When I go into her living-room, the heat and the smell hit me simultaneously. The heat is from the small electric fire, which is always on, making the centre of the room a furnace, whilst icy blasts from the winter outside creep in at the edges, around windows and under the ill-fitting door to the unheated kitchen beyond. The smell is that of stale urine and faeces, radiating from her, almost palpable in the sudden fetid warmth of the air in the tiny room, strong enough to make one gasp and mouth-breathe involuntarily.
She sits in front of the fire, her body angled slightly towards the large television in the corner, its sleek lines and modern look entirely at odds with the net curtains, the threadbare carpet and the few pieces of 1950s furniture. The volume is turned high and she fixes her unseeing gaze on the flickering screen, her face registering no emotion whatsoever as a toothless man on The Jeremy Kyle Show is booed by the studio audience for leaving his wife for her younger, thinner sister and a punch-up ensues. There is one card on the mantelpiece, wishing her a happy 90th birthday, from the care agency engaged by the Council to deliver basic care to her. Her birthday was several months ago and this appears to be the only card she got.
She is wearing a long, summery skirt in mid-winter, with an old, food-stained, hand-knitted jumper and her feet, with long, yellow toenails and fissured heels, are bare, toasting in the heat of the fire. I see a new looking pair of fur-lined slippers in the corner of the room and bring them to her, trying to guide her feet into them. It is no good – on closer examination, her swollen lower legs and feet, so unexpected given her otherwise emaciated appearance, are of variegated hue and the purpled flesh bulges painfully over the sides of the slippers. She starts to get cross and I put them back in the corner.
A carer – a cheerful, breezy, strong-looking woman who comes every morning – lets herself in. I excuse myself and stand in the icy kitchen whilst the carer expertly hoists her charge to her feet and changes her incontinence pad. The carer then bustles briefly into the kitchen, emerging shortly afterwards with tray containing a bowl of microwaved porridge, a small sugar bowl and a cup of tea. The tray is balanced precariously on an upturned wastepaper basket in front of the old woman, the stained carpet at her feet bearing testament to the apparent inadequacy of this dining arrangement. With shaking hand, she takes a heaped spoonful of sugar and sprinkles it liberally over the porridge, returning again and again to the sugar bowl, repeating the sweetening multiple times, until her breakfast is more sugar than oats. Then she starts to eat, lifting the spoon to her mouth, a good deal of porridge soaking into the wool of her jumper as it drips from the spoon. Without attempting to help further, the carer announces brightly that she is finished and will call back at lunchtime. She has been there only twelve minutes.
I ask her if I can turn the television down, so that I can try to talk to her about something important. She does not answer me, so I do it anyway. I ask her if she will talk to me about whether she will accept more help and whether she would like to move to somewhere she can be taken care of. I tell her that it seems that she is sleeping on her couch (she has some blankets to one side which she may or may not pull over herself) and, with her last care call being tea time, is not changing her clothes, her incontinence pads or even her seating position through the night. The morning carer reports that she is always sitting in her usual position on the couch when she arrives, wearing the same clothes as the day before. She becomes upset and shouts that this is her house and no-one can force her out of it.
I come back to visit her again, and again, to see whether I am able to communicate with her and understand what she wants. She always sits in the same place, staring unblinkingly at whatever is showing on the television. Sometimes she smiles at me, sometimes she shouts from her own, private world which I cannot gain access to. She claims that she is climbing the stairs daily to air the bedrooms, that she is walking out to the local library with her father and that she is cooking good plain food for herself.
She has advanced dementia. She has no friends and no family. Apart from the scheduled care calls three times a day, and occasional professionals’ checks, she has no visitors. She is a million miles away from someone else who has recently had a 90th birthday.
I find the loneliness and vulnerability of her old age almost unbearable.