Alarming.

Tags

(un)accountability, autism, care in the community, charities, coroner, court proceedings, independent living, inquest, institutions, learning disability, true stories, voluntary organisations

Another week, another inquest. Actually, this week, two of the ghastly things: Oliver McGowan‘s in Bristol and Danny Tozer‘s in York.  The Bristol Post is doing a sterling job of summary reporting of what was done to Oliver and how it is being presented in court (big shout-out to the Post’s education reporter, Michael Yong, whose coverage of this epitomises local journalism at its finest).

Meanwhile, George Julian is live-tweeting Danny’s inquest.  There are grim similarities between the treatment of both these young men, and also with what was done to Connor Sparrowhawk.  All three had epilepsy, autism and varying forms of learning disability.  All three had their epilepsy discounted, being treated as though its symptoms were behavioural or mental-health problems, rather than signs of a physical brain malfunction.

Danny’s epilepsy manifested itself as tonic-clonic seizures, the sort that used to be called ‘grand mal’.  It was known that if one of Danny’s seizures lasted more than five minutes, he needed medical attention, and it was also known that he was susceptible to seizures at any time.  The logical inference to be drawn from this was that Danny shouldn’t be unobserved or unmonitored for more than five minutes at a time, but the implication seems to have eluded the people supposed to be looking after him.  He was routinely left for ‘fifteen to twenty minutes’ in the morning for ‘private time’ (masturbation).  Danny’s Mencap ‘independent living placement’ (rebadged residential home) had installed a seizure monitor in the form of a movement-detector placed under his mattress, linked to a remote audible alarm.  But when it went off during Danny’s ‘private times’, this appears to have been assumed to be due to his movements while masturbating, rather than to any resulting seizure activity.  It also ‘was going off frequently throughout the night’, according to John Andrews, the waking night worker who gave evidence yesterday.  He reported the fact to his managers.

The alarm, appropriately for an emergency warning, was loud: “Like a fire alarm,” according to Angela Stone, one of the day workers.  Inconveniently loud.  “It was going off disturbing everyone.” said Ms. Stone.
So the engineers were called to ‘tweak’ the monitor.
“It was a case of getting the settings right,” explained Ms Stone, adding, “I don’t know where I’ve got the word settings from.”
That suggested that some, at least, of the people working with Danny misunderstood the gravity of his condition.
Ms Stone was categorical: “I felt <bed> was a safe place for Danny, we had the mat, we knew that worked, he wasn’t seriously epileptic.”
Myself, I can’t imagine in what universe repeated tonic-clonic seizures are considered ‘casual’ epilepsy.

There was no mention, yesterday, of what clinical advice, if any, was provided to the engineers to ensure the revised settings were still suitable to keep Danny safe, nor any mention of a medical opinion being sought about the ‘frequent’ alarms.  Tellingly, when Danny was found in bed, grey and not breathing, on the morning of his death, the forceful, rhythmic activity of cardio-pulmonary resuscitation did not trigger the system.
“It suddenly struck me after everything was over,” said Ms. Stone, “We’d not heard the alarm go off. I couldn’t get my head around why we hadn’t heard the alarm go off.”
In a gruesomely farcical passage, she described herself and her manager checking the alarm:
“So Rachel, the manager, and I went to Danny’s room to look at the mat, that was the first thing that occurred to us, something had happened, something was wrong. The mat was on, the light was green.  Rachel showed me how you had to move around in a certain way to set the alarm off, and the alarm went.”
“Who got on the bed?” asked the coroner.
“Rachel,” said Ms Stone.  “I didn’t have a clue how to do it.”
Nope. No clue.
Is it possible that the sensitivity of the mat’s ‘settings’ been so narrowed as to render the sensor useless for practical clinical purposes?

Jo Fannon, Danny’s 1:1 worker on the morning of his death seemed nearly as uninformed.
The Tozers’ barrister, Ben McCormack asked her, “You mentioned earlier that the only time you’d heard it was when he was having private time, was there any chance anyone would have turned it off?”
“No,” said Ms Fannon, “You’d never turn it off.”
“Had it ever been set off by someone sat on the bed talking to Danny?” asked Mr. McCormack.
“No,” said Ms. Fannon. “It required momentum.”
Mr. McCormack persisted.  “You mentioned it was changed, were you aware of the defects, what was wrong?”
“I wasn’t aware of the defects,” said Ms Fannon, “But it was replaced.”

