A romance in the twilight

Widowed and in their eighties, a
couple fall in love while in care and experiencing mild dementia. But while
they found happiness, other residents, their families and some staff were less
than enamoured with the situation. Paula Green explains the dilemma to Mike
George.

It could be said that
much of the work of social care staff depends on their understanding and
application of the ‘3 Rs’ – rights, responsibilities, and reasonableness. They
must balance clients’ rights, staff responsibilities towards both clients and
the law, and the reasonableness with which they work to reconcile the
often-conflicting interests of different parties.

As everyone knows, this is sometimes
easier said than done – as Paula Green has found. She manages a care home for
people with dementia, and during much of this year has been faced with a number
of dilemmas arising from a relationship between two residents.

Hugh Taylor and Frances Evans (not
their real names), both in their eighties, both widowed and in the early stages
of dementia, began a romantic relationship. This was  evident to all because of their uninhibited  behaviour towards each other.

Finding love in later life can be
thought of as a tremendous, life-affirming gift. But despite the couple’s right
to privacy and dignity, in these circumstances Green and her staff had a clear
duty to investigate the possibility of abuse or coercion. She obtained the help
of a community psychiatric nurse, who was trained in emotional and physical
relationship issues, to assess the situation. Following conversations with the
partners, both together and singly, they concluded that the relationship was
consensual.

However, says Green, she then found
herself facing difficulties on other fronts. She was aware that some staff
found the situation disturbing or amusing; some were heard to snigger or make
unpleasant asides. “I realised that these attitudes could create a major
problem within the home unless they were tackled quickly,” she says.

She also found that some residents were
becoming upset about the couple’s behaviour. In part, this resulted from their
demonstrative behaviour, but was also, she says, the result of a certain amount
of envy or resentment among a few.

Meanwhile, members of Evans’s
family, who visited regularly, were upset about what was happening. Mainly,
says Green, they felt that their mother was betraying the memory of their
father; they had been married for a great many years before he died. “I talked
the whole situation through with them,” she says, “especially about their
mother’s consent to the relationship. Nevertheless, at first they wanted me to
somehow separate them. We had lengthy discussions about their feelings, and
established that essentially they were concerned about the memory of their father.
It was then that we were able to move on.” Taylor’s family, however, did not
find the situation upsetting.

Green prepared an action plan
designed to both preserve the couple’s rights, and to address the concerns of
other residents. One of her first steps was to train staff: “They were reminded
about our policies on the abuse of residents by staff, and about the laws which
preserve people’s rights to privacy and dignity. I also discussed with them
their attitudes towards ageism, and through various informal means encouraged
them to open up about their own feelings. The informal approach definitely
helped.”

The plan, which Green had discussed
with registration and inspection officers, included a specific policy on loving
relationships, which formally laid out people’s rights, and staff were required
to sign up to it. It also covered ways of encouraging the couple to be more
discreet in their demonstrations of affection, while preserving their rights.
“This had to be done with care,” says Green. “On one hand we made adjustments,
for example in seating and dining arrangements, which demonstrated that we
respected their wishes to be together, but we also spoke with them about ways
in which their more demonstrably affectionate behaviour could continue but
cause less distress to other residents.” Green also spoke with residents
individually, and encouraged them to express their feelings. Some, she says
were disgusted at the public demonstrations of affection in what was, after
all, their home too.

Meanwhile, the adjustments made in
attitudes and practices within the home began to take effect. As a result, the
couple continued their relationship until Evans died a few months ago. Since
then, Taylor’s dementia has worsened markedly. “It sounds unfeeling to say so, but
it has meant that his grief has been lessened,” adds Green.

“This was a difficult situation for
us, but it did teach us a lot about our assumptions about older people, and
about how to balance residents’ rights in a practical manner,” she concludes.

Case notes

Practitioner: Paula Green

Field: Manager of an Abbeyfield
dementia care home

Location: West London

Client: Hugh Taylor and Frances
Evans (not their real names) are both in their 80s, and in the early stages of
dementia. Both are widowed. They have short-term memory loss and are unable to
carry out everyday tasks without supervision.

Case history: Taylor has been a
resident for more than 18 months; Evans for the past few months. They became
close friends and developed a loving relationship. This became evident to staff
and other residents. Evans’s family were upset about this development, as were
some of the other residents, and staff too found the situation problematic.
Green was concerned about either resident being coerced, and notified a community
psychiatric nurse. Both concluded that neither partner was being coerced in any
way. She then put into place a plan to reinforce staff’s understanding of
residents’ rights and their duties of care, and she discussed the situation at
length with Evans’s family.

Dilemma: The couple had every right
to fall in love, but other residents’ feelings also had to be protected, and
the feelings of Evans’s family taken into account.

Risk factor: Both partners were
vulnerable to abuse, from each other, from other residents, and from staff and
Evans’s family.

Outcome: Their relationship
continued until Evans died.

Independent comment

It will be interesting to see how
relationships such as those between Taylor and Evans are affected by the new
national minimum standards in care homes for older people.

The standards that give direction on
meeting needs, health care, privacy and dignity, dying, social contact,
autonomy and choice, meals, complaints, rights, protection, shared facilities,
staff training, ethos, and record-keeping could all influence the handling of
such scenarios.

The standards will, of course, cover
all residents in the home. In the situation faced by Paula Green there
would  be conflicting claims from several
parties that their needs, privacy, dignity, or rights had been affected for a
variety reasons.

Sexual activity by older people, or
people with learning difficulties, or disabled people causes the public
discomfort. In the case of older people it is generally “they should know
better at their age”.

The other residents had a right to
voice their views because it was their home as well and they were entitled not
to feel embarrassed in communal areas.

The story illustrates the dilemmas
for staff in dealing with everyone’s rights in a residential home and perhaps
crucially just how much bureaucracy comes into play when two residents want to
get together.

Dick Clough is secretary of the
Social Care Association.

Arguments for risk

– Although both partners had early
stage dementia and appeared able to give informed consent, it might have been
very difficult to detect changes in the degree of consent given, especially if
the condition of one of them deteriorated.

– Their uninhibited behaviour,
especially in open or public areas of the home, would normally be regarded as
entirely inappropriate in any social care setting.  

– The behaviour was obviously very
upsetting for other residents, causing everything from increased and intense
feelings of loneliness among some to moral repugnance among others.

– There was a danger that Evans’s
family could have felt rejected by Green’s decision to uphold their mother’s
rights; this could have led them to withdraw their support.

– Similarly, if one or more members
of staff had taken the view that the situation was unsupportable, a variety of
workplace problems could have occurred.

Arguments
against risk

– Once informed consent was
confirmed, both partners had a clear right to engage in a loving relationship,
provided that others weren’t needlessly made anxious or upset; this was aided
by the fact that there was a double bed in Taylor’s room.

– The relationship led to a distinct
improvement in Evans’s self-confidence and abilities; apart from anything else,
this suggested that she at least was not being coerced.

– The episode led to a re-evaluation
by staff of their assumptions and practice with regard to residents’
relationships, feelings and behaviour, and about older people’s abilities.

– Similarly, it made them more aware
of other residents’ feelings and anxieties, and about all residents’ rights.

– The relationship clearly made both
of them feel valued, and provided them with a life-affirming and joyful period
during a time when otherwise they could have experienced feelings of emotional
loss and loss of dignity.