Is this normal practice for a nursing home /will hospital know to help in A and E

[Monstermunch10]

Elderly relative lives long way from me ,but I do have POA
Had fall day before yesterday
Following day , yesterday they think broken bone
So phone to ask me to take her to hospital
I obviously can't ,and they say they will have to charge me to send someone with her .
I say ,not a problem,just bill me whatever it costs .
Then late last night I get a call from the ambulance asking me to come with her ,again I explained I can't ,and then they want me to pick her up after
I explained I had arranged extra payment to the home to take her .
Home phones me late last night to say they sent her alone in the ambulance to A and E
She's doubly incontinent and has very advanced dementia.
Up untill now I've been very happy with the home ,this is the third one she has been in .
Even if I lived near I couldn't of gone in the ambulance yesterday as I've two autistic sons I can't leave alone .
Will the hospital look after her ,what will happen when the hospital realises she's wanders off and they won't get any sense out of her .
Is this normal practice,are the hospitals used to this so they have procedures in place to help

Anyone

The care home should have had a form (can’t remember what it’s called) for handover of detail of your relative’s needs to the hospital. In practice, your relative will not get the personalised care she needs.

Do you have POA for health and welfare? If so (and likely even if not) you should be able to talk to the hospital about her situation, but you may need to be persistent, and you may need to use the term “vulnerable adult” and refer to your wish to ensure that she is properly safeguarded to get their attention.

If there’s any way you can get there in person, or enlist the help of someone local, it would be a good idea. However, I realise this is far from straightforward for many people.

The hospital will be used to receiving patients in many different situations but I would check with the home first if they have an update and if not try to ring them now to ensure that they have all the facts about your relative as that might not all have been passed on. In my experience the hospital will not speak to the nursing home because they are not the next of kin. You will need to communicate messages between the two. I imagine in the home they didn't have enough staff at the time to spare someone extra to go with her.

Gosh that sounds awful. Why discuss charging and then send no one ?
Yes , the hospital will look after her .

I don’t want to just pass and I’m not going to give you any horror stories as they aren’t helpful here. I presume the home will have sent some notes with her or the hospital might call the home for details. I’m afraid how she is treated will depend very much on the staff on duty and how busy they are. Unfortunately you can’t expect a home to have a spare employee who can go to the hospital with your relative even if you are prepared to pay. If she just has a broken bone, hopefully she won’t be there too long.

Ring the hospital and explain the situation.

I’m amazed they didn’t ring for an ambulance with a fall suspecting broken bone on a patient with dementia to start with! That’s really odd. We receive patients from nursing homes all the time; they sometimes come with a This is Me style booklet, and a red bag with medication and past medical history. Normally, either the nurse or OT team will ring the nursing home to get a history of base line activities of daily life.

Dementia pathways are very common in hospitals now and she wil likely be put on a closed ward (meaning requiring buzzing in and out) to prevent wandering. However, expect a drop off in terms of function.. hospital stays for patients with dementia are terrible for regression

It depends very much on the hospital and how understaffed the ward is. On some wards she will receive very good care, on others the staffing levels just don’t allow for anything beyond the medical basics. I would find out what ward she’s on and phone, giving them the details of her needs. Be prepared to try phoning multiple times across the day to get an answer.

My dad has received excellent care at three different hospitals in the North of England. In the South I happened to be on a bay with elderly people who had meals delivered and taken away without eating them as the staff just did not have time to help them. There were two nurses for the whole ward as lots were off sick.

Really patients need an advocate visiting them. Is there anyone closer to her who could go in?

Thanks for all the replies
Much appreciated
She's back at the home , ambulance took her back , without telling the home she was coming.
There was no paperwork from the hospital
The ambulance staff said she was uncooperative and they couldn't get an x-ray done ,so she has to go back in a couple of days for another appointment.
Communication from hospital to care home is very poor

In the homes I've managed we have always tried to send someone with the person if they lack capacity, (and if a relative can't go), at least to the point of admission (or return to the home). Often times,as the manager, I would go, as it didn't impact my minimum staffing or costings, (just my workload). I would wait with them in an and e, and advocate for them as needed, until they were admitted or not, and if the wait time went over the shift change at the home we would send a replacement person. We would also always send them with their hospital folder-all the info about them, meds list, little hospital pack (change of clothes, spare inco pad etc etc as needed). There are a few times we couldn't do this due to staffing and or covid of course, which didn't feel great at all, but in which case we were on the phone, no doubt annoying the hospital staff, every two hours to ensure the person was being checked on.

Different homes will have different policies and capabilities re this and technically once the person is in the ambulance they are the responsibility of the hospital until they come home. In practice for someone with dementia, that appears to me to be throwing them to the wolves tbh, so best avoided.

I manage dom care now, care in people's actual homes, and here we have care staff wait for the ambulance with the person if a relative can't come, but we can't send them to the hospital with them as there is no time and no budget at all for it, which feels awful.

Ask to see your care homes policy in this and you will have a clearer picture.

And yes poor communication from hospital to care home and or dom care agency is often poor or non existent. I've never known it so bad, in 24 years of working managing care services.

Normal although not ideal, care homes just don't have the extra staff, especially if it's during the night.