Help with NHS and hiw to be moved wards

[Tiredohsotiredandabitmoretired]

Posting here for traffic.

Can anybody advise re the above? Partner was admitted on Thursday due to low oxygen. They've stuck him on a ward which is supposedly a surgical trauma unit. (Why not respiratory? ) the other patients all have dementia or other cognitive difficulties. One patient sleeps all day then shouts/screams all night so he hasn't slept. There's a chap who keeps getting up and getting in bed with other patients. One chap urinated at the end of my partners bed and another chap just decided to defecate on the floor. Can anyone help he's never going to get better on this ward. Is this just how it is now in hospital? What can I do to help him

At least he’s in a bed and not in a corridor or put in the middle of a 4 bedded bay as the 5th patient like they do at my hospital. Just try and make his stay as comfortable as possible, curtains around the bed, device with ear phones and ear plugs for on a night. I’m sure if the nurses could do something they would, this is just the reality of some inpatient areas unfortunately, there’s an aging population with terrible social care provision.

Dementia patients often become more confused in hospital as it’s an unfamiliar environment unfortunately. Capacity is a huge issue, we have more days where we run over our patient numbers than not. Our bed managers push us over all the time.

Paying for a private room is an option in some hospitals, usually around £150 - £200 a night. My brother had 6 days of what your DH was going through, and when i visited him i was so worried as had never seen him look so unwell. He is the calmest strongest person who never makes a fuss, so I had to advocate for him, I paid for the room for 2 nights so he could get some decent rest and by day 3 he was well enough for discharge

You need to be your dp's advocate, Op.

My DH was in hospital this month and our DD and I had to chase everything. We got him moved to his own room (there was a reason why this was better for the other patients as well), ensured that he was being given essential heart medication (he hadn't been) etc etc. All the time we were both polite but tenacious. For my DH at least it was definitely a case of the staff having to be challenged before stuff was done.

I have no doubt that the staff were overworked. But as a result they were doing less than the minimum needed for my DH to get better.

I was in UCLH last month, stuck in ICU after recovering and no longer needing intensive care but still requiring health care, because there was no space on the maternity ward (in total spent five days in ICU, during that time a young patient died in the cubicle next to me - his poor family were in shock - and on the other side I had a man with dementia, obviously the only thing separating us are the hospital curtains so you can hear everything). I was then moved to their close observation bay for two nights (actually moved beds at midnight) then moved to the maternity ward in the early hours of the morning, then called ten hours later while visiting my baby in UCLH's special baby unit, and told to return to the maternity ward because I was going to be discharged, then I wasn't discharged in an orderly manner. I had the offer of counselling from UCLH because of the trauma of the patient dieing, but at that point I just wanted to distance myself from all hospital personnel. Although I experienced some amazing, compassionate, hardworking nurses and talented surgeons the systems broken.
OP, I can't give you any advice, I just want to share my experience with you.

When I had appendicitis aged 26 I ended up on an orthopaedic ward. It was full of very elderly women who spent night screaming and shouting. I knew it must have been the only bed available but it was hell on earth. Hopefully he gets moved somewhere more appropriate soon.

Op, I’m sorry I can’t be helpful but just reading this is awful. Your poor DH. I’ve (thankfully) never been in hospital but this sounds really horrible. I don’t want to ever go.

I’m sorry for you & your DH & hope he’s home soon.

Unfortunately any ward will be like this, plus there is simply no space for him anyway if he has ended up on the surgical ward whilst being a respiratory patient.

Ear plugs, eye mask, visit as much as possible to keep him sane.

I do feel for him OP - DD (then only 19!) ended up being placed on a bay of confused, elderly (mainly male..) patients whilst on an ENT ward as an emergency admission. It was very distressing for her but there was physically nowhere else they could put her. Her mental health suffered awfully through the lack of privacy, constant disruption and sleep deprivation. I’m not sure how anyone is meant to get better on one of these hospital wards either.. She ended up discharging herself against medical advice as she physically could not take it any longer than the 4 days she was there.

Most in patients now have complex needs if dementia. Sounds like he's an ' outlier' ie no gen med bed was available.
What's his diagnosis?

My Dad (entirely compos mentis and only 70) was on a mixed ward like this, due to the oncology ward being closed. He had a rare late-diagnosed cancer and died in hospital less than a week after admission. He had an exceptionally rude man opposite who kept demanding things from the nurses and pointing at my Dad saying 'that man's got cancer'. After relatives piling on the pressure for days, he was moved to a single room 33 hours before he died. It's just awful that this is how he spent his final days.

I hope you can get DH home or moved soon.

'Most wards are full of these patients, essentially ever increasing elderly population with higher levels of dementia and diminishing social care to support them in community - so they end up living out their days in hospital as there's no where else to put them'
^

100% correct. Being an NHS patient is an absolute nightmare.^

It’s absolutely terrible, both for those like your poor DH and also the poor confused elderly people who are suffering in terrible distress. Why aren’t they helped with the distress? I don’t understand why they are left to suffer in terror crying and screaming all night instead of helped to calm down and sleep with medication? It would be better for them as well as the people they disturb.

