Leaving the elderly at death’s door

[rosemary]

The NHS is a big headache for the Government. Big funding commitments were made by the Conservatives, but will they be enough?


Just as night follows day the NHS funding gap will grow over the next five years. The £8 billion was only ever the tip of a £30 billion iceberg, and the usual belt tightening and budget slicing will not suffice. The solution has to be more radical.

read in full here
http://www.telegraph.co.uk/comment/1167 ... -door.html

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[bowlingbun]

"It also means the difference between a rich, interdependent life with regular support or a revolving door of hospital admissions, infections and relapses which the NHS can ill afford to fund. A failure to invest in social care hurts families and in the end will hurt our economy."

So true. There is clear evidence from me, and other forum members, of the way the NHS is trying to force people out of hospital without real consideration of whether that person will be able to cope for any length of time. Matron just wants her rehab bed back. Social Services just want to avoid being fined from bed blocking. Family, who after all may have known the person concerned for over 50 years, are ignored repeatedly. I spent the last three years of mum's life fighting to see that her incurable condition was acknowledged and her needs met. At one stage the hospital suggested I let her go home as she had a fully adapted home. They couldn't even find a comfortable chair for her, and we were not allowed to take it in due to "infection control". The hospital League of Friends said they would buy one for mum, but those in charge of the ward didn't do anything to make her more comfortable, because then she might not leave their care?!?!

[Anne001]

Indeed, mum was turned down for CHC funding as allegedly her condition was "social" and did not rate highly enough on their criteria. One week later, they were trying to discharge her from hospital in the morning and she died in the afternoon while I was still arguing that she was too ill to be moved.

We all know that the elderly are bed-blocking but when there is nowhere else for them to go, what's the choice?

[bowlingbun]

Anne, I've just been invited (!!!!) by the CCG Complaints Officer to ask for a CHC review, after all, she died, that's surely proof enough she was ill, same as your mum. Maybe you should also ask for a review. There has been some new Department of Health Guidance saying that it should not be necessary to involve a solicitor, as I did, that it should be possible for anyone to go through the review/appeal process.

[Londonbound]

I agree that hospitals are sending people home with no consideration of their needs, they may be fit to go home or not ill enough to be in hospital.
But there is little consideration of their home life, the people might just have been on the edge of coping and the incident that caused the stay in hospital may have been the final straw.
As a charity says often elderly and disabled are sent home to cold and empty houses, if they have been in hospital for some weeks any food in the house will be off.
I had to stop at the supermarket on the way home from the hospital bringing one of my carees home.
The loose bit of carpet that they tripped on or the steps at the front door where they fell down will still be there.
A handyman visit could solve this, stick down the loose carpet, fit a grab rail by the front door, little services which don't cost much but could prevent a £500 a day hospital bed being taken up for weeks.
The NHS and Social services say about preventative to avoid trips and falls and unnecessay stays in hospital but do nothing about these issues.
A leaflet with local help and support services could be given at point of discharge, someone could pop around a few days later to see if everything is alright.
If there is support in the area, a warden, they could be informed " can you keep an eye on mr Smith, he has just come out of hospital."
There are support schemes available, 6 weeks of extra support, but no one I know has ever actually received this scheme, not told about or not eligable for it.
And just because a person is known To Social Services and already has a care package, it doesn't just mean that you can just send them home, the care package might have been inadequate in the first place.
I perhaps shouldn't say this, but I have heard someone deliberately harms themselves to get into hospital, they get looked after, they get attention, they get hot meals, they love it in hospital as they get looked after. Back at home it's just sat on their own, no attention, no one to talk to, perhaps if they were getting good social care, these incidents wouldn't happen.
As I say don't want to cause offence or upset anyone with the above but this is what I have heard.

[bowlingbun]

It's not just the elderly who are being let down. When I was discharged after major abdominal surgery on a friday, I was assured the aids I needed, chair risers and raised toilet, would be delivered to my home the same day. They weren't! As it was friday afternoon, I struggled all weekend, only to be told on Monday thst it wasn't the delivery day for my area,
. Furthermore, as my op was in a private hospital (saving the NHS £6,000) there was then a reluctance to give me anything at all! I was entitled to free post op care support, but didn't get it for that op, or the next one. I did get it for a knee replacement, the carer was lovely, but I really had to bully the hospital nurse to arrange it. While I was having surgery, mum became ill. I'd filled her fridge and freezer before my op, and written to the GP and SSD to say I couldn't care for mum for the foreseeable future. Nothing happened for a few days, then Rapid Response were called in. They'd emptied the fridge, but not been to the freezer. "Someone Else" was expected to do the shopping! It wasn't their responsibility. Surely it is blindingly obvios that an elderly bed bound person cannot go shopping?! How many hospital admissions are caused by malnutrition because someone can't shop? I agree wholeheartedly that a community "warden" would be a brilliant idea.

[Londonbound]

The problem is that Wardens are getting cut, cost too much money, so often elderly people have no on site support.
In the good old days, like on open all hours, you could get shopping delivered from your local shop, I don't know anyone around here that does that.
You can go on the internet, get shopping delivered, but many elderly people don't have computers, don't have the internet.
There just seems to be no thought, that someone else will do it, what if there isn't anyone else?
The hospital may be the first time an elderly person has seen anyone from the NHS for months, would be a good chance to see if help is needed and prevent another expensive hospital admission.

[bowlingbun]

Those controlling the purse strings don't understand that if they look after the simple local things, then people won't need the bigger things. In my area, for example, all the "cottage" hospitals have closed down. They were places which didn't need hugely expensive equipment, A&E etc., but fine for the elderly with age related conditions. Now those patients are "bed blocking" in expensive beds. Is that progress?!

[Londonbound]

Article in one of the papers about bed blocking, more than 2 million spent by hospital by bed blockers , patients were well enough to go home but no social care package had been arranged.
If that is happening all over the country then it must be costing the NHS a fortune plus taking away beds for people that really need them e.g emergencies.
Social care is getting cut which means people are ending up in hospital, costing the NHS money but then they don't come out of hospital because social care has been cut.
The government keep coming up with all these projects and fancy ideas but back to basics, ensuring elderly vulnerable are looked after properly, make sure they are getting good meals, access to help and support services, but all these have been cut.

[bowlingbun]

Are they really "fit for discharge" though? I've had many battles with the NHS over my mum's discharge, at various hospitals. On one occasion, she was supposedly FFD, I told PALS there was less than a 50/50 chance of her being at home 24 hours later. No one would listen. Sure enough, 8am the carer called, to say she'd just called the ambulance. Another occasion, mum was "pain free" but having morphine less than 24 hours later. Another time, less than 24 hours of being told she was FFD, I was rung at 1am to say she was vomiting blood, nil by mouth for days. I was told if they couldn't sort it out, she'd be dead in less than a week! The next time she was bleeding from the bowel, when supposedly fit. The time after that, by which time they were desperate to get their bed back, somehow or other, they said she was fit, then developed a chest infection which nearly killed her. In the end, she was moved to a nursing home, either by the NHS or SSD - to this day I don't know who did it, because each said the other had done it!! The should have done a Continuing Healthcare checklist assessment, but didn't. Mum was severely disabled, reaching the end of her life. Too ill to go home under SSD care, there had been too many failures by this time. BUT the NHS wouldn't accept responsibility either. So are these "bed blockers" actually fit for discharge home at all? I doubt it. They are just old and need somewhere to be properly cared for, medically and physically.