38:16because it takes time for a carer to get there
0:38:16 > 0:38:18and Mr Price can't change her.
0:38:18 > 0:38:23'Living in that distress all the time seems a very poor quality of life.'
0:38:23 > 0:38:27- You finished your tablet course, have you?- I think so.
0:38:27 > 0:38:28'What is it we need to do?
0:38:28 > 0:38:30'What is it that would make their lives better?'
0:38:30 > 0:38:34We know we aren't meeting their need at least four or five times
0:38:34 > 0:38:37a day, because she picks up the phone and phones 999.
0:38:37 > 0:38:41We're going to try and keep you at home as much as possible.
0:38:41 > 0:38:45- I'm not going away. - Well, we'll see what we can do, OK?
0:38:45 > 0:38:48It's my home and I'll be treated here.
0:38:48 > 0:38:51Absolutely. I understand that. I understand that.
0:38:51 > 0:38:53And if you can't do it, don't bother.
0:38:53 > 0:38:56Yeah. Well, we're not going to let you...
0:38:56 > 0:38:58You know, not going to abandon you, either.
0:38:58 > 0:39:01- No.- That's important. - Please yourself.- Yeah?
0:39:01 > 0:39:05OK. Dr Dhariwal's here, do you remember him?
0:39:05 > 0:39:09- Yes, I do indeed.- He's the nice one.
0:39:09 > 0:39:11Kath...
0:39:11 > 0:39:13Dr Avi Dhariwal has been assessing
0:39:13 > 0:39:16Kathleen's mental health for three months.
0:39:16 > 0:39:19So, how have the last few days been for you?
0:39:19 > 0:39:21Not too bad. Not too bad.
0:39:21 > 0:39:27Have you felt the need to give the ambulance services a call?
0:39:27 > 0:39:29I call them to get the carers.
0:39:29 > 0:39:32Yeah. Have you called them in the last few hours?
0:39:32 > 0:39:35- In the last day or so? - I can't remember.
0:39:35 > 0:39:38There have been a number of calls.
0:39:38 > 0:39:39Well, I won't call them again.
0:39:39 > 0:39:41I know, you said that to me last time, Kath.
0:39:41 > 0:39:44- I think you were upset that... - I was upset.
0:39:44 > 0:39:47Let's move away from the ambulance calls.
0:39:47 > 0:39:49Can I ask you some silly questions
0:39:49 > 0:39:50to see how your memory is today, Kath?
0:39:50 > 0:39:52I did this before with you. Can I do that again?
0:39:52 > 0:39:54You can do what you like.
0:39:54 > 0:39:56All right, all right.
0:39:56 > 0:39:58I'll try not to sort of upset you too much.
0:39:58 > 0:40:00But can you tell me what day it is today?
0:40:00 > 0:40:03- Sorry?- What day is it today?
0:40:03 > 0:40:04Saturday.
0:40:04 > 0:40:07OK. Can you tell me which month we're in?
0:40:09 > 0:40:11I don't know.
0:40:11 > 0:40:13And do you get some help here at home?
0:40:13 > 0:40:15Some carers come here?
0:40:15 > 0:40:18They do, they're very good. There's not a lot they can do.
0:40:18 > 0:40:19They do their best.
0:40:20 > 0:40:23But they're not here when you really need 'em.
0:40:23 > 0:40:25If it's too much I won't call them again.
0:40:25 > 0:40:27Who? The...
0:40:27 > 0:40:28Call who?
0:40:28 > 0:40:30The carers.
0:40:30 > 0:40:33They come anyway. You don't have to call them, do you?
0:40:33 > 0:40:35They just come, don't they?
0:40:38 > 0:40:40I don't know.
0:40:40 > 0:40:44Kath, you're a bit more upset today than you were when I last saw you.
0:40:44 > 0:40:46Yeah, I should think so, as well.
0:40:46 > 0:40:50What is it that's been unsettling you a little bit?
0:40:50 > 0:40:53I'm feel as if I'm being made a nuisance and I'm not a nuisance.
0:40:53 > 0:40:57- Right, OK.- If I need help, I need help.- Sure.
