The Tories take care of grandma

It is 11am on an icy Wednesday in Oxfordshire, and four agency workers who are about to start jobs as live-in carers for the elderly are sitting in the agency's lunch-room, fast being discouraged from the care-working scene by a long-time member of staff who can't seem to shut up about how dreadful it is.

The four women are Denise, Emma, Steph and Caitlin. Steph is from South Africa, and Denise and Caitlin just arrived in the UK from New Zealand. Emma is also a New Zealander, but she's been living in London for a while. Most of the workers used by this Oxfordshire-London agency are South African, or Antipodean. They don't necessarily have experience in care work, but they're thought to be hard-working and honest. They're also white, which makes them easier to place in the homes of the well-off elderly in Oxfordshire and London who can afford the £500-plus a week it costs for full-time, live-in care.

The name of the long-term staff member who can't be silenced about the evils of care work is Anne. She's a South African in her late 40s and has worked full-time as a live-in carer since she moved to the UK about 20 years ago. The agency describes her as one of its most dedicated and reliable employees. She has lived with and cared for her present client for nearly ten years. She looks tired today: she had to leave London at about six this morning to attend one of the first-aid, food-hygiene, and lifting courses that the agency runs. In the last year, the agency has insisted that new and long-time employees take these training courses.

Anne has fine, brown-grey hair, pitted skin, and light-coloured, bulbous eyes, which she starts to close as she comes to the end of her disheartening sentences, as though she's preparing for impact. She has a strong South African accent, but it's easy to get her gist.

'It was like the prison doors closed around me when I started this [latest] job. I cried all day and all night,' Anne says. She smiles. Denise, Steph, Emma and Caitlin stare at her. Emma doesn't stare for long. She rolls her eyes and looks away - she does this whenever Anne starts fluttering the eyelids. Emma is a tall, strong-looking 26-year-old who has been working as a relief-teacher in London. She's tough, and she doesn't have much time for people who aren't.

Anne says that South Africa terrified her, and that it still terrifies her when she visits it. She talks a lot about carjackings, murders, muggings, and a worsening insomnia that seems to have to do with a dread of blood. ('How would you treat your client if she cut herself?' an agency trainer asks during the course's first-aid training-session. 'Oh no, I wouldn't,' Anne says straight away. 'You wouldn't at home, because of AIDs.' Steph nods.)

Everybody else's fears here have to do with a dread of the conditions of the conditions of service as a full-time, live-in, carer for the elderly for this agency. A full-time, live-in carer's job pays about £400 a week, which is good money in many books. The problem is that it's a seven-day-a-week job, and the carer is required to stay in the client's home all night every night, most of the day, and for the entire weekend. The carer has three hours off every afternoon, and eight hours off one day a week, but must be back at the client's house by about 5pm every day. The carer is responsible for the client from then until the three-hour break the following afternoon.

A client may wake throughout the night for help getting to the toilet, or for cups of tea, or because they can't get comfortable. The ones with dementia sometimes roam the home at all hours - they will go to bed at lunchtime, thinking it's late evening, and then get up every few hours after that, unsettled.

There are no nights off, or out. Carers are not permitted to invite guests to visit, or stay. They are employed to meet a client's needs, and that's it. Social contact for a carer consists almost exclusively of brief encounters with the client's visitors - the cleaner, or the housekeeper, the metre-reader, and the odd relative. Otherwise, the client and the carer are alone together, shut off and locked into a 24-hour schedule of sleeping, eating and wandering around a large, shut-up, Georgian house.

It's essentially a 145-hour-a-week job, at about £2.70 an hour. The younger carers don't worry about it too much: they do it for as long as it takes to save the couple of grand that they need to set themselves up in a flat in London, and then they take off for the flat. That mostly leaves women like Anne - middle-aged women who quickly save more than enough money to leave, and even retire on, but who instead follow a wealthy old woman around a huge home as she circles the coffin. The client's relatives visit, but not all the time. They often live in Europe, and/or have high-paying jobs that make it hard to get away.

'My lady never goes out [of the house],' Anne tells her audience.

'Never?' Emma asks. She raises her eyebrows and looks out the window.

'Never?' asks Denise. Denise, who is in her mid-40s, just moved to the United Kingdom from a small town in New Zealand, where she worked as a library assistant. Her marriage ended recently, and badly. She is small and pretty, when she isn't thinking about the ex-husband and his new wife. Denise says she wanted to change her life completely after her divorce, so she resigned from the library and bought a ticket to the UK.

