Would you expect a care home to stay with care user when going to urgent care/ a&e

The company I worked for would have made us go to our next call.

Ime, the CQC are useless - we made a safeguarding complaint about the mental health trust. They just told us, they delegated it back to the mental health trust!

Anyway, A & Es can provide 1:1 care. We heard a sister (?) telling someone on the phone, last time we were there in Majors with DD1, that they had no patients on 1:1 care. When I’ve been there with DD2, among the mental health patients, there are some of them, including her with 1:1 care in the daytime. However, they probably don’t have enough staff for all the elderly, needing 1:1 care.

We have been going regularly to A and E with DD1 for 17 years, and it seems to us, half the patients in cubicles look like elderly people from care homes, with visible head injuries - and they look lost! We always feel sorry for them.

They get taken by NHS patient transport.
They have the appointment.
They get brought back by NHS patient transport.
The information from the appointment likely gets lost/ not passed on.

Ish - certainly there are ambulances available for transport but essentially in most of these types of circumstances it's a taxi with a trolley who'll check if the patient's been given their regular pain relief/paracetamol before taking them to hospital.

Once requested this will generally arrive in 2 hours, but routinely upto 12 hours. Patients will then be taken to A&E and booked in - they will pass on the handover of what the care home staff reported - i.e. "they fell yesterday but today they've got knee pain, today they're really struggling to walk due to pain".
The patient then gets moved to a waiting area - anything from the normal waiting area at the front door of A&E, or straight into one of the A&E teams on a chair/trolley. But essentially there would never be the staff allocated to sit with the patient, reassure them they're safe/prevent them from walking out.
In terms of why no body generally stops frail older people from walking out of hospital - range from 'it's a hospital, that's a completely normal everyday sight' to 'it's not a prison they can leave if they want to'.

This year there's an additional change coming in, and it's active in the area i work - the 45 minute rule. Hospital staff now only have 45 minutes to take a handover, after 45 minutes you just tell reception that you're leaving and patient is left at the front door. There are no exclusion criteria. This would include the most confused septic patient who doesn't even know their name, has awful observations, immediately life threatening presentations - if handover not taken in 45minutes then they're just left for A&E to work it out later. (the idea for this is that ambulance waits are becoming so long this is the lesser of 2 evils (patients with immediately life threatening symptoms - struggling to breath/had a stroke/sepsis/meningitis falls with open fractures are sometimes waiting over 4 hours now - so to reduce the 'abandonment' of these patients at the home unseen by anyone, now instead we're abandoning them in a hospital.

This is why partly why some proactive managers/members of staff take it upon themselves to arrange a taxi or drop patients off at hospital themselves - often they'll have enough anecdotal knowledge to recognise a resident needs to be seen in A&E for an xray etc, they know if they call 999/111 they'll be waiting 2-4 hours for the ambulance that might just drop the patient at the front door, they'll then be waiting 4-8 hours to be reviewed by a Dr in A&E. Essentially you can save the 2-4 hours by taking them yourselves. Unless it's an actual emergency i.e. broken leg can't move, sepsis too weak to stand, massive head inj cant control bleeding - then the ambulance crew don't actually do anything extra beyond taxi service - so why delay by several hours if you don't have to.

No because they're then under the 'care' of the hospital. The only exception is if the person is detained under the mental health act then someone from the hospital/care home where they are detained may have to go.

Jesus! I was a school welfare officer. I had a student have a bad accident at school once, his mother was was working a few hours away that day, other family too far. Me and one of the office staff went to hospital with him and stayed with him until his mother arrived (and for a while after, she was in such a state, bless her).

There would have been no way on Earth that I would have left a child of any age alone. We had other members of staff calling us and offering to come and swap if we had to go home for childcare etc, no one would have wanted him to be there alone.

TBH I’d have felt sorry for any HCA having to look after my Dm at that stage of dementia, when she wouldn’t have a clue what was going on, or why. On the occasion when it was a fairly nasty cut on her hand, she wouldn’t even keep still for the medic trying to dress it, kept walking about, and once the dressing was finally on, she promptly pulled it off! Ditto any more applied by care home staff. But the cut healed well enough anyway.

