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?

Also when your parents die, you inevitably end up with some of that stuff. It is hard to get rid of sentimental stuff when someone dies. You have lost your parents, the family home, some possessions is all you have left.

I still have stuff from when my Mum died 5 years ago. I know I need to get rid but I can't quite bring myself to do it. The stupid thing is it's in the garage so I don't even see it (in case anyone thinks I'm a hoarder sitting here surrounded by DM's belongings!).

@PinkSparklyPussyCat It is hard. It is unlike other possessions. Other things if you get rid of the, you can always buy them again if you change your mind. But your parents belongings once got rid of are gone for ever.

Well they cant have it both ways.

www.theguardian.com/society/2022/nov/06/rise-in-uk-state-pension-age-could-stop-women-caring-for-older-relatives

Not to mention the changes to Pension Credit for age gap couples.

You're going to be shocked when you learn about QALYs. Because there is already some of this.

It makes sense. If I am suffering from late stage renal failure, a hip replacement will not greatly prolong my life nor improve quality, and the risk is pretty high. Poor outcome for me, terrible return on investment for the NHS. Doing the same operation for an otherwise fairly healthy 20-something whose hip joint was affected by cancer, huge potential beneficial impact.

Antibiotics for infections in patients with severe dementia with clear suffering involved, or resuscitation after minutes without oxygen - most people who have worked in medicine or aged care would want treatment refused for them, in these situations. But instead as relatives we beg people to do everything for our mum, or doctors (rightly) follow pathways to prescribe things that only prolong pain for the person, and then radiate out to others.

Lots of relatives do not beg for life to be prolonged when their relative is suffering.
The problem is that sometimes relatives want treatment not to prolong life, but to ease suffering. My father-in-law wanted to die but chose to take antibiotics for chest infections as struggling to breathe distressed him. Ease suffering like this and people will happily reject treatment.

This. When DM was dying I was asked whether I wanted her to have treatment that would prolong her life. I said no, as it would have meant her wearing a mask (I can't remember the name) and wouldn't have given her any quality of life. All I asked was that she was comfortable and, as far as I could see, the hospital did everything they could to keep her comfortable.

Although I know it was the right thing to do it was the hardest decision I've ever had to make and I felt as though everyone would think I didn't care about my Mum.

@PinkSparklyPussyCat What you did was an act of love.

My mum refused treatment after a car accident that may have prolonged her life but would have left her in a pretty terrible state. But the hospital gave drugs to treat the symptoms so that her death was fairly peaceful.
In too many places that does not happen.

I have heard a fair amount of discretionary not-care does go on in hospitals re. the very elderly. I have heard nurses talking about walking past side wards a time or two, when a patient has arrested, giving themselves the time not to call the crash team.

My best friend found her early 90s father collapsed in his rose garden about 4 years ago. She dialed 999 and he was saved for another 2 years. He went from proud and independent gardener to half blind, incontinent, muddled and utterly miserable depressive in one afternoon. Somewhere along the way they discovered bladder cancer and operated. He never had another happy day, and eventually died of covid. My friend regrets so much dialling 999 that afternoon.

We would both like to know how we could ensure that no one revived us in similar circumstances.

If pensioners were more willing to part with some of their cash, the social care crisis would be sorted. Just read the stately homes thread if you don’t believe me - rammed full of exasperated adult children whose elderly parents sit on tons of money and would rather end up in A&E every month than part with it to pay for proper care or to live in a suitable facility.

Independent retirement living with support is the ideal option IMO. Some developments are brilliant, and the rent is affordable when built by local authorities or housing associations. Moving into that type of accommodation has been proved to delay the need for full on, residential care. It reduces bed blocking in hospital, it also gives families reassurance that their relative isn’t isolated.

Unfortunately there are too few of these developments given the big increase in older people.

I do agree with this, whether it's private pension cash or attendance allowance, frequently see older people not wanting to fund private care or meals services that could keep them well and out of hospital.

They feel entitled. There’s a strange mindset among British elderly that once you get to a certain point in life you shouldn’t have to pay for anything - that you’ve ‘done your bit’ and your NI payments should see you through 30 years of state pension and probably 5-10 years of pretty intensive medical and care input.

Needless to add many pensioners retired in their mid 50s so will be retired longer than they even worked for! How they thing the money stretches that far is beyond me.

They often want to pass on as much as possible to the next generation.

My MIL, who died well into her 90s, expecting limitless care from family, ofter quoted how she had cared for her own mother. Not understanding that caring for a few months for someone who died at 70 (and left her a house) was in no way comparible to the decade of care she required before finally dementia took her to a nursing home for her last 2 years.

My FIL wasn’t given a choice in it. After a hospital stay for a urinary tract infection he was discharged into a care home, with the first few weeks free and then he had to pay. He told them he couldn’t stand being in there so was let back home, but only on condition he had carers visit four times a day, which he has to pay for. He’s the tightest person I know and as far as I know, not that well off, so if he was forced to pay for care, I wonder how there are all these other people who need it but aren’t forced into it.

