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?

This was one of the reasons why I left nursing. I couldn't stand prolonging people's suffering. It was akin to torture. I have nightmares myself about ending up being dependent on others. I have an advance directive. No amount of social care will protect you from over zealous doctors and misguided relatives.

Allow housing value to be used towards care - reverse annuities or other instruments can be used so nobody has to leave their homes. It makes no sense that older people who have seen their house value skyrocket through no actions of their own (and who have, like most older people, likely received more state benefit than they ever paid in), get care subsidised by working people on middle and low incomes, many of whom are renting themselves. Including house value would allow far better funding for the sector, and more equality.

Have better discussions about end of life care. No medical professional I know would want to be resuscitated multiple times at end of life, or kept alive in a miserable state in care, yet because of a lack of information or discussion in advance, we are condemning many of our elderly to spend their last months in pain and confusion, and also with high care needs.

Theresa May tried that @OverTheRubicon. It was called the dementia tax and lost the Tories their majority in 2017 despite abandoning it.

Only one of my relatives had his life prolonged miserably. He was religious and believed it was a sin to commit suicide. So he refused anything that he saw as that.

One of the biggest causes of bed blocking is housing needs, exh was stuck in hospital for 10 months because he needed a level access property due to becoming a full time wheelchair user. If he had already been in a suitable property he would have been home in 3 months but it took the council 3 months to accept he needed priority for a bungalow & another 3 months to get him one that the OT said would accommodate his wheelchair & hoist. My friend was in hospital over a year after losing a leg until a suitable property was found for her.

We need to incentivise domicialluary care, and protect people's roles like maternity.
It's the cheapest way of providing good kind care while providing space for people to have those end of life conversations.
In Ireland, domicialliary care is about 400 euro a month, plus carers benefit and leave. Meaning sometimes family can take time out while paying their bills

I work in the NHS and I genuinely feel local councils and councillors are ignoring the fact they are causing harm, causing people to die actually as they can't get in the front door of AE / can't get in a hospital as 30% of beds are blocked as they don't buy enough social care.

They could raise council tax for highest earners in big houses / second home owners, to fix this, but they won't and it is shameful

So what if we have a building with all the people who lack capacity and have no powers in place, place all the people in there with say 1 nurse and 5 carers to 30 patients. This would free up the acute hospital bed. They wait there while the legal powers are sought then move on....but like discharge to assess but for people who lack capacity.

I am aware. Not surprising she lost, because people who've had windfall gains from property tend to want to keep them - and so do their children who want to inherit. Wealthier older people are also more likely to vote (and to vote Tory).

They said it was unjust, and clearly it isn't ideal, but it's far more unjust the way it is - people are dying younger due to lack of NHS capacity, children with additional needs are ending up with worse outcomes for their entire life because they have to wait for 18 months for assessments, or can't get proper support at school, their parents have quit work for life as there's no money left for their children's care, and working people with no prospect of inheritance nor of ever being able to afford a home themselves... And all paying to allow Kathy down the road to keep her £600k house intact and then pass the value onto her kids.

Interesting point - have also heard a pharmacist talk about the need for frequent review of medications. Apart from anything else, makes it easier and less confusing for the person taking them!

Yes this seems a good idea. Build the equivalent of the Nightingale hospital with partitions for private bedrooms.
However........ people with dementia etc fall a lot, shout a lot, need help to eat, would take ages just to give a bath or shower to (maybe 1-2 hours). So if you think about it sticking everyone in one building with few carers won't work.

You could arrange accommodation like this for those without dementia. But I suspect they are the minority.

@Thegentleman So true we only pay......
Income tax
National insurance
Council tax
VAT
Energy bill green and social fund
Stamp duty
Insurance premium tax
Inheritance tax
Fuel duty
Alcohol duty
Tobacco duty
Flight tax
Sugar tax
Savings tax
Etc etc
Then all the taxes that buisnesses pay and buisnesses rates etc that all ultimately is paid for by the public consumer in the way of increased prices to cover these taxes.
A lot of working people will be lucky to keep 50% of their income after this lot, so thats over 50% tax easily !

