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

Sadly I’ve never known it to be any different on any hospital ward.

dd was 17yo and put on an adult ward in a bay with 5 elderly ladies, a couple of whom had dementia and would shout, etc. one got up and stood on her bed at 2am one night and was shouting. The nurses loved Dd as she’d buzz to tell them when one of the ladies was trying to climb out of bed.

dh was in hospital earlier this year and on a 4 bedded bay which was full and in the middle of the bay for 3 days was a man on a recliner. They’d run out of beds. This is how bad things are.

a colleague was on a ward but on a bed in the corridor as the bays were full and was there for a week. No buzzer, no curtains, no privacy, lights on all the time, people walking past. One night at 3am another patient jumped in her bed and pissed on her!

Yes they are distressed
No there is not a handy pill that stops them being distressed. That is the holy grail and it does not exist
What works is space to wander, safe things to fiddle with, skilled nursing care, a familiar homely environment. All basically things that are not able to be provided in an acute hospital whilst also providing physical healthcare to people with a variety of needs

I have worked on a dementia ward.

And as to segregating the people in a special ward that already happens but demand far outstrips supply.

You would be better off to segregate the younger people somewhere else because nearly everyone in hospital is over 65.

My step dad was in recently with pneumonia and had the same issue. He was on a general medical ward for a week and although they moved him to different bays he stayed on the same ward and in each bay there was at least one person with dementia. It's just how it is unfortunately. The system is pretty broken.

You can speak to PALS. But if it's a case of the fact other patients are disruptive there's no guarantee it will be better elsewhere. It's unlikely they'll give him a private room as those are for people with infections or very severe illness.
It really is luck of the draw who you get in your ward. The fact he's on a surgical trauma ward but most are dementia patients shows they're probably already very overcrowded. Make sure he has ear plugs at least.
I hope he's better soon and can leave.

I have a chronic lung condition & have spent alot of my life in & out of hospital. I have always been given a side room on the respiratory ward due to risk of infection from other patients & due to the severity of my lung condition they will actually sometimes move a patient to another ward so I can take the bed on the respiratory ward. As well as spending time on other wards. Unfortunately this is what it will be like on majority of wards regardless of where he is placed, as an elderly person for instance isn’t able to just be discharged as soon as they’re better as their living circumstances may no longer be safe ect. I have had people wonder into my room, use my toilet, even had one elderly man come into my room & take my lunch why I was at the nurses station talking to the nurses. My dad also has the same condition as me & an elderly woman once wondering in complete naked!

Whilst all of this response is true, the idea that families can “take them in” is ridiculous.

And it isn’t just full of people needing “social care”- people distress at night, incontinent or defecating in inappropriate places are in severe cognitive decline and are in need of skilled care or even full blown nursing care.

my dad has Lewy body dementia. LBD is particularly characteristised with poor REM sleep, delusions and hallucinations. He is given low dose anti psychotics but they do not stop his distress or his ability to distress or harm others.

he is sectioned under 117 and has deprevation of liberty. He is doubly incontinent and cannot walk . He requires 2 staff and a hoist to change him and clean him.

he was taken to hospital last week with blood and clots in urine. Despite the RESPECT form, the family decided he’d be in pain and to call ambulance to take him to hospital to get on top of it. Otherwise he’d have been treated in his nursing home and might have been in severe pain - he needed catheter and scans to understand what treatment would be appropriate given his condition. . They kept him in one night. He was discharged to his nursing home

Previosly this year, prior to respect form, he was in hospital for 6 weeks- before they could£ find a new nursing home to meet his needs (the one he’s in now). Prior to that he’d been in 4 different places in 1 year, including mental health wards.

The idea that we as his adult kids could go to hospital and say we would take him home to look after is naive and dangerous assumption. He has DOL in place for a very good reason. He is a danger to himself and others. Violent at times, agressive. And hugely distressed. We would also be likely to injure ourselves trying to meet his personal needs in terms of changing etc. he would not have access to a bed and chair both with anti bed sore mattress .

a poster above mentions that nursing homes are in short supply. This is true. My dad bed blocking earlier this year was becuase a place for his particular needs simply wasn’t available at all in his nhs area- eventually he was placed in next door health authority in one of the few beds anywhere for him.

It is thankfully a very good place, they can nurse him, manage his distress and aggression, and are brilliant frankly. No one could provide thst level of care in any family unless you happen to be trained in geriatric/mental illness nursing .

And even then you are completely overlooking that family would need to do 24/7 shifts. It also is a huge stress to relationships - I know as I looked after my dh for 20 years with mental illness. the toll it takes to do this leaves carers mentally ill themselves, and often poorer from having to give up work.

fine if in your situation you could , or think you could, do this by “taking them in”. I’d be interested if you’ve ever had to do this yet. Thank god my dad has professionals looking after him. They are skilled, trained, and work sensible hours before going home each day and getting proper down time to relax and distance themselves form an extremely difficult job.