London and Oxford, though, are not small-town New Zealand. Denise has only ever lived in small-town New Zealand. It was the same small town, too, where she knew everybody and had a house and a job and friends. She says it's been so long since she worked as a nurse-aide that she doubts that she's kept pace with change. She keeps asking Anne if she thinks that'll be all right. The younger carers aren't worried about references. You can claim a work-record in the care industry, but you don't have to prove it. Employer references are checked, but they don't have to be from employers in the care sector. They don't even have to be from employers, when it comes down to it. You just give the agency a few names and contact details.

'The man I'll be looking after uses a bottle during the night,' Denise keeps saying. 'I would say he's all right to use it himself, though. You must have saved an amazing amount of money,' she says then to Anne.

'I've saved all of it,' Anne says.

'Have you?' Denise asks. In her most recent job, then, Anne must have saved £200,000, at £400 a week for ten years. Over 20 years, she must have saved close to £400,000.

'Why does she keep doing it?' Denise asks. 'You could retire on that in New Zealand.'

'You could probably retire on that in some places in England,' Emma says. She doesn't come back after the lunch break.

-----------------------

Everyone else decides to have a go. Caitlin is the first to be sent on a job. Caitlin is in her early 30s, and worked in public-sector PR back in New Zealand. She says that she came to the UK because she'd slept with half of New Zealand and owed the other half money. She says that she plans to work as a carer for as long as it takes to find a decent day job in London.

Caitlin's first job is a weekend relief job with a 90-year-old woman called Mercia. Mercia lives in a beautiful, very old, two-storey house just outside a tiny Oxfordshire village called Tubney. The house is big, dark and quiet. It's down a side road, and then a drive, so there's very little traffic or pedestrian noise.

Mercia has lived in the house for 30 years, but she has dementia and gets confused and very lost. She has two sons who are in their early 60s. Both live elsewhere and still work in high-powered government jobs. Neither is able to care full-time for their mother.

Mercia's full-time carer is a 45-year-old South African called Bernie. Bernie finished a Masters' degree before she left South Africa, and has been applying for jobs in relevant areas ever since. She wants to work in London, where her daughter lives. She's been Mercia's carer for three months, and says she is grateful for the employment, but that she's getting to the point where she's pretty desperate to escape. Today, she's leaving for London to stay with her daughter for the weekend. Her taxi turns up soon after Caitlin does. She runs through Mercia's care programme.

'She's not incontinent, thank God,' Bernie says. 'I would find it very hard to deal with that. It's a good idea to flush the toilet when you're passing, though, because she doesn't always do that.' Mercia hates the shower and fights and cries if she is put under it. She has a daily sponge-bath instead.

Bernie says Mercia's sleep patterns are the biggest problem. Mercia is usually exhausted by 1pm, because the medication she's on tires her out, and after lunch, she's usually ready to sleep for the afternoon and often the night, but she won't get into bed unless Bernie changes into her nightclothes and goes to bed too. This means that Bernie spends most of the day in her nightclothes in her room, listening to her stereo, and taking Mercia back to her room when she wanders into Bernie's.

They've been doing this three months now - getting up at about seven in the morning, and eating breakfast, then lunch, and then following each other around the house for about 18 hours in their pyjamas. 'You won't be able to get out of it,' Bernie says. 'She won't let you stay in your clothes. She will make you get changed.'

Bernie genuinely likes Mercia, though. 'She's got a great sense of humour,' Bernie grins, and she's right. Mercia might have dementia, but she is still able to communicate and she's often very dry.

'I might not have that after all,' she laughs when she accidentally knocks her lunchtime glass of wine over. 'No prizes for him,' she sniggers as a skateboarder falls on top of another one on television. The problem with Mercia is that like a lot of dementia sufferers, she also gets vicious and angry, particularly when she can't explain herself. It's clear that she knows what she wants, but she's tongue-tied by the dementia. She is also used to her orders being taken and her standards being observed.

Caitlin finds this out first thing on her first morning. Mercia, unusually, slept through the night. She knocks on the door to Bernie's bedroom, timidly, at about 7:30am.

'Hello?' she says. 'Are you in there?' She rattles the doorknob. She doesn't get far. Caitlin locked the door from the inside the night before, because Bernie told her that Mercia was likely to wander into her bedroom at night, and Caitlin didn't like the idea of waking up to find Mercia standing next to her bed. Caitlin opens the door to find on the landing Mercia in her nightdress and clean red towelling dressing-gown. Her curly grey-white hair is matted around its several crowns.

