Care Home Complaints

Occasionally your relative has something they cannot cope with any longer. For instance, it may be loud music from somebody's television. Ask one of the nurses if they could persuade the resident to turn down the volume to a more acceptable level. If there is no change you or your relative might like to make an official complaint. Start by speaking to the nurse in charge or the matron. If nothing is done speak to your relative's care manager if they have one, or to the manager or proprietor.

If nothing is done about the complaint write a letter to the manager or proprietor telling them no action has been taken. Suggest that they might like to visit the room and hear the noise for themselves.

Should your letter be ignored send a reminder. If you do not get a satisfactory solution to the problem write to the inspector of the home who will investigate the problem.

To make a complaint about a care home take the following course of action:

1. Make your complaint to the nurse in charge.

2. If no change complain to the matron.

3. Still no change: speak to the Care Manager.

4. No response: speak to the manager or proprietor.

5. Complaint ignored: put it in writing to the manager or proprietor.

6. Complaint still ignored: send a reminder to the proprietor.

7. Still no response: write to the Nursing Home Inspector.

8. The Inspector will:

• Investigate the complaint.
• Discuss it with the matron.
• Discuss it with the proprietor.
• Problem solved.

Checklist when Moving to a Elderly Care Home

Television Licence

If your relative takes their own television into the home, they will be required to buy their own television licence unless they are over the age of 75 years. However, their current licence is transferable when they move to another home. Please verify this with the matron or the manager.

Car Insurance

Make sure your car insurance covers any passengers from the home you choose to take on an outing.

Special Occasions

Don't forget to inform the matron in writing if you intend to take your relative out or prepare something special for their birthday or Christmas. Ensure you have their permission before you finalise your plans.

Reading Matter

If there are no library services within the home, go to your local library and borrow books or tapes for your relative. The borrower (yourself) will be responsible for the borrowed book or tapes and for them being returned on time in good condition.

Check Clothing

Check your relative's clothing at the beginning of each season to ensure they have a suitable range of clothing to match the weather. A shawl is useful for chilly evenings. Gloves, scarves, a hat and warm shoes will be needed for outings during winter weather.

Calendar

Buy a large calendar to hang on the wall. Note special events, birthdays, etc on the appropriate date as a reminder. Help them buy and write cards and undertake to post them.

Post

Ask the matron what the postal arrangements are. Most homes have a letter box for the residents' outgoing mail, it will then be taken by a member of staff and posted.

Residents' mail is delivered to the home, provided it's addressed properly. It will then be delivered to the residents by a member of staff.

Phone Numbers

Give your relative an address book with the address and phone numbers of all her friends.

Lockable Safe, Cupboard or Drawer

Residents should be provided with a facility for keeping private papers, small amounts of money, etc either in a lockable top drawer or cupboard. If none are provided, ask the matron if they can get a lockable facility fitted.

If your relative has a lot of cash with them, it must be handed over to the matron or nurse in charge to be kept in the home's safe. Make sure you get a receipt for the cash.

Comparing Care Home Costs

All homes have their own fee structure. Most homes charge different rates for single rooms, double rooms and for en suite facilities. Some homes will only admit residents who are self-funding, others will also admit those who are being helped by Social Services; some homes only admit residents who rely on Social Services for their funding.

It is sensible to contact your local Social Services offices and ask for a financial assessment before making any final decisions regarding your relative's transfer to a care home.

Your relative's care manager will assess the needs of your relative and decide the type of care which is most appropriate for them. This may be a residential care home, a nursing home or another type of care. If you disagree with their decision you may ask for a second opinion.

They will give you a list of homes in the area and guidance regarding the listed homes which may be suitable for your relative. However, care managers are not allowed to recommend any particular home. Before you visit the various homes jot down a list of financial issues you need to know about, for instance.

• Will a monthly account be sent to me?
• Do the fees cover everything?
• Are there any extra charges for anything?
• When are fees due?
• Can fees be paid by direct debit?
• Who are the direct debit or cheques made payable to?
• Do Social Services send their contribution to the home?

Your care manager will arrange for your relative to have a financial assessment. This is mandatory if they hope to have financial help from Social Services. Even those people who expect to be self-funding may benefit from such an assessment because the assessor will ensure your relative is getting all the allowances to which they are entitled.

Care Home Finance

Whilst it is not obligatory to involve Social Services, particularly if your relative is going to be self-funding (being totally responsible for their own fees) it is best to inform them and ask for advice as soon as you or your doctor realise your relative needs full-time care. A care manager will be appointed to help and advise. They will:

• Make an assessment regarding the most appropriate type of care required.
• Arrange a financial assessment if required.
• Give you a comprehensive list of homes in the area.
• Inform you which homes will give the type of care your relative needs.
• Arrange respite care during the waiting period if necessary.
• Reassess the placement of your relative during the first few weeks.
• Advise you if the placement is unsuitable and help find a more appropriate home for your relative.

If Social Services is involved four assessments will be made:

1. Assessment by a care manager to establish the type of care required.
2. A financial assessment to determine your relative's contribution towards care.
3. An assessment by the matron of the care home to establish whether the chosen home is the best possible home for your relative.
4. An assessment by the health authority to determine if your relative requires nursing care. If they do it will be decided how much nursing care need.

If Social Services are not involved only assessments 3 and 4 will apply.

The reason for the last assessment to determine the amount of nursing care a resident will need is because the National Health Service now pays for nursing services within nursing homes. This means that the resident no longer has to pay for this component of their care.

Finding a Care Home: Essential Facilities

Laundry services

Almost all homes have an in-house laundry where residents' clothing is washed and ironed and taken back to the person's room and put away. Unfortunately if clothing is not marked with the resident's name it can get mislaid.

Laundry services do not generally include articles that need to be dry-cleaned and it is usually the responsibility of the resident's relatives to take the clothes to the dry cleaners and pay for this service themselves.

GP services

Your relative's current doctor may be willing to continue to visit, monitor their progress, advise, and prescribe for them if and when they succumb to illness, on condition the surgery is near the home.

However, if it is not practical for your relative's own doctor to continue caring for them, they will have the opportunity to change to a more local practice. The matron will advise in this case.

Activities

Many care establishments have an activities programme. Some employ a person to draw up a daily activities list and put it into operation. It is difficult to suit all the residents all the time. They may enjoy some activities more than others but if they join in they will make new friends and enrich their lives.