On that occasion the medic trying to attend to her evidently didn’t have a clue about dementia - she asked me more than once to tell my DM to keep still for a few minutes…as if I hadn’t already repeatedly tried in vain….🙁

Also a teacher, and they would not. My daughter was hit by a car (she's fine). Ambulance and then family to support at hospital. No one was with her when we arrived.

I had no idea this was the case! I assumed that once in the care home they provided wrap around care for appts etc (even if it was at extra cost).

Sorry nothing helpful to offer @itispersonal but to say this stuff is a minefield.

My relatives care home would just phone an ambulance/patient transport and they'd be in the care of the NHS…
In my opinion they were sent to hospital far too frequently, the hospital stays achieved little, in fact they always returned in a much worse state showing significant deterioration after each visit but it didn’t seem possible to say no to hospital admissions. Afraid of being sued I expect.
Once on the ward it was horrible, lots of screaming and shouting and the same frequent flyer patients, or maybe they just didn’t go home. Dementia is the cruelest end.

OP, I saw a service called Driving Miss Daisy, we considered it for an elderly relative for hospital visits. It’s a car service with driver and sometimes their spouse! They pick up, stay with, chat & entertain a client. To hospital, to lunch, to shopping. It seems quite lovely & you said your aunty had money to pay for the company?

I am so sorry you had that too. It’s absolutely despicable. CCTV showed my poor dad just waking out. Well, walking as well as he could aged 89 with arthritis in both knees and with advanced dementia. He was staggering with his sticks. Not one person stopped him. You could see him just staggering past medical staff to the main road. But still, no wrong doing was found.

It was just infuriating that no one cared. The care home didn’t even call the hospital for an update, if they had, maybe they would have found out that he wasn’t there (although, it took the hospital 24 hours to work that one out when I called to ask about him).

Social services blamed me for only giving them two contact numbers. There was only me and dh! No other family and his friends all ran for the hills when he was diagnosed with dementia and I asked them for help. Not that they even tried to contact Dh. What other number was I suppose to give?

CQC said they had done their job by just leaving me one voicemail, apparently. It makes me so angry that he never got any justice.

There isn't funding for staff to stay so no I wouldn't expect it. No one works for free.

This is interesting, we had a similar situation this weekend. MIL has advanced dementia, and a Deprivation of Liberty arrangement in place. She had a fall at her care home, and was dropped at a&e, and left sat in the waiting room until 85-yo FIL arrived (an hour later)

Her dementia makes her violent and a total flight risk, so a danger to herself and others - why the home felt it appropriate to leave her sat alone in a city centre a&e on a Saturday night is beyond me.

I have raised a complaint, as I fail to understand why their duty of care ends when they deem it appropriate (despite having a legal responsibility handed to them by the council) and they think family should take over even though there’s additional health concerns at play! They hadn’t even noted her dementia to the hospital, they were totally unaware 😳

(we’re 250 miles away before anyone asks why we didn’t go)

Isn't this what patient transport non-emergency ambulances are for? Someone would pick up from the care home and return afterwards.

I am so sorry, what a terrible end for your Father.
Completely negligent of the home in my view and just terrible timing on your side, what were the chances of his admission coinciding with your operation 😢

No, they don’t stay with them.

And that’s how my dad ended up missing for three days. It was 1 day before anyone realised he was gone.

He had a fall, well, staff found him on the floor. Ambulance was going to take too long, so the manager drove him to A&E and dumped him, basically. Checked him in and left him alone.

I was in hospital myself, having an operation. I was the only family. The manager tried to call me and left a message. But you know, I was under a GA. They didn’t try to call dh.

When I was with it 12 hours later, I checked my messages. Called the care home who just said call the hospital. I did and they couldn’t find him.

He was found by a canal almost 3 days later. He had just walked out of A&E and that was that. It was deemed that that care home had done thier job as they had left me a message and checked him in to A&E.