0:40:57 > 0:41:00I can't explain it.
0:41:00 > 0:41:02Is there anything else you want to say to me, Kath,
0:41:02 > 0:41:04or anything else you want to ask?
0:41:04 > 0:41:05No. Just don't blame me.
0:41:05 > 0:41:08- I can't help being poorly.- No.
0:41:08 > 0:41:11'I don't think she has capacity.'
0:41:11 > 0:41:15Her decision-making is impaired now.
0:41:15 > 0:41:19We just have to see if we can get as much help as we can in between times,
0:41:19 > 0:41:21so that we can try and look after you here.
0:41:21 > 0:41:25We'll have to see what we can do. Yeah?
0:41:25 > 0:41:28We're keen to look after you here. It's your house.
0:41:28 > 0:41:32Okey-dokey. Well, it's lovely to see you.
0:41:32 > 0:41:34All right.
0:41:34 > 0:41:39- Bye-bye. It's lovely to see you. - Bye, Kath.- Take care.
0:41:41 > 0:41:44I suspect we're going to see a further decline
0:41:44 > 0:41:49to a point where them being able to safely manage in this environment
0:41:49 > 0:41:52- is tested.- Yeah.- And that's going to be incredibly difficult for her.
0:41:52 > 0:41:54If we carry on on that trajectory,
0:41:54 > 0:41:58at what point do we have to make a best-interest decision
0:41:58 > 0:41:59on what we do here in the home?
0:41:59 > 0:42:02Or, similarly, whether we have to take the very difficult decision
0:42:02 > 0:42:04about whether we move her?
0:42:05 > 0:42:08It is a possibility that even if the Prices feel
0:42:08 > 0:42:11that they do not want to leave their home
0:42:11 > 0:42:14that they have lived in for decades,
0:42:14 > 0:42:17if their care needs can't be met at home,
0:42:17 > 0:42:22then it is our duty to ensure that they are safe,
0:42:22 > 0:42:28and if that means moving from home then we would have to do that.
0:42:29 > 0:42:32But it is good practice to have everyone on board with that,
0:42:32 > 0:42:35including the Prices, but that may not necessarily happen.
0:42:58 > 0:43:02In the last few days, she's come into hospital with pneumonia.
0:43:02 > 0:43:05Looking at her today, she's not quite as sharp.
0:43:05 > 0:43:08I think she has clearly been a little bit unwell.
0:43:10 > 0:43:13We'll just compare that to her previous X-ray.
0:43:13 > 0:43:15Kathleen is being treated by Dr Peter Wallis,
0:43:15 > 0:43:18Heartlands' lead elderly care consultant.
0:43:20 > 0:43:24It is a challenge. As couples age, their needs can grow apart.
0:43:24 > 0:43:26Obviously, in Kathleen's situation,
0:43:26 > 0:43:29she is becoming physically unwell now
0:43:29 > 0:43:34and her needs and those of her husband do overlap to some extent,
0:43:34 > 0:43:36but they have very different care needs.
0:43:36 > 0:43:39So sometimes it is quite difficult to balance the needs
0:43:39 > 0:43:43of both patients and to get a care plan that can support both of them.
0:43:46 > 0:43:47LINE RINGS
0:43:47 > 0:43:50'Ambulance service. Is the patient breathing?'
0:43:56 > 0:43:58What's wrong with you today?
0:44:00 > 0:44:01It's your heart?
0:44:02 > 0:44:03Pardon?
0:44:05 > 0:44:07Are you having any pain in your heart?
0:44:32 > 0:44:35Leonard Price is back with us, the 83-year-old gentleman.
0:44:35 > 0:44:38He has come in, had a fall, post his chest pain.
0:44:38 > 0:44:40He has been in now three days.
0:44:40 > 0:44:42He is actually medically fit for discharge,
0:44:42 > 0:44:45we're just waiting for the social working team,
0:44:45 > 0:44:46and that's it really with him.
0:44:50 > 0:44:51I can't hear you, Len.
0:44:54 > 0:44:55I look...?
0:44:59 > 0:45:00Everybody tells me that.