Library services

There is generally a library within the homes for those residents who like to read. Sometimes the books are donated but in some areas the local library is able to bring a selection of books initially and change them at regular intervals. If there is no such facility, books can be borrowed by friends or relatives on a resident's behalf from the local library. However, the person borrowing the books is generally responsible for their safe return at the proper time.

Trolley shop

There are always a few residents who are too disabled or who have no inclination to go out. In nursing homes the residents are often too sick or frail to even think of leaving the home. With this in mind some matrons organise a weekly shopping trolley with things such as writing paper, envelopes, stamps and other useful items that the residents can purchase.

Gardens

Many homes have lovely gardens for the residents to rest or walk in. Sometimes the home's gardener or handyman will help residents to plant hanging baskets or tubs or even bulbs for them to have in their rooms or communal areas. It may even be possible to have raised flower beds to enable keen gardeners, if they are fit and well enough, to enjoy gardening again.

Religious services

The matron may already have arranged to have church services held within the home by the local clergy or pastors. If there is no religious service suitable for your relative, bring the matter up with the matron. They may be able to contact the appropriate minister and ask them to visit your relative when admitted. Alternatively, depending on distance, you could ask their own minister to visit.

Car parking

Many of the residents' visitors will have their own transport. One of their biggest worries is where they can park the car.

Most homes outside a city or town have car parking facilities both for staff and visitors. It is sometimes more difficult if the home is situated on a busy road with little or no space to park a car. The matron or the staff will know where the nearest parking places are. If the home is fortunate enough to have a car park it may prove difficult to find. When you phone to make an appointment to view the home, ask how to find it.

Sheltered Housing

Sheltered Housing or warden controlled flats are not classed as care homes but they deserve a mention here.

A warden is employed to ensure that residents who live in these flats are well enough and able to care for themselves on a daily basis, and to answer any emergency calls when they are on duty.

Each flat has a call bell or intercom which rings in the warden's office if they are in need of help during office hours. In order that the residents can call for help when the warden is off duty the residents are usually advised to hire a 'press-button-gadget' (sometimes called 'life line').

This is a call bell, usually in the form of a pendant, which residents can wear round their neck. When the bell is pressed it rings in an office in another building often miles away in another town or city. The person who answers will call the resident's next of kin and advise them of the problem.

Nursing Homes

Nursing homes have a higher ratio of staff to residents than residential care homes because the residents are less able than clients living in a residential care home. They need more help with their 'activities of daily living' such as personal hygiene, going to the toilet, bathing, etc. Some will need to be assisted with their feeding and drinking.

Clients who are admitted to nursing homes need nursing care. In all nursing homes the residents will be suffering from different illnesses and conditions.

Some people enjoy being in a home caring for a large number of residents. Others prefer to live and be cared for, in smaller ones. There are advantages and disadvantages in both cases.

The Larger Nursing Homes

Larger homes have 50 beds or more. It would be difficult and unusual to have this number of beds plus dining rooms, lounges, toilets and bathrooms, etc all on the ground floor. In view of this there may be two, three or possibly more floors depending on the number of elderly residents they care for.

The residents would be taken to their floor by lift. The largest homes may have two lifts. Access to each floor is also provided by stairways.

In some homes, particularly the more modern ones, the floors are complete with a small kitchen area, lounge and dining area, bathrooms, toilets, nurses' station and treatment room in addition to the bedrooms.

All nursing homes, whether large or small, have communal rooms for the use of residents and their visitors.

Smaller Nursing Homes

Some homes are designed to be a single storey building, depending on the number of residents they have been built to accommodate.

Residential Care Homes

Men and women are admitted to residential care homes for care such as bathing, meals, washing, etc. However, residential care homes are not usually allowed to admit anybody who needs nursing care. Most of these homes employ care assistants who work under the direction of the matron or manager. Usually a suitable weekly activities programme is arranged and even trips to the shops or various places of interest, for those residents who are interested.

The ratio of staff to residents may be lower than in a nursing home because the residents are usually able to do more for themselves. They are not expected to make their beds, do any housework or cooking but they should be able to carry out most of their own personal care when they are admitted.

The snag is that if any resident becomes ill and needs nursing care they may have to be transferred to a nursing home. Initially such a move often upsets the resident and they will need a lot of comforting and help until they learn the routine and make new friends in their new abode.

Care Options for Patients with Alzheimer's and Dementia

In England people diagnosed with Alzheimer's disease are usually cared for by the family in their own home in the early stages. There comes a time however, as the disease progresses and the behavioural pattern becomes more difficult to cope with, when carers find they can no longer cope with their relative's forgetfulness, odd behaviour and possible aggressiveness.

If you are a carer in this situation contact your relative's care manager and seek advice. They will be able to tell you which kind of home would be most suitable for them and give you a list of appropriate homes.

An EMI Home (Elderly Mentally Infirm)

An EMI home is usually the home where residents with dementia or Alzheimer's disease are cared for. A person suffering in this way will be happier in this type of home than in a nursing home. There are Registered Mental Nurses (RMNs) who are specially trained to care for residents with this kind of illness on duty at all times. They know how best to help and care for the residents.

Residential Care Homes for Elderly Folk with a Mental Disorder

These homes cater for elderly residents who suffer from such illnesses as depression or schizophrenia.

Some of the residents need to have regular medication administered by injection, usually fortnightly or monthly. The Community Psychiatric Nurse (CPN) visits frequently to monitor the residents, to give advice if necessary and to give the injections as they become due.

Causes and Symptoms of Alzheimer's Disease

This disease involves the parts of the brain which control thought, memory and language. Research is ongoing and although much has already been done neither the medical profession nor the scientists know the cause of this disease. So far, no cure has been found.

Signs and Symptoms

• Slow onset.
• Mild forgetfulness, patients may have difficulty in remembering recent events, the names of people they know - even their family members.
• Patients may not be able to solve simple problems or do simple sums which may cause minor difficulties. However, it's not usually serious enough to cause alarm.
• Most people will not suspect anything is wrong at this stage.
• The person may begin to forget how to do simple tasks such as combing their hair or cleaning their teeth.
• They can't seem to think clearly.
• They may ask the same question repeatedly, or repeat an activity, such as washing their hands, because they have forgotten they have asked the question or washed their hands already.
• Problems arise with speaking, reading, writing and understanding.
• As the disease develops the changes are more pronounced and more easily noticed. At this stage either the person or a family member, on their behalf, will seek medical advice.
• As time passes the person may become anxious, agitated, aggressive, suffer with insomnia and depression.
• They may become wanderers - going out and getting lost.
• Eventually they will need total care.

