Category Archives: Blog


Pain In Dementia Is Often Not Recognised or Treated


Pain in people with dementia is under-assessed and undertreated.

Antipsychotic drugs, sedatives, antidepressants and many other drugs are often prescribed to people with dementia. Anxious, distressed and aggressive behaviour may be the result of pain, which in some cases the person with dementia cannot express or communicate.

If it is difficult or impossible to assess if a person with dementia has pain, would it not be a great step forward to try painkillers for a short period and assess the effect, before commencing all the sedatives?

Click here for Pain Assessment for Residents with Communication Issues

Click here for Nursing Care Plan for Pain which incorporates an Assessment Tool.


Analgesia Awakens Alzheimer’s Patient From Dementia

Click here to view some real success stories of people with dementia improving dramatically after being given painkillers.

My friend’s mother has very advanced dementia and was extremely unsettled, agitated and could be extremely angry and aggressive at times.

She had never complained of pain nor showed signs of being in pain when she was being cared for.

She fractured her femur just over a month ago and was commenced on strong analgesics post operatively.

Her behaviour and quality of life changed almost immediately. She has continued on analgesics regularly and continues to have a much improved quality of life.

She is now settled, calm and  and enjoys spending time with her husband and family.

Her family are so upset that for years no one realised she was in pain.

A review in the Nursing Times discusses the main barriers to effective assessment and management of pain in people with dementia

5 key points

An estimated 115 million people could be affected by dementia by 2050

The prevalence of pain in older people is estimated to be 25-50%

People with dementia receive fewer analgesics than their counterparts who are cognitively intact

One study found three quarters of care homes did not use standardised pain assessment tools

Attitudes and beliefs among patients and nurses can be substantial barriers to effective pain management

People With Communication Issues Can Not Complain Of Pain Or Express Pain

Doctors often are not able to determine if a person with dementia has pain.

Nurses likewise may consider that people with dementia cannot reliably report pain or any change in the level of pain.

Correctly Assessing and Meeting Peoples Needs Improves Quality of Life

A simple tool, based on the ‘PAINAD’ (Pain Assessment in Advanced Dementia scale) could help:

P – Pick up on mood (are they withdrawn or irritable?)

A – Assess verbal cues (are they muttering under their breath, moaning or crying out?)

I – Inspect facial expressions (are they grimacing or looking frightened?)

N – Notice body language (are they pacing, clenching their fists, fidgeting or curled up as if trying to hide?)

Use of assessment tools and guidelines

Increasing the use of assessment tools would assist Nurses and carers in recognising pain.

Education for staff

All staff need training and guidance to be able to care well for a person with dementia. They need training to understand the complex issues of the condition, and how important empathy and understanding are.

Assessment of Pain

Consistency of care with residents with dementia is extremely important in assessing pain and delivering excellent person centred care.

Risk of Falling for Elderly Nursing Care Plan

Elderly Falls and Trips

In the United Kingdom, the number of patients readmitted to hospital after treatment for a fracture had risen significantly since 2008/9.

Click here for the comprehensive falls risk assessment

Trips and falls can be a major hazard for any elderly person.  A fall can have serious and life changing implications for a patient, and the fear of falling can impact negatively on their lifestyle and the activities they enjoy.

It is vitally important that a comprehensive falls risk assessment is completed for all patients and any issues associated with, or increasing, the risks of falls are identified.

This risk assessment must be reviewed at least monthly or more regularly  if the patient’s condition changes, because any deterioration or slight changes in the patient’s condition can increase their risk of falling.

The objective of any person centred Care Plan is to ensure the patient’s issues and needs are set out in great detail and are very much at the core of the Care Plan.

The starting point is a detailed consultation with the patient and their relatives. Any issues which might increase a patient’s risk of falling are discussed and a plan to address the issues is formulated and agreed.

Many factors can increase a patient’s risk of falling, such as their mental state and the impact that may have on memory and poor or impaired eyesight.

Hearing difficulties can sometimes cause balance problems also increasing the risk.

A patient’s mobility, steadiness and gait and any issues they have with that, or an inability to ask for  help, can increase the risk of falls.

Any medication which causes drowsiness including sleeping tablets may result in  falls.

A patient’s room and day rooms must be kept clear of potential trip hazards and where possible the patient should wear well fitting shoes, and not slippers, even though they may be more comfortable.

