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?

You might want to reflect on how those shoulders got broad @Cuppasoupmonster. A half century of work and paying tax, paying a mortgage for 25 years, paying into an occupational pension. Surely there’s no point in doing that if you’re then expected to give it away again. As it is we sell our houses to pay our care home fees.

The majority of the women don’t have a full working life of tax paying - many took years out to stay at home and have children, many never returned to work. The men generally retired much earlier, plenty in their 50s, so will have worked many fewer years than working people today. If we were made redundant and couldn’t pay our mortgage we would be repossessed, they wouldn’t listen to our pleas about working hard and having small children etc so what’s the difference? Plus if you’re in a care home you don’t need a house anyway?

From another point of view my parents bought my childhood home for under £3000. They downsized twice as they got older and the last one is currently worth approximately £225,000. They only paid a mortgage on a tiny fraction of their property value and they have twice released enough capital to pay for a very comfortable lifestyle in retirement.

@Blossomtoes

How is paying for care giving it away?

My grandma ate only fortified drinks for two years. It was not a happy two years. Not being able to enjoy food is a great loss, as is not being able to see, hear properly, lift your head up, walk, read and so on. It's horrible. I hope by my time, if it's clear you are in the last six months or so, you can choose to drift away in a lovely sleep. Hospitals provide soft food as one of the menu options as well as fortified drinks, so it absolutely is part of elder/palliative care.

Hospitals provide soft food because with loads of medical conditions or surgery that is all people can eat. I have eaten soft food in hospital as has my child when having surgery. It is not unusual.

Fortified drinks are often given when people no longer have any appetite.

@Topgub You have been very critical on other threads towards women who dont work.
And your comments about the relatives of elderly people show what you think of them. You think of women who dont work as scroungers yet you then expect family carers to take all of that disdain you dish out and do it with a smile. You then expect women to step up and care for their relatives and if they dont they are selfish. Yet if they give up their job to do so and claim CA or other benefits then they are a scrounger. You want it both ways. Family carers have met and dealt with PLENTY of health workers like yourself. And when the person they are caring for dies what happens to the carer. Down to the Job Centre treated like shit and sanctioned. And you wonder why people wont do this. If you need a group of people that you can feel superior to so badly perhaps its time for a change of career.

Without going into too much detail, if a patient is medically fit to leave an acute hospital for care (at home, a care home, convalescent or step-down care, wherever) then the receiving organisation should pay for continuing care in the hospital if they don't set up the next stage in a reasonable time. There is too much incentive for delay at the moment as it is not costing them anything.

It would also work for admissions from ambulances - the hospital should be charged by the ambulance trust for "hire" of the ambulance if they don't accept the patient and free the ambulance within an hour.

Plus if you’re in a care home you don’t need a house anyway?

I completely agree and have no issue with that. The rest of that post is complete garbage.

It’s not.

Vaccine mandates anyone? Some care workers quit because of this. Yet its never mentioned.

@Blossomtoes

So what was the relevance of you comment about giving money away?

After spending far too much time in hospitals with elderly relatives and children in the past few years I honestly believe that a massive shake up of the NHS is required - the whole system needs streamlining and modernising. Throwing money at it will do no good at all. As for the "bed blockers", I agree that NHS care homes are the answer. Non profit facilities that free up hospitals when short periods of rehab/care/physio are required who could also offer placement training in the NHS (the usual reason given that Dr's & healthcare workers of all levels cannot undertake their training). Care should also be a recognised career path with proper training given, it should absolutely never be a job that anyone at all can do. If this facility was available then maybe we could cut down the number of in-home carers roles that are out there. People could be properly paid and those requiring care would have a standard to measure against. My MIL had carers in after a fall some years ago, 2 ladies attended 3 times a day for 10 minutes at a time to make sure she was up, had got some food at lunchtime and was in bed. At no point did they help her with anything, they simply stood in the house and "checked". I forget the sums involved but it was a ridiculous amount of money that was paid to a private company from her attendance allowance. In the end, we employed a companion for her to call in, run errands and take her to appointments as required which worked out a lot better. My bedridden neighbour also had carers before she passed away. They came in 4 times a day to change her pad, first call was anytime between 8am and 10am, twice during the day and then between 5pm and 8pm which meant she could be on the same bed pad from 5pm until 10 the next morning, again a privately paid for arrangement. This is just not acceptable. So much money is being spent in the wrong places, something has to change.