I may have mentioned that G uses a number of machines.  They alarm from time to time.  If they do, I NEED to know why, in order to be sure that the action I take is appropriate and also to be aware for the future if there is a pattern of events.  If there is a pattern of events, I need to know the underlying causes: Is G unwell, or is there an intrinsic flaw in the tech?  Machines provide information.  Some do a limited amount of analysis for you, within human-defined parameters and algorithms.  They do NOT replace thinking, and they are absolutely pants at intuition and human empathy.  It’s more than regrettable that some people don’t seem so hot on these human functions either.

Now, we all know there are numpties who will take the battery out of their smoke alarm because their inability to master Toast-Making Without Charring means inconvenient decibel-levels.  But I was trying to imagine what staff would have done if a real fire alarm had gone off.  And I bet it wouldn’t have been to call out the engineers to modify the noise.

“Hi, Maple Avenue here, can you send out engineers to turn the fire alarm down? Keeps making a helluva racket. We want it so it only goes off if the fire moves in a certain way, with a bit of momentum.”

Quite apart from anything else, they’d have been as at risk as the residents of getting fried.  Because it would have been their lives on the line, and not just Danny’s, they’d  have dialled 999 for the Fire Brigade, straight away, no question.  So why were the engineers, not the emergency (medical) services, called for Danny?  Did he as an individual not matter?

It’s worse than alarming.  It’s terrifying.

Four Hours With Franklin.

Tags

appropriate vocabulary, autism, institutions, kindness, learning disability

Now that E is away at University and unlikely to be occupying his room for more than a couple of weeks at a time, the children’s Papa – a tidy soul to the core – has ambitions to turn the space a little more guest-friendly, by turfing out some of E’s more juvenile possessions.  The practicalities of this aspiration have in the first instance fallen to me. To anyone who knows me, it will be no revelation to be told that I am absolutely useless at throwing things away.

How do I know whether E is still attached to the Lego star-cruiser that he so laboriously constructed eight years ago and which has been poised for takeoff from the top shelf of the bookcase ever since?  I dare not even touch it, lest I accidentally dismantle one of its delicate protrusions and put myself permanently in the dog-house.  Ditto the Airfix, the sporting trophies, the Warhammer sets.

“Just go through the books, then”, said P.  Nope.  While P sees a rummage through bookshelves as an chance to winnow out any that haven’t been read for a while, I see it as an invitation to reacquaint myself with old friends.  One doesn’t put old friends out the door.  From The Very Hungry Caterpillar to The Tale of Samuel Whiskers, to Wolf Brother, to Smith, to The Hunger Games, to King Hereafter, E’s bookshelves are a coded chronicle of his life with us, and each of them is still a darn good read.  So having pulled all the books off the shelves and replaced them, I settled down, slightly guilty, very exasperated, and in need of cheering up and soothing, with a couple from his mid-primary-school stage: Mij Kelly‘s Forty-Eight Hours With Franklin and Franklin Falls Apart.

The thing with good books, I find, is that on re-reading, you come across bits that resonate as new, because you have changed in the interim.  I first read Three Men In A Boat in my very late teens, on a Scotland-to-London train, disrupting the entire carriage with honks and snorts of mirthful recognition at the posing, mock-heroics and ineptitude of the young-adult heroes.  Twenty years later, with the benefit of knowing my brother’s personality-plus Jack Russell, I read it again and was convulsed by the contributions to expedition-packing – long-forgotten – of Montmorency the terrier.

Re-reading Franklin, the adventures of an accidentally-animated shop dummy, I laughed again, as I expected to, but I also began to see another layer that didn’t appear to me ten or twelve years ago.  Franklin, born into the world of humans as a six-foot baby, has no understanding of people or how things work, which leads him to repeated close shaves with law-enforcement.  He doesn’t talk, although he learns to repeat sounds, words and phrases that he hears.  He is literal-minded.  Asked to lend a hand, he does what any sensible shop-dummy would do: unscrews one of his at the wrist and passes it over.  He relies heavily on his flesh-and-blood siblings, Gertie and Joe, to protect him from the consequences of his unwittingly disastrous actions. They understand, from a knowledge of his past, what his probable intentions are and what his apparently out-of-context repetitions of stock phrases mean.  They know that when he says, “Ow, ow, ow, motorbike stars”, he means his legs are hurting and “Body no Perkins, body cow”, means actions were stupid (like the cows) but not malicious (like Mr. Perkins).

