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.

Average life expectancy in Pakistan is 66.

A bit like it was in the 1940s here.

If the DB won't help perhaps that is a reflection on how the DPs brought him up. I think you definitely have to toughen up when caring for the elderly. Everyone's sympathies are with the old person, 'poor old dear', the carers aren't considered (except by another in the same position).

I think time have well and truly changed. We are living in an age where everything is more expensive, housing pension etc so often in families to people have to work. I'm days gone by people live near family and they supported each other but now people ar so wide spread. Traditionally I think the women of the family brought up the kids then later on took care of the elderly relatives but now we are all at work and don't have the same time available for older people. Older people are once younger people and have different personalities. My MIL expects a lot of myself and DH, she has a daughter who lives round the corner who tea her shopping once in a while but nothing else. We have a five month old and she is entirely dependent on us making a fifty mile round trip to visit every darn week, but we go because we have to. I don't think people should be made to feel guilty for not a spending the weekend clipping hedges and cleaning houses. We made my MIL PY somebody to clean her house and do the garden. DH and I work full-time it is too much to expect us to look after her house when our house was permanently a mess. We do holidays, visiting and hospital appointments. We have a better balance, I know Social Services a over stretched but sometimes family are to.

I am desperate to avoid hospital or care home. I have a condition that is likely to render me disabled and unable to either care for myself or end my life.
As the law stands I will not have a choice other than to find a way to end my life before I get too disabled to do it. I cant ask anyone to help me as they will end up in prison.
I wish there was a dignitas clinic in the uk.
Believe me I worry about this every day but unless the law changes I cant see how to manage it.
I would be willing to bet that there are many people in the same position dreading the prospect of needing care.

Bed blocking is not about sorting out online shopping etc its about setting up the correct care package delivered by professionals

Well said.

I don’t think our society is set up to allow for that kind of thing in the way it used to.

My SiL gets very cross that DH and I don’t do more for PiL now they are both old and frail. But we live over 800 miles away and it costs about £200 every time we visit (which we try to do every month, but that’s hard). Moving back to DH’s home town isn’t exactly feasible, as it’s a tiny mining village in rural Wales with no jobs – basically – we’d both be unemployed if we went back there. And if they moved to us, then they’d be miles away from his DSis and that part of the family, not to mention completely isolated from the rest of their support structure.

We do online food shops for them, but we can’t trim hedges or give them somewhere to live. SiL can’t have them come and live with her as she physically doesn’t have room – she’s got 3 DCs and not a huge house – and when they aren’t able to live in their own home, that is a massive worry.

I also would say that the old system of ‘family look after their own’ actually meant that a lot of people, 90% of them women, were expected to make huge sacrifices to be carers, and it became another reason to not have a career, and not be independent. It wasn’t an ideal solution at all.

My DGM was a "bed blocker" for a time. She needed to be in hospital after a fall and had ulcerated her leg. She was not agreeing to go into a home. But she was living alone, in a house that was no longer suitable for her needs, and services in her area were decent but not enough (and she couldn't cover private services coming more often). As it was, she was getting 2x60 min visits at the start and end of each day and a 30 min visit midday (all of which were slightly shorter in reality as the carers had to include travel time in those slots). But when alone, she had turned on the cooker and burned out a saucepan/kettle a couple of times after she forgot about it, and a few other issues with loss of short term memory.

DM, DAunt and DUncle all did what they could, in their own ways. DM lived 250 miles away, DAunt worked FT (and lived on the other side of the same large city so at least 40 minutes drive when NO traffic at all) and DUncle was very much unable to help (alcoholic, marriage broken up and almost homeless himself). They did manage to persuade DGM to move to a home after a 3rd hospital admission - and had facilitated her getting home as fast as possible in the interim - but she needed more support than was available. I think she spent 6 weeks in hospital on the last admission, and part of that length was because the homes wouldn't accept her as she was now "higher needs" because of the leg ulcer. She then spent 3 weeks in the home before passing away (her last admission had been to a "long stay" hospital focused on elderly patients, and she had then moved to the home attached to that hospital).

My other DGM also spent time in hospital in her last year. But she had different medical needs that were easier to deal with and also a better family support network. She had 1 DD still living at home, 2 other DDs married and living within 10 minutes drive, 1 DS married and living only 15 minutes away, all of whom were involved in caring physically and supporting the care. 2 other DSs were either extremely busy living about 40 minutes away (vocation) or living 250 miles away, but also both involved as much as they were able and supporting their siblings too. And as well as all that actual ability to care surrounding her, they had the wherewithal to fund private carers coming in at times, and to get other supports when needed (stairlift, wheelchair, hospital bed and hoist etc) to help them caring for her.