What Causes Alzheimer's Disease?

The cause is unknown at present but there are several factors which may be contributory.

Age

• The risk factor increases in people over 65.
• As people reach their seventies and eighties the risk factor increases. This is known as 'late onset Alzheimer's disease'.

Family History

There is a rare form of Alzheimer's which is familial. It usually occurs between the ages of 30 and 60 years of age and is inherited. This has led scientists to believe genetics may play a role in some cases. However, the more common form which occurs later in life shows no sign of being inherited.

Symptoms of Dementia and Care Options

Dementia is a brain disorder that seriously affects a person's ability to carry out the activities of daily living. Dementia is progressive and incapacitating if it occurs in the earlier years the mental deterioration advances more rapidly and is more severe than if it starts in later years. In people over 65 years old early symptoms resemble the forgetfulness of ageing. Many people worry they are becoming demented.

The earliest symptoms

A close relative may notice failing memory and initiative. The person may become irritable. The loss of memory is a gradual process, patients can often remember incidents in their past but cannot remember recent happenings. This is called short-term memory loss.

After a time the relatives may notice the person does not understand what is said to them and they appear to have lost interest in their former activities and hobbies. Not all signs of confusion or impaired capacity in the elderly are due to senile dementia. There may be another cause which when treated can reverse the condition. If your relative has this problem persuade them to see their doctor who will probably refer them to a geriatrician (a consultant who specialises in the care of elderly people). They will give advice on the patient's management and/or may refer them to a clinic, sometimes known as a memory clinic. The patient will be seen by a consultant, who not only specialises in the care of the elderly person but also in memory loss, its cause and management.

The most common form of dementia in elderly people is caused by Alzheimer's disease.

Assessing a Relative's Care Needs

It is helpful if you make notes of all the various pieces of information you learn about your relative. Thus new knowledge will help you find the right care home for them.

Try to establish how your relative copes with daily living, and whether they have any help from social services such as a home help.

Try to find out in which way they are incapacitated. Are they mobile at all, or do they have any appliances such as a walking aid to help them? Some people have trolleys so they can transport their food and drink or other things and use it to help support themselves at the same time.

Is your relative able to prepare their own meals, take their food and drink to the table, sit down, eat and drink without help?

Do they suffer from any illness that requires a special diet, such as diabetes? Food allergies also have to be considered so alternative foods or special diets can be prepared for them. The matron needs to know in order to instruct the chef and ask them to visit the new resident.

Can your relative get to and from the toilet by themselves? Sometimes it takes too long for this to be accomplished and elimination takes place before the toilet is reached. If the matron knows about this problem arrangements can be made for a resident to be taken to the toilet at regular intervals before they are desperate to eliminate. Hopefully this will solve the problem.

Take notes about the amount of pain, if any, your relative suffers from. It would be useful to find out what medication they take to keep them relatively pain free. Severe pain is sometimes treated at a pain clinic, to which their doctor would refer them if it was thought necessary.

A few people who are not really able to care for themselves any longer develop pressure sores on their sacrum, elbows, heels and other places, in fact anywhere where there is constant unrelieved pressure on the body. Sacral sores can be made worse by incontinence. The matron will want to know if your relative is suffering from any skin condition including pressure sores so the problem can be assessed by the doctor and treated.

Building Confidence via Anchoring

Anchoring is a way of drawing on past experiences in which you felt confident to help you cope better in the present. It's another powerful weapon in your confidence armoury.

An anchor is any stimulus that consistently triggers an emotion. To use an anchor you have to:

• Generate in yourself the particular set of feelings you wish to recreate.
• Programme your subconscious to associate those feelings with specific words and gestures.
• Use those words and gestures to trigger the desired feelings when required.

Sportsmen and women use anchors continually. For example, tennis players bounce the ball repeatedly before serving to calm themselves; most runners go through an elaborate routine to centre themselves, much of which is not strictly necessary to the actual performance; and the mighty All Black rugby team go through a series of rituals before each match to intimidate the opposition and fire themselves up.

You constantly anchor feelings in the nervous system whether you like it or not, so why not learn to use this to your advantage? Using anchors you can feel calm and confident, or energised and confident whenever you wish.

• Choose an event you shortly have to face, when you need to remain calm, but you fear could bring on nervousness. Start working on your anchor a few weeks before the event. Get into the relaxed state and recall a time when you felt really calm and confident. Relive it in as much detail as possible. If you can't think of a suitable time just pretend to be confident. If you have a good imagination, your subconscious won't know the difference. When the feeling is strong, put your thumb and fingers together and gently whisper, 'Cool, calm and confident'. The stronger the feeling, the more successful will be your anchor. Affirm that every time you make this gesture and repeat these words, these same calm, confident feelings will return. This is called 'installing the anchor'.
• Just before the actual event you were rehearsing, and if necessary during it, take a deep breath, put your thumb and fingers together and repeat your chosen phrase silently or aloud. Say it with conviction. Allow the confident feelings to flow through you. This is called 'firing' the anchor.
• Alternatively, install an anchor when you experience good feelings as you go about your activities. This is effectively what athletes do when they raise their hands above their heads as they break the winning tape. If they were to do this repeatedly they would find that simply raising their hands above their heads would trigger those winning feelings.
• Practise anchoring every day until it comes easily to you. The more practice, the better.

Reinforcing Self Esteem

To enjoy a better life you must focus on your potential, not your limitations, and concentrate on what you do well. You must make the most of your natural aptitudes and abilities.

Of course everyone has weaknesses, and it takes courage to admit to them. But it can be equally harrowing to accept that we have our strengths and acknowledge that we have talents and personal qualities that others don't have.

This section is about your strengths and making better use of them. You'll discover you have many on which to build.

The world is full of unsuccessful people who have talent but lack confidence and tenacity, who feel that no matter how good they are at something, someone else is bound to be better. Don't be one of them.