The second she sees Caitlin, Mercia stops moving.

'What's this?' she hisses. She's staring at something and she isn't pleased. 'You can't have this,' she says. Her eyes are hard and she's trembling. She's trying very hard to demand a response, or give an order. 'What's, what's, oh no, what's this?' she says, flicking her hands at Caitlin.

It's clear that Caitlin has no idea what the problem is. She seems to decide that Mercia is confused, rather than angry, so she puts her arm around her. 'I'm Caitlin,' she says to Mercia. 'Remember me? We met yesterday. I'm going to help you for a few days while Bernie's away.'

Mercia shoves her away. 'No!' she yells. 'Oh no, what's this? We can't! Oh, oh, oh, not this! We can't, we can't, no, not this.' She shakes with frustration as she tries to find the words, and she swats at Caitlin's arms.

Things shamble on in this tenor for five, or even ten, minutes. It's only when Mercia turns her head away and closes her eyes while swatting that Caitlin gets it: there's something about Caitlin that Mercia can't stand to look at. Caitlin looks at Mercia wrapped up in her red dressing gown and finally works it out. Mercia doesn't think that Caitlin is decently covered. She's wearing a short, lightweight nightshirt, and Mercia doesn't think there's enough of it. Things change dramatically when Caitlin re-emerges from the bedroom wearing the floor-length, flowery blue dressing-gown Bernie left on the back of the bedroom door. It doesn't seem like the kind of thing that Bernie would wear, either, but she probably bought it because Mercia demanded it.

'That's it,' Mercia says. She sighs with relief. Caitlin takes her hand.

'The girls should have breakfast,' Caitlin says.

'They should,' Mercia grins. They walk downstairs. Caitlin gives Mercia a bowl of fruit and cereal, and sits her in front of the television.
-------------------

Mercia finishes her breakfast and starts looking for Bernie.

'Where has that girl gone?' she starts asking at about 9am, opening the front door to look down the drive. She can't remember Bernie's name, but she does understand that she's gone. 'Where has that girl gone? She's my cousin.' She opens and shuts the front door every five or ten minutes, for most of the morning. She walks a little way up the front drive each time, until Caitlin, who is always behind her, takes her arm and walks her back.

Mercia is also concerned about her eldest son, Peter. Peter lives in Paris with his wife and children, and he rang to talk to Mercia, and to introduce himself to Caitlin, just after Bernie left. He spoke to his mother for a while, and a memory of that conversation comes to Mercia every half-hour or so during the weekend. It worries her. 'I'm worried about that boy,' she says repeatedly. 'I don't want him to miss me when they come.'

Mercia eats the heat-and-eat meal that Caitlin microwaves for her lunch and drinks a glass of wine. She says that she's starting to feel tired at about 1pm.

'I think I'll go up now, dear,' she tells Caitlin. She looks exhausted: pale and blue-lipped. She heads off towards the stairs.

'I'll be down here,' Caitlin calls after her. She takes Mercia's plate and cutlery into the kitchen and starts washing them. Mercia walks into the kitchen as Caitlin is drying the dishes. She's changed into her nightclothes. 'Are you coming up now?' she asks Caitlin. She puts her hand out.

'No, I don't think so,' Caitlin says. She isn't as sympathetic a carer as Bernie. She isn't cruel, but she's younger, and much less likely to take orders in the first instance. She also doesn't realise that Mercia's dementia will dominate her time with Mercia, whether she ignores it or not. If she doesn't go to Mercia, then Mercia will come to her, and on it will go, until Caitlin leaves Tubney, or loses the plot.

Mercia's grey eyes widen. 'Aren't you, you tired?' she stammers. She's frightened, or unsure. She puts both of her hands on Caitlin's arm. 'Are you sure you won't have a rest? Where has that girl gone?' she says. She pats Caitlin's arm.

'It's too early for me to go to bed,' Caitlin says firmly. 'You go up and I'll come up a bit later.'

'Are you sure that you wouldn't like to come up?' Mercia asks again. She looks up then and makes eye-contact. This sudden eye-contact always makes a dementia sufferer look very threatening. It's a direct stare and it makes people like Mercia suddenly look cunning and very coherent. It probably doesn't mean much, but it looks like it does.

'I just want to sit down quietly and write a letter to my father,' Caitlin says. This works brilliantly. Mercia laughs when she hears it.

'Oh,' she says. 'That's very nice.' Caitlin puts her hand on Mercia's hair, and turns her head a little, to break the eye-contact. Mercia looks very grey-faced again now. 'I think I'll just go upstairs, because I'm really rather tired,' she says.