You should consider any of these issues which are causing an increase in the risk of falling and where possible suggest or agree a plan which will address or improve the issues and record this.

Anything, however simple, that can be done to help should be recorded and implemented, such as ensuring the environment is free of clutter and ensuring a call buzzer or alarm is given to the patient.

Safety of the patient is of course paramount, and a key consideration when preparing this Care Plan.

You need to look at ways of ensuring the patient’s safety, which may involve the use of a pressure mat next to the bed to alert staff when the patient gets up, bed rails to prevent a patient falling out of bed or a lap strap in a wheelchair.

Any form of restraint must be assessed as a benefit to the patient and agreed with the patient and relative. You need to record your assessment in detail.

You need to look at any equipment which the patient will be using, such as a zimmer frame or walking aid and assess what risks they might have by using them.

When considering the issues central to a falls Care Plan, you need to strike the right balance, and look at what risks prevail in promoting and encouraging the patient’s independence, but at the same time minimise as far as possible the risks of falling.


Make Your Care Home More Dementia Friendly

It is such an important goal for all care homes and care facilities to ensure they enhance and, where possible, improve the quality of life for the residents with dementia. The Kingsfund assessment tool enables Care Homes to do this. It contains seven different sections looking at different aspects of the physical environment and a set of questions for each section. It encourages everyone to become involved in assessing how dementia friendly their care facility is.

Kingsfund Tool

Click here to download the Kingsfund Tool.

This tool was brought to my attention by an independent sector development officer. He talked of the merits of taking a good hard look at your Care Home from the perspective of the person with dementia and he recommended this tool.

It is a real beneficial and practical help to the manager and staff, because it helps to evidence improvements and developments in a Care Home or care service.

We changed many things as a result of using the assessment tool. Some  changes were very small, but overall these changes improved the level of how dementia friendly our Care Home was, and is today.

Each section prompted analysis and improvement. Simple things such as looking how inviting the entrance was, how obvious was the location of the doorbell, and how easy was it to use. This of course not only helps residents with dementia, but also those with diminished sight. The tool re-enforced the importance of group seating to encourage conversation and interaction between residents.

The names plates on bedroom doors were doubled in size to make them more obvious to the resident. We created new signage for the public areas of the Care Home, again making it far more noticeable than previously, but this also included a lot more additional signage to help direct residents around the Care Home.

The garden area was developed to add raised flower beds to give residents the opportunity to enjoy gardening without bending if they did not want to do that. Garden areas were also secured to give residents complete freedom to be outdoors whilst at the same time ensuring their security.

The residents, relatives, staff, management, and other healthcare professionals were involved in the assessment and the residents were consulted and involved in the decision making process. Everyone has learned from and enjoyed the whole experience.

The changes which can be made are in many cases, small and inexpensive, and relatively easy to make. Collectively they help the residents to maintain their independence and enhance their quality of life.


Nurses in Britain are Buried by Paperwork

Nurses in Britain are Buried by Paperwork

Nurses in Britain buried in paperwork in Britain spend an estimated 2.5 million hours a week on “non-essential” paperwork that’s where Planning for Care can help

The Royal College of Nursing believes nurses are burdened with too much paperwork and too many targets.

I think every nurse would support that belief.

The view adopted by the inspectors and auditors appears to be ‘if it’s not written down, it’s not happening.’

In reality, there can be a well written Care Plan but the quality of care might bear no resemblance to what is set out within the Care Plan.

Nurses would much rather spend their time caring for patients or residents than completing paperwork such as care plans.

Unless nurses are producing excellent Care Plans, Care Home grades will suffer.

30 years ago written Care Plans did not exist, but the care delivered was, in the main, very good or excellent.

Perhaps this was because nurses did not have to spend much of their time producing the volume of paperwork that is necessary today.

I do very much believe in the benefit of care plans today.

It is the way forward and if written well, can really have the capacity to have a substantial effect and improve the quality of care.

Documentation is a crucial aspect of care, which facilitates the continuity of care and it forms an accurate record of care provided. It is now vitally important that the quality of resident’s care and nursing documentation is of the highest standard.

How Our Care Plans Can Help

A good system of Care Planning undoubtedly can help the nurses and carers complete the paperwork far quicker and more comprehensively.

