Bed blocking in hospitals

[SummitLove]

AIBU to think that actually a lot of this situation is being caused by families taking no, or very little responsibility, in caring for their elderly relatives?

Are we, as a society, now in a situation where many of us our so entitled we just expect social services or the health services to provide everything? Seems to have been a huge shift from families being involved in care to families expecting others to provide care for elderly relatives.

Mooching over this thought today and would love to hear responses from both sides.

Have three elderly people near us (one couple and one single) that we help out as their families appear to have washed their hands of them. They rarely visit, don't organise simple things like online shopping, or come and help with trimming the hedges in the summer. Honestly, it's been so cold these past few days that I would have expected someone to have called or check in on them.

Also it seems to me that extra provision is down to the women to sort out. The men get off lightly.

Most people work until retirement age so can't care for elderly, frail relatives. Many people don't want to become careers and would rather pay someone else to do it. Cups of tea and hedge trimming are one thing, changing and disposing of incontinence pads is quite another. How many people are really going to want to wipe their mum or dad's bum?
This. Since I retired 3 years ago my 90 year old mother has needed more and more support to enable her to remain in her own home which is in a very rural area. At the start I was responsible for taking her to the shop and other places, and making sure that she had a hot meal most days. In the last 6 months she has needed more and more care and is now doubly incontinent and very immobile with very little memory capacity although not 'ill'. I have managed to deal with this, with the help of my sisters - the nearest of whom lives 4 hours away - and Mum has just been awarded a care package for morning and evening care. However, I still feel responsible for her and am still going to her house morning and night to make sure that she doesn't attempt to get up or go to bed before the carer arrives.
All this for a somewhat cantankerous old woman who hasn't really inspired true affection in any of her children sadly! What has been very successfully instilled in me is a feeling of duty and responsibility. Living a mere 5 miles away from my mother makes it relatively easy for me to help out but visiting 3 times a day [like I've had to do recently] soon takes over your life. Not sure how this post has a bearing on the original post but it offers an insight into what it's like to actually have to care for someone on a long term basis.

Also if you want to get extra provision, send a man in. He will get all the help he needs.

Yes Tinsel which is why I did say I can understand it in those situations however this is not always the case. People that have always done their best for their families are being left too and that's cruel. You don't know that. The nastiest person in my family is a total street angel!

Granny Dumping = IMO more a case of informal or paid carers getting winter bugs and there being no back up carers available

Granny dumping = just another way of blaming the most vulnerable group (i.e carers) for the failings of social care. A bit like blaming NHS bed shortages on families...

OP
I have worked in geriatrics/MfE in the past. I can assure you that very few patient's who are delayed discharges are in this situation because no-one is available to trim their hedge two or three times a year, or not able to pop in every couple of days or get a few bits of shopping, although this is the case for your relative/friend. This relatively low level of need indicates a degree of mobility and that they are comps mentus, as this level of care need would indicate that they can get themselves washed, dressed, make meals etc without any assistance.

The vast majority of patients who are delayed discharges to have significant care needs (which doesn't have to mean complex needs) and either need a pretty comprehensive package of care at home (or similar provided by family), a bed in step-down/respite, or nursing/care home placement. The biggest delays for us were not the patients needing the occasional visit- which could arguably be done by family or those requiring low-level district nursing support.

9/10 delays are due to waiting for funding to be allocated and then another delay because of shortage of resources for care package or waiting for a nursing/care home placement to become available (especially if the family have chosen homes with a waiting list). Often patients going home are also waiting on equipment, (such as hospital beds, showering/bathing equipment or mobility aids) or adaptations to their homes (e.g rails and grab handles).

My grandparents lived a 3 hour drive from my parents who were the nearest. GP lived very rurally, so no home delivery by supermarket. What practical support could they give, other than a visit every few months during which they helped with odd jobs/batch cooking for freezer and so on. Sure, it was nice and helped a little but it was never going to make the difference between my GF needing carers or not.

Ok here's my take on it.
In an ideal world, an elderly person/couple may have amassed a sizeable resource in the form of pensions and a paid-off mortgage. They then have the resources to pay for their own good quality personal care for many years.
Alternatively a son or daughter may choose to take on the role of a full time career, perhaps to the detriment of their own health and family but in return for an inheritance, having saved the state (NHS and social care) a fortune.
Pretending that the role of being an unpaid carer is something that can and should be done out of duty/altruism/tradition/love is simplistic and idealistic as a blanket assumption.
It is understandable that those who have been forced into the caring role may feel put-upon, and wonder why others aren't dutifully making the same sacrifices for their own parents! However, the stories above illustrate why each case is different.
We either:

1. Increase income tax A LOT to provide extra funds for convalescent beds.
2. Start with the assumption that all paid-off home equity/pensions are fair game to fund elderly care and stop the assumption that the state can pick up the bill while inheritances get handed-down. There will always need to be a safety-net. I confess I have no idea of the numbers of frail elderly in the UK who do not own their homes and rely on state pensions/housing benefit etc.

