AIBU to put complaint in about carers? Aunt now in hospital with 50% chance.

[PhoebeFluffingtonFyffe]

I started this thread last week

https://www.mumsnet.com/talk/chat/5508722-caring-for-elderly-aunt-who-hides-health-problems-and-wont-speak-up?reply=151320727

There has been a very upsetting development.

I just got home 2.40 am after being at the hospital with my aunt from 9pm when she was taken in whilst I was at work. She has necrotising fasciitis and has just had an operation to take away a hell of a lot of basically rotting flesh. She's had this for over two weeks but we didn't find out what it was until now, thinking it was a pressure sore until Saturday morning.

The day after I posted this I went to intercept the district nurse who was visiting her that morning to make sure she told her about the 'pressure sore'. I arrived when the morning carer was there. Neither my brother nor I have been there at the same time as the carer. I noticed the carer was giving her a strip wash using the same bowl that has been used for washing up. This has been going on since September, every morning. The same flannel used over and over and left on the radiator (which isn't switched on). I only just found this out.

She injects herself in her side with insulin, and if mucky water and scruffy flannels are used then the infection and bacteria could have got into her system through an injection site.

The carer told me that she was concerned about the pressure sore and I said that is why I was there. The district nurse came and I made my aunt show her. She cleaned it, took a swab, took some photos and dressed it saying she would send the swab to the clinic and we would get results by Monday.

Saturday morning my aunt texted my brother saying the dressing had come off, the wound was weeping and it smelled horrible. The carer had already contacted the district nurse. The nurse didn't turn up, my brother cleaned it and put on a new dressing.

He went to her house today. I got a message at work (I'd planned to go to see her on the way home) to say he had called 111 and they had taken her in and he was following. Just before I finished work he messaged to say that the surgeon had said what it was and she was going into theatre that evening. I managed to get there before she did, and we waited around for the outcome. It seemed to have gone as well as possible. Still a long way to go and things can still go very wrong though.

She had a hospital check up two weeks ago and she said she had a swelling on her hip. They just looked at it and measured it. Wouldn't you think they would have raised concerns then?

We are very upset and very furious.

WWYD? The carers have been strip washing and dressing her for months. Nobody has noticed this - I cannot believe it.

Then you need to make a Subject Access Request (SAR), this will give you all the information you need. However, this is dependent on you being your aunt’s Power of Attorney. Otherwise, only your aunt can make that request, and I’m guessing at the moment that’s impossible.

I’m so sorry about your aunt, I hope she’s comfortable and gets well soon.

Thank you everyone. She has had two rounds of surgery and it is looking quite good, thankfully. She's breathing for herself, but quite distressed but only to be expected - it's because she can't see much (she was also unable to hear). She has also been discovered to have a rather nasty ear infection in both ears, and a perforated eardrum. No wonder she couldn't hear. She's getting that looked at now. The medical team are great.

We are hopeful she'll be able to give permission to access the care notes eventually when she is feeling better and we'll address those issues then.

Thanks again all.

It’s all very difficult, isn’t it when so many people are involved in care at home and there is no one with the whole picture.

for example, whoever was doing the laundry must have been aware that there was only ever one flannel in the wash but didn’t draw any conclusions from that.

id agree that a care or nursing home setting might work better. These homes are not necessarily horrible and do at least have an overall coordinated view.

Hope your aunt recovers soon.

I'm pleased to hear your aunt appears to be improving. I hope and pray she continues to recover 🙂

It's a good opportunity to review the whole picture for your aunt if she lacks capacity to manage her own care needs. Often carers are brilliant at what they do but we tend to forget they are low skilled workers on minimum wage. They are only expected to do as they are told. They have an awful lot of responsibility considering their low wage. It sounds like your aunt needs support to manage her care needs, not just carers to carry out the tasks. It maybe worth considering power of attorney if you or your brother are willing and able. If not, you can ask the local authority to point you in the right direction.

Getting Lasting Power of Attorney in Health and Welfare is a must going forward - though the last I heard, there was a backlog and this can take a while, also signatures need to be in particular order and witnessed, not that easy while your aunt is in hospital, but doable... Still, if it takes months to achieve I'm not sure that helps you with any SAR stuff, though you can get your aunt to do the right signatures if she is alert now.

Do your own research on other carers in the area; others disagree with this but I would exercise caution getting the local authority involved if you are divulging your aunt's situation - they could interact with strong-arm tactics to get her into a £2K a week care home, not saying they will, just saying they can. Harder to do if your relative has mental capacity.

That said, I've found the longer they stay in hospital the worse they get - they patch up one set of problems and offer up another; for instance, they don't get them out of bed and sit them in a wheelchair or anything.

In my experience it is a fool's errand trying to get anyone held to account in adult social care - particularly if you live in Surrey.

Thanks again everyone and yes we will be pursuing Lasting Power of Attorney in Health and Welfare. She's eaten small amounts, but is very distressed, talking about "topping myself" - she's unable to see or hear properly, but is so confused with the medication she's not able to take in information such as she will have her cataract op in three weeks while she's in the hospital, and the ENT specialist is visiting today, or that the antibiotics for her ears will take a day or so to really kick in. The hospital are very pleased with her progress which really is a minor miracle.