Well-meaning adults, such as Joe and Gertie’s parents, don’t quite get this, at least not until they have spent time with Franklin and begun learning to understand him.  And even then, the parents get it wrong, initially thinking only of how presenting papers on Franklin to international conferences will enhance their standing as scientists.  Strangers, pardonably, think Franklin is weird or rude when he addresses them as ‘Podgy’.  They aren’t to know this is his attempt at complimenting them for being a ‘prodigy’.  And some strangers, learning just how different Franklin is, see him as an opportunity for money-making: as a freak-show exhibit; as a subject for containment and study; as a tabloid newspaper headline.  In pursuit of their own aims, they ignore or dismiss Franklin’s rights to bodily integrity, autonomy and self-determination.

Echolalia, language differences and communication difficulties.  Incomprehension of the world around him.  Reliance on others’ attunement.  At risk of exploitation and/or incarceration.  Not quite human.  Sounds very familiar, doesn’t it?

Perhaps that’s why there was never a third Franklin book.  Perhaps, having created her living mannequin and seen him evolve, maybe without her realising it, into someone who looks very like an adult with learning disabilities and autism, Kelly just couldn’t imagine a future for him.

P.S. The Franklin books are long out of print, but occasionally resurface second-hand.
They are available together as an e-book called The Franklin Files.

Health and Capacity.

Tags

#7DaysofAction, #justiceforallthedudes, assessment, autism, care in the community, learning disability, Local Authorities, NHS

So I was doing some background reading for a piece I was writing for #7DaysofAction and it involved trying to get a good grasp on the Mental Health Act 1983 (as amended by MHA 2007) and the Mental Capacity Act 2005 as they apply to ATUs and other NHS provision, in order to understand how what has happened to so many autistic young people came to happen.

For a non-lawyer, it was a bit of a brain-melt.

The Mental Capacity Act is intended to protect people who lack capacity to make their own decisions.  If there is a reason to suppose that a person is incapable of making a particular decision because of a cognitive impairment, then someone else can be designated to make that decision in the person’s best interests.  The decision-maker has to take into account the person’s preferences and ensure that in each case, the decision made is the ‘least restrictive option’.  When it comes to decisions around where a person should live, there’s a whole extra layer of protection – the ‘Deprivation of Liberty Safeguards‘ or DoLS – intended to make sure if a person is in hospital or a care home, that person lives in the least restrictive environment that can meet their needs.  The Safeguards require the professionals making the decision to show that the proposed restrictions on the person’s liberty are in his or her best interests, and to arrange for the person to have independent support (an Independent Mental Capacity Advocate, or IMCA) to help evaluate and challenge the restrictions.

So far, so good; but the DoLS require the organisation which is applying for a DoLS authorisation to restrict someone’s liberty, to certify that the person ‘has a mental disorder’; and to consider whether they should instead be considered for detention under the Mental Health Act.  The MHA is much more wide-ranging than the MCA; while the MCA is exclusively concerned with capacity, the MHA provides for a plethora of situations in which people may need to be compulsorily treated for a mental illness, including where they are a danger to themselves or others, and where they have committed or are accused of a crime.  Although the statutory guidance under the Act – the Mental Health Code of Practice – says that the person receiving treatment should be involved in its planning, that his or her wishes should be taken into account, that family and/or carers should be involved unless the patient asks for them not to be, and that treatment should be given the least restrictive way possible, this sits uneasily with the forensic, criminal-justice parts of the Act.  Patients are also supposed to have support from an Independent Mental Health Advocate (IMHA) to enable them to understand their rights and  to support any appeal to Mental Health Tribunal against continued detention.  Yet even when the person is detained under civil provisions, the treatment regime for patients with learning disabilities seems to have a strong forensic flavour, along the lines of: demand complete compliance with a regime of generic treatment and prescribed behaviours, unmoderated by any reference to the person’s particular condition(s) and needs; and apply restrictions and sanctions for any failure to comply.  Look at what is happening, today, to Eden and Jack.