Can I also please point out that if these uncaring female family members DID take a sebatical off work to do the elder care. they themselves would then probably retire worse off and less able to fund their own care or fund a move to an adaptable home!

sumitlive

But you can do things like pop over for a cup of tea, or pick up some fresh fruit and vegetables, or making sure that the heating was working and she was OK when it was very cold surely? In my OP I am not mentioning big-things, I am talking about the little things impacting bed blocking.

I do all those things already but this the level of care my Mum needs when she is in hospital it way beyond this.

the payback is to be a complete dick to them when they are elderly

so just because someone is related to you, you have to sacrifice your life to look after them?

People used to look after their elderly relatives because "elderly" meant late 60s/70s and the period they were looking after then for was short. People had their kids much younger, generally, so an "elderly" parent might have only been about 50 when their children were in their late 20s - and therefore not very elderly at all!

Nowadays people are having their kids in their late 30s and well into their 40s and therefore might have a toddler AND a parent in their 70s/80s. In my view, the toddler/child has to come first.

In addition, some people have quite extensive needs. Even if I had had a very close relationship with my father, I could not have looked after him in the last months of his life. He needed two carers to lift him. Even if I gave up work, I could not have covered his needs on my own. Our house is too small to accommodate a live-in carer. Having a carer come to the house would not have worked because they could not time their visits for when he needed to go to the toilet. A nursing/care home was by far the best option even though it was like a prison and I can understand why he didn't want to be there. I also don't think it's a good idea for people to be giving up their jobs to look after elderly relatives - because then the state has to pay out in benefits and has a heavily reduced tax take. It would be better to have a social care insurance scheme and properly fund care and nursing homes - as well as care in the home.

As far as the NHS is concerned - bed-blocking happens because of a shortage of care home places - and the fact that nursing homes need proper nursing staff, so there are more care homes, and fewer nursing homes. Some people, like my father, need a nursing home - a care home can't cope with their needs.

I also agree with the points made above about people needing to consider their age when making decisions where to live etc. Instead of living in a 4 bed house with steep steps in a hilly area with no buses, it would make more sense to buy a flat or bungalow in a flat area close to shops and/or public transport.

Can I also please point out that if these uncaring female family members DID take a sebatical off work to do the elder care. they themselves would then probably retire worse off and less able to fund their own care or fund a move to an adaptable home

This too. I read an article a few months ago about someone who had cashed in their pension early to fund care home fees for an elderly relative (not their parent) and I wondered what the heck they were going to do when they reached pensionable age if they had already spent all their money.

It's so frustrating though, all of our retired relatives are really anti modern homes - i.e. homes with wide dorways, no split levels, wide stairs, adaptable bathrooms.

Even for relatively minor things like cataract removal or other "minor" surgery, they need help as their "characterful" homes are totally impractical

I feel it's somewhat unfair, we do help but it makes helping a 10 times harder job when the "quaint" retirement cottages they all bought has random steps all over the place! (2 steps down to the bathroom, a split level living area with 3 steps up to the kitchen).

It makes it a much heavier job than it needs to be!

Not rtft but both times I've been waiting to be discharged it's been pharmacy that have kept us waiting for hours. Effectively blocking my perfectly good bed.

It's called 'delayed discharge' where I work. It's caused by a number of things.

Paperwork completed and sent to the correct team to be allocated to a social worker. Then the patient has to wait for the social worker to assess the patient, however this often is delayed as relatives want to be present at the assessments or we can't get the relatives to come in to sign the paperwork in the first place as they are working or busy.

Then an ot and physio report is needed (why the physio and ot notes that the ward staff use can't be accepted I don't know as they contain the same information) which can take a while.

Then the social worker makes their decision ie care package (which can take a week or so to organise) even longer if there is issues around self funding, catchment areas etc.

If the patient is for a care home then its longer. The social worker finds a list of homes that 'fit' the patients needs as the care homes have strict criteria for the patients that they accept and hands this list to the next of kin to have a look at the homes and decide. Then the homes that are chosen by the family are asked to assess the patient on the ward. If the patient fits the criteria then there is normally a delay as the homes don't accept new residents on Fridays, over the weekend, after 4pm and they want x y or z providing for the patient such as hospital beds or air mattresses etc. So these have to be prescribed,funding agreed and equipment delivery arranged.

By this time the patient has probably developed a chest infection/urine infection/deranged bloods so is now medically unfit which means the whole process is ground to a halt and has to be restarted once the patient is fit. It can't all just be reinstated, it has to be started from the beginning again

This is a simple discharge process to be honest. It doesn't take into account
-- relatives arguing over funding,
-son and daughter arguing over which home mum goes into,
-the relatives that ignore the phone calls and messages asking them to ring as dad is fit for discharge and has been for three weeks but we can't do anything as they have to signed the papers
-the next of kin to bring the house key in so mum can actually get back in the house.
-next of kin to bring the bed downstairs to provide a micro enviroment (bed,commode all in the living room, like a bedsit)
-family members that insist mum cannot go home even with a four times a day care package and must go to rehab ( even though physio,ot and social workers say patient doesn't meet the criteria)

Then there are the patients that refuse care packages, go home, fall and are readmitted back to the ward as a failed discharge (which is a bad mark against the ward)

There's also the care homes that refuse to accept their residents back as their needs can no longer be met ie the care home has had enough of the lady that sings at 2am every night or fights bites and swears.