Good news is that she will be moved on to a ward, today or tomorrow, in fact we have asked for a quiet room if possible - she tends to get very frustrated and start shouting at the staff when she's upset and it's not fair on other patients.

Many care agencies now use electronic care plans and check in systems on phone apps so it may not be a red flag that there was no care plan in the file

That’s incorrect - it’s confidential and only if the Aunt gives permission could they allow the op to see notes/careplans/risk assessments etc

Yes laundry; clothes, towels, bedding is essential for bed bound patients to be washed and changed daily.

Regarding food, I've seen biscuit crumbs develop into bed sores and have also observed cutlery in the bed.

That's terrible! She isn't (wasn't until the weekend) bed-bound, but sat in a chair all day long because she has limited mobility. Because she can't see, she spills things as well so it could be as you say (crumbs) or the injection site.

My brother did all the laundry and took good care of it. Bedding changed every week as well as doing the towels and flannels.

She did have one of those plug-in blankets on her chair though, and I don't think that had been washed (well it couldn't, it's basically an electric blanket).

a lot of newer electric blankets can be washed - you detach the plug and wire from the oval shaped clip on mine.

she was sat on a blanket?

if she is sat in her chair all day what sort of pressure relief did she have on it? We generally provide a repose contur for recliners or a repose for a normal chair.

We had a lady who was accidentally sat on the chair control for a day - awful damage caused

I found with DM and DF having carers, they would do what was in the book to do no more, or worse would ask DF ( dementia and fiercely independent) or DM ( very slow speech probably due to stroke damage) what needed done, which inevitably was less than what they should be doing. I had great sympathy for them though as mostly they appeared to have been thrust into the job with little training and had they done everything needed it would have taken them well over their allocated slot. It felt like they needed someone to do all those extra tasks and coordination of their activities. They had a cleaner but DM would only allow her to change the sheets once a fortnight.

Do you know what length of slots your Daunt is paying for ? It could be possible that the level of care she needs exceeds the allotted time. But really it does sound as if she is beyond the stage of living at home- shame that it has come so early in her 60s. I would say to the discharge team that you think it’s an unsafe discharge if they try to let her out on her current package.

You could raise a complaint with the care agency, but I would probably focus my efforts on what happens next.

Yes, another one saying that if you have the money, and hopefully there will be plenty in sales right now, get a washable electric blanket. I have one and you just disconnect if, then wash on gentle. Here’s just the very first thing I saw when looking. She cannot have it in hospital due to fire concerns, but it could be a lovely welcome home present.

ETA: I forgot the silly link.
https://www.amazon.co.uk/PROALLER-Electric-160x130CM-Auto-Off-Washable/dp/B0D8VHSJWN/

When your aunt is being discharged please ensure she is assessed for NHS continuing healthcare. It sounds like she might be eligible. This would not only mean she would not be required to pay for care but also that the care would be overseen by the ICB which is - in my experience - of a better standard.

She wouldn’t meet the CHC threshold from what op has written here.

I disagree, but either way a checklist should be completed.

Well, I agree she wouldn't meet the standard for free NHS Continuing Healthcare. I mean, they won't fork out if they can avoid it - but see other threads on this issue and decide for yourself. My view is it is best to stay off the radar of social services, but it depends where you are going with this. They may press for her to enter a care home, and depending on your situation, that may be the best, I don't know. But it's not like everyone in your aunt's condition in a care home gets free healthcare, it doesn't work like that. The idea is, the sale of your house pays for it, and subsidises council-funded care home residents.

Otherwise the State would be bankrupt.

Her needs are not intense, complex or unpredictable. Her needs are social and predictable. Even bedbound patients, wouldn’t necessarily meet the CHC threshold. She possibly may qualify for FNC but not CHC

https://assets.publishing.service.gov.uk/media/630399dae90e0729db4b59f9/NHS-Continuing-Healthcare-Checklist-guidance-2022.pdf

Agree with this

Hard work. Low pay.

They would follow the care plan, and then ask your parents what else they wanted doing?

DM’s care slots were 15 mins each. They couldn’t do much in that time other than follow the care plan (get her breakfast, wash up, change sheets, whatever).

She had a separate arrangement with an individual who used to do her ironing but also run errands eg collect prescriptions or post a letter, but then that person would just bill for her time ad hoc - a care agency can’t really do that with multiple clients and a schedule,

Maybe I worded that badly. Sometimes whenI observed them there they would ask my DPs what needed doing rather than checking the care plan. The bare necessities for DM would be done - toileting and meds - but often that would be it. I am not blaming the carers, but it does seem as if the system doesn’t work very well unless there is consistency in carers, being lucky with some good carers and someone in place to oversee it.

Thanks again everyone for comments which we're talking on board. She's doing good actually, out of bed and off the catheter, eating, but ranting and raving over the weekend with post ITU delirium. Seeing people in the room, thinking she was at home and someone breaking into the house, yelling Pete! Pete! That has calmed down now but she's still convinced we're keeping things from her (we're not).

We've got some good ideas from you all so thank you. The weather is better so the electric blanket isn't an issue for now but we'll throw it out and purchase a washable one (or two).

I must admit we were in a daze last year with arranging care and took everything on face value. She spent ten weeks in hospital last year and they were appointed when she came out. We were quite naive.

She's not at the point of being discharged for a week or two yet.