Eighteen days, seventeen nights.

Two falls, two smashed windows.

ON THE JUNE bank holiday weekend, my 81-year-old father was brought to Our Lady of Lourdes hospital, Drogheda by ambulance after a fall at home in Dundalk.

He was found on the bedroom floor by my mother at 7am on the Friday. Dad was wedged between his bed and the door, confused and unable to get up. He may have been lying there for hours.

Dad received a diagnosis of mixed dementia – vascular and Alzheimers – after an MRI in April but we had been aware for some time that he was suffering from more than just age-related memory loss. It’s a callous disease for anyone but for a life-long reader unable to retain the paragraph he’d just read to the point that picking up a book became a taunt, it’s particularly cruel.

My 83-year-old mother had been caring for him at home with some relief from me on the weekends. My sister and Mum had been going through all the care options – the twice-weekly home care assistants had just started and looked to have struck up an immediate rapport with Dad, but then he fell. We had been expecting something like this to happen. But not yet.

He spent a day in the Emergency Department being thoroughly examined, ruling out any injury, but on discovering a kidney infection, he was moved upstairs to the dementia ward that night. Dad spent a further 17 days there.

The reality of hospital

The ward layout is similar on each level, so I was brought back to 2019 when Dad was two floors below in Endoscopy after a stomach bleed followed by a heart attack.

This time, his shared room afforded a bird’s eye view of Millmount Tower and the church steeples on either side of an invisible Boyne. Out on the locked balcony, the seagulls harmonised with approaching sirens. My father’s first roommate was a harmless but inquisitive walker in his 90s who liked to stand behind Dad’s chair and trace delicate fingers across his bald pate, mussing the fine strands of hair. When it came to the issue of visitors’ seating arrangements, this bundle of pent-up energy would happily haggle with you over the price of chair rent he thought appropriate.

From down the hall in the women’s room, peals of irresistible mirth abruptly switched to screams of ‘You’re hurting me!’ followed by a string of salty epithets any self-possessed fishwife would be proud of. A nurse reassured Dad that the woman was not in fact being manhandled, but was just a little sensitive to being touched.

The roommate’s man-nappy often failed to house a bulbous swollen testicle whose cantaloupe weight encouraged him to sit on Dad’s bed to take a load off. After 10 days of no visitors, he got drafted by a nice lady from a nursing home called Castleross, which I misheard as Castle Rock. As long as Annie Wilkes from Stephen King-town wasn’t in charge of podiatry and the lending library, I thought, he’d be fine.

Amid heavier security than pre-Covid, the ground floor communal areas felt like an Existential Airport. Destinations: Life, Death and Somewhere In Between. Departure times varied. Arrivals were every other minute.

On the west wing of the sixth floor, the level of care and empathy on display was especially heartening. These kind people had either been selected for their professional patience or had learned it on the job. They are, after all, dealing with a walking wardful of incontinent kleptomaniacs. I write this in the knowledge that the description awaits us all, and with the explosion of Alzheimer’s cases, sooner than we may think. Despite the cramped conditions and the sweltering temperatures in Dad’s south-facing room during a mini-heatwave, the daytime care was excellent. Nighttime however was a different story.

Challenges

An elderly patient’s family is warned at every turn that the staff can’t prevent falls, and so it comes to pass. Dad fell twice during the night shifts, sustaining nasty cuts on the back of his head, bruises and a skinned elbow and lower leg. The anti-anxiety medication prescribed made him very drowsy, which may have contributed to his failed co-ordination.

We certainly noticed the difference in his alertness and ability to walk steadily, from before he was given the Quetiapine which they couldn’t give him until after the antibiotic had run its course, and afterwards.

After the first fall, we begged for a ‘special’ one-to-one carer to keep an eye on the room overnight. It wasn’t allocated. Then he fell again.