Both DGMs were living in the houses that they'd lived in all or most of their married lives, and were in their 90s at that stage. They had friends and neighbours still around. At that point, it would have confused both even more (and both had short term memory problems) if they had to leave their familiar surroundings. And in both cases, they wanted to be independent, and generally were until very close to the end. (DGM1 had been over to visit her DD2 on Christmas Day still pretty spry, but ended up in hospital for her 1st stay in mid-January and did spend a significant amount of time at home again in between the 2 stays, before going back in to hospital in early June and dying in July; meanwhile DGM2 had been admitted for roughly 4 weeks the previous autumn for an infection, got home and was up and about at home until Christmas, but was mostly bedbound from shortly after Christmas until the Monday a week after Easter when she died).

Both were considered bed blockers, even though both were in beds for longer stays and were in hospital for medical needs. In both cases, the family did what they could. But there was a big difference between a large family still physically close and able to assist (including a number who were already retired themselves so able to do more), and the smaller family more geographically spread and with less financial resources to support their DM.

DGM1 had had double bannisters fitted to the stairs years before, a downstairs bathroom built with a shower and a seat, upstairs bathroom had grab rails and seat in the bath etc, she had phones in every room, and had worked out systems for herself to keep herself warm, fed and comfortable in her own home (a couple of rooms were more or less shut up and not used while she kept a couple warm and uncluttered for her to move around easily in). Meals on wheels came in weekly, DM and DAunt kept her freezer filled with "granny sized" portions of individual meals and soups for her to just heat up, she had friends who called on her, a good taxi service on call for when she needed to go out, the local shop did some deliveries to older folk like her (community with a good few older people, and who had used that shop for years) etc. But there came a point at which she could no longer be independent and the family were just not able to step into that gap and cover the extra needs. There is huge pressure on nursing home and old folks home beds here, as we have quite a large elderly population, so there is a waiting time to get in.

Oh, and while I wasn't as involved with DGM who lived nearer to me (my side of the city) as her DCs already had it all sorted, DH and I did a lot for the other DGM on the other side of the city - DH looked after her garden for over a decade, cutting grass every 3 weeks, keeping paths clear so she could go out when she was still fit and able, making sure there was some colour in her flowerbed to see from the kitchen etc. And he also did a fair amount of DIY jobs over the years, fixing bolts, changing lightbulbs, fixing broken windows or whatever - he just took to having tools in the car when we went over.

I would also add to the freezer contents - I'd make batches of shepherd's pie and fish pie and the like for ourselves and put a few in individual containers, which we'd bring over when we were going anyway. We would always get in any shopping which she wanted. I would do any cleaning jobs that were needed, and keep an eye for things like trip hazards (there was one carpet that occasionally needed to be nailed back, for example) and for signs of her not being able to cope, so DM and DAunt could step up the support they gave or organized.

And DD and I would sit and have tea with her, and chat, and hear the same stories on every visit as her memory started to fail more, but with a smile on our faces as she enjoyed the time. She didn't need clothes washed or sorted as she kept on top of that herself very well, she didn't need personal care either, it was company that she wanted. But even we found it hard as we were at least 40 minutes away, DD was small, DH was working overseas and only had 1 weekend in 4 at home (1 weekend was fully away, and the other 2 weekends he was either arriving home at midday on Saturday or leaving at midday on Sunday as it was to the other side of the globe he travelled), and I was also working FT, going to DGM took a full half day by the time we got organized (packed up everything and did whatever shopping was needed), travelled over and back, and spent at least 2 hours with her.

Its not 'bed blocking'.
Its 'people who have nowhere else to go'.

On the other side, it was mostly the 3 DDs who did the personal care aspects, and the paid carer. DGM absolutely DID NOT WANT her DSs involved in that aspect.

The DS who lives nearby was the "greatest baker of scones" ever, and that was his "job". He did lots of other stuff for his DSis's, gave them lots of meals so they only had to heat them up rather than cooking, brought in shopping when he came over, and did a lot of cleaning when his DM wasn't looking etc. But he was working around her prejudices and the way she had raised them all (what was suitable for boys to do and what was suitable for girls to do).