A system of personalising care planning for the elderly, which Planning for Care provides, can vastly improve the delivery of care and help Care Homes improve the grading they are awarded by the Care Inspectorate by helping them meet their regulatory requirements.

“The challenges facing everyone in the care sector are growing exponentially with constant changes in law, increased regulation and the potential threat of litigation.”

The focus on nursing appears to have changed and, instead of it being a wonderful, satisfying and fulfilling occupation, it is now very much a race against time.

It is in everyone’s interest that the standards of care improve.

The National Health Service, and nurses in Britain are wonderful institutions which have to survive and flourish.

Progress is a great thing, but there needs to be a balance to ensure there is no deterioration in the very core standards and values of nursing. We need to rethink the path we are taking.

The days of placing massive importance on positioning each pillow case with the closed end facing the entrance door of the ward have gone!

But was it really such a pointless exercise?

In those days every nurse knew every detail about every patient, and every aspect of patient care was delivered with precision and thought.

Patient care may have been delivered in a task orientated way, but attention to detail was everything.

The pride nurses had in their job was tangible.

A mixture of the nursing cultures of yesteryear and today is, I think, needed to help elevate nursing to the high standard of profession it should be.

View our free sample Care Plan or our full range of Care Plans here. 


Music can be an Amazing Therapy for Dementia

Dementia and Music

In my experience music can reach many individuals who suffer from dementia in a very special way.

We asked families to tell us the resident’s favourite music which we recorded onto an ipod, the music was specifically chosen for them.

For some residents it had a remarkable effect.

For one gentleman who had very little interaction with his wife or carers, and very little interest in anything it gave him a real interest in something. He was much more expressive and animated, and he started communicating with everyone.

His wife admitted that when she was first asked to try this, she was really sceptical.

She said that she could not believe the difference in her husband, he was much more happy, he showed a real interest in everything and his quality of life improved dramatically due to the music.

An improved or good quality of life for any elderly person should be every nurses or carer’s goal.

Music has dramatically improved many resident’s quality of life, It has been wonderful for the person and very special for their families.

Music has power especially for individuals with Alzheimer’s disease and related dementias.

It can spark compelling outcomes even in the very late stages of the disease.

When used appropriately, music has the power to change mood, manage stress-induced agitation, stimulate positive interactions, facilitate cognitive function, and coordinate motor movements.

This happens because rhythmic and other well-rehearsed responses require little to no cognitive or mental processing.

A person’s ability to engage in music, particularly rhythm playing and singing, remains intact late into the disease process because, again, these activities do not mandate cognitive functioning for success.

Most people associate music with important events and a wide array of emotions.

The connection can be so strong that hearing a tune can evoke a memory of the event and take the person back to that time and place.

Prior experience with the piece is the greatest indicator of an individual’s likely response.

Music that is soothing for one person may remind another of the loss of a loved one and be tragically sad.

If the links with the music are unknown, it is difficult to predict an individual’s response.

Therefore, observe a person’s reaction to a particular arrangement and discontinue it if it evokes distress, such as agitation, facial grimaces or increasing muscular tension.

It is such a simple idea but is really worth trying as it can make a difference.

Click here for a person centred Nursing Care Plan for dementia.

Old hands

“The NHS saved my life” – Stourport grandmother

A GRATEFUL Stourport couple have heaped praise on NHS staff who helped save her life after she was rushed int for emergency treatment.

Jennie Abbotts was taken ill after spending a day with her husband Rob and their grand-daughter Charley Belle on February 22 during the half-term break.

She suffered chronic stomach pains and vomiting and when her condition deteriorated, she was rushed to hospital where she underwent a laparotomy to sort out her twisted bowels – a repeat of a previous condition she had 20 years ago.

But she said the immediate response and dedicated care she received from the 111 NHS helpline, Primary Care at Kidderminster Hospital, paramedics from Dudley and finally Worcestershire Royal are what kept her alive.

She is now recovering at home and, in the week thousands took to London streets in a march to support the NHS, the couple – who have two children each from previous marriages and six grand-children – wanted to give their heartfelt thanks for the support they received.

Mrs Abbotts, a 67-year-old retired Wyre Forest District Council PA, said: “The consultant said had Rob not called for help and had they not operated as quickly then I wouldn’t be here today.

“All the staff were incredible. Firstly, the 111 helpline operator helped ensure I got seen at Kidderminster immediately before Dudley paramedics rushed me to Worcester.