Quite a complex question to answer really, and to some extent they will given a low level of sedation, but essentially due to frailty and other drugs they'll likely be taking, in addition to trying to keep them 'medically optimised' - sedating them all to the point of being settled would likely result in a rapid increase in deaths. Both in directly because of the drugs and in days/weeks - hospital admissions typically really set back elderly people's physical health in terms of fat reserves, mobility, cognition. If they were sedated during the stay they'd rapidly become too frail to ever have a hope of being discharged.

Theres definitely an argument to speeding death for these patients in distress, I know what personally id prefer for me if I knew that was my future. But in practice not going to happen.

To help with the distress they really should just be discharged, but unless families take them in providing a bed and someone to look after them essentially they're waiting for an appropriate social bed - there just aren't enough. So they remain in the cold foreign hospital environment with no social activities/distractions for them just hurried medical staff who have multiple different tasks they have to do & no care home like facilities - lounge, open spaces, music.... We need a big shift in how social care is provided/funded to have a hope of positive change.

What works to sedate dementia patients is anti-psychotics, which now carry black-box warnings of risk of death for dementia patients. There was a big policy shift in the UK in 2009 away from chemical restraint of people with dementia because of the high number of excess deaths it was causing. There’s a Human Rights Watch Report from 2018 about their [over]use in US nursing homes that does a good job of explaining the consequences of their use.

The respiratory ward likely has a similar if not worse profile of patients so it’s nothing to do with the type of ward he’s on. Unfortunately the aging population means more elderly people are being admitted to hospital with dementia/confusion,etc…they need to be on a ward somewhere and pretty much every ward will have at least one patient with dementia on. You’re welcome to speak to the ward sister about it but there’s a good chance he would be in a similar position if he was to move elsewhere.

you could enquire about whether your hospital has a virtual ward which is when patients are discharged home with oxygen or whatever they require and have a daily review at home. It’s a fairly new thing so not all hospitals have it yet.

I think wakefulness , a reversal if sleep pattern, confusion and in some agitation is a more accurate description than distress. So maybe calling out constantly for something ( eg bedpan) but due to lack of memory not realising the bedpan has been given - or wanting to walk around in the night etc.

We only give sedation if the patient or staff are in danger due to aggression or severe agitation

Though with some patients we often have psych review and they start a regular anti psychotic such as Quetiapine

My FIL died in a ward like this. It felt inhumane. When my MIL went to visit him the guy in the bed opposite masturbated in front of her. It was like Bedlam.

Everyone loves the NHS until they experience this end of it.

Sorry you are going through this OP. Echoing advice to pull curtains round, earplugs for night and noise cancelling headphones if you have them for the day.

Respiratory is usually full of nursing home patients who have developed LRTIs and pneumonias or elderly people who have come in from home but are no longer able to return due to their declining health and are now stuck on the ward while waiting for Social Services to sort out nursing homes or care packages for them.

That's just the nature of hospitals unfortunately. They're noisy, busy places.

What!!?? Speeding death? For elderly patients in a trauma ward?

Trauma wards have always been like this. Those patients will mainly be elderly who have fallen and broken hips. They could be your grandad who was doing his own shopping and plodding on last week but has now had a major life event. Surgery and hospital stay can cause delirium which may and usually dies lessen as they progress. Hospital admissions are horrific for older people due to the complex impact of being in hospital as well as the medical impact of post surgery.
They're in the right ward. Younger patients and boarders from other specialities have always been horrified. As have many nurses who used to end up working on the ward from bank or other areas (in the days when that happened).I worked on trauma wards and ortho wards for 30 years. This is normal often for periods at a time.

Sorry Op. As pp have said you just need to support as much as possible until a bed becomes available elsewhere or he's ready to go home. Unfortunately he may not be considered ill enough in the pecking order of others needing to be on the respiratory ward so may go straight home from where he is.
You'll exhaust yourself focusing on actioning this. The process will be happening but due to demand you may be stuck.

Chances are if you move wards it’ll be the same on the next ward

practically every ward had dementia patients

I'm very sorry to hear of your husband's health and hope he gets better soon. I have recent and significant experience of NHS wards. sadly this has been my experience of the 8 different wards my wife has been on since April. I'm sure the staff want him to be on the correct Ward but they just can't get him onto one because of the bed problems. My only advice to you would be to keep pushing and pushing and pushing for your husband as nobody else will. If a bed becomes available they might be more likely to move him in order to get rid of you sad but this is the way things are. On every Ward we've been on though the staff have been wonderful.

As others have pointed out pretty much all wards these days. Awful places to be when you're sick. they're noisy with people making noise continuously throughout the night you might find the correct Ward isn't actually any better.

Many people these days seem to find it acceptable to play music on their phones without headphones on hospital wards.

Ah, I see the ethical dilemma if it could make their condition deteriorate, though if I were in this state I would want to be helped to be less distressed and would not want to have my life preserved at all costs when this was the quality of it. We need a much more grown up conversation about end of life options, including euthanasia, in this country. Also, of course, much better social care provision too.

I guess it’s the problem of having wards instead of all private rooms in hospital. No thought is given to creating an environment conducive to recovery or healing when the hospitals are designed. And I guess they’re running at a level of fullness often that precludes designating certain wards to dementia patients so they can be cared for in one area. It’s a shit show all round for everyone.