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?

@Topgub Rubbish. Most elderly people would want to be made comfortable and go their way quietly. They do need to do end of life forms with their doctor saying do not resuscitate or whatever. The problem is that social care is desperately underfunded - so if an elderly person goes home to an unfit house s/he cannot be discharged or is discharged and then readmitted in days costing the hospital a penalty. They also may have a spouse not able to cope with them and no family nearby.

It doesn't help that carers are paid a pittance and there is no defined career path - so carers tend to be stop gap. And run ragged by council demands they spend 15 minutes to visit an elderly person. Private companies here offer half an hour in the morning - can you imagine getting them out of bed, washed and dressed, medications administered and fed in that time? to say nothing of cleaning sheets?

Sorry mistype
*Bit of waiting occasionally for a wet large complex card package at home but days not weeks ...

The place they got my dad into was perfect, it used to be a cottage hospital and now provides physical rehabilitation and also has a minor injuries unit. People get the help they need and it enables them to get back to their homes more speedily and takes pressure off the main hospital.

There need to be more of these places, it just makes sense. My dad was in a room with a man in his forties who’d lost part of his leg in an accident so they’re not just for the elderly either.

• for a very large complex care package

Sorry my phone hates me! It autocorrects in bizarre ways!

Land Value Tax to fund more social care places. Let the Duke of Westminster and other major landowners pay for it.

@Tiani4

Are they spreading the message?

@iwasabedblocker just ignore that poster who won't leave you alone, they seem to obsessively target anyone vulnerable and honest. I'm sorry you went through that through no fault of your own and I'm sorry that that poster is making you feel bad about your experience.

There doesn't need to be "bed blocking" if the LA and health service work together

Expect when court processes override those . Our biggest challenges often aren't about finding what is right fit for our clients but other factors

Honestly I think the answer is just for the NHS to draw a line where their responsibility ends. If you’re healthy you get discharged - whether you need additional care after that isn’t their problem. Families would have to step up, or people would have to manage on their own, or organise their own care. I think it’s wrong that this responsibility is being laid on the NHS, it shouldn’t be their job to organise care after people have left hospital.

Properly funded social care.

I expect so
We are not the only LA that has these excellent tested arrangements

Nodding along with a lot of this. I have an elderly relative (who also has a very long term profound disability) who went in to hospital with covid before they knew about covid and was stuck in hospital for over a year as there was nowhere for him to come out to (his needs increased so much in hospital, no regular social contact/physio etc that he could no longer be supported at home- already had 4 x a day carers and his wife). Along the way many infections etc but they kept treating everything despite that fact he is 80+ and unable to eat (tube fed)/sit etc. He was discharged to a nursing home that his wife is now using £4k a WEEK to pay for, for him to be depressed in a bed 24/7. My heart breaks for both of them, neither of them have any quality of life - her life is on hold- and she is so scared about all the money.

Family cannot step up. Not even talking about my situation as his needs were always beyond family support. But we are all working, raising kids. AND for many of us, we are realising our parents have not been there to support us when we were toiling and on our knees with young kids/work etc, they had "raised their kids" and were off on holiday and enjoying themselves. so not only do we not have time, we maybe also don't have the inclination when we were offered no support at our time of need.

Well , now, Wes always live better funding .. most people don't want their taxes increased and social care reform bill (delayed several times) may impact on that.

But I can't comment

If by Sticking a plaster over another and kicking the can down the road you mean keeping your parents alive: yes that’s what gps do. People with a high amount of comorbilities would be dead 40 years ago. Now we kick the can down the road and we get to live longer, and in a physical and mental condition that you wouldn’t see back then.
people also need to understand how prolonging unnecessarily the life to very frail and sick people is not dignifying nor compassionate. For example, some patients, bed bound, peg fed, advanced dementia and recurrent aspiration pneumonias which mean recurrent hospital admissions for IVs as painful procedures such as nasal suction (aka passing a tube from your nose to your trachea to aspirate all yucky stuck while you choke in these secretions). I would say, why not accepting they are at the end of their lives and further hospital admissions do only prolong suffering speak with palliative care team and try to keep them comfortable in their residences. Before everyone jumps at me, This is only for those very advanced cases were everyone can agree that patient quality of life is extremely poor and health is very fragile with recurrent hospital admissions and no mental capacity (if patient has capacity this should be respected, whatever it is).