Well because I've had a lot of experience I suppose.

For those stating about sedation.

Imhe, The NHS seems very adverse to giving sedation for anything other than the shortest time.

the evidence is clear that it does hasten death.

but as an alternative they prescribe low dose long term antipsychotics in a lot of cases . Even though the evidence is far from clear in clinical trails is does anything at all. And equally can cause increased risk of death and shorten
life span. Given antipsychotics are not, according to registered uses, recommended for dementias, (I know this as used to work for company making antipsychotics) this seems to be a particularly uk nhs thing.

my dads care home are part of a Clincial trial to try to find alternate drug protocols rather then antipsychotics to manage the extreme distress, aggression, delusions and hallucinations that these dementias can cause (varies according to which dementia type).

Right now psychiatrists, GP, nursing homes etc are very limited on what they can give, in terms of drug protocols, to distressed and agitated dementia patience.

Even if that patients is Sectioned under mental health act , there is no authority for any nursing staff or care staff to restrain or restrict a patients unless they become a danger to themselves or others. I was horrified to learn that my delusional dad had been going into elderly women’s rooms in a previous care home, when he could still walk, in the middle of the night. They can’t put locks on doors and we were told they couldn’t restrict his movements within the DOLs closed wards. It’s bonkers. But it is what it is.

id also add we’re living longer due to treatments for heart conditions, cancers and the myriad of diseases that used to kill people off in their 70s. The number of people with dementia is growing, as it is a disease of old age and will increase for an aging population. Until a major breakthrough happens in treatments we will see nhs wards dominated in all specialist and non specialist wards by elderly with cognitive issues or in extreme distress.

BUT, it has alsways been present. Perhaps in lower numbers. I was on surgical ward in my early 20 in 1990s and remember an elderly lady shouting all night and crying, and another who snored terribly. Even when I had my c- section in 1994 I left hospital after 4 days chronically sleep deprived form other women’s babies crying all night and coming and going on wards. Seem to remeber there was blood puddling on floor occasionally and other post partum leakages. Hospitals are not like a school dormitory, or hostel. They’re full of distressed, ill people and all the unpleasantness that goes with that in its most graphic form.

OP, This is standard. As others said, accept and mitigate with ear plugs and make sure he always sleeps with alarm within reach. Talk to staff to see if he can have some meds at night that can help him get back off to sleep quaintly if disturbed like co- codomol (if he needs painkillers) or an antihistamine tablet. Even with more beds in nhs , he’d come across this in any ward in all probability due to aging population. No, it’s not great. Get him home asap. And give him tlc and good sleep for multiple days to recover.

This is very true.
itvtook a long time and a lot of pushing, to get our dad recognised as end of life and get a RESPECT form in place. He was in hospital in feb prior to this and it was grotesque to see him like that.
he is now in a specialist nursing home. A rare beast that has good trained nursing and care staff, and a purpose built home. He/we are very fortunate in that respect. He has Lewy body dementia and is 88.

but even then he was taken to hospital last week. Eldest sibling contacted by Gp In middle of night as dad in great pain and distress with bleeding, clots in urine . We decided it would be cruel not to admit him to hospital to try to relieve his pain - he was cathetered, put on if antibiotics and discharged back to the home in 48 hours …better for him and he is now much more comfortable.

but the RESPECT form is very clear that he’s not to go to hospital now by default. It is only for his comfort and quality of life- not to prolong life.

he had a heart attack/stroke a couple of months back. He had stopped eating and drinking for about 4 weeks prior to that . We were all called and sat with him 24/7 for 4 days. He then bounced back- went back to eating and drinking albeit is now on mushy food diet only. I think, sadly, all of us (his children) were left a little disheartened that it didn’t kill him. His quality of life is appalling, despite the better than average nursing home . He has a firm grip on life, despite his end of life pathway. 😢

@Dartwarbler
You've misunderstood the meaning of my post - I was highlighting the exact thing you've gone on at length to explain - that the level of care they require is significant/specialist, the beds for these patients just aren't there in sufficient quantity so they remain in hospital - numbers of these patients are increasing/community beds decreasing so hospitals are overflowing with bed blockers they're unable to safely discharge- because the alternative is to knowingly discharge them to somewhere that clearly couldn't cope/cater for them, such as their family where no doubt all adults would be out during the day working/no adaptations in the house - they will actually do this eventually but you've got to have a lot of pressure from NOK/PoA health to demand it to occur - where as many of these patients have no regular contact with family/let alone a family that would advocate for them.

