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?

Very very comped issue.

FWIW my own DGM was in a home for 8 years, she didn’t know who any of the family were at all. Multiple hospital admissions at that time, lots of care given, all funded because she didn’t have means. She was well-cared for but her package must have been very expensive. She very slowly dwindled away aged 92… not ill, just very very old.

She’d been one of 8 children, of whom only 4 survived childhood. In the ‘old days’ the population was far, far smaller overall, and there were far far fewer people.

i don’t know what the answer is. Resplendent is good, and right… but the population of frail but just about managing people is growing. I’m not sure how many people just die in their sleep when they’re old, never having needed lots of medical/surgical intervention, social care, care home etc. Probably not that many.

A neighbour of ours is well in his 90s. Owns and lives between two houses. Retired in the mid-1980s. Very little family help and he’s increasingly frail. Absolutely could pay for help but absolutely won’t.

People also expect the system to find all things for all people. I think people could/should be charged for the ‘hotel’ services of hospitals. We all have to feed and wash ourselves every day at home… could we not charge a nominal fee to all inpatients for this? Complex I know.

And to PP who found herself struggling as a younger-age person. Your DC who couldn’t get time off work had a statutory right to take unpaid time off to care for you and make arrangements for your care as their dependent. I could go on Amazon now and have a commode delivered tomorrow for under £80. I know your story is complex and you should have had OT intervention on discharge but there were things that could quite easily have helped.

I have very good older friends who have ‘future-proofed’ their home… think downstairs bedroom and shower room, cupboards fitted out and made accessible, accessible kitchen. They don’t need it yet but they may.

Then my DFIL who lives alone and in a very remote place but refuses to move anywhere else to access the support he really now needs, never mind Heath and social care.

So much of it is individual mindset.

Also individual means
Also service efficient
Also funding
Also workforce planning
Also local area dependent-saying everything should be the same everywhere just doesn’t work

Viral wards! Have enough of those...
I assume you mean virtual!

@coffeetofunction
And the same service and probably even better in other counties

We have been doing this for YEARS in my LA

Preventing hospital admissions
Getting people out of acute hospitals quicker
Re- abling people

I am pretty sure we aren't the only LAs and NHS commissioning areas (CCGs now ICBs) joint planning doing so

In fact I know for sure we aren't

AIBU is not a good research reliable survey of what is happening now or has been happening for years . It's very anecdotal (and sometimes from experience many years ago)

Refuse treatment and starve to death?

They need to listen to people more, when you are of age and sound of mind you should be able to put together a document stating what you wish to happen in certain circumstances. If I ever get the type of terminal cancer my father got I would ideally like to be euthanised, same if I get dementia, have a stroke causing irreversible damage. Suffering is not my bag. I don’t care what age this could occur, I’ll cancel my ticket there and then thanks. What’s the point of suffering and lingering.

My late aunt always said she wanted to live come what may, even dementia, she wanted everything possible to be done to prevent her death. She was in perfect health at the time and young.

At age 85 she was diagnosed with dementia, refused help, ended up in hospital numerous times, we were told by medical staff she was a ‘bed blocker’, so not sure that term is goady. It’s factual and accurate I guess, just a bit insensitive. She needed to go into a home. She refused, she was released with an inadequate care package, fell in the road during the early hours of the morning and was found by a bus driver. Again resulted in hospital, finally deemed to not have capacity (she previously passed the Psychiatrist’s test and answered more questions than DM who is fine). She then moved to a care home which she loved thankfully.

Well spotted yes.... Definitely virtual wards

I definitely think the elderly ‘culture’ in the U.K. plays a part in all this. It seems to be a pattern that people retire or get past middle age, and move to large houses in the countryside with unmanageable gardens. No amenities within walking distance, hospital 15+ miles away. Eventually they withdraw from society and just sit in watching TV all day. When they can no longer manage the house and garden they refuse to move because ‘it’s their home’ so they have falls and end up in A&E.

I definitely think planning for your old age before you reach it is very sensible.

This. Couldn't agree more and I think the NHS needs restructuring from the top down. Throwing money at it is not the answer.

Tbh it's been a problem for years but now it's just even worse primarily due to all the finding cuts social services received over the last decade. If we want a decent Public Health Service and proper social care we need to increase tax amongst many other things, such as organisational change that are needed, like a cull of middle and senior managers as one example!

Also the divide between social care and health care needs to be reviewed and reassessed. Ideally it should all come under one umbrella. There are way too many overlaps as well as a not remotely joined together! Currently I am seeing patients coming into hospital and I am flabbergasted that they are even surviving at home with no care let alone barely managing. It's absolutely horrendous!

Honestly for my and DH we would rather be gone than live in a care home so for us the answer would be assisted dying.

Maybe tax breaks for children who taken in their parents.

Acceptance of lower standards of care.

Group homes instead of in house care to free up staff.

Differentiation between social vs medical care and what is required.