• Head a page of your notebook 'My strengths'. Now write down all your good points, everything you like about yourself. For example, are you a good communicator? A good cook? A talented artist or musician? Good with numbers? Handy with tools or good at fixing things? A sympathetic listener? Don't hold back. Keep writing until you've thought of at least two dozen. Add to your list over the next few days whenever you think of a new strength.
• Write down this sentence: 'I like myself most when.' Quickly, without thinking about it too hard, write down the first thoughts that come into your head and add them to your list of strengths.
• List your strengths as your partner or best friend would see them.
• Go through your list of strengths, and for each consider:
  - How can I make good/better use of this?
  - How can I do or use more of this?
  - How can I do/use it more often?
  - Write your answers in your notebook. Think about them. You may wish to amend your goals in the light of these new insights.
• Make a list of personal qualities you wish to develop or acquire. Begin by making up affirmations that encapsulate the kind of person you wish to become. For example, 'Every day in every way I become more and more patient. ' Use your affirmations every day.

Building Self Esteem

Some people think it's a sin to love yourself. They consider those who love themselves to be selfish, conceited and rather unpleasant. But they're mistaken. They confuse self-love with false pride and narcissism (being in love with yourself ) which is quite a different matter. Vanity and arrogance are usually a form of bravado engaged in by people who love themselves too little and are trying to cover it up.

If you don't love yourself you'll have no sense of self-worth, and no feeling of acceptance or belonging.

Furthermore, your capacity for loving others is directly related to how much love you have for yourself. You can't share anything you don't have. How can you truly love another if you don't feel worthy of giving and receiving love? Impossible.

The belief that you need to be different from how you are in order to be loved causes a great deal of misery. Unless you are happy within, you'll never be truly satisfied with what you do. Loving yourself unconditionally is the key to happiness. But you don't have to be perfect: the most loved person in the world makes mistakes! You don't even have to do your best. You don't have to prove anything. You're all right because you're all right, and lovable exactly as you are.

• Reflect on your attitude to loving yourself. Is it OK to love yourself? Or do you consider it sinful? Arrogant? Conceited? If so, from where does this attitude come?
• Write down this sentence: 'If only I were... then I'd be lovable.' Quickly, without thinking about it too hard, fill in the gap with whatever comes to mind. Examine what you've written. Does it really make sense?
• Regularly pamper yourself. Treat yourself to an occasional massage, aromatherapy, sauna, a long soak in the bath, reflexology, a manicure, whatever you fancy. Not only does it help recharge your batteries, but it also reminds you that you deserve the very best.
• Use these affirmations: 'I am worthy of all the good in my life.' 'I am open and accepting of myself and others.' 'I am loving, lovable and loved.' 'I feel warm and loving towards myself at all times.'
• Practise TFM - Time For Me. Make time for yourself every day, for relaxing, doing as you please, having fun. This sends a powerful message to the subconscious that you deserve it and you're worth it. Besides, if you don't make time for yourself, who else is going to make time for you?

Overcoming Low Self Esteem

Your self-image began to take shape even before you left the cradle and was pretty well established by the time you reached the age of 8.

By then, on average, you had already received over 70,000 negative dictates: 'Don't do that', 'No you can't', 'Who do you think you are?' 'You'll never make anything of yourself,' and so on. Most of these were run of the mill reprimands to which adults attach little importance; but they affect a child deeply and the accumulated effect can be devastating.

The means by which a person moulds the behaviour of another using a combination of reward and punishment is termed conditioning. You experienced plenty of it as a child, much of it negative. Very few young people reach adulthood without having their confidence dented in some way.

Once you understand your conditioning you can unravel the knots, dispense with the ropes that tied you down and leave them behind forever.

• The means by which a person moulds the behaviour of another using a combination of reward and punishment is termed conditioning. You experienced plenty of it as a child, much of it negative. Very few young people reach adulthood without having their confidence dented in some way. Once you understand your conditioning you can unravel the knots, dispense with the ropes that tied you down and leave them behind forever.
• When were your parents or guardians most proud of you? When were they least proud? How has this affected you? When (if they are still living) are they most proud of you nowadays? When are they least proud? How does this affect you today?
• Where did helping you to build your confidence and self-esteem rank on your parents' or guardians' list of priorities? Did they praise you often? Criticise constructively? Were they generous with their time? Or preoccupied with other things, like enforcing the house rules or pursuing their own interests? Make notes on how this affected you.

Confident Body Language

When you move confidently and carry your body confidently, you not only feel more confident but others assume that you are.

You may be surprised to learn that only 7% of the information you transmit to others is in the language you use. The remainder comes from:

• 38% How you speak - quality of voice, accent, voice projection, emphasis, expression, pace, volume, pitch etc.

• 55% Body language - posture, position, eye contact, facial expression, head and body movements, gestures, touch etc.

Whereas people often try to disguise their true feelings in their utterances, they communicate them freely through their non-verbals. When your body language tells a different story from your spoken words, guess which is believed? The answer is, your body language. It imparts eight times as much information.

• Stand in front of a mirror. Hold your head up, back straight, shoulders back, looking straight ahead. Try to make yourself look bigger, as if you're taking up more space - good posture automatically takes up more space. Now walk briskly and confidently around the room. How do you feel? A proud, upright stance makes you look more important, even if you're not especially tall. It makes you look younger and slimmer too.
• Hand and arm movements are very expressive. Learn to use your hands for emphasis, and keep hand movements smooth and flowing. Avoid:

1. Folding your arms or wrapping them around yourself (like a cuddle). This indicates a closed, defensive attitude and makes you appear unapproachable.
2. Placing your hands in your pockets.
3. T apping on surfaces such as tables and desks with your fingers or on the back of your other hand.
4. Fidgeting, scratching, wringing your hands (which shows tension).
5. Touching your face or neck. This reveals discomfort or embarrassment.
6. Become aware of all your mannerisms and gestures. If possible video yourself, watch carefully and make adjustments.

• Eyes are very expressive.

1. Lively, sparkling eyes are attractive. They say, 'Talk to me, I'm approachable.'
2. Looking away shows disinterest or deviousness.
3. Looking down conveys submission.
4. Confident people make more frequent eye contact than people who are unsure of themselves, so develop a steady gaze. When you enter a room move around comfortably, smile and make gentle eye contact with everyone; not too much, not too little.

