Shaking with rage, can't sleep, NHS treatment of elderly

[Krupkrups]

My Grandma (89) has finally come out of hospital tonight finally after nearly nearly 5 weeks.

There's been nothing wrong she had a fall nothing broken, nothing but they wouldn't let her go home my uncle has lived with her for past 8 months since his divorce and she had a career who comes on a lunchtime. They said because she didn't have anyone at home which is bullshit, then social services got involved who were a shower of shite, then the hospital 'forgot' to discharge her twice despite my parents, uncle and care team being at home twice waiting.

Before going into hospital she could;

Get herself and dressed nicely

Get Downstairs / upstairs

Get herself to toilet and wipe herself - no incontinence pants

Make herself food and drinks (hot drinks, kettle on etc.)

Do crosswords

Move around the house with, slowly and with the help of a stick and frame but she did

Her memory was clearly going and she has slowed down cognitively in conversations but she knew we all were still enjoyed face times from my children, still read the paper.

She's come out and frankly it's like she's come out of a Victorian asylum, I am heartbroken, she looks deranged when she's awake sunken eyes strange rolling eyes, has lost an absolute load of weight - she was always very slender possibly too slender before now she looks like a famine survivor.

She is incoherent most of the time when awake.

Can't get out of bed / apparently is imobile - well yes she is now

Can't feed herself isn't eating when being fed

Is wearing adult nappies which have to be changed and the carers are changing and wiping her mess

Is covered in bed sores

I am weeping and raging I feel like driving to the hospital and punching the nurses in that ward in the face!!!! What have they done to her.

I agree with all that. There also needs to be more whistle blowing and internal reporting systems so staff can report things. If you read consultant Peter Duffy's "Whistle in the wind" book, it's very illuminating as to the attitude of management when reports of lazy/incompetent staff are made, even by a highly experienced/respected consultant. Basically he was the one hounded out! That tells you all you need to know about the current NHS!

The bed sore situation is appalling. Care has gone right downhill since I started in the NHS 45 years ago as a nurse.
I'm a podiatrist now and I'd say around one third of the people I see are horrendous heel pressure sores on people who have been in hospital.. it's appalling and no amount of reporting changes anything.
I've been left disabled due to hospital and GP negligence and this should never have happened.

I'm pretty accident prone and went through a spate of having falls in my flat (slipped on the laminate flooring whilst not wearing non- slip socks, twice, then fell off a chair I was standing on to reach up for something). I'm in my 30's and had no real injuries to speak of, but did suffer from very painful costochondritis (inflammation of the cartilage between ribs in the middle of your chest) for months on end and I ached generally all over for a few weeks after each one.

Now imagine that older people are generally more frail due to their age and different physical makeup than someone who is much younger, they may not have as much fat on them to cushion their joints and muscles if they fall, healing in general is much slower for them too. Then there is often a psychological component too - the fear In older people once they've had a fall can be very intense and make them very scared of mobilising after it's happened.

It's fairly well known that, again especially with older people, every day you're in hospital it takes you a week to recover from it - so if she's been in hospital for 10 days, that 10 weeks it may potentially take to recover from it. Muscle wastage per day that someone is in bed in hospital is anywhere from 2-5%. If she had developed delerium as well (can be either hyperactive eg very agitated or hypoactive eg very sleepy, not interactive with people, not eating etc) that would further make her recovery more difficult.

They should not have allowed her to develop pressure sores, though. She should have been regularly repositioned from one side to the other to try and prevent these from developing. Even then it can be tricky sometimes - especially if someone is very frail, they can appear very quickly if they're on areas that don't have much cushioning, regardless of turning frequency still, especially if they're in bed all the time.

Might be an idea to get GP tests as it could be an infection. These can cause symptoms similar to your description - at least to eliminate. My handicapped brother had the same.

I work for the NHS and the number of family members I hear telling me they cannot cope and need “something done” cos their elderly relative keeps falling enrages me and I have to start steps to get the person admitted to hospital for their own safety as the family have seem to given up.

This process then overwhelms the system and we end up with numerous bed blocking elderly patients not getting the correct care as the wards don’t have enough nurses to care for them properly.

I'm not sure what you're enraged about?

What do you mean the family seem to have given up?

What do you want the family to do when an elderly relative keeps having falls?

Look after them better?

instead we get them stuck in ambulances outside A & E for hours with non life threatening stuff or bed blocking also causing an ambulance and overall drain on resources.

When it needs whistle blowing to solve an issue then it has already been left far too late.

The feedback should be an integral part of care provision. What went well, what went badly. Of course you have to sort the wheat from the chaff but if something keeps coming up then managers/supervisors need to be addressing it.