The resources just aren’t there to watch every patient over 24 hours. Everyone understands that. It’s just hard to watch it unfold when it’s your own disoriented loved one tottering along the hard floors of an unfamiliar environment looking for a toilet at 3am.

Dad’s new roommate was an urbane conversationalist, Olympic hall-walker and serial escapee who like his fellow dementia-sufferer in the bed opposite had no idea why he was being held there against his will. He claimed to have been expelled from his last nursing home for smashing a window. It turned out this wasn’t a brag but his modus operandi.

‘Shattered a window’

In Dad’s final week, his roommate shattered a window in the room by ramming a wheeled meal table through it. Two nights later, he did it again, this time with a heavier TV stand. A young security guard assigned after the first incident struggled with him but failed to restrain him from his goal.

When two of the witnesses have memory retention problems and both were groggy from anti-psychotic PRN medications, it’s impossible to ascertain how traumatic or disruptive this may have been for both of them beyond marking my father’s agitation, exhaustion and out-of-character tears when we arrived.

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One element you try to avoid around dementia patients is sudden, loud noises. Imagine how shocking the sound of a heavy piece of wheeled furniture smashing through the window of the room you’re sleeping in might be. Twice.

Over the weeks, we repeatedly requested that Dad be moved to a step-down ward in Dundalk for a two-week respite so that my mother, herself suffering from back pain due to long-term injury, wouldn’t have to make the daily journey up the motorway.

Dad’s discharge had been delayed by a urinary infection that had to be treated and then by heart issues – his usual high blood pressure unhelped by the environment and then bouts of low blood pressure from not drinking enough fluids. He had been on a drip at the beginning of the saga but kept wanting to pull it out. It later transpired that a major holdup on the move was that the consultant who makes the discharge decisions was on holiday.

What to do next?

On the Monday after the second window breakage, we informed the discharge coordinator that we were concerned that Dad was not safe there, and like a magic incantation, the words ‘not safe’ unlocked the administrative wheels and Dad was moved that day.

We followed the taxi that took him, strapped into a wheelchair in the back, to the Dundalk step-down ward.

Even though it was supposed to be a two-week respite to give us time to organise permanent care for him, after Day 1, we were under sustained pressure from both HSE locations to find him a permanent bed in a nursing home or find the combination of public and private home care that would give him 24-hour supervision. Again, the claim that Louth doesn’t have the staffing to shadow a wandering patient is impossible to refute.

My sister and mother had seen the care homes in the Dundalk area that Mum could manage to drive to. On the Thursday, I visited the one that had a bed for him and on the Friday we drove him there, booking him in for six weeks of respite care while we considered our options.

Our Lady of Lourdes staff did their level best to ensure a warm atmosphere for patients and their families, from the volunteer doorway greeters to the cleaners, porters, health care assistants, nurses, medical interns, doctors and consultants. If any populist election candidate ever needed a succinct reminder of the success and outright necessity of immigration to this island, they could do worse than break a bone and be tended to by the tireless Filipina nurses, Indian doctors and Eastern European Healthcare Assistants of our groaning HSE.

We are extremely grateful to all the staff of Our Lady of Lourdes, who did their very best to care for my beloved father in challenging circumstances. Yet the facts remain — two falls and two smashed windows, all on the night shift of the dementia ward. This begs the questions:

• Is this skeleton staffing level good enough to keep our vulnerable patients safe overnight?

• And what happens to dementia cases with no one to advocate for them?

• Could the ever-thickening layers of HSE management be stripped down and savings utilised to pay more staff to do the hands-on care?

• Does last week’s announcement of an extra €1.5 billion in funding and the lifting of the HSE’s recruitment freeze on Monday, despite the retention of the restrictive staffing ceiling from December 2023, provide an opportunity to improve nighttime patient safety?

These questions are not posed to the staff we met but to CEO of Health Service Executive (HSE), Bernard Gloster.

Nick McGinley is a freelance writer, voice-over artist, performer, casting director and workshop leader.