• Your breathing is very important too. You can calm down instantly and become less tense and anxious by taking your attention to the breath, slowing and deepening it. Practise calming the breath. Slow breaths and a steady gaze, combined with an anchor such as 'Cool, calm and relaxed', can combat nervousness any time, wherever you are and whoever you're with.

• Make better use of your personal space. Try to make yourself bigger. The more room you appear to occupy, the more confident and important you appear. But moving too close to others is unsettling, so don't get too near.

Developing Assertiveness Skills

Even if you've never considered yourself to be assertive, mastering a few basic techniques soon starts to reap untold rewards.

• Decide to become more assertive.
• Think like an assertive person, and think of yourself as one.
• Imagine yourself behaving assertively and being treated accordingly.
• Act assertively. Start by taking small steps. Keep going until the uncomfortable feelings fade.
• Use these affirmations: 'I think, speak and act assertively at all times.' 'I used to be passive, but all that is changing. I am becoming more assertive every day.'
• Mentally rehearse potentially difficult situations. 'Imagine' and 'feel' yourself handling them assertively. 'See' others responding accordingly.
• Practise assertive non-verbals. Be aware of the non-verbal signals you give out:

1. Talk unhurriedly, with a clear, steady tone.
2. Make a habit of taking slightly more time to reply.
3. Give relaxed eye contact: not too much, not too little.
4. Avoid fidgeting, scratching, and touching your hair and face.

• Make your point clearly, with conviction, and don't waffle. Then shut up. If you don't succeed straight away, say it again, and if necessary keep repeating it. Change the wording if you wish, but not the message. Stay calm and don't allow yourself to be sidetracked.
• Sign up for an assertiveness course. Make sure it offers plenty of opportunity to practise with other people. If this is not possible, buy an eduactional video or set of audio tapes on assertiveness, and apply it!

How to Build Self Confidence

The formula for building confidence, indeed for bringing about any personal change, has five elements.

First, develop self-awareness: know yourself, acknowledge that there are aspects of yourself that you wish to change, and understand what has stopped you feeling confident so far.

Then apply the ITIA Formula (pronounced eye-tea-ah):

• Assert your intention to be confident, and make a commitment.
• Change your thinking. This includes changing restrictive attitudes and beliefs.
• Use your imagination. Imagine yourself as a confident person.
• Act as if you are already confident. The more you speak and behave confidently, the more confident you will become.

All four parts of the ITIA Formula are essential, otherwise the change is unlikely to be permanent, or worse, nothing may change at all.

• What difference would it make to your life if you knew without any doubt that you could achieve anything you set your heart on? If you like jot down a few comments in your notebook.
• Write down three beliefs that you hold about yourself which could be limiting your confidence. Now think of three beliefs you would rather have, beliefs that would empower you and bring confidence. Cross out the limiting beliefs and write these empowering beliefs in their place. What would you have to do for these new beliefs to come true?
• Make yourself very comfortable, either sitting or lying down. Close your eyes, take a few deep breaths and relax. Allow your imagination to flow freely. What would it be like to be perfectly confident? What difference would it make to your life? Let your mind drift for a few minutes, then open your eyes and write down everything that comes to mind. Keep this list: you have it in your power to experience all this one day. Remember, whatever your mind can conceive and believe, you can achieve.
• Commit yourself to behaving more confidently, as from now, even if it feels like an act. Do what actors, musicians, politicians, sports stars and many others do the world over - pretend you're confident, even if you're not. For instance, calm your breath, stand upright, look people in the eye and speak with a clear, unwavering tone: you will immediately feel more confident.
• From now on make this an unshakable rule: stop putting yourself down. Never say anything about yourself, either silently or out loud, that you don't sincerely want to be or come true.

Gaining Self Confidence

As the greatest and wisest teachers have always taught, improving the quality of your thoughts improves your life almost immediately:

• The Bible quotes King Solomon: 'As a man thinketh, so shall he be.'
• The Buddhist text, The Dhammapada, states: 'We are what we think. All that we are arises with our thoughts. With our thoughts, we make our world.'
• The Greek philosopher Socrates said, 'To find yourself, think for yourself.'

When you think like a confident person, you automatically feel more confident and act more confidently. Positive thinkers are the happiest and most successful. Sometimes all it takes to change your life forever is a single thought!

Humans are not robots: you can intentionally choose how to think, and if you are serious about building your confidence you must start changing your thinking patterns without delay.

• When you think like a confident person you feel more confident and act more confidently, so commit yourself to taking charge of your thoughts. Write this sentence on a small card and repeat it to yourself, with conviction, several times a day: 'I am a positive thinker - I think and talk confidently at all times.'
• Consider: Are you a negative thinker? A killjoy? Do you find it difficult to think positively? Does your conversation often take on an air of doom and gloom? This awareness is critical to your wellbeing now and in the future, so be totally honest with yourself.
• Promise yourself that from now on you will never:
  - Put yourself down.
  - Say you can't.
  - Say that what you want is impossible.
  - Tell yourself that you are incapable of learning anything new.
• Practise making sentences which start with assertive statements such as 'I can', 'I am', 'I want', '1 do', and 'I choose'.
• 'Yes!' is one of the most powerful affirmations you can make. Say it often, with enthusiasm. Display it in big letters on your Wall of Confidence. Say it whenever a new opportunity comes your way. And - try this and notice the difference it makes - say it with relish when you face a difficult problem or challenge.

Effective Self Motivation Techniques

Building confidence takes time, patience and effort. You will have to take a few risks. At times you will feel anxious. How can you motivate yourself to put up with the discomfort and persevere? We humans are motivated by:

• A want or need which induces tension. Only if these are un satisfied can there be motivational power.
• Perceptions of 'pleasure' and 'pain'. We seek pleasure and are driven by a desire to avoid pain.
• Hopes and expectations that we can get what we want, and that everything will come right in the end.

The strongest motivation comes from a passionate desire for something pleasurable, coupled with the avoidance of pain.

The best way to motivate yourself is to set yourself some worthy goals, find plenty of reasons why you want to accomplish them, and keep in mind the consequences of failure - which is what you are about to do.

