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?

Make the NHS a better / more efficient organisation ( lots of money going to waste in the NHS currently) and put more money going into social care. Make social care a viable career - not minimum wage. Stop talking about people being clinically ready to go home .... everyone needs to be working to the same ends, if a discharge fails, it will cost the health service more, so stop the artificial divide between clinical and social care. Treat social workers with the same respect as nurses / consultants (often more poorly paid). Make it clear to older people and their families that they will be expected to cover some of the costs of care as the state will not fully fund it ... I could go on ....

I wasn't the person who wrote this but I think anyone who has worked with very elderly people in hospital and residential settings would probably agree.

we have created a situation where we prescribe medication to vastly prolong life often beyond a point where life is kind or comfortable any more. Nearly everything can be treated these days meaning that life expectancy has increased but the reality is that means many many more very infirm and dementing people requiring care, and often living pretty painful and/or miserable lives in their final years.

Pneumonia used to be referred to as 'old mans friend'. These days we fill people full of antibiotics, blood thinners, statins, stomach tablets to stop the other tablets from causing harm, memory tablets etc.

we have to start looking at quality of life rather than quantity of life.

personally I'm already in the process of writing an advance directive requesting that if I'm no longer able to medical decisions for myself and that won't change that I don't want any life prolonging medications, I just want pain relief, food for as long as I'm happy and willing to eat it and any medications necessary to keep me calm/not distressed until I pass away.

What were their plans for coping as they aged, 'miles from family'?

I'm not a fan of interim care beds / step down facilities because it's well known that the more you move frail people the poorer the outcomes. As PP said, invest in community supports to maintain people's independence and health

My mum (a care worker) says this. Many of her patients fall about, constantly in and out of A&E, only to insist on going back home again and won’t entertain paying for further help. It makes me quite cross actually. One patient she had lived in flats, every time the paramedics arrived they had to break down the communal door as he couldn’t remember the access code. It irritated the other residents no end.

@iwasabedblocker

Sorry I mighthave misread your post? You said you waited as in pt for 3 weeks waiting on a commode?

So you must have known you needed 1?

if you couldnt afford to pay for help then 1 of your adult children should have come to help you. Pretty shocking they didnt.

The system just can't afford to be all things to all people unfortunately and we have to stop acting like it can

I understand that but my sibling and I both work, several times now I’ve had to travel a significant journey to go and support convalescence for injuries, serious illness and I’ve needed to negotiate time off work. Sometimes paid sometimes not. I’ve had to be creative and set up Rotas with other family members/ neighbours and request flexibility around working remotely and compressed hours. It’s not easy I agree but I don’t think leaving someone alone in that situation is right or fair.

Two of the three very elderly frail women were absolutely insistent on going home as they 'could manage'. They could barely get across the ward unaided!

Many elderly people are terrified of hospital - sadly some feel they are being sent in 'to die'. These elderly people had parents who still talked about going to the 'poorhouse'. They have almost inherited a fear of 'institutional care'.

Not an answer to the question, but 'delayed discharges' is a slightly better option than bed blocker.

We need more intermediate care beds, and a functional and funded social care network on the other end.

I honestly think older people need to arrange care themselves, through either family help, paying for it (selling the house if necessary) or social insurance (including some kind of Medicare-type subsidy for poor people). We should all be planning to pay for our long period of old age. Many older people now have been drawing pensions for decades and are sitting on enormous unearned wealth in their houses. So if a person is bed blocking they are discharged to a cottage hospital/care home immediately and presented with the bill.

I have a magnificent idea.

Next to us is a huge continent. They all belong to a trade club. It allows all the people of the club to travel freely between each other's countries and work.

Why don't we ask if we can join. ? I'm sure lots would like to come and work here. We have a beautiful country. English is a popular language to learn and our education system used to be highly valued. Our wages would be attractive especially to the poorer countries in Eastern Europe ...

What do you think. Have a stumbled across a brilliant solution ?

Any solution is going to cost money, but government funded social care would cost less than private care, because private companies have to make a profit.