More than one of them has built a kitsch "stepping stone" style path between their parking bay and the front door so that the lawn wraps around - it's ridiculous! you couldn't push a wheelchair up it and someone on crutches would need a LOT of assistance to navagate it.

So something that should be just a bit of help to get indoors, put the heating on and make a cup of tea, becomes a HEAVY job with lots of leaning and lifting…..

… which we do, but if we didn't/couldn't, we'ld be the selfish ones? not the people making their retirement homes as carer-unfriendly as possible?

(ETA these relatives have enough money to chose somewhere practical or at least some sort of middle ground, we can't chose a home with space to take in unwell relatives)

Even if we were paid carers and not family, the set up/environemnt isn't really an appropriate place to be carrying out care from the carers points of view.

It makes me quite annoyed actually. They want "character" or X-preriod only when house hunting and don't give a thought to how back breaking it would be for people to come in and help them in spaces that can't be adapted with aids

So, on a more positive note, what can we all put in place to make it easier for everyone as we age?

My husband and I (61 and 54) intend to move to a modern flat or bungalow, step free and with a supermarket within a very short walking distance. Also with public transport very close.

As we are both currently healthy we can take our time to find this fabulously convenient place. This is unlike our parents. All four lived in unsuitable houses and refused to move to more convenient residences.

My husband is an only child and I have one brother who lives in the USA. Our ill parents have been very demanding on our time without meaning to. Now the two that are left are in a care home.

It's all so sad and could have been a little easier if they had planned ahead. So we intend to.

That sounds sensible fabulous. I'ld say stretch yourselves to a bungalow if you can, freeholders can be arses about adaptations (know of one example where a leaseholder wanted to self fund a ramp and free holder refused, so they have to use a temp ramp to the main door (there's a lift inside) which a carer has to carry up and down/in out of the car.

Things you can adapt if you own your own home in advance:
Lower the light switches, put in a wetroom (they don't have to look clinical) make sure bathroom sinks have space for a chair/stool and aren't to built out with cupboards IYKWIM

Suspended ceilings probably limit what you can instal later.

Yoga & pilates, quite smoking and eat well so you heal faster.

OP I'm a bit confused.
On one hand you say that families should club together and help care for relatives when they become infirm but then you also agreed with my earlier comment of my going to Switzerland when my illness becomes much worse.

Do you think that more infirm should perhaps consider this action?

Sorry if it's been brought up but I really don't think we've had enough of a conversation about old age generally in society.

It used to be if you had a stroke or cancer, or something similar you died. We survive so much more now. That's a good thing in many ways but we are also dreadful at accepting death. My 90 year old grandmother was in a nursing home. She was skin and bones and ready to die.

Whilst there she was offered chemotherapy, a pacemaker and was given antibiotics numerous times. She lay in bed getting sores and multiple infections. Her quality of life was zilch. She wanted to pass away. The doctors kept trying to treat her. She went on for a year longer than she wanted and suffered for all of it.

This discussion is obviously very fraught but at the end of the day we seem to have a culture of keeping people alive quite often when it's detrimental to the individual. It's easy for me to say now but i'd rather have a heart attack at 80 and pass away than have a heart attack followed by 15 years of miserable life with massive care needs.

The conversation to be had isn't just about bed blocking or even something like euthanasia. It's about having more agency over what constitutes a good life and a good death.

Could the chemotherapy have been offered for palliative reasons? Not everything is about curing a problem, sometimes it's just to reduce distressing symptoms.

Mil is in a care home. She's 90 and extremely frail with chronic health conditions. If dh was to care for her, it would mean that we'd basically have to split up and he would live with her (ten miles away) because she wouldn't be able to be left. Carers going in regularly just wouldn't be enough. We still have school aged children and I'm sure they'd want to see their dad and I know I still want my husband around. We can't have her here as our house is tiny.

Dh has been responsible for her for around 12 years now and is very tired and worn down due to it she'll probably outlive both of us.

" and besides, Mum didn't want to go to a care home why? was it a funding thing?"

No Tinsel she was just desperate to go home. She was scared that if she went to a care home, she might be told that she had to stay there.

No Tinsel she was just desperate to go home. She was scared that if she went to a care home, she might be told that she had to stay there

But she's wrong, it's the exact opposite!
Prolonging your stay in hospital, simply because you don't want an interim respite bed, is what will make you more likely to get sicker and degenerate and need a permanant nursing home bed
Stepping down to a nursing home is more likely to get you home than staying in hospital for another couple of weeks and picking up infections etc