• Ask yourself, 'What am I trying to achieve by believing I lack confidence?' Write down the answers. A difficult one, this. You may have to be more honest with yourself than you're used to; but don't skip over it just because it makes you feel uncomfortable - your answers may illuminate and surprise you.
• Write down this sentence: 'If I had an excellent self-image and total confidence in my abilities, I would...' Write down whatever comes to mind.
• Take each item on your list and make it a firm goal. Write it in the form: 'My goal is to...' Commit yourself unreservedly to working towards these goals.
• Make yourself very comfortable, either sitting or lying down. Close your eyes, take a few deep breaths and allow your imagination to flow freely. Imagine you have accomplished the goals you set yourself. Visualise them coming true in every detail. How do you feel? When you open your eyes write down any thoughts that come into your head.
• Think of something you can do as a first step towards each, one action you can take to get the ball rolling - even if it's just making a short phone call or reading a relevant magazine article - and do it now. No exceptions, no excuses!

Developing Self Confidence through Self Acceptance

Self-acceptance means acknowledging that you are as you are and being comfortable with it. It doesn't necessarily mean liking every aspect of yourself.

But bear in mind, self-acceptance does not mean giving up on yourself. If some disliked aspect of yourself is important and can be changed, do something about it. There's no point in feeling bad about something you can change, just as there's no point in feeling bad about something you can't!

• What aspects of yourself do you find most difficult to accept? Are there times or situations when you find it harder to be self-accepting than others? If you wish jot down what stops you giving yourself permission to be as you are.
• Use this affirmation: 'I accept my... and my... (the attributes you have underlined). This is me, and I'm wonderful, aren't I?'
• Do you ever feel that your best is never good enough? If you judge yourself as not good enough, no amount of achievement will ever satisfy you. Ask yourself: 'How realistic are the goals and standards I set myself?' There's a paradox here. There's nothing wrong with having high expectations of yourself: low expectations lead to underachievement. But impossible ones destroy your confidence.
• Write down this sentence: 'When I fail to live up to my expectations or fall below the standards I set myself, I tell myself...' Write down the first six thoughts that come into your head. Why are you so hard on yourself? You don't have to be perfect, you know.
• Stop comparing yourself with others. You'll always find people who are better than you at some things, and people who are worse. The only meaningful comparison is between you as you used to be, and you as you are now . No one is better than anyone else, just different. If you lapse into thinking 'I'm not as... (attractive/clever/athletic etc) as.', stop it. Tell yourself, 'I'm a wonderful, amazing being. I'm good enough, and I'm grateful for it.'

Building Self Confidence

How do you eat an elephant? One bite at a time. How do you climb a ladder? One rung at a time. How do you build confidence? One step at a time.

When you take small steps, the anxiety you inevitably feel is more manageable. That's why it's important to have a go at things which you would previously have found scary on a regular basis. Do you find it hard to talk to people? Strike up a conversation with one new person every day! Do you keep quiet even when you have something to say? Speak up, say your piece! You gain encouragement and feel more confident every time you build on each small success.

• Do something practical to expand your self-confidence every day. Take measured risks. Each small step should be accompanied by a clear intention, an affirmation (or change of thinking) and mental rehearsal.

• Adopt the Boy Scouts' motto, 'Be prepared'. Before taking each step, do your homework. Find out what you need to do, practise the skills and acquire the relevant knowledge. Ninety per cent of the outcome in any activity depends on the quality of the preparation undertaken.

• As you tackle each step, use the full ITIA Formula (see page on 'Building Confidence' ). Use an affirmation such as: I am confident, enthusiastic and fully capable of... (name the step you are about to take).

• Mentally rehearse each step. Imagine it done well and 'see' it working out perfectly.

• Now go ahead and do it! Ignore any anxiety or discomfort, and remind yourself that anything your mind can conceive and believe; you can achieve. If it doesn't work out, change your approach if necessary, and try again. Above all, keep your mind on what you want, never lose sight of your goal, and persevere.

Useful Genealogy Sites

Widespread use of computers and internet access has added to a more recent spurt in the growth of what is now an industry. However, as we shall see, you cannot get very far if you limit yourself to the internet. But it is a catalyst, and attracts those who might never get started on the orthodox genealogical route. You can still have plenty of fun and, depending on your surname and what has been done already, you may strike it lucky in ancestral cyberspace.

Ancestry.com

This popular site holds huge set of databases. Much of the site can be searched without a charge, in particular 'vital' data on births, marriages and deaths. You can print or download whole ancestry (back) or pedigree (forwards from an ancestor) trees, being ready-made hierarchies of relationships that others have contributed. A single search with a date may provide the direct ancestral tree as far back as the data included on the site.

You can print out a family tree either as charts or text relationship hierarchies. If you strike lucky with your particular name you might produce a direct line back to the seventeenth or sixteenth century in an hour or so. This is where the computer comes into its own, as such a feat might take days or weeks of searching at record offices. The information in ancestry.com has been transcribed from civil public records and parish registers so will have a reasonable chance of accuracy. Spellings need not be critical as these databases use the Soundex system. However, only by reference to original records (such as birth and marriage certificates and parish registers of christening, marriage and burial), can you be sure of the validity of an online record.

Familia.org.uk

Familia is a web-based directory of family history resources held in public libraries in the UK and Ireland . It was originally created and maintained by the Family History Task Group of the EARL Consortium. It is now being developed by the Co-East consortia of libraries in the Eastern region.

Familia is the online starting-place to find information about materials in public libraries which will help you trace your family history.

The Civil Register of Births Marriages and Death

You can find births, deaths and marriages records from 1837, when civil registration was introduced by law, at the local record offices and also at the Family History Centre in London.

The FHC indices are alphabetical in quarter years, so that the March 1880 index, for instance, will include events between 1st January and 31st March in that year. If a search is confined to names, dates and places from these indices the same transcription principles as above apply, even though you have less items of data and you are working from a secondary or tertiary (compiled) record rather than from a photographic film of the original. So you can still adopt a routine system, with columns for each item, and allowing in this case a number of records on a pre-printed page.

The parish registers continued in parallel with the new civil records, of course, but the latter offers a more complete and perhaps more reliable record.

Organised Support for your Ancestor Search

The following organizations provide help and support for ancestor research:

Society of Genealogists

www.sog.org.uk

This society has its own archives of records that can be accessed at their office in London and offers a unique combination of research material, guidance and support. It is a charity whose objects are to 'promote, encourage and foster the study, science and knowledge of genealogy'.

