Help! 4 hours waiting for ambulance

[Bonnynorton2]

DF has fallen and broken his hip. He has dementia. He has been lying in pain for probably about 7 hours at at home.His carer found him 4 hours ago and called an ambulance. They are still waiting. The carer has been unable to visit other people he cares for or go home. I live 5 hours away. If I had known the wait would be that long I would have left immediately. Any suggestions about what I can do? DF lives in Dorset and I live in London.

Private ambulance - you will still be triaged on admission by crew and treated accordingly.

There is NOT enough trucks on the roads with qualified staff, beds in hospital to hand over into, social care to support people coming out the other side. The system is woefully underfunded.

OP I am sorry this has happened to your DF. I hope he is feeling more comfortable now.

How is your dad today, OP?

@Bonnynorton2 how's he doing now?

He had a fractured hip. It was operated on yesterday and he is recovering. My next battle is to make sure he is not discharged home without proper care. He has been living alone at home in a very rural area a long way from me and has become increasingly vulnerable. I have spent the last year and a half making enormous efforts to get social services to help us but I have been repeatedly told they can't provide anything more. We can't afford anymore care or residential care. I am absolutely dreading discharge. I can't cope and he is not safe.

Hope your Dad has been given something for the pain and has been made comfortable.
What a terrible state things are in when people are waiting so long for an ambulance and then proper care in hospital.

Outcomes for a NOF can be very similar to chest pain.

Not put in the best way but there is a very very high mortality rate with hip fractures in the elderly.

Wouldn’t lie to the ambulance service though

My nan fell and fractured her pelvis.

Somehow it was arranged for her to go for rehabilitation care for a few weeks once discharged... my be slightly harder with the dementia but I would look into that.

Also his mobility would be greatly restricted so get straight onto social services ( a hospital referral helps ) for an health assessment/ financial assessment for home help.

Be forceful but polite social services are also stretched so you need to be a big enough pain to be remembered but also remember they are struggling too my mum retired as a social worker about 8 years ago she was part time and had about 90-100 people too look after ... hiesy the strain is crazy x x

Good luck x x

cherry the outcomes for a fractured hip are not similar to the outcomes of some type of chest pain.
Fractures hips are not immediately life threatening (although the mortality rate is 50% at 1 year), and advising someone to make up symptoms to jump the queue is irresponsible.

OP, I’m sorry you’ve had to go through this, but it’s fairly common place across the UK. The NHS is under strain, made worse by thousands of people like cherry. Sadly, voting for a different political part won’t make any difference. It’s a bottomless pit and you could inject £100billion a year and it would just disappear. I’ve said in many posts and I’ll say again.....we, as in the public, need to decide what we think our health is there for and the rest needs to be charged for. Do we want
-limitless ivf
-gastric banding
-24 week premature babies saved to require 24/7care for the rest of their lives
-90 year olds with dementia going to ITU
-£100k spent on cancer treatment for a young mum to give her 3 extra weeks of life, mostly spent unconscious
-free car parks
-hospital transport for everyone who claims they have no friends or relatives to pick them up.
The list goes on.

it’s a bottomless pit and every time it’s suggested that a service is cut or the car park costs need to go up (for car park maintenance) Everyone is up in arms.

He was assessed about 18 months ago and we have had a financial assessment. Social services provide care visits 3 times a day. However, he needs someone with him all the time in order to stay safe and his life (appointments, bills, shopping, house maintenance etc) needs looking after. This is almost impossible for me at a distance. Social services say they can't provide any more care and we can't afford to top it up. We have no room for him at my home and it is anyway inaccessible (stairs). He also does not know the difference between night and day and it would be difficult for the whole family to sleep. He also wanders off. He would wander into busy streets if he lived in the city with us whereas in his village he is much safer out of doors.

I am sorry for what happened.
He was in his house, as you know, which is why his priority was low.
Can you sell his house?
Perhaps social services will reassess for residential care being needed?

How bad is his dementia? My dad (advanced dementia) fractured his hip last year, rough timeline was just over two weeks in hospital then they deemed him medically fit for discharge. At this point he was almost completely immobile.
We were given hardly any notice to attend a meeting with the hospital social worker and discharge coordinator, they were pleased to tell us we could take him home the next day, no care package in place.

I'd phoned one of the dementia charities for advice and they told me to stand my ground, not be bullied by the professionals, keep saying the words "safeguarding issue", and basically refuse to let them discharge him home. Eventually they agreed to temporary care in a residential home, he stayed there 6 weeks.