“There is so much negativity about the Royal but I think they are all marvellous. The care was unbelievable. It was a frightening time for us but they were reassuring.

“They are under so much pressure but still did a magnificent, professional job. Of course, the NHS could do with more funding and they would deserve every penny.”

Retired butcher Mr Abbots, aged 66, added: “I just want to thank them all for everything they did. The nurses are modest and say it’s just what they do but they are incredible.”

A spokesman for Worcestershire Acute Hospitals NHS Trust said: “We’re delighted to hear Mrs Abbotts had a positive experience at Worcestershire Royal Hospital.

“This case is a great example of NHS organisations working together to deliver efficient and effective care.

“As a Trust we are always pleased to receive positive feedback – which we will share with the staff involved in Mrs Abbotts’ care – and we wish her well in her recovery.”

Sourced by the The Shuttle online


Elderly Care: The problem no-one can fix

Gathering dust on a shelf in the Department of Health’s London headquarters is a plan for reform of the care system for the over-65s in England. It is the much heralded cap on care costs, which was a key part of the 2015 Tory manifesto .

It was meant to have launched in April. But last summer ministers announced it was to be postponed until 2020 amid concerns it would not work given the pressures in the system.

Officially it still remains policy, but many doubt it will ever see the light of day – even former Care Minister Norman Lamb, one of the architects of the plan, is in this camp. Instead, they believe it is destined to go down on the long list of failed changes to the system.

The care system has remained more or less unchanged since it was created, along with the NHS, after World War Two, when life expectancy was nearly 10 years shorter than it is now.

But people are not only living longer, they are surviving with more complex conditions that require care and support. So just at the time when you would expect the amount of support provided by the government to be rising, it is falling.

Councils complain they do not have enough money – the Local Government Association estimates the gap between what they need and what they get will be about £4bn by the end of the decade. That would leave them about a third short of what they need

So what can be done? Over the years a variety of suggestions have been put forward.

Increases in tax or national insurance contributions could be used to put more money in – and in a way this has already been done, as councils have been given the power to raise council tax to fund care. But already it looks like that will not be enough.

How much does it cost to be old?

State of care for the over 65s

One million

people with care needs go without help

  • 4 in 10 people in care homes pay for themselves
  • 300,000 fewer people receive council-funded help within four years
  • £100,000 or more is now spent on care in later years for 1 in 10 people

Other options include diverting existing spending on pensioner benefits (the winter fuel allowance for example) to go on care. But ministers seem reluctant to tackle that.

In the dying days of the Labour government, a plan was drawn up to create a universal care system – giving everyone a minimum entitlement to care.

But the Tories leapt on that, suggesting it would be paid for by a “death tax”. And it was soon consigned to the bin.

There has also been talk of merging the system with the NHS – the budget for which is 10 times more than what councils spend on care.

But following Andrew Lansley’s changes to the health service, there is little appetite in the corridors of power for more structural upheaval.

Instead, the NHS is being encouraged to, in the words of one social care director I spoke to, tinker around the edges by setting up shared budgets under a scheme called the Better Care Fund, currently worth £5bn a year.

The result is that councils are left to limp on. Each year, they cut the amount of care they can provide.

It leaves people to pay for themselves, rely on family and friends or, increasingly, go without care.

Elsewhere in the UK, the devolved governments have tried to offer more generous access to help in the home – it is capped in Wales and provided largely free in Scotland and Northern Ireland.

The hope is that it will keep people well – and their costs down. But people still complain they are struggling to get the help they really need.

It means those with money are increasingly having to subsidise the government-funded system – people who pay for their own places in care homes pay nearly 50% more on average than the fees councils pay homes.

Meanwhile, those without have to rely on family and friends or simply go without. As always, there will be calls for reform. The problem is no-one seems to have a plan.

Source BBC News


A Mediterranean diet in the UK would save 20,000 lives a year

The lives of 20,000 Britons a year would be saved if everyone ate a Mediterranean diet, it is claimed.

In the first study of its kind, doctors evaluated the effects of an olive oil, fish and nut-rich diet on the health of ordinary people in England.

It revealed that one in eight deaths from heart attacks, strokes and other types of cardiovascular disease could be prevented if everyone followed a Mediterranean diet.

The Cambridge University researchers said this makes the eating plan as good for the heart as exercise.