This is an excellent post.
I am going to steal it for future use.
I hope you don't mind ? 🙂

I don't know anything about end of life care, but it strikes me that there is a terrible parallel with the failure of maternity services across country. Decisions are being made on the basis that families are too inexpert and too sunk in exhaustion and grief to be able to fight systems and accountability that is just MIA.

They get away with it because once the suffering has been gone through, it is a fact that nothing can change. And so the funding and political decisions that sustain the wrong are perpetuated over and over again.

Family cannot step up
No such thing. My 80yo mother broke her hip and couldn’t walk but the hospital said she was capable of looking after herself (she wasn’t) and discharged her. I had to take two weeks holidays from work at short notice and stay at home to look after her, then my husband had to use two weeks of his holiday as well. After a month she went home, really she was borderline in terms of self care but we couldn’t get any more time off work.

I enquired about paid care but was told she could only claim if her disability lasted longer than 3 months. So if it was less than 3 months she either had to pay for care (on a state pension living in a council flat, no chance - and how on earth are we supposed to organise that level of care with a couple of days notice - and who would take a care job that only lasted a few weeks!). Or a family member had to look after her (what if she had none?) They said for short term disabilities less than 3 months they expect the family to juggle the responsibility between themselves and use up their holidays etc.

If I could have left her in hospital I would have done, because it was a massive problem for me to stay off work at short notice - I didn’t get paid and it put my job at risk. But apparently this is what they expect. There’s no such thing as “can’t step up” - you have to, otherwise your family member just gets dumped at home unable to look after themselves.

So I guess the bed blockers are those who will need long term care. Because those who need short term care are just getting kicked out.

Now, I'm probably going to get flamed for this, but here goes -

I was looking at death stats for Covid and in Oct in UK they were running at 615 - 735 per week
(The total number of deaths from Covid is 209,000 to date.)

Now given that, sadly, most of the deceased have had serious health issues and comorbidities associated with age, this should lead to a reduction in those needing long-term care.

Yet, apparently Delayed Discharges are still a problem.

Can anyone throw some light on this?

That's what the cottage hospitals used up be for before they were closed down or repurposed - a place to help rehabilitate while patients transitioned to going home, and with more physio than the quick sessions they get on a ward. Both my parents at various times have been in a regular hospital waiting to go home as medically but not physically fit.

@ShelaghsCottage

There are lots more elderly people and people requiring care and support than those figures?

I do think we're almost at the crisis stage where people will have to be discharged (or not admitted in the first place) when they are medically fit, regardless of care needs or social circumstances

People don't want to change and they certainly don't want to have to pay.

So I can't see any other options. Especially with the tories in charge who are about to cut, not increase spending

Snap , except they just ignored me and sent them home , now I don't know where to turn or what to do

None of us know when we will have care needs but once we are over 70, if we take our time to downsize it saves a lot of issues later
My 71 year old husband would laugh at the idea of downsizing when he's finally got the time to actively enjoy the house and improve it!
When my Dad became Ill we made a micro environment for him within his own house until we were finally able to persuade him to move in with us. But he was in his 80s and with a lot of health problems.