Federation of Family History Societies

www.ffhs.org.uk

This is the umbrella organisation of the local Family History Societies already referred to. It has affiliation with societies and organisations around the world, organises conferences and runs national family history projects. From the FFHS website you can find the contact details of your local Family History Society - see 'Contacting our Members'.

Guild of One Name Studies

www.one-name.org

A one-name study is a project researching all occurrences of a surname as opposed to a particular pedigree (the ancestors of one person) or descendency (the descendents of a person or couple). A true one name study covers the whole world, although some are limited perhaps to one or more countries. The Guild of One Name Studies invites membership from people doing worldwide research, and this is a good way to

register your interest in a name and share information. As you will imagine, most names are uncommon, or certainly not the most common, although any name is eligible provided a person can show they intend to research worldwide. A website name search will reveal whether your own name, or one you want to research, is currently being studied by a guild member.

The Journal of One Name Studies is published quarterly and includes information, ideas and articles for members. A register of one name studies is held and there is a Guild email forum offering a permanent email address with your name followed by @one-name.org. Many names are also associated with one name societies and produce a periodical newsletter. Doing your own family research may be lonely until you meet people covering similar territory, so in this way you can quickly establish like-minded people when researching present names world wide. The Guild holds meetings and arranges speakers around the country.

Finding a Professional Genealogy Researcher

Some readers may want to hire a professional researcher, perhaps for specific research or because they cannot spare the time personally. Specialised work, such as reading documents in Latin and Old English may be right outside your expertise, although you can add these to your family history aims if and when your research requires it.

You can get advice on most of the main genealogy sites such as GENUKI and the many UK links online. Various family history journals and newsletters also feature advertisements for a whole range of local searching and more specialised services. Bear in mind, however, that many enthusiasts carry out work free of charge on the basis of 'give and take'. This especially includes visiting a local record office to do a search or collect a certificate that can save a lot of time and expense and is an ideal form of reciprocation.

Overseas researchers, such as those from the USA, can benefit particularly, as well as novices who have not yet the expertise to be of much help reciprocally.

There is also scope for people in the UK to share work with someone who lives at a town someone else is researching, in return for reciprocal help. This is where the family history societies and mailing lists help in putting people in touch with each other. All this keeps the cost down, avoids the need for professionals, and adds to the social aspects of family history as a hobby. Many amateurs who have given many years to their research can provide more expert help than those making a charge. Only by giving as well as taking can such an invaluable network be maintained. Check out the society or email the secretary in your 'target' town to find out what voluntary services can be expected, and how best you can use these and economise on time and effort.

Common Mistakes when Tracing your Family Tree

We can be thankful that what is important has long since been identified by generations of genealogists who learned the hard way - by making mistakes galore and putting disproportionate effort into relatively fruitless activities.

When it comes to old records - or any aspect of your family history interests - a few carefully chosen bits of knowledge and core researching skills will suffice for most people most of the time. Mistakes are inevitable, but it is better to learn from one rather than six.

Not every word or event has equal importance to your overall research. Names, for example, have high priority, along with places and dates as they form a foundation for later research.

A 'trees and forest', or 'detail and big picture' approach applies across the board. There are some things that a detailed word by word study will not reveal, such as the context and comparisons in other parts of a document. Likewise, a fast skim read will miss important detail.

Much of the difficulty in reading old documents relates simply to the personal style of the handwriting, complete with flourishes and idiosyncratic embellishments. Some types of handwriting were not taught at school, but by notaries and other professionals to their clerks or students. For example the 'secretary hand', the 'italic hand', and the 'court hand' all had distinctive forms of character and abbreviations. All this is on top of the differences as taught by different teachers, and of course the individual's own style.

Remember that records were made by individuals, with their own ideas, feelings, talents and intentions. They even had their own grammar and spelling. In an age of universal illiteracy there was not much accountability nor standards to apply. Why shouldn't a clerk spell a name three different ways in the course of a single document if its owner couldn't spell at all, and it made no difference to the purpose of the record or the efficiency of the system it supported?

Much of the methodology of understanding archives boils down to comparison. For example, comparing unknown words and characters with known ones in the same document. Depending on the size of the document, start from the same page, then work forwards and backwards page by page in turn - you may not have to check far for a given word, and familiarity will help with other queries. The job is much easier if you know the context and what is probably being communicated or recorded. Thus by finding a difficult word or character whose meaning is clear, you can better understand it in a less obvious context.

Tracing your Recent Family History

Start with what you know. Draw a simple family tree showing your grandparents, parents, yourself and your children. Add birth, marriage and death dates. Ask older relatives for information until you have got as far into the past as possible. Target your oldest relatives. Write to or telephone those living at a distance. Get to those you don't usually hear from as there is more chance of finding something new (rather than Nan 's same old stories). Great aunts and uncles are a potential gold mine. Siblings of grandparents and great-grandparents usually provide more new information. Recollections of childhood and family intelligence can vary a lot, but it pays to get it all recorded anyway. Contemporary friends, neighbours and work colleagues of your oldest relatives can also usually contribute. They may have seen much more of them than the family.

Precious Stories

Whatever your eventual aims in tracking down your ancestors it usually helps if you start off in this way. Get as much readily available information as possible on both sides of your family even though your main objective is to research your father's side surname. Jot it all down in a bound notebook or diary so that nothing gets lost. You don't know what you may finish up doing in your FH exploits, and easily obtainable information may take on special value in the future - to others as well as yourself. Domestic investigation is good practice for the research skills you will need at an increasing level. If it involves a bit of detective work, even better. We will cover your specific aims shortly, but the idea is to make a hands-on start and gather all the information you can, which might well influence what you do thereafter. This is a standard, boring rule but it does pay dividends and you will probably have fun doing it. Make a start, anyway. All too soon older relatives die off and precious stories are lost forever.

Family Surname Searches

You may want to use surnames in one of two main ways. One name studies are popular, and these relate to a single surname usually on a worldwide or countrywide basis, regardless of individual family lines. If your name is uncommon, this can be an interesting kind of research and a fascinating hobby in its own right. The other use of surnames is in the course of genealogy and family history research when the surname is your prime focus of interest. This may be a single paternal or maternal name tracked as far back as you can, or one or more of the many names you can trace by following marriage lines.