The Mental Health Code of Practice was extensively revised in 2015, in the last few months of the Coalition government.  It now contains a whole, separate chapter on learning-disabled and autistic people and the relevance of the Mental Health Act to their care.  It is explicit that inpatient services are not relevant to people with autism or learning disabilities who are not mentally ill; that long-term residence in NHS care is not appropriate.  It contains the phrase, ‘hospitals are not homes’ and is clear that behaviour is communication and that ‘challenge’ is often incorrectly construed as the person being challenging, when it is actually the environment that is challenging the person.  The 2015 Code says that the Mental Capacity Act should be considered and applied along with the MHA; no more MHA automatically trumping MCA.  Read it for yourself.  Chapter 20.

‘Treatment’ is often not appropriate or even applicable: what people need when they are finding the everyday world difficult to navigate, is support.  And a person doesn’t need to be in hospital to get support.  In most cases it can be perfectly well provided in their own home.

A year on, the recommendations of the Code of Practice are taking far too long to trickle down into practice, which is why I am delighted to see that five families are collectively challenging the lawfulness of their autistic and/or learning-disabled family member being detained under the Mental Health Act when it is not (or is no longer) true that:

(a) he is suffering from mental disorder of a nature or degree which makes it appropriate for him to receive medical treatment in a hospital; and
…
(c) it is necessary for the health or safety of the patient or for the protection of other persons that he should receive such treatment and it cannot be provided unless he is detained under this section.

I wish the dudes and their families all the best and have everything crossed for a definitive win, because at the moment, MHA culture seems to be eating policy and strategy for breakfast, elevenses, lunch, afternoon tea, dinner and supper.  Here’s hoping the law will prove a lot chewier.

Lessons Learned.

Tags

#107days, #AdsThePoet, #IamThomas, #justiceforLB, #justiceforNico, autism, cerebral palsy, Down syndrome, institutions, mothers

Exam fever has descended on our house, for the second year in a row. Maybe I’m on the brink of senility, but I don’t remember exams being this big a deal when I was at school. You went to lessons, did your homework, did timed single questions every month or so, sat mocks in January, kept pegging away at practice papers, and then stocked up on hay fever preventatives and treatments before the real thing in June. And, of course, you got a year off from public examinations between your GCEs and your A Levels.

The consequence for schools of public examinations three years on the trot seems to be that there has been very little time in each year for consolidation of knowledge. Eldest has been galloping through the various AS syllabi right up to the end of this week, and now he goes on study leave. Er, what? In effect, by the time he gets to his A2s he will have lost half a term’s teaching from his A-Level courses, compared with the length of time his father and I each had.

Still, his GCSE’s have taught him how to revise methodically, and he has been busy since Christmas condensing his notes down on to file-cards – a different colour for each subject, with coloured spots on them to code for topics – and then expanding them up again. I don’t think I acquired that sort of skill until I was at University – and even then I only used it for subjects such as law or history, where facts trumped flair. For language and literature, I just seemed to absorb the books, and, faced with a choice of questions, never had much trouble finding something on which to hold forth in a manner pleasing to the examiners for the length of a forty-five- or sixty-minute essay.

One of my courses was twentieth-century French ‘literature of ideas’: mostly mid-twentieth-century existentialism. I adored the ambiguities of Camus; enjoyed, in an arms-length kind of way, the waspishness of Sartre (though I could have done without the stodgy density of L’Etre et le Néant); mulled over de Beauvoir alongside the shelf-full of 1970’s feminist texts that my Hall room-mate was only too delighted to lend to me; and laughed out loud at Roland Barthes’ nostalgically lyrical descriptions of wooden toys. A man who could seriously write, ‘le bois ne blesse pas’ (wood does not hurt), was a man who, in my opinion, stood in great need of the salutary experience of being on the receiving end of an alphabet brick flung with malice, force and accuracy by a younger sibling. Evidently Barthes’ brother was gentler than mine were, or perhaps, being junior by twelve years, young Michel had been too awed at the brick-flinging stage by the teenage Roland to subject him to these projectile assaults. But I appreciated M. Barthes’ description and dissection of the then-latest Citroen car, the DS – a bubble of glass and sleek enamel, floating on hydropneumatic self-levelling suspension, which was such an idol that its name was pronounced ‘déesse’, or ‘goddess’.

Unfortunately, it wasn’t enough to read the books; we had also to grapple with the philosophical concepts behind them: Camus’ Absurd; Sartre’s phenomenological ontology; de Beauvoir’s Other; Barthes’ semiology.