A DSonIL was reknowned as a gardener, so he looked after the garden. In reality, his DW was a big part of that too, and the others all did a bit, but that was "X's job" in DGMs mind. The other DSonIL would come and play games like scrabble and cards with her, and sit in front of the fire chatting a lot of evenings. Both DSILs actually also did a lot to keep their own households running smoothly, and cook meals for their DWs and often for the other couple (they live very close so could "mind" each other when needed), particularly around the 2 who still were working FT. The DDIL also did a lot, although she also had to look after her own DM as well (another large family and enough DCs close enough physically to support each other). The DS who lived away visited frequently (he was still working FT) and the DS with a vocation was extremely busy but came to visit and sit as often as he could, and that was what was most helpful to the family at that time, sitting with his DM and also sitting with his DSibs when they needed to offload.

But there are many many families who are not able to pull together like this. Either there are not enough children/wider family members to share the load sufficiently, or the needs of the older person are too great for the family to support, or the wider family are too far spread to help out regularly, or they have too much going on in their own lives (work, their own DCs, money issues, etc) - or indeed, they may not have the relationship with their parents/the elderly person that makes them want to be involved. There is a need to ensure that there are enough supports available for those who need them, of all sorts - as I said, 1 DGM lived at home, alone, for almost 20 years since she was widowed, and the last 4 of those were as she slowly started to decline - but she had her supports around her and was able to stay pretty independent until the last 7 months of her life (in her late 90s).

OTOH, we went through a 5 week period when DFIL was ill, and I know "bed blocker" was thrown at DMIL 1 day - she'd had him home for almost a week during that time, and they arranged a hospital bed etc for him, but he really deteriorated very fast and while he spent a further 2 weeks in hospital after that, he was waiting for most of that on a hospice bed, and the family were totally unable to manage him medically at home, nor physically as he was a large man. That 10 days in the hospice was important. But there are some in the family who feel guilty about him being so long in hospital - they literally couldn't manage him at home, and he himself knew it and didn't want to be there, but there were no beds available in the hospice so he did have to stay in hospital. It is cases like his that makes me angry, when the family is given the guilt trip, but that there was literally nothing more they could have done (no caring services were available to come for long enough to give enough help, and it was literally 5 weeks from DX to death in his case so nothing could have been arranged in advance).

Re what they do elsewhere, in many parts of the world people simply have no choice. And in many countries where healthcare is poor or simply unaffordable, people will typically not live so long.

While working in Cambodia my dd witnessed an elderly woman whose large extended family was looking after her. They were poor and had no choice. She was incontinent, so they sat her outside, tied to a chair so she wasn't wandering or weeing all,over the place, and washed her down once or twice a day.

We have Indian friends living in Mumbai, who we see most summers. I was once telling the woman how often we are told by pious politicians or celebs how nasty and selfish we Brits are, to put our elderly in care homes, when in other countries people look after them themselves.

She said it was rubbish, at least in India. She herself had at the time a very elderly mother with dementia, who was looked after in her own home many miles away by two live-in carers. As she pointed out, such things are infinitely cheaper and easier to arrange there than here. She added that anyone who could afford it would almost certainly do the same. Anyone who couldn't afford it - I.e. the vast majority - would have no choice.

Skooba When you say We need an Esther Rantzen type person to start insisting that people write a living will when in their 50s/60s asserting no further treatment after reaching a certain degree of Dementia do you really mean insist?

I'm 64, thank you, and I don't want anyone, least of all a second-rate Esther Rantzen wannabe, telling me when to make a living will.

'I also would say that the old system of ‘family look after their own’ actually meant that a lot of people, 90% of them women, were expected to make huge sacrifices to be carers, and it became another reason to not have a career, and not be independent. It wasn’t an ideal solution at all.'

Spot on.

From all I've seen and heard over many years, there is far too much keeping alive of people who are both very elderly and have a very poor quality of life. People are stuffed with medication, in and out of hospital on drips, coaxed and badgered to eat and drink when they no longer want to do so,
^prescribed endless fortified drinks to keep them going because they can't or won't eat enough.
For what?? ^

Call me cynical, but as I said up thread, at the end of the day a privately run nursing home is a business. They exist to make money. Empty rooms don't make them any money.
It's in their interests to keep a person alive as long as possible.