We need to provide more support and social care. When I trained (many many moons ago) there were day care centres where the elderly could go and provide not only very important social support and activities but also care some were showered and or bathed and as importantly respite for family and friends. These type of places also important as people were informally and formally monitored "Mrs Smith seems a bit muddled today lets speak to her GP" or Mr Browns mobility os deteriorating lets get the physio to have a look at him" all for free provided by the NHS or local council. But when we tried to find something for my MIL there was absolutely nothing even if though we were happy to pay for it there was nothing.
I personally cant see the difference between a convalescent home and a care home (not a nursing home) the former just sounds posher! There are also some "interim care" homes around often run by charities and overseen by GPs which are basically convalescent homes offering the final step before discharge to home but as everything has been cut to the bone by this government the one near me has recently shut. And as always none of these places can get staff.
It is all about funding, pay staff a decent wage, who wants to flog themselves in a care home for the minimum wage work shocking hours including nights weekends Xmas often with no enhancements when you can earn more in Aldi? Lack of staff quite simply means a lack of beds in an interim care homes/residential homes/nursing homes or staff in a community care setting. Bed issues are partly caused by the low level at which social services pay for care, they set the amount they will pay a week to a residential/nursing home. They also decided how many minutes of community care they are prepared to pay a day. This means in England (where community care has been privatised) carers usually don't get paid for driving between houses so you might work a 15 hour day but only get paid for a 10 hour day because no one pays you when you're not actually visiting someone.
When my dad was in a nursing home and after 6 years ran out of money at £1200 a week SS stepped in but would only pay £500 a week, somewhat reluctantly the home agreed that he could stay there but that was only because he was a "long term resident" the nearest home that would accept him was 20 miles away and had a waiting list 4 months long. Care homes which accept a high number of residents being funded by SS will by there very nature have less staff (I know because Ive worked in these places) and pay the minimum wage and inevitably have a high turn over of staff/lots of vacancies many who are often poorly trained and demoralised. Obviously a shortage of staff in these type of homes effects the umber of beds available.
We have an ever increasing ageing population, according to the Kings Fund we are living longer but not healthier lives. We need to do so many things, health promotion obviously look at obesity, poor diets alcohol and smoking lack of exercise particular for those who are currently relatively healthy in their 60s and 70's, we need to provide more support both emotional and financial to those living alone, to families friends neighbours who are carers and we need to pay staff caring for people on the community/care/nursing a decent wage treat them with respect give them training and a career structure make it a desirable pace to work because you genuinely are making a difference to peoples lives.This all takes money we as a society have to decide how we are going to fund this. Do we pay more taxes? More inheritance tax? Take a charge against someones home to pay for community care? Making people use here assets to pay for home care? Forcing people to sell their homes to pay for any care is unpopular but maybe we have to accept that this is the only solution. But so many rent now, if those renting are hoping one day to inherit and buy a home of there don't because their parents are using up all their money to pay for care then thats another time bomb we are sitting on.
As Ghandi said: 'the true measure of any society can be found in how it treats its most vulnerable members'.
The elderly are at the least entitled to a high standard of compassionate care, it's so easy to forget that we will all be elderly one day, the financial burden on our society of providing compassionate care is huge but this is surely what we will want when we too are elderly and vulnerable.

This is what they did to me too. Mum was unable to walk after her surgery and told them so, but they discharged her anyway, saying she was medically fit and had no dementia or anything that prevented her living independently, and anything else wasn’t their problem. So we juggled her between us while using our holidays from work, until she had recovered enough to go back to her own home. She could have done with six weeks in a short-stay convalescent home where she didn’t get medical attention but just help with meals and toilet and washing. But these don’t exist apparently?

Dystopian is keeping people alive and in pain and distress long after their bodies and minds are failing.

No medical professional I know who works with people in end of life care or dementia care would want their life to be prolonged, most have advance care directives making this clear.

However families' very understandable desire and concern about holding onto their loved ones (and fear of uninformed judgements like the ones you're discussing) stop the right discussions from happening.

People don't want to pay. That's it really. Apparently you can't get carers even at home but if you offered 40,000 a year for a 40 hour week you would get someone. They could come and make breakfast each day then split the other hours over the week, family stepping in for one or two days per week.
Perhaps draw down on the 1 Million pound house to fund it.
But, like childcare, no one wants to pay.

Also care in the elderly person's home probably results in a shorter but happier life.
Once in a Care Home the residents are 'kept safe" ie they don't go anywhere much or do anything much - should a patient have a fall then the Care Home is lambasted. This needs to stop. I don't really see why no one could visit during lockdown. Some might have contracted Covid and died and some might not like the rest of the population. My relative in a care home got Covid and was fine.