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What about Dorothy? How our services fail the vulnerable

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What about Dorothy? How our services fail the vulnerable

Dorothy is 94, living alone, her husband died 25 years ago and with no children or family living near she relies on a telecare kit, an hour of care a day and more recently a meals on wheels service which brings her a meal to microwave each day. Her next door neighbour gets her some shopping each week and she relies on the good will of the other residents in the block to help her out.

Last Tuesday she had another fall, trying to get up from her chair to get to her bedroom.  She had called an ambulance, but it had not arrived, so she rang my partner, who lives nearby to come and help her.  Within ten minutes he had arrived but could not get in as the carer who attended that day did not replace the key in the secure box.  So she had to shuffle her way on her knees to the door to open it for him.  The ambulance men arrived a little later but decided she was well enough to remain at home. This is not the first time she has fallen.

Earlier in the summer we received an anxious call from her, she had arrived back from hospital the previous day after a fall earlier in the week (something down to blood pressure and medication).  She had spent the last twenty four hours without electricity or heating, her services had been turned off whilst she was away but no one had checked to turn them back on when she was sent home.  She had not eaten anything as the food in the fridge had gone off and she could not make herself a hot drink.  My partner went to help her, turned the utilities back on and brought her some provisions to help see her through.  She decided to pay for meals on wheels so she would not be put in that situation again.

When we saw her a couple of days later she said she was ok, but really missed cooking for herself and really wanted to eat some pasta.  So every time we make a bolognese we do a portion for her and buy her some ready meals when we go shopping if we remember.

We popped round to see her on Saturday to see how she was doing and if she needed anything.   She was still aching from her fall but was getting worried about her money situation.   She uses cheques to pay for bills and to get money out (through another neighbour who does her shopping).  But she had only one cheque left, our first reaction was that perhaps her replacement book had been stolen, banks usually send these out automatically.  We rang the bank for her and after ten minutes of the usual automated system we got through to a person.  I explained the difficulty of the situation, Dorothy has hearing problems and cannot see very well.  But we had to go through security questions and explain to Dorothy that she needed to respond.  Some half an hour later the adviser spoke to us and explained that the bank does not send out chequebooks, this policy stopped some time ago and they have to be requested by phone or in person at the bank. We explained about Dorothy’s situation but there is nothing they could do, other than rely on someone to order a book with her next time.

Reflecting on Dorothy’s situation made me realise how difficult her life is made.  She wants to remain independent in her flat, something all public service organisations want as it is much cheaper than providing full time care in a home.  Her carers are all different, so she does not get the chance to form a relationship or bond with them, sometimes she cannot tell who is a carer as they change so often.  Her reliance on her neighbours means that she can live her life, but these neighbours are also getting older and more frail and likely to need support too in the future.  The local area is changing, flats are being taken over by private landlords and people are coming and going, so it is much harder to know and build a relationship with a neighbour.  Her financial situation makes her vulnerable to people who may use the opportunity to take advantage of this.  There is no other support for her.

And I have to ask myself why are we not getting the basics of living right for those older and more vulnerable people in our society? 

Personally I think we (policymakers, commissioners and funders) are so caught up with chasing the next big thing in public service design, responding to cuts, reducing demand and looking to scale and replicate what works, that we are neglecting to get the basics and fundamentals right.   Impact maps, disruptive innovation, innovation in technology, social action what do all these things mean to people in situations like Dorothy?

Situations where you cannot scale and replicate support that requires such individual attention or people are living in areas where there is a clear deficit in social and community capital and little motivation or investment to help stimulate it.  Where technology serves to frustrate rather than enhance someone’s life and your ability to survive and remain independent is at the mercy of the goodwill and trustworthy nature of your neighbours or family (if you have one).

We need to reboot our thinking and actions and we need to do it quickly and when we are looking at designing an approach, fund or service then ask ourselves a fundamental question before we go ahead… what about people like Dorothy?

Till next time
Caroline Masundire