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If a parent worn out by unemployment, debt or marital trauma feels that they are about to abuse their child, a cry for help will unleash a planned response from numerous caring agencies, a response insisted upon by law. This can ultimately involve the abused or the abuser being removed from the family home. Contrast this to the exhausted carer who makes a similar plea for help before they abuse their elderly demented relative, and one finds that no compulsory help is forthcoming, the law is not automatically involved. It has long been recognized that a minimum legal framework imposing compulsory duties on statutory bodies and perhaps individuals is long overdue. The Law Commission recognized this and incorporated a similar requirement into its 1993 report on mentally incapacitated and other vulnerable adults – Public Law Protection (HMSO).

The majority of the elderly mentally frail live in the community (only about 6 per cent live in institutions) and they and their carers, given the right amount of help, would like them to remain there. Surely the approach of a caring society will be to keep as many people out of institutions as possible, and those that need either medical or social ‘homes’ should then have a right of entry for their own safety and well being. Any legislation, however, must be seen to enhance the independence of the individual and not be seen as a way to reduce individual liberty. The admission to a rest home should be a positive choice for the elderly person, and if the issue is violence then other solutions should be explored such as the perpetrator moving out, not automatically the elderly victim.

The elderly with dementia will form the largest group whose needs require legislative safeguards. As the disease progresses they will become increasingly vulnerable and their needs in terms of housing, social and health services become more important. Currently there is no legislation that can effectively enhance the life of a sufferer. No one (carers especially) can insist that the local social services provide sufficient day care to allow that person to remain at home in comparative safety. No one can insist that a carer receives a break from caring at least once every few months. No one can insist that the housing needs of a sufferer are met to enable them to function at home with help and hence stay in the community. (Some people think that the 1986 Disabled Persons Act does include some of these rights, but that the Act is being ignored.) Thus if needs were not being met someone could speak on behalf of the elderly person concerned and ensure that the law was enforced, allowing the elderly mentally frail the same right to levels of care as other members of society. The NHS and Community Care Act 1990 legislates that assessment of an elderly person’s needs must be performed if requested (by social services). Whether or not this constitutes a legal right of the person to have all the assessed needs provided for by a local authority remains to be seen.

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Tight shoes and cutting the big toe nail around the corners are bad habits which frequently precede the appearance of an ingrown toenail. Doctors that cut a wedge off the toe nail down to the nail fold to provide immediate relief often set up the condition to occur all over again.

Cotton wool pledgets placed under the affected edge of the toenail lift the nail out of the nail fold and allow it to grow out and over the site of impaction. There is little place for cutting out the nail bed under a general anesthetic and only in the most difficult of circumstances should the nail be torn off from the base of the toe. Five days of antibiotics are often required when the nail fold is exuding pus and throwing proud flesh up and over the side of the toenail.

Home Remedies

Don’t wear tight fitting shoes. Wear thongs or sandals or cut the shoe away from the big toe nail around its edges. Use daily cotton wool pledgets dipped in antiseptic placed under the nail. Cover the toe with Savlon, Betadine or Tea Tree oil and apply elastoplasts dressing every day.

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