On the day of my Final in this particular subject, I had somehow managed to set my alarm-clock an hour early, and having risen, bathed and breakfasted before I discovered my mistake, I decided not to go back to bed – I didn’t fancy getting undressed and having a second bath before re-dressing – and instead did some last-minute cramming on Mythologies. I’d already memorised a number of quotations, but in his last piece of the book, a mid-length essay called ‘The Myth, Today’, Barthes helpfully provided a little table of levels and degrees of meaning, which I now copied out several times. Two hours later, in the exam hall, I was faced with a question on semiology that begged for a neatly plotted table to support my disquisition on the evolution of sound into symbol into mythic significance. I duly sketched it out, wrote my five hundred words, did the other questions required, went home and thought no more about it. Months later, my tutor pounced on me at the faculty post-graduation sherry reception and told me how the examiners had been particularly impressed by my grasp of semiology in my Barthes essay.

I didn’t tell her about my last-minute cramming, or that I could no longer remember anything much about semiology beyond the notion that ‘things can be more than they seem’ and the general outline (but not the content) of the ‘Myth Today’ table. University had also taught me the wisdom of accepting a compliment gracefully and of not digging unnecessary holes beneath my own feet. I smiled, and thanked her, and moved on. The lessons in social graces I had not only learned, but practised and internalised; the Barthes, alas, had been learned, but not remembered.

That, I think, is the problem with the ‘lessons learned’ from Winterbourne View, from Stafford, from twenty, thirty, forty years of horrified discovery. Each time, the lessons to be drawn have been so obvious that even the most wilfully ignorant could not dismiss them. Each time, the atrocities have been roundly denounced, the promises to learn sonorously delivered. Each time, it is claimed that the lessons have been learned; and each time it has become painfully evident that if they ever were learned, they have not been properly remembered.

Such lessons have to be learned collectively, at the organisational level, so that they become part of the organisation’s automatic reflexes. Otherwise, the learning dissipates, as individual staff-members leave the service and their replacements are not imbued with the same knowledge. In an organisation like a hospital, the loss of knowledge can be startlingly rapid. While a core of staff may be long-term employees, many health professionals need to keep moving on to new posts in order to foster their careers, while many non-medical staff may also be in short-term jobs. Staff turnover across the NHS has been calculated to be of the order of 25% per annum. That’s a very rapid attrition of any unembedded learning.

Services need to organise themselves so that they don’t just learn: they retain and transmit what they have learned, so that future versions of themselves know that people with epilepsy don’t get left alone in the bath; that people with very high care needs and a risk of aspiration are not, at their most vulnerable and precarious times, made to share the attention of a lone staff-member with three other similarly disabled people; that people whose mothers are worried about their significant chest infection need to see a doctor as soon as possible; that having a GCS of 3 just now doesn’t mean that you have never had, and never will have, a higher score.

Learning a lesson is useless if you don’t remember it.

Letter to Martin Foley, MP, VS Govt : Minister for Housing, Disability and Ageing; Minister for Mental Health; Minister for Equality; Minister for Creative Industries.

Tags

adult LD services, autism, institutions, true stories

To: martin.foley@parliament.vic.gov.au

From: kara2008
Date: 6 February 2015 09:00
Subject: Appropriate services for James Pascoe

Dear Mr. Foley,

I was delighted when the Department of Human Services agreed to free James from being shackled to a hospital bed and to support him with expertise and care.

I am horrified to hear now that the agreement has not been kept.  James’ parents are so alienated by James’ house staff that they have had to make the heartbreaking decision not to visit him.  The expert agreed to has not been paid in six weeks and must withdraw.  A special programme to allow James to recover from weeks of being shackled to a hospital bed, and from the preceding trauma that led to his admission, has never been put in place.

James was taken back to hospital because he became so distressed that he was hitting his own head to the point of an ambulance being called.  He went into the emergency department at the hospital on Thursday 29th January 2015 and is once again being subjected to the degrading treatment of being shackled to his bed while no attempt is made to rectify the underlying cause of his problem: that his accommodation takes no account of, and does not support, his autism-related needs.

His parents have asked Brendan Fogarty of DHS Northern Region to let them manage James’  funds and hire their own staff, pay the expert and get James the help he needs. Mr Fogarty will not change the status quo.

