Cockroach Cafe - Autumn

On a separate note I had a random thought today that I thought I’d share on here as it may be helpful to someone now or in the future. Well it’s not entirely random but it would take far too many words to explain the convoluted route to get here.

For those of you keeping an eye on elderly loved ones who are just on the cusp of managing - how are their feet? At that stage my mum was washing herself and wearing clean clothes every day and able to chat - but she’d stopped paying attention to her feet but not said. One day (actually Christmas Day afternoon) she asked me if I’d have a look at hers as she’d not been able to cut her nails “for a couple of weeks”, and would I mind very much doing it for her.

I’m not squeamish about feet so I said yes of course. They were awful! Some toenails had got so long they’d curved round and were digging into the pads of the underside of the toes. There was a fungal infection so bad on her big toes that the actual fungus was visibly growing on the top. Memorable Christmas that one.

Now the point of this isn’t to make everyone but to say that it had got very painful to wear shoes and even walk in her slippers. Which contributed overall to her decline because she got it in her head that walking hurt her feet even when they were sorted.

So ask your loved ones about their feet and whether they need to see a podiatrist (chiropodist in old money). I know it may be One More Bloody Thing To Do but I do think it’s essential hygiene/health.

Plus, if it saves just one other person from spending their Christmas scraping orange fungus and finding cutting tools to deal with horn-like nails, it will be worth it.

I think both the organisation of the NHS and the training of doctors and nurses hasn’t caught up with the reality we all know. Ie that people live longer but with poorer quality of life for the last couple of years. They just aren’t set up to deal effectively with the merry go round of crisis-hospital-unsafe discharge-crisis.

Plus, there being a significant number of family members who still insist on the elderly being treated for everything (mentioning no names but examples of difficult siblings on this very thread).

I have a small sliver of hope that our current PM “gets it” thanks to his families experience with his dad, and his stated desire to get the often talked of “national care service” finally off the ground. It should get cross party support, I seem to recall Boris Johnson wanting to do it but it seemed to go in the “too difficult” box. If done properly it could transform the NHS by removing all the “bed blocking”. Which isn’t the patients fault!

@JeffLebowski
Hold on in there, we can get through this.

Are you getting updates from the hospital? Has she seen anyone like physio etc? What's her usual living situation?

@Eclipsing that is a good point. As it came on so quickly I think I've been assuming it will go just as quickly. But I need to remember that isn't necessarily true.

Dealing with my DM when she is absolutely, inconsolably distraught because she thinks the nurses are conspiring against her is soul-destroying. And this has only been going on for a few days. I need to go and see her again in the next day or two but I'm dreading it.

@JeffLebowski , I don't want to alarm you unduly, but delirium can take a long time to settle and some folk never get back to their pre-delirium state. Obviously, fingers crossed that your ER improves quickly but it might be best if you plan on the basis that that might be a very slow and possibly incomplete process 😕

@PerdreLeBleu
That sounds sensible.
Along with things like decent patient transport, comms with family members, notes across different areas (GP, various hospital areas etc).

And community nursing!

There is also something about housing options, so many elderly people end up in unsuitable/unsafe housing, because the alternatives aren't much better from a practical point of view. Retirement flats where you have to drive?!

When I'm queen of the world I will sort this out!

Thank you for all of the replies earlier. I told my mother a lie to say the shop doesn't have an online shop any more. I feel so guilty lieing to her but I just can't cope with this. She had a list made and it was only really a few things that can all be got with Tesco. Nothing too urgent. I had a quick look at one item already and it's not there any more. I was able to buy it in the physical shop a few months ago but it's not online. A list that would only really take about 10 or 15 minutes of she was to give me the list but she won't give it to me. She wants to talk me through her list and get me to show her where she can investigate and examine things and the shop and it would take a few hours. One thing on her list makes no sense. She wrote soaf anti bac. I never heard of that brand soaf before. This isn't the first time this has happened. It happened a few times where she gets confused on some crackers or biscuits and she's not able to say it or thing or it comes out very wrong or it's mash of other words. But to be honest this isn't a surprise for me. I live with her and I can see a decline and it's clear there's something happening but I am being denied a diagnosis and support until a crisis. It's gut wrenching.

@Podgedodge well the surgeons do like to have something to do... 😉

@rookiemere the other 0.1% is spent on people under 70.

Discussing this with friends in a similar situation we did wonder if there should be dedicated elderly person medical units dedicated to their care and maybe more abilities to do home visits? Maybe GPs who only deal with those aged 80 plus who then become familiar with the patient (continuity of care) and actually have specialist knowledge of the issues relating to elderly people which often are as much mental as well as physical.

Re the dehydration leading to UTIs my friend’s elderly MIL constantly got UTIs due to dehydration and was a doctor refuser. However the dehydration was caused by a refusal to drink anything because the only toilet was upstairs and she had poor mobility so going to the toilet was a trial. Her family suggested putting in a downstairs toilet to address the issue but she refused! As it turned out she ended up being rushed to hospital due to delirium caused by a UTI. Unfortunately they then found out she had advanced cervical cancer and died 4 weeks later. I don’t think maybe the idea of a dedicated unit would have helped her but it may for the ones who do constantly see medics who don’t identify all the issues.