You had a really traumatic accident followed by a further upsetting discharge without support right when Covid was starting. It’s bound to be very tough reliving it and having your experience picked to pieces like a debating point is surely bound to be horrible.

If you can abandon your name change, hide the thread and watch or read something uplifting you might be able to find your equilibrium.

Thank you for sharing your experience. There will be silent readers thanking you too. 💐💐💐

@Cuppasoupmonster definitely think the elderly ‘culture’ in the U.K. plays a part in all this. It seems to be a pattern that people retire or get past middle age, and move to large houses in the countryside with unmanageable gardens. No amenities within walking distance, hospital 15+ miles away. Eventually they withdraw from society and just sit in watching TV all day. When they can no longer manage the house and garden they refuse to move because ‘it’s their home’ so they have falls and end up in A&E.

That sums it up neatly.

I definitely think planning for your old age before you reach it is very sensible.

And this is something that needs to be promoted.

If we can pay millions to refugees for hotels, send millions for a war that isn't our fight, pay foreign aid to a country with its own space programme!... we can afford to build more care homes and train more staff. And give them an actual wage that'll bring the right people into those jobs.

Oh for an edit button! Sorry.

This situation will deteriorate dramatically in the coming decade.

There will be a significant increase in the number of elderly people needing care in the coming years. However, a decreasing population with zero immigration means little or no care will be available.

It doesn't ever pay to own stuff or plan for your future cos if you haven't any money the tax payer funds it....but I'm afraid if any of us need care in old age we need to make provision for it. That means selling your house etc. I know it's massively unpalatable, but that's the only way health care can be funded.

@NearlChristmas I understand there are people who won't step up because they're greedy. However, there are a lot of people who have no children nearby - even in another country - or no children at all, no partner - or a partner who equally can't cope.

@Cuppasoupmonster I am not sure about the elderly culture that you talk of. I work in a inner London A&E so none of the elderly patients that I see are like you describe.

One big problem is the success of medicine and science. People are now been kept alive with so many complex illnesses for a lot longer than even 10 years ago. The survival rate has gone up for so many chronic diseases, which is great for science but the reality is an ageing population. Once it was rare to see a 90 something year old. Now half the medical wards are full of 90 somethings.

The problem with this is this longevity does clearly not equate with quality of life. The suicide rate of the elderly is on the rise now which is heart breaking.

No I don't like that idea. Giving big companies access to desperate or poor people who will work for low wages is not helpful. I used to be a carer, working for £6.25 an hour. We asked for a pay rise as all were struggling and were told no, if we don't like it we know where the door is and that they were going on a recruitment drive in Poland, and were going to put multiple people in a house share and they would work at the care home.
The elderly patients I cared for also got very distressed when the carers couldn't speak good English or would converse in a foreign language while giving personal care.
Giving big companies easy access to poor people willing to work for peanuts or grateful for any work keeps the wages and conditions low for all carers.

Why is it unpalatable? If you’re in a care home you no longer need the house anyway?

Over admitting the elderly into hospital and then keeping them there so long they lose any independence they may have had .

I'm curious at where this is.

We have rural areas as well as towns and border a city.

That is absolutely terrible of you have people waiting in hospital for months. In our area. I one waits long as we have LA funded carers team to get them home then progress to ongoing care with various contracted agencies and if they can't take the POC it goes to other (more expensive ) awvone or third tier searches of agencies (expense jumps up) . Our LA has invested i. A wound care market.

We might get blips ( during school summer holidays ) occasionally with slightly longer waits than a week or two so for huge POC (as quite rightly a care agency won't take on what they cannot confidently reliably cover) but it is never "months "

Doesn't sound s good if this is real?

I'm so sorry can you guess what I typed I type Rik fast and my phone autocorrects so much 'as I post' it looks fine when I type it! 😱

Why wouldnt it be real?

It's real and not unique.

Most places are facing similar issues

In our area * no one waits long

They did the same in P/boro , built a fancy new PFI funded Hospital with a third less beds when the population of Pboro has increased exponentially. Crazy economics.

We need the Cottage Hospitals reopened for post op / post hospital, ambulatory care. Have a support team of Occupational therapists, Physiotherapists, Social Workers, District /Mental Health Nurses working alongside readying /enabling
patients for discharge.

Use the Cottage Hospital as their base for all the specialities to interact speedily.

Encourage nursing enrolment by voiding the nurses UNI fees providing, once qualified, they work within the NHS for 10 years.

Reinstate the SEN (Enrolled Nurse) ward based training, They were some of my most dedicated staff and their in house training could be facilitated to accommodate family responsibilities.

Give councils ring fenced funds to adapt homes for basic home care.

Adjust planning laws to allow property adaption for the purpose of housing your elderly kin. Encourage looking after your elderly at home by giving tax concessions in wages.

They need to cut out a tier of middle management pen pushers in the NHS and all the £109k Diversity Advisors.... Put the money into front line staff