@crosstalk

When they are actually dying?

Yes.

But it takes along time sometimes to get to that point.

Lots of interventions. Lots of life extending medications and procedures before the inevitable is accepted.

It's a fact that the largest health care spend per person occurs in the last year of life as we fight the inevitable.

I'm a bit surprised people are denying this is the case.

Lack of actual experience probably.

I'm certainly not suggesting we euthanise elderly people.

But we do have to have serious conversations about what the state can afford or is willing to provide.

Health and social care are expensive. really expensive.

It has to be paid for some how.

Personally I'd massively increase taxes, crack down on tax avoidance and care fee avoidance.

Reverse the govt focus on care in the community and introduce nhs care homes and social care.

Lots of focus on prevention.

And yes. Discussions with pts and families about what is a realistic expectation on prolonging life. And what is reasonable to expect the nhs to provide for what we pay in.

A national care service sounds like a great idea- and could work more closely with the NHS to make things more successful for people. Unlike private care homes, it wouldn't need to be run for a profit, which is already a saving- and if successful, I imagine it would also save the NHS some money.

Yes, there would need to be money paid in from somewhere, but right now it's clear the taxes we are paying are not supporting our national infrastructure- so we need to increase taxes somewhere. It doesn't have to be income tax, there are other taxes which could be looked at- certainly a windfall tax on large profits etc.

That said, I do think our priority should be looking after society as whole, not accumulating increased wealth!

If we could push wages up, an increase in income tax wouldn't be so bad, as well.

I don't think it's viable to force people to rely on friends/family, it's not always realistic, and ultimately it pulls people out of the workforce.

I actually can't believe people would rather have euthanasia than increased taxes, which is what a lot of this thread boils down to. People with capacity can already refuse care if they want to.

Social care pay is piss poor for HCAs and conditions. The NHS you will get unsociable hours payments , sick pay and maternity leave. Social care has none of those perks and minimum wage. Social generally pays better for nurses but not carers. They are seriously struggling with recruitment. You can getter perks working in a supermarket.

@iwasabedblocker just ignore that poster who won't leave you alone, they seem to obsessively target anyone vulnerable and honest. I'm sorry you went through that through no fault of your own and I'm sorry that that poster is making you feel bad about your experience

Absolutely agree.
If I was a person 'bed blocking' reading this I'd be afraid of someone putting a pillow over my head if any of these posters were in health or social care.
Heaven help they way our society is going - survival of the fittest!

This is exactly why competent support was needed. Getting things to work at home might mean sourcing equipment, helping friends and relatives to think through or negotiate time off, and in this instance rapidly assessing the new Covid regulations.

Everyone’s situation is unique and there are widely differing ways to make the jigsaw work for someone to go home with support.

It doesn’t work to say ‘it’s up to the patient to take responsibility’ because I think it is very likely that there are a large percentage of patients stuck like this who really don’t want to be. If they were able to organise their discharge they’d be out of hospital like a shot.

@Tiani4

My area cannot source care at all.

There are no carers. Not private, not LA.

The average wait for a POC is 3 months.

Full poc? No chance

Well they must all be sorely disappointed because the NHS is shite. It has been for decades, but it’s less than useless now.

The problem is manifold, but the first thing to remember is that many patients who are 'medically fine' are still chronically ill or are too frail or disabled to live without support

They are in a position where nothing further can be done medically

Elderly patients who refuse social care after major surgery are some of the biggest culprits - they often refuse access to their homes for occupational therapists to assess living conditions and see what adaptations can and need to be made

Although assessed to be 'of sound mind' they often have very unrealistic ideas about what they can and can't do - expecting an equally frail spouse or family who live miles away to pick up the slack

They need to do physiotherapy, maintain a medication regime, eat regularly and make regular appointments for blood tests, physio or medical appointments

They are often in denial about diabetes, heart or thyroid issues or how long it takes them to do something and refuse to change diets, take pills or injections and neglect themselves, often leading to hospitalisation.

Solid, 'social care', where carers oversee drug regimes is expensive, hard to organise and it's often refused.

I actually can't believe people would rather have euthanasia than increased taxes, which is what a lot of this thread boils down to

Exactly. Slippery slope. What next - withdraw care for all premature babies?