As an example check out this thread, it's a situation unfolding yesterday: https://www.reddit.com/r/NursingUK/comments/1f5vebh/canibeforcedtoworkfor24hoursstraight/
There's a single nurse covering the entire home, night staff have called in sick so she's left to cover for 24 hours because no other cover. This is a nursing home in the UK with a single member of nursing staff covering the whole home for 24 hours straight/wondering about just walking out leaving the residents on their own and the keys on the desk - apparently a situation that happens routinely. - The manager apparently just turned their phone off at the request for help!!!

My Dad has dementia and was in hospital two weeks ago. Sadly he had to be there for treatment and the change of routine is scary plus his infection meant he had delirium (dementia patients are prone to delirium.faster) and was a pretty awkward man for half his stay, until the antibiotics kicked in. He's absolutely not an awkward man.

It response of the nurses was tangible when they realised I was happy to bring him back home (he lives with us) as soon as they were able to safely discharge him. The ward was full of elderly many with similar issues and clearly unable to live on their own at least at this point.

My dd tried to take her own life and ended up in the ITU on a ventilator for 3 days. She was discharged from there........to a maternity ward. I kid you not. The midwives were baffled and dd was discharged swiftly after that with no mental health support whatsoever. I dread to think what would have happened had our wonderful GP not been able to refer her to the crisis team.

As a Paramedic I routinely come across worse/mad desperate situations. It's relatively normally for pt's as described in the OP/patients who are normally completely disorientated, prone to agitation - yet live alone in the community locked in their houses - family monitor on cameras, carers drop food in etc. (we turn up because family see they've fallen on the camera/carers find them on the floor so we turn up to pick them up) - then end up in a weird decision making nightmare - essentially no new medical problem which needs treating, pt doesn't have capacity but there's a not for hospital plan in place/family say don't take them to hospital as it's a nightmare to get them home again and reset up the care package (because it's clearly unsafe and only occurs due to pressure from family not wanting them to be in hospital), goto flag to safeguarding or social referral but then they're mardy because no one has consented and we're arguing it's best interests for a review.... And we're left deciding either to lock them back up inside the house and walk away (a patient with no idea the people in green are paramedics, can't hold any kind of conversation or answer a simple question, wouldn't recognise they need toget a drink from the tap - but they're in a property with a cooker/electric kettle, knives.... ) - or take them to the hospital as a place of safety (which can seem like the obvious thing to do).

However in practice this means taking a patient whom quickly becomes terrified because they don't recognise who we are/what we're doing and won't be reasoned with. We're not allowed to sedate them for transport- so if we're taking them it;s a case of physically restraining/tying them up with blankets and strapping them down whilst they thrash out/try to bite absolutely terrified. Knowing that the agitation will continue in hospital (as it's not acute disturbance of the mind due to infection etc). This is essentially what commonly happens but essentially they were less agitated locked in the house alone, but essentially if they're found dead x days later then you have to justify why you allowed it to happen. At the start I (correctly I still believe) felt this was a decision above that of what a paramedic should be making and would call the GP/OOGP team because I often genuinely think the situation living alone is kinder (but not easy to justify on paper really), however they resoundly will tell you to of course take to hospital.... but then they're not the one that has to hold their hands down during the transport to stop them escaping the restraints whilst getting scratched at and bitten - genuinely traumatising for both of us.

I hope she is feeling better now?

Also hope OPs DH is better soon. This is a depressing thread.

When my husband was in after surgery went awry he was on the urology ward. Most of the other patients were elderly and would walk in the night. The nurse said to him that every ward is a dementia ward now. The wife of one elderly man was adamant he never walked anywhere when my husband said he was sundowning most nights. The standard of care in this country is so below a decent standard and we are paying for it.

How is the standard of care related to people having dementia??

Our care of dementia patients is actually very good.
There are some patients who need a 1:1 not least because of wandering/ falls tisk but there is not always staff to come to the ward from management.
Most young people are discharged quickly so the vast majority of in patients in hospitals have complex needs/ disability/ dementia /multiple comorbidities or are medically optimised but the family can't cope/ doesn't want them home/ isn't able to care for them and they wait weeks to months for carers or a placement.

Just read it again, still reads like I read it 🤷🏼‍♀️. But happy with your clarification now. We are therefore on same page 👍

After my Dad experiencing this, and then me going thru it for one night I have never stayed in hospital without earplugs and a sleep mask. I even keep disposable earplugs in my handbag just incase I taken in in an emergency. There's no saying another ward would be any better. Even if the ward is quiet there's always knobhead families who pitch up and disturb the peace anyway. Can you get any earplugs to him?