0:45:02 > 0:45:03Do what?
0:45:06 > 0:45:07No.
0:45:07 > 0:45:11It is no good me coming out now with you not there.
0:45:11 > 0:45:12Have you been worried about me?
0:45:19 > 0:45:21He is having the time of his life!
0:45:35 > 0:45:36He does love me, really.
0:45:39 > 0:45:41SHE COUGHS
0:46:22 > 0:46:25'This case is not straightforward.
0:46:25 > 0:46:29'The dilemma here is we have a huge health system
0:46:29 > 0:46:32'and so many professional people involved -
0:46:32 > 0:46:34'social care, health care.'
0:46:34 > 0:46:40And with Mr and Mrs Price, my worry is that they may be falling
0:46:40 > 0:46:43through all these different systems around them.
0:46:45 > 0:46:47After six months of disagreement,
0:46:47 > 0:46:51social services now accepts the doctors' view that Kathleen
0:46:51 > 0:46:54has lost the mental capacity to make decisions about her care.
0:46:54 > 0:46:56It's a difficult situation, this,
0:46:56 > 0:46:59from her perspective and obviously the team's,
0:46:59 > 0:47:01because clearly, as we know,
0:47:01 > 0:47:06she has lost the capacity now for the fine detail of discharge planning,
0:47:06 > 0:47:11and so, as a team, with her husband, we need to act in her best interests.
0:47:13 > 0:47:19Good afternoon, Leonard. I'm Louise, a social worker here at Heartlands.
0:47:19 > 0:47:22I'm here to support you and your wife.
0:47:22 > 0:47:28'We could make a decision that would mean that Kathleen and Leonard
0:47:28 > 0:47:31'would never see their home again.
0:47:31 > 0:47:33'That's a massive thing to do.'
0:47:34 > 0:47:38You know, we are so often the decision-makers, and it's hard.
0:47:38 > 0:47:39It is hard.
0:47:40 > 0:47:42Right, um.
0:47:42 > 0:47:44We have met today to talk about
0:47:44 > 0:47:48Leonard and Kathleen's future care together.
0:48:03 > 0:48:07Len, although Kathleen is considerably better
0:48:07 > 0:48:11in comparison to when she came into hospital
0:48:11 > 0:48:15when she had pneumonia, she is not as well as she used to be
0:48:15 > 0:48:21a few months ago, and she does now need quite a bit more care.
0:48:21 > 0:48:25In particular, she requires oxygen most of the time
0:48:25 > 0:48:29to help her breathe comfortably, all right?
0:48:31 > 0:48:34I am going to ask Dr Dhariwal and Professor Tadros
0:48:34 > 0:48:41to tell us a little bit about Kathleen's mental welfare,
0:48:41 > 0:48:43because she has not been quite as sharp,
0:48:43 > 0:48:46and at times, has been a little delirious on the ward,
0:48:46 > 0:48:49particularly when she first came into hospital.
0:48:52 > 0:48:57Since February time 2013, I think there has been a gradual decline,
0:48:57 > 0:49:02probably more pronounced with Kath than Leonard.
0:49:02 > 0:49:05And Kath will consistently say she wants to go home,
0:49:05 > 0:49:06she wants to go home,
0:49:06 > 0:49:10but I don't believe she understands
0:49:10 > 0:49:13the risks of returning home.
0:49:25 > 0:49:28Leonard, I think you have done a very good job
0:49:28 > 0:49:31to look after Kathleen and keep her going.
0:49:31 > 0:49:36When I looked at Kathleen, I agree with Dr Dhariwal and Dr Wallis,
0:49:36 > 0:49:43I don't think she truly understands the consequences of her needs.
0:49:51 > 0:49:54She's got a brain and she has always had a very good brain,
0:49:54 > 0:49:58but her judgment is not as good as it used to be.
0:49:58 > 0:50:02Because Kathleen is not able to understand
0:50:02 > 0:50:04the amount of help that she needs,
0:50:04 > 0:50:09we've got to try and act in her best interest,
0:50:09 > 0:50:13and if I may, I'd like to ask our social work colleagues
0:50:13 > 0:50:15for their thoughts on that.