I think you missed my point or maybe I missed yours .
I agree I don’t blame OP at all

I think there needs to be more support given to family members to stop burnout. Quick response crews to get people up rather than waiting many hours on the floor. Have a care system that functions rather than waiting for crisis point. If people knew they could ask and recieve help in a timely fashion when necessary they wouldn’t be constant refusing to have people return home from hospital.

Ooh you're a treat.

My Grandma is 92 and till a few months ago was living independently then started having falls.

Her eldest son is 71 and having chemotherapy. Her next son is 69 and recently bereaved after years of caring for his wife. Her eldest daughter 60 and has a benign brain tumour. Her youngest daughter 58 and on palliative care at home.

They've all mucked in for years. Shopping, cleaning, taking her to appointments, managing her finances and just being with her.

And before she broke her hip and was admitted to hospital were going round in emergencies when she'd fallen.

How did you want them to look after her better? Move in? When she fractured her hip did you want them to not bother the NHS so she wouldn't block a bed?

I think you might need to leave the NHS love if you're so burned out you think the elderly are a drain on resources.

In many cases, there are simply not enough staff to be able to do this.

We were very happy to be asked to arrange visits to coincide with meal times, it meant we could feed Mum, staff could feed those who didn't have family, this was in 2016.

The money paid to the staff expected to do this is literally peanuts, less than they would get on the 'tills in Tesco, same with Social Care.

There is another thread on here complaining about what a struggle it is on a £120k pa family income.
Many people really do look down their snooty noses on people who clean, care etc for others.

@DoingthefullGareth But that isn’t what this thread is about. Many of us have had the experience of an elderly relative going into hospital fully coherent, mobile with no continence issues and coming home a short time later a shadow of their former selves due to poor care.

For what it’s worth, my nan had family visit her every day, we did her shopping, her cleaning, took her to appointments etc. We couldn’t have done any more for her yet the NHS destroyed everything within a few short weeks. We didn’t get the same person back.

I think this highlights the issues 'social ' care services are experiencing, and how it directly impacts the nhs/ hospitals. There are many 'bed blockers' and a number of elderly people are admitted into acute hospital beds for purely social reasons.
Closer to home was a reasonable policy in theory but the govt have failed to deliver. We need more community beds!

Again going to have my tin hat on.

The elderly ARE a drain on the resources of the NHS as they are at present.

More money is poured in and the results are worse and worse. In other countries the family are expected to step up and look after an elderly person and of course there are cultures where the elderly person lives with their extended family.

Until we start to accept that a lot of us are going to go on well into our 80's and 90's nothing is going to change. These elderly people are unable to do a few more hours at work or indeed work at all. Yet their 'demands' are huge on the NHS resources. Bed blocking and such like. Having time to go to the GP time and time again. My friends Mum in her mid 80's is a regular. Knows the key words to use to get an appointment.

My suggestion is that we start to fund elderly care from the time we start work. An extra say 1% that goes into a elderly care pot. Special hospitals set up who specialise in elderly care.

Of course the usual suspects will claim that Amazon should pay, billionaires (the handful that are eventually left!) or even Bill Gates! They wont want to pay for anything that they might not end up using. Well welcome to the real world.

That is what insurance is for. Its a complete waste of money until you or your loved one needs to use it.

No one wants to pay for improvements. They just want others to do it.

Yes,every time I visited hospitals it was full of elderly people on the wards.

Screaming, trying to get out of beds with broken hips. Attacking other patients - I have seen it all. Last visit I found a women who had decided to visit the mens ward which was literally in the next bay. I tried to guide her back because she was trying to get into bed with some poor chap who look horrified. She was also only wearing a pull up. Eventually as I was talking to her to try and persuade her to come back with me a nurse turned up.

Not surprisingly I am still working in my 60's to afford private care. There is no way I am sharing a ward with anyone.

We cannot keep going like this. Lets have a grown up conversation about co payment. Something that makes people quite honestly take responsibility for their own health. Not demand a wheelchair so they can go out for a fag!

And yet if someone is in hospital for more than 28 days disability and carer benefits are stopped because the DWP deems the NHS to be caring for them

Having spent many, many hours sitting with DM in A&E on different occasions I do wonder if a Geriatric A&E department approach is needed, similar to children's A&E departments.

Staff trained to communicate with patients who may be struggling with understanding what's going on. Better access to get social services assessment. Greater willingness to listen to family members who have a better understanding of the patient's situation prior to arriving in A&E.

My local A&E seems to be set up to deal with healthy people who have suffered a calamity. However, when I have been there a significant proportion of patients are elderly with more complex needs. (There is no privacy in A&E).

Obviously the OP needs to put in a complaint with the hospital. Best thing to do is to number all your complaints so they can be addressed one by one.

