Well, we had the big meeting and, to cut to the chase, I am optimistic it will prove to be productive.

Present were Lana, the case manager; Sophie and Diana from ACAT; Patrice and her boss Nancy from Sydney Home Nursing Service; and Dr Humerus, the psychogeriatrician; Greg; Rachel; and I. The only time Nancy and I have spoken was when I was absolutely enraged that Patrice had aggravated mum and then told me that their service was about to be withdrawn. As it happened, Nancy and I got on great today.

We started shakily. There was a palpable nervousness in the air that I found a little mystifying. Lana asked representatives to give a short summary of how they thought things were going. I thought this was just an ice-breaker and preparation of common ground before the real business was due to start, but it went on for a long, long time, frequently descending into undirected dialogue and numerous forms of 'no, what I meant was...', 'I wasn't trying to say you were...', etc.

Our post-meeting analysis was that Lana looked as if she had aged considerably since our last meeting, was a lot less assured, and seemed rather slow on the uptake and dithery. I may call her to ask if she is suffering from something. Greg and Rachel thought that she and Sophie seemed quite apprehensive and defensive. They concluded that the two of them were scared of me. I am willing to admit that my past telephone conversations may have been more forthright than social workers are used to.

During the somewhat rambling opening discussion Nancy, Diana and Dr Humerus emerged as the ones who were focussed, constructive, and really listening. Lana, Sophie and Patrice gave the impression that they could have talked all day without making any proposals. At times my frustration was immense. I was keen to move the meeting onto substantive issues, but felt I had to tiptoe on eggshells to avoid upsetting the more delicate personalities.

I asked if the various services had come together before like this to discuss other cases - intending to follow this question with another about what procedure they had followed. There didn't appear to be a standard procedure, nor any other, for that matter. We rambled for half an hour and then when I asked Lana how long she thought the meeting would last she said one hour. At this stage I thought it was time to get our list of problems out and go through them one by one. I passed out the copies and we got started. Given the earlier dilatory wanderings I was surprised at how well we worked on the list. Below is the result: a new version of the table. The column of Proposed Solutions has several amendments and most of these involve the social services. I shall be circulating an email detailing what we agreed, and everyone will be able to refer to this in future.

In the mean time, there were a few other things to note:
  1. There is still no arrangement for dad to spend another day at day care, even though Lana had said some weeks ago that she would organise this.
  2. ACAT had not approached Meals on Wheels about our suggestions for modifications of their service - as they had promised.
  3. Patrice was clearly still on the job, even though ACAT had given me the impression that they would ask SHNS to find someone else.
  4. We were advised to go to the Guardianship Tribunal to get legal guardianship over our parents. It is now too late in mum's decline for her to be considered compos mentis, and for her signature on an assignment of guardianship to be considered valid.
  5. Yes, as expected, there was pressure for us to 'think more' about nursing homes. When I asked why, how many waiting lists we need to be on, how many nursing homes we ought to check out, and other questions - I got ridiculous or contradictory answers. In exasperation I asked 'what do we have to do that we are not now doing?' and Diana answered 'Probably nothing.' The assumption, incidentally seems to be that mum and dad cannot be accommodated in one place. I found the misleading information we were given on this subject extremely frustrating.
Here, then, is the new manifesto, as agreed with ACAT, SHNS, NBCC, and Dr Humerus:

Original Problem

Current Solution

Proposed Solution

Food

1. Eating cat food
(not really a serious problem).

Put the dry cat food in a dispenser.

Buy single-serving cans of cat food.

2. Not finishing Meals on Wheels meals

MOW will put food out on plates, and if there is too much resistance to this they will leave the meal containers unsealed, and take the lids away with them.

3. Not eating fresh fruit and vegetables

Dad frequently eats fruit and offers it to mum.

Provide fresh fruit and vegetables at weekends and during the week when possible.

Social services will visit three times a week (on Wednesdays to do some cleaning, and at about 4:30 pm on two other days to provide food for mum and dad, but first feeding the cats.)

4. Eating food past its use-by date

Regularly clear out the cupboards.

5. Very poor evening meals

Provide high energy biscuits and cook or leave meals when possible.

See proposed solution to problem 3 above.

Medical

6. Not taking medicine

The nurses administer medicine every day to dad.

Dad gives it most days to mum.

The nurses will adminster medicine at about 1:30 pm, take no for an answer, and avoid trouble when it flares. They will not visit on Wednesdays (see proposed solutions to problems 8-11 below.)

7. Missing doctors' appointments

Manage appointments for them.

Cleaning

8. Not cleaning cutlery and crockery

Do it occasionally.

On Wednesdays, when dad is at day care, Rachel will give mum an outing. During this time social services will clean the house. Lana and Rachel will organise this between them.

9. Not dusting

10. Not washing clothes, bedding, or towels

11. Not cleaning the floors or toilet

Psychological

12. Boredom

Dad goes to the Day Care centre once a week.

Gill sometimes takes mum out.

Social services will arrange a second day out each week for dad.

Take mum and dad to cafes near schools, pet shops, sweet shops – together as a family when possible.

13. Confusion

‘Distraction and subtraction’ (reduce clutter in the house).

Provide a large calendar with each day crossed out as time progresses. The nurses will cross out the days for mum and dad.

Social services will provide a combination mini-safe to contain housekeys for fixing to the outside of the house – so that if the house is locked up we can always gain access.

Change the locks so that they cannot be deadlocked from inside.

14. Mum stealing the mail

A secure mail box.

Hygiene

15. Not showering or bathing

Dad showers before going to Day Care and church.

Continue to persuade mum (a female may do better than a male), and try various incentives.

Ply mum with alcohol.

Replace all soap in the house with sorbolene (because it doesn’t matter if it is left on the skin and not rinsed off).

Try evening bathing, before going to bed, and try a wash rather than a shower or a bath.

Try a bit of deodorant to mask the smell.

Try using wet baby wipes.

Social services will provide a shower stool and a handheld showerspray.

Safety

16. Vulnerability to robbery and violence

Remove real valuables to safe storage.

Limit the amount of money in the house.

Install cameras.

Ask police to keep a closer watch on the house.

17. Uncertainty on the outside steps

White lines have been painted on them.

18. Mum's attacks on dad

Counselling dad and possibly mum when it happens.