Please do what is needed to protect James from further inhumane treatment. Autism is a developmental condition, not a mental illness, and coercive mental-health approaches are likely only to escalate James’ stress and reduce his chances of recovery.  He needs to live in a way that allows him to be what he is and what he is supposed to be – an autistic young man – in an environment that supports him instead of presenting him with unmanageable challenges at every turn. James needs to be helped by people who understand autism and don’t try to force him to comply with non-autistic ways of being.

Please  allow James’ funding to be self managed so his family can try to break this terrible pattern.

With thanks in advance

Kara

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Update:

To: Kara2008
From: donotreply@dhs.vic.gov.au
Date: 6 February 2015 09:01
Subject: Re: Appropriate services for James Pascoe

Thank you for your email. Your email is currently receiving attention and a response will be forwarded to you at the earliest opportunity.

Yours sincerely

from the Office of Martin Foley MP
Minister for Housing, Disability and Ageing
Minister for Mental Health
Minister for Equality
Minister for Creative Industries

__________________________________________________________________
This email contains confidential information intended only for the person named above and may be subject to legal privilege. If you are not the intended recipient, any disclosure, copying or use of this information is prohibited. The Department provides no guarantee that this communication is free of virus or that it has not been intercepted or interfered with. If you have received this email in error or have any other concerns regarding its transmission, please notify Postmaster@dhs.vic.gov.au
__________________________________________________________________

The Internal Refugees.

Tags

assessment, ATU, autism, institutions, true stories

This time last year, 17-year-old Tianze Ni was living happily with his parents in Fife.  He has autism and learning disabilities and attended a special school.  Then he hit the teenage developmental/existential crisis that derails so many adolescents, and in the absence of any suitable placement, was escorted by police to Stratheden hospital in Fife and admitted on 28 April 2014, for what was supposed to be a one-night-only stay prior to a Tribunal hearing on the 29th.  He never returned home.  Stratheden was not suitable as a placement either; indeed, it transpired that nowhere in all Scotland was there an establishment that felt able to cater for Tianze’s needs.  The Scottish NHS made the decision that Tianze should be referred to an assessment and treatment unit in England.  After the Tribunal, Tianze was sent in May 2014 to an ATU in Middlesbrough for an assessment period that was to last at least six, but no more than 12 weeks.  He has been there ever since.

Over the summer, there was talk of finding a residential school for Tianze, but it hasn’t happened.  Part of the trouble seems to be that Tianze isn’t responding to treatment – quite the reverse.  He is endlessly miserable, begging to come home, composing a song about how much he misses his home and his family and singing it to his mother at every opportunity.  He expresses his frustration in destructiveness and doesn’t trust the staff; with good reason since he knows fine well that the people in charge tell lies, starting with the one about ‘only one night’ in Stratheden and going on with the ‘maximum 12 weeks in Middesbrough’.  Since he was sent to Middlesbrough, Tianze has been so unhappy and angry that he has begun to self-injure.  It seems impossible to find anywhere else to take him on while he is self-harming, but until he gets out of his present environment, he will almost certainly be unable to stop himself.  Classic ATU Catch-22.

So for 8 months, Tianze’s parents, Nina and Clinton, have been making a weekly 400-mile round trip, which takes 12-14 hours on public transport, in order to visit him for the permitted two hours.  Sometimes a visit has been curtailed or cancelled without warning for some deemed infraction on Tianze’s part of a hospital behaviour policy that he does not understand and has certainly never signed up to.  The Nis are worn out and their business is suffering.  Their petitions to various Scottish Health Ministers have got them nowhere.  They have had enough and have decided that they can no longer make these long trips.

They have not, however, abandoned Tianze.  Instead, they have abandoned their home of ten years and their adopted country of Scotland, upped sticks and left the Kingdom of Fife for the borough of Middlesbrough, so that they can be near their son.  If ever anybody has been forced by authority into becoming internally displaced persons, it is surely the Nis.

And if ever anybody wanted an exemplar of unconditional parental love, the Nis again provide it: they have given up all that they spent the last decade building, purely for love of their son and to try to do the best they can for him, in appallingly difficult circumstances.  They, and Tianze, deserve better than to be arbitrarily chased from pillar to post with no permanent home in prospect.  They shouldn’t be turned into refugees.

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