Cardiovascular disease is behind more than one in four deaths, killing 155,000 Britons a year.

Study author Dr Nita Forouhi said: ‘A higher level of adherence to the Mediterranean diet could have a significant impact on lowering the cardiovascular disease burden in the UK.’

Dr Forouhi crunched data on almost 24,000 men and women aged 40-plus from Norfolk whose lives were tracked for up to 20 years.

All filled in a detailed dietary questionnaire, underwent various health checks and recorded whether they smoked and how much they exercised.

None suffered heart problems at the start of the study but, by its end, 7,606 of them had suffered a heart attack, stroke or other problem, and 1,714 had died as a result.

Those who ate the most Mediterranean-like diet had the fewest heart problems, the journal BMC Medicine reports.

The traditional diet of Greece and southern Italy involves eating meals rich in fruit, vegetables, cereals, nuts, seeds and olive oil.

Dairy products, fish, poultry and red wine are also encouraged, but red and processed meat should be eaten in moderation.

Numerous studies done in the Mediterranean have shown it to benefit health, but those done in other countries have provided conflicting results.

And no proper research has been carried out in the UK, despite health authorities promoting the diet.

Dr Forouhi said: ‘We estimate that 3.9 per cent of all new cardiovascular disease cases, or 12.5 per cent of cardiovascular deaths in our study population, could potentially be avoided if this population increased their adherence to the Mediterranean diet.’

UK-wide, this would equate to almost 20,000 lives being saved annually.

The change could also provide numerous other benefits, with a Mediterranean diet warding off ills from cancer to diabetes and Alzheimer’s disease.

Image result for mediterranean food

The Cambridge University researchers said this makes the eating plan as good for the heart as exercise

Dr Forouhi added: ‘Encouraging greater adoption of the Mediterranean diet looks like a promising component of a wider strategy to help prevent cardiovascular disease, including other important factors such as not smoking and maintaining a healthy weight, blood cholesterol and blood pressure.’

Professor Ian Johnson, of the Institute of Food Research in Norwich, said: ‘This is a careful and rigorous study showing a relatively small but potentially important association between higher adherence to a Mediterranean-style diet and reduced risk of heart disease and death from heart disease.’

The British Heart Foundation welcomed the research but cautioned that there is more to good health than just eating well.

Tracy Parker, a dietician at the charity, said: ‘The researchers found that those with high adherence to the diet were less likely to be smokers and more likely to be physically active – both important independent factors in reducing a person’s risk of cardiovascular disease.’

Source Mail Online
Family eating lunch outside in garden

Meals with family ‘could help spare’ dementia patients from malnutrition

Eating traditional family dinners or listening to soothing music could help to protect people with dementia from dehydration and malnutrition, a study has found.
Older people with dementia are among those at the highest risk of both conditions as they may be less aware of drinking enough fluids or remembering to eat.Experts tried more than 50 mealtime interventions among more than 2,200 people with dementia, and found serving family-style meals in a homely environment could help boost nutrition and fluid intake.

More than 90,000 Scots are living with the degenerative brain condition, which can affect memory, language and understanding.

Lead researcher Dr Lee Hooper, from University of East Anglia’s (UEA) Norwich Medical School, said: “The risk of dehydration and malnutrition are high in older people, but even higher in those with dementia.

“Malnutrition is associated with poor quality of life so understanding how to help people eat and drink well is very important in supporting health and quality of life for people with dementia.”

While no intervention was wholly successful, the study published in the Geriatrics journal today suggested a holistic approach to mealtimes was promising.

Dr Hooper said: “It is probably not just what people with dementia eat and drink that is important for their nutritional wellbeing and quality of life – but a holistic mix of where they eat and drink, the atmosphere, physical and social support offered, the understanding of formal care-givers, and levels of physical activity enjoyed.”

Amy Dalrymple, head of Policy at Alzheimer Scotland, said an array of factors can cause issues with eating and drinking, such as sensory overload, coordination problems or pain.

She said: “This wide range of potential factors mean that a personalised response to each individual is crucial to make sure that people with dementia are being supported to eat and drink in the way that best suits them.”

Brazil’s mothers left to raise microcephaly babies alone

Ianka Barbosa was 7 months pregnant when she found out her child had microcephaly. Before the baby was even born, the father had gone.

Barbosa, 18, blames the break-up on her baby’s abnormally small head and brain damage that doctors link to the Zika virus she contracted during pregnancy.