It isn't always as simple as a healthy person being admitted when it happens to an elderly person. Often there are under lying health conditions, frailty, even just the change in environment. Then the risk of hospital acquired infections to consider. Not to mention assessments for further care and things can change overnight (an elderly patient may fall, develop abnormal blood results, a high temperature/infection any of which might change care parameters).

In their own home with familiar surroundings and routines many older people cope well, even with some cognitive issues. But they often struggle with a hospital environment which is noisy, stressful, unfamiliar and can be scary.

I don't know wether the OPs complaints are valid or not, only thing to do is communicate with the hospital directly.

I couldn’t agree more @MichaelandKirk but that’s a difficult conversation that few want to have unfortunately.

They cannot discharge without a care plan in place if they deem her to be unable to look after herself, its not safe. If they sent her home with no care plan and she fell again then she would end up straight back in hospital which is not what anyone wants. It can be distressing, my Grandfather waited 6 weeks for there to be available community carers before they could discharge him. Social care is a mess.

Old people can deteriorate very quickly, and I experienced this with both my grandparents. It's awful and distressing but ultimately it's not the fault of the nurses there.

I'd say a lot of the current problems go right back to "care in the community" when we lost a huge number of beds in "hospitals" due to closures. Our small city had four "hospitals" which were basically a mix of convalescence wards, OAP wards and disabled wards (mental and physical), some long stay (semi permanent) some short stay. Literally hundreds (maybe even over a thousand) of beds between the four "hospitals", which were mostly for "care" rather than medical treatment. I remember in the 70s my grandma going into them for a few weeks after every hospital admission, likewise my 18 year old brother went into one after a bad motorbike accident following several weeks in the "proper" hospital, for learning to walk again after he'd been in traction for a broken femur. Minimal doctors and qualified nurses as they could deal with lots of patients during the working day and most didn't need medical treatments anyway.

When all that was got rid of and we switched to care in the community, we now have doctors and nurses driving round between peoples' homes, probably spending as much time travelling (especially with congestion etc) as they do actually attending to patients. Likewise with carers. So more likely that the patient will do more harm to themselves as they can't have the same 24/7 supervision (except in the most serious cases), and when they fall, etc., it could be very long waits until help arrives.

Care in the community was a good idea, but successive governments haven't increased the numbers of doctors and nurses accordingly to account for the fragmentation of location of the patients, who may be spread over a very wide area. At the same time, we should have doubled or trebled the number of medical school training places for doctors and nurses, especially when we then went on to give the GPs the new contract meaning they could opt out of antisocial hours, and then of course, population growth.

Now we have the double whammy of people languishing in hospital beds because they've nowhere safe to be discharged to, despite no longer having medical needs, at the same time as doctors and nurses in the community being grossly over-stretched meaning less able to cope with lots of people needing care at their homes.

Similar situation here @Badbadbunny My town had a main hospital and a separate one for elderly care which worked well for years. Then the decision was made under PFI to knock the old hospital down and build a smaller one and close the elderly care unit completely. The rationale was ‘care in the community’ and care homes would be utilised to prevent bed blocking.

Of course none of that happened and now we have a growing town with a hospital that was far too small for the population when it was built many years ago and I dread to think how many more houses have been built since then.

The proper care of the elderly has always been an issue, back before "Care in the Community" yes we had far more beds, we had huge Geriatric Wards, patients lined up suffering from all types of dementia etc etc.

My mum worked in these, she said they were awful places, after she retired from the NHS, she worked as a Matron in a privately run Nursing Home, the care was far far better but since then, funding for these has been slashed, thanks Austerity!! and beds are scarce, along with decent staff.

100% to the pp who said we need to have some sort of social tax, paid specifically to fund our elderly care... a re invention of National Insurance if you like.
Expecting the likes of Amazon etc to pay is silly.

My MIL recently experienced similar incompetent treatment in hospital. She went in for a routine procedure & was meant to stay for one night……she finally came home six weeks later after suffering pneumonia, norovirus and a stroke. The staff didn’t even realise she’d had a stroke until at least 12 hours later when DH went to visit and it was completely obvious because she couldn’t move or speak. She had missed at least two meals during that time and no one had noticed her symptoms. She went into hospital independent and now needs a lot of care. She’s lucky to be alive.
I have always been a huge supporter of the NHS but now don’t think it’s safe.

This is so sad, and I feel so sad for you and your Grandma.
She may have delirium which has possibly worsened following discharge from hospital - Google nhs delirium information for some tips on how to help her out from your side.

I’m a nurse (no longer ward based) and regularly comment on how patients decondition during an in patient stay. Often this is due to irreversible causes but also because the patients need to be out of bed and encouraged to mobilise.
definitely report to your GP. A safeguarding referral should be completed and make sure she has a district nurse visiting regularly for her sores.