0:50:15 > 0:50:18Sometimes, people just manage better in their own home,
0:50:18 > 0:50:22but obviously if it's not working, yes, we do have to step in,
0:50:22 > 0:50:24and I do acknowledge that.
0:50:24 > 0:50:27I'm not saying that all the points raised today are not valid,
0:50:27 > 0:50:29because I do think they're valid,
0:50:29 > 0:50:33but I'm constantly thinking about what Kathleen would want.
0:50:33 > 0:50:35She is saying she wants to go home.
0:50:35 > 0:50:39I think at some point, you are going to have to make the decision,
0:50:39 > 0:50:42with our help, that it's not possible any more,
0:50:42 > 0:50:45and maybe we look at an alternative, which is...
0:50:47 > 0:50:49No, we are not talking about putting her away,
0:50:49 > 0:50:52we are talking about you both being somewhere else
0:50:52 > 0:50:57rather than at home, where the care is there 24 hours a day.
0:50:57 > 0:51:02She has the care staff there if she needs them and you remain together.
0:51:07 > 0:51:10Leonard, what is important for you?
0:51:10 > 0:51:11Just going home,
0:51:11 > 0:51:15or actually you and Kathleen remaining together
0:51:15 > 0:51:17for the rest of your days?
0:51:19 > 0:51:20I agree with you.
0:51:20 > 0:51:24You need to be together. You're a good team together.
0:51:24 > 0:51:26What Professor Tadros is trying to suggest
0:51:26 > 0:51:29is that by keeping you both together
0:51:29 > 0:51:33somewhere where you can both receive the help that you need,
0:51:33 > 0:51:36you are more likely to be able to stay together,
0:51:36 > 0:51:40rather than one or other of you coming backwards and forwards
0:51:40 > 0:51:41to hospital, you see.
0:51:42 > 0:51:44We have been talking around various options
0:51:44 > 0:51:46that might suit you and Kathleen.
0:51:46 > 0:51:53One of the options may be to purchase some private nursing care,
0:51:53 > 0:51:57particularly overnight with two carers to look after Kathleen,
0:51:57 > 0:51:59to enable her to be kept at home, but...
0:52:00 > 0:52:02Yes. But there is a cost to that,
0:52:02 > 0:52:07and we will look to see how much can be borne by the statutory services
0:52:07 > 0:52:09and health services,
0:52:09 > 0:52:13and whether there is any cost that might fall to you on that.
0:52:13 > 0:52:18The second option is to see whether we can go into a care home setting
0:52:18 > 0:52:22to see whether it is something that suits you both,
0:52:22 > 0:52:26because that is another option that keeps you both together
0:52:26 > 0:52:28and gives you both the care that you need - all right?
0:53:03 > 0:53:07- Morning, Mrs Price. Hello. - Your hands are cold.
0:53:07 > 0:53:11- Yes, it is not a very nice day today, I am afraid.- No.
0:53:11 > 0:53:16Um, Kathleen, Dr Brown and I wanted to come and talk with you
0:53:16 > 0:53:20about the plans we're making to help you
0:53:20 > 0:53:25- and your husband Leonard leave hospital.- That's right.
0:53:25 > 0:53:28Now, because of your health problems
0:53:28 > 0:53:32it's difficult for you to really plan in detail
0:53:32 > 0:53:36everything that's needed for your leaving hospital.
0:53:36 > 0:53:38- I know.- I know you are keen to get involved
0:53:38 > 0:53:41and we want to keep you involved and keep you informed,
0:53:41 > 0:53:45but you are not quite as confident about making plans
0:53:45 > 0:53:48and holding all the information in your mind as you were before.
0:53:48 > 0:53:52- I can't do it. I admit it.- Yes.
0:53:52 > 0:53:53Because of that, Kathleen,
0:53:53 > 0:53:57it is important that those who have your best interests at heart,
0:53:57 > 0:53:59and that is obviously Leonard,
0:53:59 > 0:54:02and I would hope that you think that the doctors and nurses
0:54:02 > 0:54:06and social workers are trying to work with you and help you,
0:54:06 > 0:54:08it's important that together we all do the right thing
0:54:08 > 0:54:09for you and Leonard.