If you have the time there's a very good forum on the Alzheimer's website. I did shit loads of reading while sitting at my dad's bedside. There is funding available (NHS Continuing Health Care) if your dad needs actual nursing care and not just social care, but it's extremely difficult to qualify.

I can't stress this enough: get everything in writing. No matter how nice the staff are face-to-face they will deny anything and everything when it suits them. We are seven months down the line and it's unbelievable the mistakes that have been made and the lies that they have told to cover their own arses.

Best wishes to you and your dad.

@collectingcpd well said, the amount of money spent across all services on non-essential care (and I include ivf here, even as someone who has infertility issues) or where we could fund ourselves is staggering- the 'free' calpol at chemists really irks me, it costs the nhs a lot more than it would for the parent to just buy the £1.50 medicine. As a society we seem to expect or feel entitled to a lot for no cost. I work in the public sector and see/hear it often.

Germany have a much better system, involving a mix of statutory and private health insurance. Our nhs is fundamentally broken, but if health insurance is mentioned the uk is outraged. Yes- lets be more like Germany, scrap brexit and shake up the nhs!

OP, I hope your dad is recovering. Do you think this might convince him to relocate or move in with you?

It's absolute bollocks to say that extra money would disappear without improving anything. Utter shit. £100billion is nearly the whole budget, so would have a transformative effect.
In the years of coalition/tory govt NHS spending has risen by about 1ish percent a year, compared with 4ish throughout the life of the NHS and 6ish percent under the last Labour govt. It feels shitter, more stretched and under resourced because it is. Money would change that. Your choices and political choices change that.

Sorry to hear about your dad Bonny

I'm a community physiotherapist working in a rural location and have lots of experience of working with patients with dementia post hip fracture.

At the moment while he is on an acute orthopaedic ward the priorities will be ensuring he has good pain relief, that he is eating, drinking and getting some good quality sleep. I know this seems absolutely basic information but he has had a fracture followed by a long lie, a period of (necessary) pre-op starvation followed by a GA and orthopaedic surgery. He is elderly, has dementia and is very likely to have some elements of frailty. Pain relief, fluids, food, good quality sleep are essential for his recovery.

From a physio perspective the therapists will be wanting to get him up and weight bearing and usually walking with a frame, and sitting out as soon as possible.
These are the recently published Chartered Society of Physiotherapy Hip Fracture Standards.

Given what you have told us about your father it is likely he will need a longer than usual period of rehabilitation which may involve him being moved to a rehab ward or, if they exist in his area of the country, another location (such as a cottage hospital) to give him more time to reach his rehab goals and potential.

The physio and OTs who are seeing him on the ward should have ascertained from you what his “baseline” is; what does he usually walk with, does he go outside, is he able to get in and out of a chair, off the toilet, in and out of bed independently? Does he need help with washing and dressing? Who does his shopping and meal preparation? Has he had any other recent falls? All this sort of information combined with what his current care package is will inform them of what they need to be working on with him to ensure a safe discharge.
If he does go home then the community therapy teams will take over and follow him up.

Almost certainly a discussion will need to take place with your dad and yourself to establish if discharge home is a safe option and assessment of his capacity to make this decision will need to happen. But not yet! It’s too early post fracture for this to happen given all that he has endured over the last couple of days.
Almost certainly a social worker will need to be involved in his discharge plans. If he is deemed not to have capacity to make the decision on returning to his own home then a decision with be made in his best interests. You will be involved in making this decision with the rest of the MDT. It may be that he needs to be placed in a residential or nursing home but all these options will be explained to you, including financial implications of this decision.

I hope that’s been of some help. I'm so sorry, and angry on your behalf that the long wait for the Ambulance happened.

If you have any other questions please feel free to PM me.

It’s not a real life example of austerity, it’s a real life example of an over bloated welfare state. If medical was only available free to those who can’t afgord to pay and actually need it would be much easier to fund. It’s imposdible to better find the NHS as it is because there isn’t any money. The government is getting into more and more debt (which will have to be paid) trying to fund the half baked services it currently provides. Throwing money at the problem won’t help because we have no money to throw. Glad your DF is in hospital now but watch them like a hawk. Getting treatment in an NHS hospital is a risk in and of itself.

