Missing Teeth and Other Failings

She knew who she was, who I and other relatives were, but not where she was exactly or why. Memories and knowledge laid down long ago remained. Current experiences were hard to fathom. Hospital was difficult. Her cognition got worse with each stay.

I wasn't going to write about this but a report from the Alzheimer's Society brought it all back. People with dementia don't fare well in hospital.

In fact, says the report, Fix Dementia Care, the care they receive is often dangerous and inadequate and it's costing the NHS over a quarter of a billion pounds a year. Patients with dementia are staying in hospital far too long, they're falling and breaking hips, they're becoming malnourished because staff don't realise they're not eating enough. Their needs are not understood.

It's true. Last year my mother was in and out of hospital - several hospitals - until her death in the autumn. A bad fracture after a fall at home, various other scares and - ultimately, inevitably, quickly - pneumonia. Nothing chronic (apart from dementia), nothing else terminal (apart from old age - she was 93).

She knew who she was, who I and other relatives were, but not where she was exactly or why. Memories and knowledge laid down long ago remained. Current experiences were hard to fathom. Hospital was difficult. Her cognition got worse with each stay.

People with dementia don't make easy patients. They may be non-communicative, non-demanding and thus easily overlooked in a busy ward. Or they may be fractious, frustrated, repetitive and overly demanding because they don't know what is going on and misjudge the motives of those trying to help them. My mother was a bit of both.

The medical care she got was, as far as I could tell, first-rate. So was some of the nursing care. There were nurses who were friendly and patient, were clearly 'dementia-aware' and, at best on some dementia-specialist wards, empathetic and imaginative. For example, I saw one nurse doing her paperwork beside the bed of an unvisited patient with dementia rather than barricading herself in the nurses' station.

But in acute medical wards, where the pressure may be greater and there are usually some very sick patients, you take your chances if you have dementia. Again I witnessed some very good care. But a significant number of nurses were brusque and impatient, going through the routines of administering medication, taking blood pressure, changing dressings, doing what was strictly necessary but without a kind word or genuine engagement. Honestly, I wanted to say, you can talk to my mother as if she's a real person while you're taking her temperature, even if the conversation is a bit one-sided.

And then they lost her teeth and her hearing aids. First a set of false teeth on a removable dental plate and then a few days later the aids. In both cases, they were there one evening when I left and gone the next afternoon. My mother of course didn't have a clue. My guess is that she had taken them out and put them on a food tray which had then been whisked away, uneaten food, teeth and all.

The staff weren't very interested. Losing your teeth and hearing aids hardly seemed life-threatening. But communication with my mother had been difficult anyway and now that she could barely hear, was much more so. And eating, something she wasn't that interested in of late, was even less appealing without a full set of teeth.

I wrote to the hospital and and was invited to meet the ward manager and a matron. I pointed out that I wasn't making a formal complaint but just wanted to know what had happened and be assured that it wouldn't happen again to other patients. (Tip: a complaint that isn't a complaint but expresses concern and makes reasonable enquiries usually gets a better response.)

We had a positive meeting. They were sorry, acknowledged the failings and said that my mother's stay had coincided with a period of regular staff shortages and heavy reliance on agency nurses. They agreed that people with dementia needed better nursing care. They promised new systems which would stop teeth going missing. Result. I was impressed.

I haven't been back to that hospital to see how things are going. But a few months later my mother was in another hospital and the same thing happened again. The previously lost hearing aids had been replaced by the NHS (at a cost of around £1,000 each, I guess), had survived various hospital admissions and then - in yet another acute ward - one went missing again...

The Alzheimer's Society talks about the shocking variation of hospital care for people with dementia. Its report says that while there are notable examples of excellent care across the country, the difference from hospital to hospital (and, I would suggest, from ward to ward) is too great and there is inconsistent understanding of people's needs.

Variability is in the nature of services as complex and people-dependent as health or education. Inspection processes are there to uncover, measure and compare. As a journalist I am aware of the the number of times I have written 'it's a mixed picture' or 'provision is patchy' or 'services vary'. Good practice exists. Scaling it up is so often what it's about. If some can do it, why can't others?

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