My mother is now a "bed blocker" she's 88, has lived with my family for the last 5 years. She has paid for private carers for the last 8 years, gradually increasing the amount she needs. Her dementia has now got so bad and her mobility so poor she has had 6 falls in 1 month. She is now on her 2nd hospital stay and has been assessed as unsafe on a QDS package of care at home and she needs a care home. She has recently become aggressive and her mobility is almost to the point that she cannot weight bear. Her pensions and a lot of savings have paid for her care. Costing at the top end £2500 a month for care at home. She cannot now afford a private nursing home which would be more like £6-8 K a month ( we are in London) so she is now a bed blocker waiting for placement. Yes she will contribute whatever she has to the cost, as did my father, as did my aunt.

In a nutshell not all elderly people sit on their cash and don't use their income/ assets to pay for care. Not one member of my family has done. I am also and A&E sister, 23 years of nursing experience and as much as some people may be sitting on their cash refusing the part with it, I have only actually seen this in the very wealthy believe it or not. The vast majority of the elderly are not avoiding paying for care so bed blocking. This really is not the main problem or cause. Many elderly live in poverty, many elderly do not own their own homes, many live only on a state pension. We have been facing a crisis of an aging population for decades, the government knew it was coming and we made no preparation for that. There is a lot that could have been done to prevent this and it simply was just ignored.

@Orangebadger So sorry to hear about your dear Mum. Very sad for her and for you.

I absolutely agree with every word of your second paragraph - instead of people wrongly blaming elderly 'bedblockers' (horrible word) they should hold the government to account who have inadequately planned for the elderly population. The Tories love divide and rule, setting us against each other. In a civilised society our taxes should ensure adequate services for all generations.

many elderly do not own their own homes,

75% of pensioners are mortgage free. They are the wealthiest demographic in the country. The number of elderly ‘in poverty’ is tiny compared to working age people and children.

Can I ask why you dislike the elderly so much @Cuppasoupmonster?

It's not as simple as being mortgage free. What happens when someone else is living in the home? DH is 20 years older than me, if he needs care what do you think I should do? DM did an equity release on her home so she could stay there when DF died so although she was mortgage free she only owned 50% of the equity which would have paid for a care home for around 2.5 years. What happens then?

You many think everything is black and white but it's not.

rammed full of exasperated adult children whose elderly parents sit on tons of money and would rather end up in A&E every month than part with it to pay for proper care or to live in a suitable facility

I can only speak on behalf of my mum who
a) had seen my father die (literally) in our local hospital as a result of a nursing error. She was terrified of meeting the same fate. There comes a point where old people attend funerals on a regular basis and see fewer and fewer people who go into hospital actually leaving. Being in a home or hospital is synonymous with loss of autonomy (even if that isn’t the case) which is difficult to manage, particularly when you are still mentally well.

b) had an only child, single parent daughter (me) she was desperate to help out as much as she could financially and consequently resisted going into a home long past the time when it would have helped her ( no pressure on my part, she helped me out when Imdivorced and I benefitted enormously from her money then. As far as I was concerned, I had had an inheritance that had already proved life changing). It was only when she became unable to live independently and power of attorney kicked in that I was able to override that.

How do you suggest we manage the autonomy of an older, physically frail person who is mentally healthy?

When were you last in a care home? Would you honestly be happy your loved one was left their full time? I saw over 30 when I put my mum in one. The ones I would have wanted were all full. It was a dreadful decision to have to make.

I don’t dislike the elderly as individuals at all. I was very close with all my grandparents, and still am with the one who is still alive. Who is a wonderful forward-thinking woman with socialist principles and shares my views on this matter. She’s very well known in her village and has spent her life befriending and caring for elderly people through her church, but over time became exasperated with the enormous amount of wealth a lot of them sat on while running others (and the NHS) ragged for free.

Like ‘men’, when we discuss them as a group, it isn’t personal. But we cannot deny that the elderly are the wealthiest demographic in this country while simultaneously the biggest user of the NHS. The latter is to be expected due to age of course, but a lot of the resources are used on falls and accidents that could be prevented if they weren’t so resistant to spending their money and living in a suitable facility. This is then crippling the health service with tragic results for younger people, and isn’t fair. They’ve arguably (as a group) drained the resources out of the country and have handed it to us in a terrible mess.

What happened to your mum after the equity release? That seems fairly risky? In terms of losing a lot of cash for the purpose of staying put an extra few years.

While I’m at it, I also believe in charging people who turn up at A&E due to overconsumption of alcohol or drugs. I believe the only way out of the NHS crisis is a personal responsibility drive as well as extra funding and a push to encourage the elderly to understand the effects of their actions on society and plan properly for retirement.