I'm all for copay, actually. But...
Means testing can be more expensive than a free service.
Recently I heard story about a cost-recuperation programme that cost £40k; they recovered £5k. It's being cancelled.

Elderly parents are such a worry. Especially when they are so far away.
I hope you can get something sorted for his ongoing care.

Lego obviously £100billion would make some difference, but nowhere near what you’d think and it would be decades before the public would feel it. Firstly there are no staff; tens of thousands of nurse and doctor vacancies, not enough being trained and thousands leaving. You can’t fix that overnight. There is a 25% shortage in A&E consultants and training places have been underfilled for years....it takes the best part of a decade to qualify as a hospital consultant; so even with a massive injection of money the staffing shortage is going to take decades to reverse. Ditto the replacement/enlargement of crumbling and not fit for purpose buildings. Millions of the money will end up in the pockets of managers and other non clinical and often not needed staff. Millions will be wasted. And I also don’t think the state should have to care for its citizens from the cradle to the grave without citizens taking some responsibility for their own health; the NHS and welfare state in the UK has created a whole generation of entitled people who think that they are owed everything with zero responsibility on their part.

LegoFriday I totally agree. I was a nurse for 26 years and saw few Governments come and go in that time. Every time the Tories got in standards in healthcare went down - funny that eh? When the excellent Hospital I worked in began to implode during the austerity measures I decided I’d had enough and left. My husband is a hospital consultant and he used to be so proud of the service he could provide but since this Government have been in power now his specialty is a shambles.
I do wish people would stop repeating the myth (and frankly propaganda) that the public are to blame for “wasting” resources. Or that people are greedy and want too much healthcare!! We are a first world Country and we can afford a first world first class healthcare system, but whether our Government actually want that or not is the question!
Leaving an elderly person lying on the floor with a broken hip is not first world or first class. We can do better than that.

Leaving an elderly person lying on the floor with a broken hip is not first world or first class. We can do better than that.
Totally agree. But lying and telling the ambulance service that you have chest pain when you don’t (as suggested upthread) to get speedier treatment is an example of abusing the service. And anyone who has worked in the NHS could tell many tales about service abuse.

Thank you so much for your replies especially scribbly. What you say sounds very reassuring and I am sure a description of best practice. Unfortunately my experience of reality of dementia care is much more like dusts. It would not surprise me at all if he were discharged home without warning. I have had so many experiences in the last two years of things just not happening and people shrugging their shoulders. I am an assertive and articulate person. I make sure I speak to everyone I can and put everything in writing but it does not seem to make a difference. It has very badly affected my mental health and our whole family. I have had periods if not being able to work or function, just sleeping and crying. It's shit.

Sorry to hear that op,
does your work offer counselling and advice for you?

The public are the first to get the blame, you've only got to read threads on here - someone could have all four limbs hanging off yet they'd be told not to go to A&E or how dare they phone an ambulance.

My dad worked from age 15 to 70, I could count on one hand the number of times he saw a GP in that period. So yes I think he did actually take responsibility for his own health. That didn't matter one tiny bit when he had the audacity to develop dementia.

Since his accident last year we've had involvement with numerous members of staff, from 6 or 7 different public sector agencies/ departments. We're no better off than we were six months ago, from a care perspective. All those staff are busy ticking boxes and form filling. They've had sick leave, annual leave, maternity leave, we've had fuck all.

Instead of blaming the public some of the HCP need to look inwards. Listening to agency/ bank nurses bragging how much they are earning and trying to encourage regular staff to do the same whilst telling relatives they should be the ones changing the bed.

Bonny and Dust it is truly appalling the experiences you and your loved ones have endured; an absolute national disgrace that the most frail and vulnerable members of our society, and the people who care for them get treated in such a terrible fashion.

Something you can do, as an advocate for your father is get the names of the HCPs who are currently caring for your father and raise concerns and ask questions. If the ward has a discharge liaison nurse get their name.
“I am very concerned that my father is:
“Not back to baseline”
“At risk of unsafe discharge” or “At risk of failed discharge”
are useful phrases you can use to share your concerns.

At this early stage one thing you can be doing is looking for signs of delirium in your father.
This is helpful information from the Alzheimer’s Society on what to look for.

Take care of yourself too if you can. Hospital environments make this difficult for patients and family alike but if you can take some regular breaks during the day to get outside into the fresh air and have a walk, something to eat and a bit of mental down time that will help a little.
Sending you strength and a supportive mumsnet arm squeeze.