THE SERVICES AVAILABLE FOR PERSONS WITH DEMENTIA AND HOW TO USE THEM: LOCAL AUTHORITY SUPPORT (SOCIAL SERVICES) AND VOLUNTARY ORGANIZATIONS

The local authority has to provide many different services. These range from home helps — often the mainstay of a care network that enables an old person with dementia to continue living alone or a family to carry on coping — to day-care provision.

Among these services is meals-on-wheels which aims to ensure at least a basic standard of nutrition on several or most days of the week. Remember, however, that although the meals-on-wheels service may deliver food, many elderly people with dementia don’t eat it! Sometimes this is for practical reasons such as ill-fitting dentures, but often it is because of lack of supervision. I can remember visiting one lady in her mid-eighties, whose dementia had been a problem for three or four years, but who was still living at home. Her general practitioner had asked me to see her because she was losing weight and becoming more frail. The house smelt awful and when I went into the scullery, a little room behind the kitchen, I discovered 123 of the meals-on-wheels service’s foil containers, most unopened, none empty, of those which had been sampled, most looked as if no more than a forkful or two of food had been consumed from them.

The local authority also employs social workers who are highly trained professionals with a wide range of skills and responsibilities. The social worker, unless based in a geriatric or psy-chogeriatric department, is very unlikely to work only with the elderly, but nevertheless will be very knowledgeable about the provision of local services. He or she will be trained to advise about welfare entitlements, can provide a list of local nursing and residential homes, and can liaise with the home-help and meals-on-wheels services.

Social services also run day-care centres. Some of these are specifically for the elderly with dementia. As well as providing some welcome daytime relief for carers, they can also provide a stimulating and pleasant environment for the elderly people who attend. Sadly, however, they are unable to cope with the more severely demented people and may require those attending to be mobile. Unless they are specifically established for people with dementia, they may not be able to deal with confused people who wander or those who are aggressive or otherwise more difficult to manage, socially.

As well as providing day care, some social services, and also voluntary bodies, provide sitting services, either at night or in the daytime. This enables a hard-pressed carer to escape from the house and have some freedom without having to make arrangements with day centres or day hospitals. More importantly, a night-sitting service allows the carer the opportunity of getting a full night’s sleep. Continually broken rest at night wears one down and can be the final straw for many carers.

Voluntary organizations tend to provide the same sort of facility and support as those social services already mentioned. These voluntary services often come into being because of a lack of provision by the local authority or health service. They usually spring up as a result of the initiative of an enterprising individual who is or was a carer. They range from day centres, sitting services, lunch clubs, and drop-in centres for confused elderly people, to support groups for the carers. The latter are described in more detail in a later chapter.