What’s the answer to ‘bed blocking’?

[Cuppasoupmonster]

Another day, another article about ‘bed blockers’ (put in speech marks because I know it’s a bit of a goady term).

I was shocked to find out a third of beds are taken up by ‘social patients’ in some trusts, who are medically fine to be discharged but can’t be because the care they need afterwards isn’t in place. I feel irate that the whole point of lockdowns to ‘stop the NHS from being overwhelmed’ needn’t have happened if it wasn’t overwhelmed in this way to start with.

Whats the answer? Early intervention so they don’t end up in hospital in the first place? A rise in taxes to pay for more services? I’m not sure the working population can afford to pay more tax.

The ‘ageing population’ issue means this can surely only get worse?

It is nothing to do with death and decline being taboo, it is fucking dystopian that people would rather kill their relatives early than fix social care. Something completely weird going on.

Funnily enough I don't want to off myself early. Would rather have functioning social care and health care.

Functioning social care won’t prevent episodes of terror and panic if you have dementia

Firstly my last post had some terrible autoincorrect 😱

But no, people can be moved without capacity to D2A beds and home with care or to placements under capacity assessments and best interest decisions . And then DOLs application auth requests, They cannot be however if they object and lack capacity. As that's an application to Court of protection (COP) if not returning home. If they have no appointed LPA health and welfare to decide in their behalf. . Social care has no control over COPtimescales and judges who can seem removed from IRL pressures, costs, and it is incredibly slow and frustrating- although I didn't say that,....

Deputyship is financial only . So if some one is moving to a placement without capacity to manage their money LAs can do short term funding arrangements until eithegcfluebt affaurscteam or deputy applicant decides that.. It's all very technical but I think you meant the earlier situ.

No it's not killing people off , we don't allow euthanasia in this country. It's illegal , you can refuse Antibiotics , artificial feeding, build up drinks and request pain relief. Many people don't have them or it's too late , they have already lost capacity so at the mercy of relatives or HCP decisions. I have the right to decide I don't want to kept alive , bed bound and incontinent with low quality of life.

I am not killing myself if I need someone to pop in daily to help me dress and wash. Bloody disgusting to suggest that as a solution.

I didn't say it would. But the ida you can solve all the issues by just offing people is a bit grim.

I've worked in Health and social care for years , many people cry begging , in constant distress. Doctors too scared to prescribe more pain relief, sedation in case theres an adverse reaction or event. I've argued on behalf of many patients one was just given paracetamol up until 3 weeks before they died, they were groaning and crying constantly.

Yip very slow process but what if we house them in non acute hospital places while they wait for said legal documentation??surely that would free up some acute beds.

Then pain relief guidance needs to be sorted out.

But it would be nice to discuss social care without people suggesting we need more voluntary euthanasia.

I am glad my parents did not die in your hospital. They had excellent pain relief and sedation. No groaning at all. Instead a morphine driver fitted and good constant pain relief.

Nobody is suggesting it it's not offing yourself , it's refusing treatment that will prolong your life. I absolutely do not want to have dysphagia be put on a pureed disgusting diet , have thickened fluids get constant chest infections and given antibiotics as I keep inhaling food and drink. I do not want be offered build up drinks as I keep losing weight from not being able to bloody eat and drink properly. Dying is not pretty for a lot of people.

People on end of life care at home often do not get enough pain relief because of a lack of qualified staff to administer it often enough.

eithegcfluebt affaurscteam or deputy applicant decides that

Client affairs team or deputy applicant in family gain deputyship via COP for their finances and then manage their money but placement can go ahead before then.

(If the client without capacity is not "objecting")

That's a safeguarding of alleged neglect reportable to CQC and local social care, if so as that really should not and doesn't nor usually happen

Anyone who is on palliative care End of life usually are l referred to local palliative teams and would be under their GP actively who is responsible for ensuring good end of life care and Pain management .

GP also decides when they meet fast track rapidly deteriorating imminent EOL CHC criteria

I can't comment in NHS provision but that's what is process

This was in a private hospital for complex needs but no I was not happy with the medications offered. There's reluctance because of prescribing issues with the elderly and polypharmacy. Very risk adverse , I do understand in case problems but if a person is in terminal decline isn't it better if they had adequate medications earlier on ?

It does happen. You ring and no one can come for 3 hours or more. And from speaking to others it is fairly common.

@Mrsmch123
I confused what you mean

I have spoken to length in this thread (if you RTFT) about discharge to assess beds and provision when someone doesn't have legal financial deputies that is not insurmountable

And when on occasion if they don't have LPAs health and welfare that best interests decisions under MCA 2005?principles are made. Except when a client themselves are defined as objecting to any move. As that has to go to court of protection.

No legal powers to move anyone then - talk to the COP judge if you can get an appointment & court date earlier .... it's rare but it is one of the few (& rare) reasons for long delayed hospital discharges which is entirely led by court and court delays. I say that with no comment.

@antelopevalley
As I said it's a safeguarding if not quickly resolved - if in a care home it's easily reportable and resolved as the care staff will be into it via GP or OOHs GP.

When at home it's all primary health care (nhs) led, and as it is report to GP practice manager if no quick GP response, or call out of hours for OOHs Gp to visit / teleconsult and prescribe if over weekend, No one should be left in pain in EOL care and usually GPs refer to palliative services when they have someone going EOL , organise anticipatory pain meds, and palliative care teams have very quickly reactions and service.

I'm so sorry to hear if this has happened to one if you'd loved ones.

@Worriedddd
Yes you would hope so
I am not their individual prescribing clinician
I'm reading your post as something that happened in the past, rather than now as I'd say get on the phone and speak to consultant if now!

@Worriedddd
No one on MN can really comment on medical care your loved one had though, as not seeing their charts - there are processes for after event, to ask for it to be reviewed. And processes at the time to ask quickly why and what decisions are being made if you have permission to be discussed with

I work in this department.

The answer is to put more money in to social care support. We need more social workers so the ones we do have aren't snowed under and taking a day and an age to submit new contracts for care for the patients to allow care companies to start providing care.

Care companies have NO staff because they are paid terribly. They need to be paid a better wage to try attract more people to the job because currently the companies are restricted to how many new patients they can take on.

They need to better fund the social care support finance departments so they have enough staff to process the new clients care packages. Instead the roles and funding is being cut so it will get worse and it will take even longer to process new clients packages and funding.

Even getting a hospital bed delivered takes time. It is all very slow.

It’s far from dystopian not to want to live with dementia. I’m not going there. Fuck that for a game of soldiers. No amount of the most luxurious social care would compensate.

@Blossomtoes utterly agree. My Granny had dementia. In a fantastic care home, but any slight chest infection/uti she would be given antibiotics. I guarantee it’s not why she would have wanted.

If I am diagnosed with dementia I don’t want any active treatment. Let me get pneumonia “the elderly persons friend”.