'You do that and I'll just write this letter to my father,' Caitlin says. This really does seem to please Mercia. She smiles, then pulls Caitlin's hair, to bring Caitlin's face down next to hers. Caitlin helps her into bed.

'You will let me know if that boy comes, won't you?' Mercia asks.

'I promise I will let you know as soon as he comes,' Caitlin says. 'We'll both hear the doorbell and I'll come and get you right away.'

'Thank-you, dear,' Mercia says. She pulls Caitlin's head down again, and rubs her nose against Caitlin's. 'You will let me know if Peter comes, won't you? I'm a bit worried that I'll miss him while I'm up here.' Caitlin promises to wake her up the second that anyone arrives.

Caitlin returns to the living-room. It's about 2pm. The house is silent. Caitlin makes a cup of coffee. She is just sitting down with it when the living-room door opens and Mercia comes in.

'Hello dear,' she says.

'Hello,' Caitlin says, smiling. Mercia looks tired and very pale. She pulls the net curtains back from the big living-room window and looks out. 'I didn't mean to come down,' she says as she stares through the window, 'but I'm a bit worried about missing them if they come.' Mercia doesn't look at all well. Her lips are blue, and her hair, eyes and skin all seem the same grey colour. She seems dizzy, too. She's usually sure-footed, but she can't seem to move now without holding onto something.

'I think you need to sleep,' Caitlin says.

'I am rather tired,' Mercia says. 'I'm a bit worried about missing them up there when they come.'

'I promise I'll let you know as soon as they turn up,' Caitlin says.

'Oh, thank-you very much, dear,' Mercia says. She's got her head in her hands, now.

'Do you want me to take you back upstairs to bed?' Caitlin asks. Mercia smiles.

'That would be lovely,' she says. 'I feel very tired.' She looks exhausted. Her face is a grey as her hair.

'Okay,' Caitlin says. Upstairs, Caitlin helps her climb back into bed.

'Goodnight, dear,' Mercia smiles. 'You will let me know if Peter comes, won't you? I'm a bit worried about missing him while I'm up here.'

'I'll wake you up as soon as he comes,' Caitlin says. Mercia smiles, and closes her eyes. Caitlin goes back downstairs and turns the television on. A few minutes later, the living-room door opens, and Mercia walks in. She looks even paler now, and she has to hold onto the door to steady herself.

'I've been trying to go to sleep,' she says, 'but I'm a bit worried that I'll miss that boy when he comes. You will let me know if he comes, won't you?'

'I will,' Caitlin says. They walk upstairs again. Mercia gets into bed and Caitlin goes back downstairs. After a few minutes, the door opens again, and Mercia comes in. Caitlin helps her back to bed. Mercia's back downstairs in minutes. Her face is horribly pale by now, and the blue colour in her lips is darker than it was. Her eyes keep closing and she staggers whenever Caitlin lets go of her.

'I'm just a bit worried about missing that boy when he comes,' she says. She totters over to the window and pushes the curtains aside.

'I promise I will come and get you the second he arrives,' Caitlin says. 'You have to stop worrying. You're very, very tired.'

'I am rather tired,' Mercia says.

'I know,' Caitlin says. She helps Mercia back into bed. It's now about 3pm, and Mercia's been up and down the stairs at least ten times. This time, she goes to sleep. Caitlin, sitting downstairs, finishes the bottle of red wine. She goes to sleep and wakes up at about eight. Mercia hasn't returned, and Caitlin decides not to wake her to eat. She goes to bed, locks the bedroom door from the inside and set her alarm for seven the next morning.

When the alarm rings at 7am, she puts Bernie's headphones on, and starts listening to her boxed set of classical CDs. At about 7:30am, the door-handle begins to shake. Five minutes later, the whole door starts to vibrate. It looks as though Mercia is throwing herself against it. Caitlin keeps the headphones on, though, and lies there until about eight o'clock.

'Hey - hello,' Caitlin says when she finally opens the bedroom door. Mercia is standing there, looking horrible. Her eyes are red and wet and her mouth is open and her red dressing-gown is damp and filthy in places. It looks as though she's tried to feed herself, or pour herself a drink, or even rolled around outside.

'What's this!' she shrieks. She's trembling so badly that she can't keep a proper grip on the door-handle. 'I couldn't... well, if you can't be, if you can't, well, well, well...' She's beside herself, but can't explain why. Caitlin takes her hand.

'Let's have some breakfast and get dressed,' Caitlin says.