Police gave no shits. Adult social care gave no shits. CQC gave no shits. hospital gave no shits. That was the care home we moved him to after he was abused in the first one he was in. All his life savings and home went on being treated abysmally (it was too dangerous to have him with us, we tried, he set fire to my house and tried to feed my baby a battery, I was killing my self watching him 24 hours a day).

In my experience as a Paramedic it's extremely rare for care homes to have staff to send with patients. It used to be done years ago but no longer and it's families that are informed about the admission/if they want to meet them at A&E etc. Considering placements seem to be charged at around £800 a week and staff are paid minimum wage you'd think there would be some funding to assist.

If there's no family essentially the patients go to Hospital without anyone to advocate for them - we obviously hand over why they've been taken upto A&E but that's all we can do.

When I started in the role it was normal for care home staff to travel with patients when they had dementia/lacked capacity but it's just not the case anymore - I suspect it's partly due to becoming a much more defensive society/expectations for being taken to hospital to try anything/every test possible are higher (even when even when x condition is diagnosed the patient is too frail for the treatment.

A perfect example of this today - 92yr old booked for transport to hospital for biopsy of a lump found on CT (at families insistence) ?whether it was cancerous. they've already been palliated, they've already have end of life medications prescribed (injectable opoids for pain etc but not being given as they're not in pain at present! Admittedly not expected to die imminently but in the notes they weren't going to be for further surgery beyond biopsy as that's all that could be done under a local anaesthetic as were too frail for general. So essentially patient just being put through a painful procedure which could well result in a complication - infection from surgery, c.diff/hospital pneumonia from the ward with absolutely zero expectation that any treatment would be provided should it turn out to be cancerous beyond what's already been prescribed for them.

The over testing in my opinion only leads to very frail confused people being taken out of the place that had some familiarity & staff who know them - to end up on a ward in Hospital surrounded by strangers/staff who dont know them, plus there's no lounge or dining room they can walk to, staff have such little time/though must not fall in hospital so patients kept in bed/transferred in wheelchairs/trolleys they just decondition with little hope of ever getting back the strength they had before they were admitted 'just in case'.

Sorry bit of a rant, but it always strikes us as totally mad that when you're 40 and need tests because you have severe symptoms/worsening pain/headaches/exhaustion - where you might actually be fit enough to survive treatment/live long enough to have a meaningful benefit - enjoy family/get back to work etc - then you end up waiting months or more. But instead wait 40years till you're 80 with dementia living in a care home and now you're expedited for all tests - have a bad headache get a CT same day, bit of abdo pain - CT/bloods/USS... More complicated then this obviously/more likely to be something sinister when older but you've got to die of something!

No.
The patient will be attended to by the medical staff in A&E.

When I worked in a care home we could accompany residents to pre-arranged appointments but unplanned, emergency visits, we had to hand off to family where possible and paramedics/hospital staff where not.

The home always had the minimum number of staff they were legally required to have. To send one to A&E for 10 hours would put every other resident and the remaining staff into an unsafe situation.

It was in the contract when mum went into the care home: we could choose to take her to appointments ourselves or pay extra for them to do it.

Without such a prior arrangement, I can understand them asking a relative to take over. I’d be interested to know what would have happened if your mum had said she couldn’t do it.

@itispersonal . Do you mean they ill/injured child would be watched at school until a person collected them or that a member of school staff would actually accompany them to A&E until a person took over?

Ideally both the dc and the elderly adult would be taken and accompanied to A&E as soon as they needed to go but unfortunately that is not usually what happens.

It's crap that your Aunt's dc don't help and you are worried about the impact on your own mother. It could be worse, you might be needed to drop everything at a moment's notice to deal with your mother's A&E emergencies too.

Do the council now manage your aunt’s money? Could you speak to them if you have time and explain the situation and that being the emergency contact is too much for your DM? They may be able to use your aunt’s money to pay for care staff to accompany her to appointments.
It really isn’t feasible that one of the staff to leave the home for X hours to stay in hospital with your aunt and leave the home short staffed. It would be dangerous for the remaining residents.