MIL has allowed me to accept op date.
Only because ‘I bullied her’ and ‘surgeons want you to have operations’.
Plane tickets to go down booked so all as much go as they can possibly be. She is big mad with me though.

I'm starting to think 90% of NHS funding is spent on old ladies who have a UTI, dehydration and are delirious and may have fallen over and hurt themselves.

There must be a better way.

@JeffLebowski I think there is a real unwillingness amongst HCPs to recognise that a patient hasnt 'got better'. Part of this is because it messes up their KPIs. Partly it is because at a very basic level they cant accept that not everything is curable.

IME with DM, patients were given roughly 2 weeks in any given ward. After 2 weeks strenuous efforts would be made to discharge the patient or at least move them on. DM was moved on to the re-ablement ward despite having a raging UTI which was clear in her blood test results. Didnt matter, she was scheduled to move on so on she must go.

@JeffLebowski solidarity.

The Good Housekeeping mag arrived today, she was able to understand that Aldi mince pies won best in class and I've got to bring some with me tomorrow.

But also chatting absolute rubbish... I think she's read too many crime novels.

@JeffLebowski I hope you get somewhere now that the Dr has agreed to do cognitive tests. I think part of the issue with anything relating to cognitive problems is that HCP are rarely given time to spend very long with any patient, and you often see a series of different people (even in hospital). So it's hard for them to realise what's unusual. Plus, often people with cognitive problems are surprisingly good at hiding them in the very short term, and with 'official' people. I remember taking DM for some blood tests when we were waiting for a memory clinic appointment. For weeks she'd been having increasingly worrying delusions, calling me at all times of the night, claiming to have fallen (there were never any signs of an actual fall), accusing people of trying to steal from her etc. But she put on a great show for the nurse- smiling, saying how much she was enjoying the good weather etc. Even when she asked directly how she was feeling and how she was managing on her own she replied that everything was absolutely fine and she had been going out on the bus to see friend (which sounds perfectly normal except she had not left the house without help and a lot of persuasion for months). When I explained the real situation to the nurse and asked if there was anything that could be done to speed up the full assessment Mum acted like a grumpy teenager, clearly cross with me for 'snitching' on her. (The nurse did flag it with the GP though and they did get us a referral to another HCP who helped a lot).

Continuity of care!
that was talked about upthread, and could really help so much with at least some of the situations we are all dealing with.
I hope your DM recovers the best she can as soon as she can.

@Podgedodge i think there's just a lot of staff turnover so there's limited continuity of care. There's just a series of staff who give the meds, do the next set of obs and update the notes, which then get read by someone else who tweaks the meds and round we go. If it's not in the notes it didn't happen.

DM is "getting better" because her obs say she's no longer got infection markers in her blood and urine. The fact that she's not sure what continent she's on only becomes apparent if you chat to her or she sends you a bonkers text. The problem is that getting through to the doctors on the ward to tell them this really hard as no-one is capable of returning a sodding phone call.

@JeffLebowski and did that raise any alarm bells with Dr before he talked to you?
Are we really all just shouting into the void here?

@GnomeDePlume she went in with (drumroll please) a UTI and dehydration.

I got through to a different doctor today who also mentioned hospital delirium as a possibility but he also said that when he saw her this morning she seemed fine. He was surprised when I told him that not an hour earlier DM had sent me a text saying the nurses were trying to make her pay for everyone's lunches but she didn't have any dollars... He's going to do some cognitive tests.

Ive read it and totally agree with you Especially regarding the tissues . But being my mums carer, I thought it threw up a lot of important issues

I’m my mums carer and I’m the contact point for appointments for both hospitals and GP. My mums deaf so she couldn’t deal with a phone call and I have to take her. So it’s better for them to deal with me . Plus my mum mislays any hospital letters .

@JeffLebowski apologies, I cant remember why your DM was originally in hospital.

Something I am now aware of is 'hospital delirium'. I think this can be provoked by a number of things: broken sleep, unfamiliar surroundings, dehydration, repeated UTIs.

If that is what your DM is experiencing then the 'cure' is going back to normal surroundings.

@funnelfan thank you. You reminded me that while I can grasp things intellectually quite quickly, it can take weeks for it to filter down to knowing it at an emotional level.

DM is still in hospital and frankly delusional. The UTI has been pretty much sorted and they're looking at discharging her but she's mentally veering from able to hold a normal conversation to inconsolably distraught because she thinks she's in New York and the nurses are conspiring against her. I've not had much luck so far in getting the medical staff to appreciate this is a sudden downturn for her.

This morning has revealed that she's spent much of the night messaging her entire contacts list pleading for help so I woke up to lots of messages from various people asking what's going on and why I'm "ignoring" her. Is she answering my calls? Of course not.

@Podgedodge I'm coming late to this conversation, but hope she agrees to it. I can't remember the full background to her situation at the moment, but just wanted to say that I had prolapse surgery in my 40s and it was major surgery, completely wiped me out for a few days and I needed a lot of support in the first couple of weeks of recovery, it was as much as I could do to wander round the house a bit and make a cup of tea, sitting anywhere was really uncomfortable (a lot worse than after childbirth). It took three months for me to feel fully normal. So whatever care she has now, she will probably need a lot more in the first few weeks.