Basically we need more beds in hospital, and we need convalescent or step down provision, so people who don’t need the specialised care of a hospital, but can’t go home yet, either because they need more time, more physio, or the provision of a home care package can get the care they need whilst freeing up the more acute beds in hospitals.

We also need the ability to pause care packages, when the person has to be admitted to hospital - I have a friend whose elderly relative is in hospital at the moment. They had an established care package before this admission, and if they had been going on holiday, they could have paused the care package - but as they are in hospital, the entire package has been cancelled, so now, even though they are fit to go home, they can’t be discharged until a whole new care package has been organised and put in place. If the package had been paused, this patient would be at home already, and a much-needed bed would be freed up.

From a patients point of view this is really tricky. So much pressure on hospital staff to get patients discharged means patients being sent home not well enough to cope and ending up back in hospital. Unfortunately have first hand experience of this. Also many patients are lying in hospital waiting for scans/diagnosis etc and due to staff and equipment shortages they are waiting days … even when classed as acute. Again, unfortunately, first hand experience of this too. Money is clearly being poured into nhs but it’s either not enough of not being spent effectively. Didn’t see a single member of staff over the age of 50 in 7 weeks- and rarely saw the same nurse or doctor twice which contributed to disjointed care and longer stay as a result- not good as a patient or for ‘bed blocking’ :(

The new hospital in my city has fewer beds than the old one. I'm not aware that our city's population is shrinking, or that there has been a sudden proliferation of convalescent homes so god knows what will happen. It would be nice to think that the old hospital which is very close by will get knocked down and a convalescent home built there. But not looking like it....

@Cuppasoupmonster @Topgub has spent hours on another thread devoted to being a SAHP so I don’t think they will necessarily understand the juggle for those working.

I am a nurse and it’s dreadful. It’s not the patients fault and it’s a lack of funding and investment when this was so clearly going to come to a head that’s caused it.
We need more money. More rehab beds, more respite beds, more beds in ‘care homes’ but for patients like @iwasabedblocker who needs it for a short time. We also need to pay carers what they deserve to make these jobs appealing and fill them.

I can’t see it happening. I can see us legalising euthanasia and some old people using this to prevent from being a burden.

On paediatric wards we struggle with the amount of CAMHS or ED patients waiting for tier 4 beds or any camhs input.

Mental health is so underfunded, there is little community support. The patients turn up in a&e in the evening when camhs have generally gone home so they end up being admitted. We have care homes bringing in the teenagers saying they can’t cope with them anymore and they’re left with us for weeks waiting for a new placement. There are little to no escalated beds or foster placements. We have some of these patients for months being looked after anything from a 1 to 5 nurse ratio depending on their needs (I.e likely to kick off). It’s unsustainable.

I have recently been in hospital and seen the problem, not enough community/rehabilitation beds, not enough care home places, difficulty setting up home care packages, no falls teams to stop full admission and so on. Such a shame as the vast majority of patients in this situation want to get out of hospital anyway!

I am lucky, I have had family care. Without that I would be absolutely stuck, like @iwasabedblocker

If they were centrally funded and staffed, there wouldn't be the massive profit motive, which drives the thousands of pounds a week charges, as we wouldn't have care home providers and shareholders wanting their dividends.

As far as I know, the UK has always recruited from all over the world. So anyone from the EU, Europe or the rest of the world are abd gave always been welcome to apply and work for the NHS. Isn't that brilliant and egalitarian?

Until very recently DH and I had 4 parents aged 84 to 94 all with significant needs and all an hour away snd not in the same direction. It doesn't matter how flexible and creative you are, it doesn't work ifif you work full time and yhe bills don't get paid if you don't.

I see a lot of people who have too much money to be able to receive free social care, so they simply refuse to pay for it. They then reach a crisis point, get admitted and get discharged with free care for a limited period of time, when it comes to the point of that care ending and needing to organise social care, they then refuse because they don't want to spend their money on it. And nobody can force them to spend their money on care, so they gradually deteriorate again and then get admitted and then the whole cycle begins again, or something awful happens and they end up needing a residential or nursing home placement so all that money they thought they were protecting disappears.