0:54:09 > 0:54:14- Yes. I will soon let you know. - OK. I am sure you will, yes.
0:54:14 > 0:54:17And what we said we would try to do
0:54:17 > 0:54:19is that we would try to allow
0:54:19 > 0:54:23- you and Leonard to be safely at home together.- Yes.
0:54:24 > 0:54:27But it's only fair for me to point out
0:54:27 > 0:54:29that is going to be a tall order,
0:54:29 > 0:54:33because you do need a lot more help now than you did before.
0:54:33 > 0:54:39- Yes.- Now, the second thing that I wanted you to understand was that,
0:54:39 > 0:54:44if is not possible for us to safely look after you and Leonard at home,
0:54:44 > 0:54:48the next best thing that we came to the conclusion was
0:54:48 > 0:54:52that we needed to find somewhere where you could have all the help
0:54:52 > 0:54:54that you need that kept you and Leonard together.
0:54:54 > 0:54:57Please, don't let me keep away from my home.
0:54:57 > 0:55:00We will do our best to make that our first option...
0:55:00 > 0:55:02- I beg you. - ..to try to get you home.
0:55:02 > 0:55:06- I beg you.- No, I do understand.
0:55:06 > 0:55:09If we can't do it then we will have to pay.
0:55:09 > 0:55:11- I am not giving my home up.- No.
0:55:11 > 0:55:14But you must let us guide you, because at the moment
0:55:14 > 0:55:19you are not really well enough either physically or...
0:55:19 > 0:55:22You are not quite able to think through all the implications.
0:55:22 > 0:55:26I can do. I know what's what.
0:55:26 > 0:55:28I know you don't always get what you wish for,
0:55:28 > 0:55:30unless you start paying, and I don't think it is fair
0:55:30 > 0:55:34that we got to start paying for private care.
0:55:34 > 0:55:36I don't, honestly.
0:55:36 > 0:55:41I mean that. I would rather take me chances, and suffer.
0:55:41 > 0:55:44Don't worry about paying and money,
0:55:44 > 0:55:47we will talk to your social workers about that
0:55:47 > 0:55:50and see what arrangements we can come up with, all right?
0:55:50 > 0:55:52And we will come back and talk with you again.
0:55:52 > 0:55:55As long as you don't expect me to foot the bill, cos I am not.
0:55:55 > 0:55:56I would rather lie and die here.
0:55:56 > 0:55:59- All right.- Thank you.- Well, thanks for talking with me, Kathleen.
0:55:59 > 0:56:02- You are welcome. - Bye for now.- Thank you.
0:56:04 > 0:56:07Our role as clinicians is to try to do what is best for
0:56:07 > 0:56:08Kathleen and Leonard,
0:56:08 > 0:56:12but we will come up against what resources are available.
0:56:13 > 0:56:17And it is something that's going to be an increasing issue
0:56:17 > 0:56:19because we know that society is ageing -
0:56:19 > 0:56:24there is a steady increase in the numbers of people
0:56:24 > 0:56:27with frailty who need a considerable amount of care,
0:56:27 > 0:56:29and that is going to be expensive.
0:56:43 > 0:56:46- KATHLEEN:- Being at home, that's the most important thing.
0:57:05 > 0:57:07- KATHLEEN:- The system is all wrong.
0:57:07 > 0:57:10The left hand don't know what the right hand is doing.
0:57:10 > 0:57:11That's the impression I get.
0:57:52 > 0:57:54I never slept last night, Gladys,
0:57:54 > 0:57:57because I knew what was going to happen.
0:57:57 > 0:58:00It's hard being a carer. It has an impact on everyone's life.
0:58:03 > 0:58:09There's nothing else, nothing else we can do for you. Nothing.
0:58:13 > 0:58:16What judgments do we make about people older than us?
0:58:16 > 0:58:19Should we be challenging ageism?
0:58:19 > 0:58:22Join the Open University debate around ageing by going to...
0:58:26 > 0:58:29..and follow the links to the Open University.