I'm 64, thank you, and I don't want anyone, least of all a second-rate Esther Rantzen wannabe, telling me when to make a living will

True, Andrew, I didn't put it over properly. What I would like is a system in this country where people are obliged to plan their old age. So an advisor CAB/SS or whoever sits down with them and works out where the money will come from, what their priorities are eg stay in own home, be near family, supported accommodation etc. That would also mean that money earmarked at that stage for care cannot mysteriously disappear when frailty approaches which I'm sure happens now. I was thinking of an ERantzen type person to push gov to set this up.
This would also inform people of what the costs might be, and what might happen if they have no finances or support available when teh time comes. Ime at the moment the elderly resist any change so having had a few decades to mull it over and tweak it a better outcome might be possible than is the v expensive debacle that we have at present.
Many people develop Diabetes, Parkinsons etc in their 60s. It would be good if we at least acknowledged that these are a possibility and what would we do if it happened.

Whatsthepoint there's enormous pressure on care home places. Rooms don't stay empty long. Less than 24 hours in some cases. If you're really going down the cynical path you get more 'extra' money from a resident not at death's door, but I think personally you're way off beam.

OP I can see you've been listening to posters on this fairly lengthy thread, and fair play to you. If you do know anyone with substantial caring responsibilities, why not offer to give them a couple of hours' respite, not to allow them to do more caring but just maybe for some time to themselves? Caring full time is wearing and stressful beyond belief, however much you love someone.

I don’t think our society is set up to allow for that kind of thing in the way it used to.

Indeed not, though I think it's also important to point out that the sort of family care needed to stop someone 'bed blocking' is, contrary to the OPs initial post, a completely different kettle of fish to what's gone before. Our society has never been set up to allow for an increasingly small percentage of working/caring aged people to meet the care needs of an increasingly high percentage of elderly people with highly complex care needs. It's a double whammy: not only is our society not set up in the way it used to be that facilitated more in family/community care, but the care needs have spiralled at the same time.

My parents are both in their early 80s They are struggling to get up the stairs. They dont want a stairlift put in which i have suggested and tried to persuade them to do many times.

They wouldnt sell because my mum is always saying they worked too hard for that house. And it was our childhood home. Also culture comes into it a bit because my mum is Italian and in that culture usually family do the caring and yes i agree.....its usually women.

Heres the real kicker though MNers If they do stay in their own home it may mean DH and i could move out of our SOCIAL HOUSING flat later on freeing it up for someone else who needs it.

If they were to sell (which they wont because my mum worked damn hard for it and doesnt want to move) DH and i would definately be staying put very indefinately so im guessing that going by this thread i wouldnt be able to do right for doing wrong!

skooba The second edition sounds better

Helena the problem is that if they need to go into a care home they might be forced to sell in order to pay fees. I think I'm right in saying the Council won't force you to sell if one partner remains in the house, but if they both need care it may have to go regardless of an intention to pass it on to you.

Cave as long as they get the care they need would be the most important thing. If that was to be a care home then it would have to be.
My 21 year old niece also lives there.

There are so many interesting points to this thread. Without wanting to derail it, I would like to ask everyone with experience a question.

What would have made (or did make) things better, faster or easier for either the relative or carers in your situation and at what point would it have been needed.

My answer:

1. Our experience would have been greatly improved by proper advice before my DF was discharged from hospital. All that was made available to us were social workers who had nothing more creative to suggest than throwing Dad into the nearest available care home regardless off standards, but because he was self funded were unwilling to help us understand any of the procedures or explore availability

2. I would have paid for a service whereby someone on a consultant / advisor type basis stepped in and guided us with what we need to do and when. For example, helping us navigate the first traumatic weeks, what to prioritise at home, how to research options, when and how to press doctors and medical staff when you thought needs were not being met, carrying out research on care options and availability in our area, helping make decisions and transitions and set up the right support for continuing care

3. I DID benefit greatly from the fact that my DF left everything perfectly set up, accounts available and in order, paperwork clear and available, income and expenditure balanced, sufficient cash to pay for emergency care, clear intentions on what he wanted (to be at home with my DM). This was done years in advance and maintained every month the bills came in. Call it a living living will??

What would have made a difference to you?

Heres the elephant in the room............poor housing.

www.thisismoney.co.uk/money/mortgageshome/article-3890656/Five-year-old-HOSPITALISED-Circle-Housing-fails-make-home-warm-dry.html

Helena, sorry my post read as if I was accusing you of expecting an inheritance, that's not what I meant . I mean your folks might be adament they want to leave you the house but that they might not be able to if circumstances change.

Oh no CaveMum no worries It didnt come across that way at all