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?

I thought the elderly in care homes were dying off in droves during Covid 2020? If that was actually the case, why aren’t there plentiful care home places?

Borgqueen the ageing of the large boomer cohort means there are more and more of them every year.

I feel the solution is for better funding of social care - more staff and better paid- it's a shame that those people we trust to look after the most vulnerable members of society are paid minimum wage and treated so badly. I'm not saying that they need to be paid as much as (for example) a qualified nurse, but better pay and working conditions(such as allowing reasonable paid travel time between calls) would likely result in better retention of staff.

On a harsher level, when a pt is medically optimised for discharge, they should be discharged to the first available place that meets their needs and their financial contribution, and family can start looking for another care placement at that point if they would prefer. I remember as a junior dr one man being in hsopital for almost 2 years after his stroke, because the family blocked every attempt to discharge him to a care home - they insisted that they must all be in agreement, and every time a care home place came up they were uncontactable/abroad/ felt it wasn't suitable for a variety of reasons.

The oldest boomers are 77. I doubt many of them are troubling Care homes yet. The real crisis will start hitting in about ten years time. Future governments would be very wise to start preparing now.

We need a wealth tax. That’s the only thing I can think of that will raise the capital to do anything more than sticking-plaster solutions.

The well off, paying huge care home fees, already subsidise those with no assets in the same homes, plus they will pay 40% tax on a big chunk of the money they take out of their pensions/investments to fund the care.
We need ‘ future Care needs’ insurance alongside life insurance. I find it insane that it isn’t a ‘thing’. It should be tax deductible, like pension contributions.

@BorgQueen if you drop dead of a heart attack at 68 do you get a refund? I agree in principle but that’s the only scenario I can think of where it wouldn’t work, apart from those fortunate enough to stay unusually healthy and compos mentis until they die of old age or something.

Cottage and community hospitals would 100% help. We are lucky we still have 1 of these style hospitals locally, but 3 others have shut down, 5 if include the next trust, where their a+e also closed and we now cover that area too. The problem is though, we dont have nurses to cover the wards and bed we do currently have, theres no one to staff these cottage hospitals anymore

Harold shipman

Harold Shipman would have been nominated for canonisation by my late DMIL if he had terminated her misery.

I think everyone in the country should have it, we could pay premiums during our entire working lives and claim against it in time of need.
Who knows, perhaps we could call it National Insurance.

That's an amazing idea @blameless! Wonder if it could take off?!

for Cottage hospitals would it not be a mix of a few registered nurses and band 2-4 HEalthcare assistants that were required? So perhaps easier to staff than first thought. We could also make truly multi-disciplinary teams with physio, OT, SLT & and others, many of whom could be redirected from current acute and community posts. Cottage hospitals would make a masssive difference for people who don’t need to be in an acute ward, but need further care and rehabilitation to return home

The modestly well-off already do pay, if they need care. After six months in a care home during COVID, DMIL's cash savings had gone so her POA sold her house to fund the rest of of her life. It absolutely was not living the dream, but she was warm and clean and comfortable and well fed in pleasant surroundings, and although I know she hated every minute of being looked after, that was what was necessary given her inability to live independently. She had, for several years, told us fantasies about her excellent social life but it was really a lonely miserable existence, endured so she could stay in her home with her memories. It couldn't be continued.

My NHS physio told me that if there was one thing she would encourage in women in their late 50s and early 60s, it would be to practise your balance - standing on one leg for as long as you can - and then with eyes closed etc. it’s easy to do when you are washing up, waiting for a train etc etc

Building in super-simple habits to help you improve your balance gradually over years, even if, like me, you are a bit useless at exercise, can reduce the likelihood of a fall in the first place.

Cottage hospitals are a really good idea, worth revisiting, but the land and buildings have been sold off as McCarthy & Stone flats for over 55s. The over 85s are the issue. And there are going to be more and more of us (67 now). In declining health. I think we need a contributory non-profit organisation insurance scheme to look after us all in our dotage.......... but I don't believe many people would believe how much they would be paying in or how little care they would receive in return. Most people would think it was like buying a week on a cruise, for 52 weeks a year without the nice weather.

@Figmentofmyimagination my Pilates teacher says the same. Balance is important. Sadly, even after 20 years of Pilates practice, the skills decline with age anyway.

Cleaning your teeth, standing on one leg, with your eyes shut is a good measure of how old your body is, not your chronological age.

@MrsAmaretto

To a certain extent yes, but they would still require nurses as a band 2 cant give medications, and band 4 can only give oral medications if a TNA im not sure if the old band 4 assistant practitioners can, but either way trained nurses would be required to some extent, and theres also a shortage of HCAs due to the pressures placed upon them and the low pay they receive. Plus most band 4s are topping up to band 5 as soon as possible after realising its basically the role of the nurse for less pay. I was a HCA for many, many years before i did my nursing degree, its a hard job for basically minimum wage these days, almost ever shift we are short on all staff. So that isnt a solution either unless again, nhs banding pay is addressed at all levels.

I thought health care assistants in the nhs got 27,000pa but care workers in the community it was more like 12000 -I might have that wrong but if there’s a big gap then setting up hotels or nightingales with workers on 27,000 is a big cost.

HCAs certainly don't get £27K in the NHS. Most are a band 2 a few band 3.
It's between £20-23K

Either way, at hospital or in social care they don't get paid enough. A good HCA/ carer are worth their weight in gold. They really can be life changing for people at home, in care and in a hospital, an enormous support to us nurses as well as patients I say this personally and professionally.

www.nhsemployers.org/articles/pay-scales-202223