Surnames on the Internet

Surname resources are at soc.genealogy.surnames.britain and soc.genealogysurnames.ireland. GenServ is a volunteer-operated collection of family history GEDCOM files, from which you can have a trial 60-day access if you submit your own files - a mutual, or reciprocal resource. Rootsweb comprises a community of thousands of web pages where you can search for names. There are links to information on getting started, family history centres, the ROOTS-L mailing lists and genealogy-related files you can request by email and lots more. For example an article entitled Computers: Changing the Face of Genealogy (relatively old [1989] but valid). Surname Helper lets you search for a surname linking you to its website source anywhere in the world, such as a UK county GenWeb project. The World GenWeb project is a non-profit, volunteer based project collecting genealogical data around the world. FreeREG provides details of baptisms, marriages and burial records. It is part of the FreeUKGEN project and companion to FreeBDM. These are just being developed at the time of writing. You can also browse or search for surnames on ancestralfindings.com, where you will get email addresses of the people doing the research.

Starting a Family Tree

The following rules, tips, principles and guidelines will help towards a painless start, whatever approach you want to take to family history. More important, they will provide the right foundation for a pleasurable, long-term interest in the subject that will more than reward your time and effort.

• Work backwards. You may well have a famous ancestor but you can never be sure until you have made the connection in a 'tree' that connects to your mum or dad. Add a 'great' to your great-grandparent and one more 'great' at a time. The more recent the records are, the more reliable and legible they will tend to be. You will therefore meet the joys of funny spelling and handwriting gradually as you work further back in time.
• Have a method. Any method is better than none when it comes to keeping records. Just bear in mind that ancestry records grow like Topsy, like twigs and leaves on a tree as compared with its single trunk and few main branches, so you will need spare capacity in every part of your recording system. Make these common sense principles more than good ideas, but part of your routine way of tracking, recording and filing information.
• Do as much as you can before you arrive at a record office, such as preparing separate sheets for different records or types of records. You will save valuable time you can spend instead on actual transcription during your limited time with the source documents.
• Transcribe data exactly as you find it. This rule applies also to layout, such as the order of columns of a census form. You will soon become familiar with layouts of registers and certificates, so a different, personal layout will be confusing later. Transcribe errors and all.
• Don't go off at tangents. Old records can be so intriguing that you are tempted to pursue anything of interest, even if it is not part of your family history aims. Suddenly the afternoon is gone and you realise you haven't got half of what you set out to get. Stay focused.

What is Genealogy?

'Family history research' is said to be the fastest growing hobby in the UK, as well as being the second most popular topic on the internet. Tracing ancestors seems to go deeper than your average hobby, fulfilling some sort of basic need to get to know our origins and, presumably, understand ourselves better in the process. It can certainly throw up some great stories, quotable even outside your own family circle, and provide no end of fun and pleasure.

Based on the number of generations we have clocked up in a few centuries, and the remarkable effect of compound growth, we all have recorded ancestors in plenty. It seems that statistically even the most anonymous of 21st century families are the progeny of a motley congregation of the good, great, sick, sad, strange, evil, infamous and interestingly mediocre. Like leaves on a summer tree, those early branches (we must come from somewhere) soon make big numbers, harbouring more Toms and Marys, let alone thieves and paupers, than you would have thought a respectable family tree could bear. Each Tom and Mary has a story. Some, because of our rich genealogical resources and the internet, can be tracked down across the centuries. In a sense that true family historians know well, these people can be made to live again.

Tracking down your ancestors can involve family history, genealogy or both. What's the distinction?

• Genealogy usually refers to recording your family tree, or pedigree, as far back as you can go, over one or more family names.
• Family history, on the other hand, puts the people you find into their historical context and the aim is to find out as much about them and their contemporary history as possible - their stories. The history or story part is what makes it addictively interesting.

The US leads the way in family history as a serious hobby. Americans are probably better represented in research into UK, 'old country' ancestry than UK residents themselves. So, although some of the top websites are US biased, they none the less have plenty of content about British ancestry, useful to British researchers. The UK is certainly blessed with a wealth of archived material housed in public records offices and libraries, stretching back to the Norman conquest.

Anyone prepared to delve into a little Latin and Old English and expand their school history can search these very early dates - if not there is no end of help available. This is attractive to many thousands of new world descendants of the islands - including Australians - who have no less affinity with their Anglo Saxon roots than natives and whose ranks have fuelled the growth of family history to its present popularity.

Given commitment and enthusiasm, that world, and its citizens that held your name, is within your reach, just waiting to be discovered.

Choosing a Care Home

How do you know which care home is the most suitable for your beloved relative or friend? How can you decide where they will be happy and well cared for?

Many hospitals complain there is a bed shortage. It is claimed elderly patients cause this because they have nowhere to go after leaving hospital as there is nobody to look after them at home and so they have to stay in hospital. They now need care and help with the activities of daily living such as washing and dressing etc. Some elderly patients are fit enough to be cared for in a residential care home, others need some or total nursing care. There are also elderly patients in the early or middle stages of Alzheimer's disease and others who suffer from a mental illness.

Hospital staff are anxious to free the beds as soon as possible to make way for new patients who need surgery or urgent medical treatment. This puts pressure on care managers and the patient's relatives to find somewhere where their loved one can be cared for on a temporary or permanent basis.

To help a new resident feel at home and as happy as they can be in the circumstances, they need to have the basic requirements for an elderly person. These are:

• privacy
• comfort
• warmth
• appropriate food
• kind, understanding staff
• company with people with whom they can make friends
• clean clothing
• toilet training, incontinence pads and pants if required
• help with washing/bathing and toilet
• occupational ploys - hobbies, crafts, etc
• somebody within the staff with whom they can relate
• hand rails along walls, in bathrooms, toilets, etc
• competent care when they are healthy
• competent care during sickness, i.e. headaches, migraines, colds, etc
• a good sized, nicely decorated bedroom with an adequate amount of serviceable furniture including a comfortable bed and chair, wardrobe, chest of drawers, a chair for visitors, commode (if required) curtains and bed linen, towels, etc, hand basin or en-suite facilities.

When all the hard work is done and your relative has settled down you will be able to relax and congratulate yourself on a job well done.