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?

My late DF was a bed-blocker for 6 weeks, after he was admitted following complications of late-stage Huntington's disease. His care during that time was abysmal, and adult social care were stuck trying to find him a place in a specialist care home during lockdown. The only place they could find was 4hrs away from my mum, but they transferred him there to free up the hospital bed, essentially.

It's a horrendous state of affairs, and I wish I had the answers.

@iwasabedblocker

I'm not being nasty.

This is the reality we are in.

We either pay a lot more and massively increase the amount of hospital beds and staff or people will have to accept that there is no help available.

It's awful but that's how it is.

Amd inescapably, unrealistic expectations of what can be provided is a big part of the problem

@NameChangeLifeChange

And the point of that wee dig that didn't even make sense was what?

Over a decade of austerity has meant that the NHS and even more so social care have been hollowed out. The cuts efficiency savings have actually made these services less efficient, by creating delays, staff shortages and a lack of flexibility.

There used to be convalescent homes with some medical oversight, but really as a halfway house between hospital and home. They enabled people to regain strength and start to become independent after a hospital stay. All the ones near us are now bijou apartments.

My local hospital was rebuilt about 5 years ago with fewer beds. We were told that in the future we wouldn’t need so many because people would be treated in the community and acute disease would be prevented. It was actual magical thinking.

This. And attendance allowance is not even means tested! Still some won't spend it.

More care homes.
Round here, lots shut down during covid. Residents died, and without the fees the businesses weren’t viable. Availability of dementia beds is down about 35% since 2019 .

Agree. Euthanasia sounds rather harsh but a change in the law on assisted dying is definitely needed morally.

@iwasabedblocker

I'm not a mind reader.

Your post didn't say it was nearly 3 years ago.

But that might also explain why you struggled to get help.

Things are much much worse now.

It was a failing home which most residents had moved out of. Those few people left were given the option to stay and have their care taken over by the Trust. Or they could relocate.
The rest of the beds are used for patients as care packages are set up.

We can choose, restructure the state to put back all the cuts the Tories made and pay for that, or have shit services.

My wonderful former headteacher neighbour was told he had hours to live a year ago. He has a heart condition & Parkinsons. He was in hospital, but then rallied so was discharged to a nursing home but he hated it. After a month, he came home with various promises of carers 3 times per day etc.

I spoke to his wife last week. She is on her knees. The promised "care package" has failed to materialise because in our area there simply aren't enough people willing to do a (IMHO shitty) job for NMW. They have someone in to help get him up, but apart from that, his DW has to do everything. This has nothing to do with money as they can afford to pay for his care, even though it is medical rather than social. Thanks to the people who voted for Brexit and who continue to vote in the Tory party, there aren't people here who are willing or able to do those jobs.

OP, I have no idea but as my 87yo DF is now staying with me, I am seriously concerned.

Pretty sure you were if you had vulnerable family living alone? Couldn't one of them have arranged a commode for you?

But you are solving this with the benefit of hindsight and not in chronic pain, trauma from an accident and a financial crisis.

Even the best surgeon can’t take out their own appendix. Iwasabedblocker would probably be ace at advising others what to do now she’s survived the whole ordeal. At the time competent support was needed.

I know of a fantastic unit that used to take people who were say medically fit but didn't have poa/guardianship/social work assessment they stayed around 6/24 weeks. It was outsourced to an private company so was closed due to legalities of not technically being nhs run. But if they could replicate that with nhs staff it would certainly free up acute beds.
we also need more care homes

I'm not saying the other poster is right but if I remember correctly you were allowed to travel if it was to care for an elderly or vulnerable person. You would've come under this surely.

My 89 year old dad was a bed blocker for a couple of weeks, after breaking a hip, he didn’t need any more hospital care as such but he couldn’t be discharged back to his sheltered housing because he needed more rehabilitation with physio and help with walking again but the physios and nurses were too busy to assist him so therefore he wasn’t improving and so couldn’t be discharged.

It was a vicious circle, but luckily last week they managed to get him into another place which provides rehab and now after physio every day, he’s going home on Friday. If it’d wasn’t for this halfway house place he’d still be taking up a bed in hospital for who knows how long.

I work in Adult Social Care, I also have a MIL who has been a "bed blocker" a few times over the last few years.

DH is an only child. His DM moved 5 hours away when she retired (aged 60) and made it very clear that she wouldn't make any journeys back to see us, if we wanted to see her we would have to do the travelling. When I was hospitalised 25 years ago when pregnant with ds2 we begged her to come and help whilst out childminder was on holiday for a week, but she said it was "too much effort" and refused. She has never looked after our dc for even 5 minutes. Her choice.

But in return, whilst DH and I are both working ft, I refuse to drop everything and go and care for her in order to get her out of hospital.

In my job, I'm acutely aware of the strain on the system. A system of step-down facilities alongside better pay/conditions for care workers would help a lot. Brexit has decimated the care industry, and the workers who are left are underpaid and overworked.

There needs to be a new approach to social care and how it is commissioned.

Encourage people to move to assisted living and/or nursing homes at an earlier age. Many people won't countenance leaving their homes until there is a crises event (such as a fall) which lands them in hospital where it is discovered they are too frail to be sent home.

Better GP care for the elderly - more regular check ups after 50/60 etc so any sudden deteriorations in health are noted and acted on. Reinstating community nurses.

Now this is controversial but in terms of funding, I think we should crack down on those who can afford their own care but who weasel out of paying e.g. by transferring assets to family members in their old age etc. Recoup care costs from the estate once someone is deceased.

As usual, the least informed, (a la @Topgub and @GelatoQueen ) shout the loudest 🙄
Labour in their last manifesto suggested creating a national care service to try to solve the problem, ensuring decent training and career progression as well as providing high quality care and rehab.
In my experience many older folk don't want to be kept alive indefinitely.
Unfortunately relatives may feel differently.

@Neome

Indeed.

But it isn't the place or the role of acute hospitals to provide it.

And we have to stop thinking it is.