“I think, for him, it was my fault the baby has microcephaly,” said Barbosa, wearing a blue dress and cradling tiny two-week old Sophia in a cramped bare brick house where she now lives with her parents in Brazil’s northeast.

“When I most needed his help, he left me.”

The house, which overlooks a polluted stream on the edge of a poor neighborhood, is now home to a family of nine. Only Barbosa’s father has a job doing occasional building work.

Her ex-partner, Thersio, says he does not see Sophia, but avoids discussing microcephaly and blames Barbosa’s parents for the break-up. “I gave her the choice, are you your parents’ woman or mine … And she chose her parents.”

Single parents are common in Brazil where some studies show as many as 1 in 3 children from poor families grow up without their biological father, but doctors on the frontline of the Zika outbreak say they are concerned about how many mothers of babies with microcephaly are being abandoned.

With the health service already under strain, abortion prohibited, and the virus hitting the poorest hardest, an absent father is yet another burden on mothers already struggling to cope with raising a child that might never walk or talk.

At a specialized microcephaly clinic in Campina Grande, psychologist Jacqueline Loureiro works with mothers to help them cope with stress and trauma. Of the 41 women she counsels, she says only 10 receive adequate financial or emotional support from their partners.

“At first many of the women say they have a partner, but as you get to know them better you realize the father is never around and the baby and mother have effectively been abandoned,” Loureiro said.

Loureiro blames Brazil’s macho culture, which she says is particularly strong in the northeast.

Gender roles are strictly defined and women still tend to care for the baby and look after the household. The added burden of having a child with microcephaly strains this dynamic, says Loureiro, and often the man ends up leaving or refusing to help.


Much remains unknown about Zika, including whether it actually causes microcephaly in babies. Brazil said it has confirmed 745 cases of microcephaly since October, and considers most of them related to Zika infections in the mothers. It is investigating another 4,230 cases of suspected microcephaly.

Until the World Health Organization declared Zika a global health emergency last month, there was little interest in microcephaly and no data for its toll on parents. But studies into children with other special needs shows it substantially increases the chance of marital breakdown.

Jennifer Lewis, who runs the U.S. based Microcephaly Foundation and has a 12-year-old daughter with the condition, is not surprised fathers in northeast Brazil are abandoning partners and children. Her charity has a network of around 5,000 families and she says the majority are single mothers.

“I see single mothers all the time, where the fathers have left, the fathers have got scared. I even see married couples where the father has pretty much nothing to do with the child,” she said in a phone interview from Phoenix, Arizona.

Campina Grande’s health secretary, Luzia Pinto, told Reuters the city is planning to provide housing for mothers and children with microcephaly through a government housing program in order to help with the crisis. She also ensured a psychologist was hired at the clinic to offer support.


Few Brazilian jobs give enough flexibility for parents to better share the responsibility of looking after a child with special needs. This is made even more difficult as parents must often travel for hours to visit the few specialized clinics operating in Brazil.

At the clinic in Campina Grande, 20-year-old Rogerio dos Santos is one of only two fathers present. Standing in the whitewashed corridor, he says he’s shocked by the tales of fathers abandoning their children but says it has been hard to get time off at the gas station where he works.

For fathers like dos Santos, the support network in Brazil is lacking. Whereas the clinic runs a support group for the mothers, there is no specific help offered for fathers.

“There is a certain amount of fatalism about fathers leaving, unfortunately,” said Gary Barker, who promotes gender equality though ProMundo, an organization he founded in Rio de Janeiro 19 years ago and which now works in four countries.

For Barker, the health sector needs to offer support specifically for men.

“There needs to be an understanding that a baby being born with microcephaly is an event that is going to increase the chance the father’s not going to stick around and he’s going to need some extra hand holding,” he said.

In the small town of Algodao de Jandaira, an hour from Campina Grande, Josemary da Silva pours a cold bath to relieve her son Gilberto from the relentless heat. The five-month-old baby with microcephaly stops crying briefly as he is washed in a pale blue plastic tub.

The father, after whom Gilberto is named, first saw his son one month after he was born and has rarely visited since. Two months ago he stopped contributing the $30 a month he had paid to help da Silva care for the child.

“He says he loves him. But what kind of love is this,” she says as Gilberto starts to cry again.

Source Reuters