'No!' Mercia shrieks, still shaking. 'If you can't be, well, well, I just don't know... if you can't, I knocked, I knocked...' She presses her lips together and shakes her head. Her whole body trembles.

Caitlin barely reacts. 'I think we should get dressed and organised in case Peter comes this morning,' she says, looking at Mercia. Mercia's expression changes in an instant. She laughs, then pulls Caitlin's head down to rub her nose against Caitlin's.

'I don't want to miss that boy,' Mercia says. And so it begins again, right through Sunday and well into the early hours of Monday morning. Washing and feeding Mercia takes a lot longer than it should, because she keeps leaving her seat to walk over to the window. The sponge-bathing is almost impossible, because Mercia keeps striding out of the bathroom, naked. She's strong and determined and she shrieks whenever Caitlin grabs her. 'Don't do that!' she yells. 'Don't you, don't you, that's, that's enough!'

Mercia is still waiting when Bernie's cab arrives on Monday morning. She tears down the hall and out onto the drive when she hears the car's tyres on the gravel. Neither she, nor Caitlin, look good. Mercia may have had several hours sleep, but Caitlin was awake most of the night. Mercia kept getting out of bed and walking up and down the stairs, and when Caitlin locked the Mercia's bedroom door after putting her to bed for the fifth or sixth time, Mercia banged and rattled the door and screamed.

'She's waiting for Peter to come,' Caitlin tells Bernie, as Mercia hurries down the path towards Bernie's taxi.

'I know,' Bernie says.

---------------------

Other clients are able to speak. Lila is one. Lila is 80, Oxford-educated, and the freehold owner of a beautiful, five-storey Georgian house in Kew. The house is worth well over a million pounds, and Lila's lived in it for more than 40 years, but it's driving Lila and her family round the twist.

Lila can't cope in the house alone anymore, because she can't climb the four flights of stairs. She's unable to move now without a wheelchair, or a carer and a cane. She's not happy about any of this. She has been through three carers in three months. This is not an agency record, by any means, but enough to warrant a bit of a laugh at HQ as each carer rings up to resign.

Lila has three children and a husband, but they all left the house a long time ago, and now live here and there in Europe and the UK. Her husband moved to Essex years ago, when Lila moved her new boyfriend into the Georgian house. The boyfriend didn't last too long, and Lila was left on her own. Things started to deteriorate for her about six months ago. She fell over on a pedestrian-crossing when she was trying to smack the boot of a car that she thought was travelling too fast. She broke her hip in the fall, and had to start wearing a hip-brace. She's allowed to remove the brace now, but she refuses to. She's frightened of dislocating her hip, which she has done a couple of times now. She even wears the brace to bed.

She recently rang her husband, to ask him if he could put the past behind him and move back in with her and look after her, but he declined. 'He always was weak,' Lila spat as she hung up. 'He really is useless. He kept saying to me that he was too old for all that. I said to him 'well, I'm old too. We should be old together.' But he won't come. He's absolutely hopeless.'

Lila's children are Oxbridge-educated professionals who don't seem to like each other much. The younger two resent their older sister, Anna, because Anna is Lila's favourite. Anna, for her part, seems to agree that her two younger siblings are indeed the inferior beings that their mother says they are. 'I suppose that's my fault,' Lila says a lot. 'I always absolutely adored Anna. I suppose I shouldn't have made that obvious, but I just adore her. I never felt that about the other two.'

Lila pays more than £600 a week for a live-in carer and cleaner at the moment, and she'd rather keep doing that than sell the house and live in a single-level place. The problem she has is staff turnover: that, and a certain blindness to the reasons for it.

'Come and sit here, girl,' Lila says as soon as the new carer arrives. 'I want to know if you are going to be better at listening than the other girl. I want to know if you're going to be kind. Sometimes, I want to have a drink and I should be able to have a drink when I want to. I don't want to be told that I can't have a drink, so I hope you're kind.

'This is my house and there's a story here. My two youngest children want me to leave it. They want me to sell it, because it's worth a lot of money and I need to have money to pay for you. I've got an overdraft at the moment. I've had offers for more than a million pounds for the house. I've had two offers for more than a million pounds for it. My son wants me to move to live closer to him. That's not what I want to do. He says it's because it's near him. My eldest daughter doesn't think I should have to do that. She thinks I should be able to stay here if I want to stay here...' There's nothing especially wrong with this monologue, except that it never stops. Ever. Lila talks if you're there. She talks if you're not. No wonder Anne was out of her mind.