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preferably by a trained occupational therapist, but the day to day work could be carried
out by voluntary or untrained personnel. On the whole, the elderly mobile in the
community suffer very little compared to the handicapped, and it is essential that these
day centres should take patients with quite severe locomotor disease, some of whom are
only wheelchair independent. This emphasises how essential adequate transport
arrangements are.
(ii) That domiciliary services must not break down at week-ends and holidays.
It has even been seriously suggested to me recently that patients should be admitted to
hospital for the Christmas period as they cannot be maintained at home. These remarks
refer particularly to Home Help and Meals on Wheels services. It is unfortunate that
home helps are so very difficult to obtain for more than one or two days a week, and
that Meals onj Wheels should, let alone not function at the week-end, only function
twice a week, and it would certainly be an advantage if the service could be extended
as soon as circumstances permit.
When one is organising the geriatric services for a community it is most important
that:—
(a) Hospital beds should be reserved for patients who are medically ill or need
heavy nursing care.
(b) Local authority welfare homes should be reserved for the severely handicapped
who are only partially independent.
(c) Modified housing schemes with wardens attached should be reserved for the
more independent who need only minimal supervision.
Authorities at present often cater for a type of person who is physically and
mentally healthier than those for whom the need is greatest. The fact that the London
Boroughs cover domiciliary health, welfare and housing services, creates conditions,
one hopes, whereby suitable schemes can be provided for the elderly, according to their
degree of dependence and their consequent need".
ACCIDENTAL HYPOTHERMIA.
It is, of course, a well-known fact that hypothermia, or the condition of extreme
cold leading to a drop in body temperature can be extremely dangerous and sometimes
fatal to the elderly and very young.
Having regard to the large proportion of elderly persons in the Borough, arrangements
were made for emergency kits to be made available on a 24 hour basis for use
by medical and nursing staff, in order to ameliorate and prevent such environmental
circumstances.
The hypothermia kits consist of self-heating cans of soup, sleeping bags, blankets,
hot water bottles, thermometers, convector type oil heaters, matches and change for
electricity and gas meters. They are stored in the Hostel at 11, Rosslyn Road, Twickenham,
which is reasonably centrally placed in the Borough. The oil heaters were very
kindly donated to the Borough by the Oil Appliance Manufacturers' Association.
The purpose of the kits is that, in an emergency, and wherever practicable on
medical advice they are used to raise the temperature of the environs prior to possible
urgent admission of a patient to hospital for treatment. (See also page 39—Health
Education).
CHIROPODY.
A revised chiropody scheme was approved by the Council and came into effect
on 1st June, 1966. These facilities allow patients to be treated in the surgeries of
chiropodists and, in the Twickenham area, the option of treatment at a clinic. Requests
for domiciliary treatment are normally made by the patient's family doctor, and
supported by a medical certificate. There has been excellent co-operation between the
department and the local chiropodists.
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