dilemmas

This week: is my father being ill-treated? When Juliet leaves her father in his old people's home he's upset, saying one nurse teases him about his incontinence pads. The manager says, `nonsense, he's always game for a joke', but Juliet wonders: should she go further, or would he get picked on more?

When I look back on the way I have behaved, visiting elderly relations in old people's homes, I often wonder if I couldn't have made their time easier. My grandmother used to insist that nurses brought in strange characters in grey top hats and crinolines to pay her unwelcome visits; my great- aunt swore that the moment I left her the nurses took her down to the cellar and beat her with iron bars. Her arms were covered with bruises, and though I knew that it was unlikely any nurse could be bothered to beat her up nightly, the answer that "old people bruise very easily" - which is the response I got when I asked - doesn't, in retrospect, sound totally convincing. Perhaps the nurses treated her roughly, and this translated in her mind to assault; I shall never know. We visitors often feel guilty about visiting old people in homes, particularly when we know they are going to die soon and that there is very little we can do about it all, and often we would rather do anything than make a fuss, particularly if we dread the hassle involved in moving them somewhere else.

It may be that Juliet's father is suffering some kind of paranoia, but it doesn't sound likely if he's only complaining about one nurse in particular. And the issue itself - incontinence pads - sounds horribly accurate as a target for teasing. Nurses can often make "poo, pee and parts" cracks when changing patients' clothes, simply because they are so hardened to that aspect of life, and they often simply don't realise how embarrassing it is for people who've lost the ability to be continent, and that men always hate their genitals being the subject of a joke - or anything to do with them. Little boys hate jokes about their willies, middle-aged men feel deeply threatened, and even an elderly man who may never have sex again can feel tremendously humiliated. Just because he is old doesn't mean he isn't a man; just because he's incontinent doesn't mean he's not worthy of respect.

Of course, it could be that Juliet's dad is simply terribly upset about being left, and at the end of a visit gets over-emotional about this incident which he appears to carry off with a smile when it's happening, in order to blackmail Juliet into staying or comforting him. But what's unusual about that? None of us likes being left by our loved ones, whether it's at a boarding school, a summer camp or an old people's home. Things we may be able to shrug off in our own surroundings do get out of proportion when we feel in general at the mercy of everyone around us.

Juliet ought to have a word with the nurse concerned, who almost certainly doesn't have any idea of the hurt she's causing. The nurse would be more likely to respond if talked to personally rather than be a subject of an official complaint. It's likely that she doesn't even know how hurtful she's being, and even imagines that Juliet's father goes along with the joke. At least this ought to be Juliet's first move. But if nothing changes there are various steps she could take, as readers have suggested, to take the matter further. It's highly unlikely that her father would get picked on more, since he appears to be quite an amiable patient; and as no one wants trouble, or for the home to be associated with bullying or teasing tactics, I'd think this was a pretty easy one to sort out. The only problem is in getting the courage to tackle itn

What readers say

Take his complaint seriously

You were right to take your father's comments seriously. Regardless of his ability to take a "joke", this clearly is an issue which he doesn't find amusing. I suggest that you talk to him again in private to clarify the nature of the bullying and teasing and its frequency, and then go back to the owner of the home. It is not acceptable for such a complaint to be dismissed.

You may find it helpful to speak confidentially to a member of staff on Help the Aged's free national advice line, Senior Line, on 0800 65 0065, open 9am to 4pm, Monday to Friday. Our service offers general advice on housing, community care and benefit rights and is available free to older people, their relatives, carers and friends.

Elizabeth Lodge

Senior Line Manager, Help the Aged

Old people can be difficult

I am an Englishman working in an Altenheim (old people's home) in middle Germany.

There may be some truth in Juliet's complaint, but a lot of people don't realise that when parents or relatives live in such institutions they often undergo a partial character change due to their drastic change in surroundings and lifestyle.

Very often the workers in these homes know the relative better, because of the intimate day-to-day contact. I am caring for an elderly lady who has a serious incontinence problem but is convinced that everyone knows about it and can tell she's wearing these pads. The outcome is that she will only wear the smallest pads, so she ends up wetting herself and the chair she happens to be sitting in, often the floor too, and then people really do notice her problem.

When we try to explain, she gets aggressive and often violent. It's a constant battle between her aggression, and catching her before she wets herself. Which is extremely difficult.

Frank Byram

Lower Saxony, Germany

Such bullying is common

Juliet must report her concern immediately to the UKCC, the regulatory body for nursing, midwifery and health visiting. All we need is the name of the nurse and the outline of her father's allegations. Juliet needn't worry about whether or not the allegations are true; our investigations will discover the truth. If the nurse is innocent, she has nothing to fear. If the manager of the home is a nurse, then she must be reported to the UKCC as well, for her failure to take action. Unfortunately, this type of occurrence is all too frequent. Nursing homes provide the largest single source of complaints about nurses' conduct and abuse of the elderly.

Dr John Knape

United Kingdom Central Council for Nursing Midwifery and Health Visiting

My grandmother suffered needlessly

My grandmother was in a highly esteemed home 22 miles from where I live. I could get to see her only every six weeks, and other members of the family visited her when they could. She often complained of ill-treatment, and although in my heart I did have my doubts, I brushed them aside because I was worried that if we complained we would be asked to take her away, or that she would be victimised in our absence.

Since she died I have discussed this with the family, and discovered that we all had our misgivings about the home but because we were unable to visit more often we none of us did anything.

My father is now in a home near me. He raised a similar complaint to that reported by your reader. Determined not to make the same mistakes again, I raised it with the staff nurse, who talked to the member of staff concerned. It has not recurred.

I will always carry with me the guilt that I feel for not looking after my grandmother properly when she most needed me. A good home will address your concerns, and a reluctance to complain will only encourage poor ones to flourish.

Michelle Haynes, London NW7

Next week's problem: I want my lover to leave her husband

Dear Virginia,

After 24 years of marriage my wife and I separated amicably three years ago. We still do things together with our two grown-up children.

Seven years ago I acquired a lover, and we meet for excellent sex, champagne and caviar at a local hotel. We talk twice a week on the phone but she's married to a real MCP. Although I have been happy like this, recently I've been feeling lonely and wanting a proper relationship. My lover was horrified. She said she'd never have the courage to leave her husband, how much she loved me and so on, how happy she was with the status quo. I could put pressure on her, but could I face the responsibility of breaking up another marriage, with all the pain it involves? And anyway, am I mad to think that a relationship based on occasional sex and telephoning could translate into a stable marriage?

Yours sincerely, David

Letters are welcome, and everyone who has a suggestion quoted will be sent a bouquet from Interflora. Send personal experiences or comments to me at the Features Department, `The Independent', 1 Canada Square, Canary Wharf, London E14 5DL (fax 0171-293 2182) by Tuesday morning. If you have a dilemma of your own you would like to share, let me know.