Yes and it's done to prolong life when you have incurable disease. I have no wish to have my life prolonged if I get dementia so I wrote it in my advanced directive. Many people with advanced dementia or illnesses get dysphagia and will die from pneumonia from inhaling food. Many patients don't like purees so end up losing more weight. I had a patient crying for a Chinese takeaway. We weren't allowed even though this person doesn't have long to go. I don't want that for myself when my time comes.

Bringing the "social care" component back into the NHS's remit so it becomes true "cradle to grave" care

Ain’t that the truth! Topgub loathes women who don’t work for whatever reason, but suddenly expects an army of unpaid family carers to be available…

It's not always possible to look after your relatives though is it. How can someone who works full time, has young children and a mortgage to pay take on full time caring responsibilities for an elderly relative?

And for many it isn't an elderly relative. For many it's multiple elderly relatives. Until a few months ago we had 4, youngest 84, with issues including severe disability following a stroke, mid 90s with heart failure and mobility issues, multiple issues including stage 4 cancer and alzheimer's. Try juggling that with earning a living.

I’m sad to say I know people who are caring for two generations of elderly - their own spouses with age-related diseases and very old parents. Who don’t function in brain or body and need constant watching.

As experts tactfully say, the very old are ‘resource intensive’.

There aren’t enough adults in this family to look after the elderly, let alone the grandchildren. Four 90-somethings and one middle-aged cancer sufferer depend on one woman with two kids, three jobs and a rabbit. Her older sis has already died aged 72.

The fam’s had to pull in its teenagers to do shifts. Which is not on, cos the work’s frightening and depressing enough without scaring the kids.

Family isn’t the answer - the elderly and sick can demand two decades of care or more. Even then, cultures where it used to be common had loads of children to share the load.

Having had first hand experience of dementia i would invite all middle aged people into nursing homes ( perhaps a Shadow shift) and then get them to sign a legal form, " if I get dementia, do I want this existence for myself?
Or would I rather be gently put to enteral sleep ( with all necessary medical checks)
.
I can see absolutely no point in keeping elderly, frail and unbelievably vulnerable people alive who cannot remember themselves or their loved ones.

So that's one recommendation.

For my own Df, he did have lot's of home services that came to him , he didn't have dementia but was physically unwell.

His biggest issue was an unsuitable bathroom ie no where to wash properly and no one to clean his flat.

However he had regular, almost daily nurse visits until the end.
He also had excellent home care when he had a nasty fall visiting me.

So services do exist in some places but obviously not all.

Reopen cottage hospitals to care for elderly so they arent in acute settings

Make gps actually do some work. I called at 8am o the dot, my phone appointment happened at 5pm. Was told to buy items on amazon as my "treatment". I have temp spikes over 40.5° with full rigor having to depend on children to care for me or i go hosp where ill likely sit in a corridor with no one to help me.

Hosps are over run because other primary care services aren't fit for purpose or have closed

But is being euthanised “ gentle eternal sleep “ or any other such euphemism. Surely the process must be similar to lethal injection? They still can’t get that right and some live to tell the awful tale. So whilst the administration of the drugs may be gentler is it really this magical fading away it’s made out to be?

?

Unfortunately end of life care is barbaric and abysmal, I'd rather be able to chose and take my chances!

The only choice you have right now is a advanced directive and decline life sustaining treatment. Like CPR ventilation, artificial hydration and nutrition. Declining to be put on puree food, build up drinks , antibiotics and ask for pain relief. The only choice we have is basically either starving to death or succumbing to infection. Would you let that happen to one of your pets? There's no choice on death for humans. Death isn't pretty or a short lived process for a lot of people it can be very long..