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.

My dm was in hospital last year and they “forgot” to feed her lunch one day and despite her asking multiple times, it never arrived. Dm was 69 at the time and totally with it. Matron was so dismissive when I questioned how it happened. I asked calmly but matron said “you need to stop shouting” … I wasn’t at any point raising my voice. I did say “this isn’t okay” which sparked her comment. Honestly, I think you need to watch loved ones closely when in hospital. Some nurses are amazing but some are not!

My gran is 92 and fell recently. She was only in hospital for a fortnight but she declined cognitively very rapidly, which apparently is not uncommon for geriatric patients with a hospital stay. She has rallied a bit since coming home as we were seriously considering a care home for that first couple of weeks, but while she has regained some cognitive ability it’s clear that there is a degree of permanency to this change.

It’s part of the reason why falls and stuff are so dangerous in the very elderly, not just because of the physical aspects but the effect it can have them on them cognitively.

Oh, it didn't take long for the racism to surface.
Nurses who qualified in other countries have to meet UK standards as outlined by the NMC
https://www.nmc.org.uk/registration/guidance-for-employers/nurses-and-midwives-trained-abroad/
In my experience, most overseas nurses are more sympathetic to the elderly as they are honured and cared for by family, not consigned to the 'too much bother' list as often happens here. We also only see the person they are now (frail,, confused, too slow) rather thaan realising they once may have been a ceo of a ftse 100 company...

Elderly frail people are characterised by their inability to right themselves again after an assault to their health. Your gm suffered a fall, and that will have triggered the decline, on top of that a change in environment nearly always triggers deterioration.
As others have said, check for a uti

And how do you know they didn't train in the UK?

and then he said after about 3 days she just slept for another 3 and again no one would give him a straight answer as to why

So, an elderly person, who had a fall, ended up sleeping for 3 days straight essentially. I imagine the staff couldn’t tell your uncle why as they were trying to work out if there was something going on that was causing this (and which may have also been relevant/or not to the fall). It’s amazing when the system does investigate things, it’s slammed, and on the other hand, if it doesn’t bother and just ships people out the door it’s also slammed.

It’s very common for a fall to precipitate a natural turning point for many elderly. It’s not at all unexpected she is very different to the person you saw previously. What are you thinking the hospital staff have done to cause this? The only thing that screams out is if you say she was sent home with bedsores? That shouldn’t occur. Otherwise, unfortunately it’s a progression to the new normal for a very elderly person. I’ve seen people who were spritely, active, very mobile, completely independent in all aspects of life, cognitively sharp, turn into the recognisable husks in a very short time post first fall, and that’s even with excellent private medical care, no expense spared and timely discharge.

If you believe she’s become significantly more confused post discharge, maybe get GP to rule out UTI, dehydration etc, otherwise it’s what happens with age I’m afraid.

What is a peripheral catheter? Ironic that you are complaining about nurses not understanding you.

I've just come out of hospital after major surgery.
Our local hospital has a bad reputation as it is in a poorer area with posh surrounding villages. The MC don't like to go there. I would say the clinicians are also 50% not white. That makes for some pretty shitty abuse of staff. I'm in a mixed heritage family so it never surprises me when people say things in front of me about their care from foreigners.
My recent stays (January and March) have been fine. Food, personal care and surgical.
I went in with a bed sore and it was spotted on day one. Ditto a chest infection. I was in a room with two behaving badly women (70+) who expected the nurses to work as their scivies (one asked for the nurse to go down to costa!). Neither was doolally pop.
What I did come home with was an allergy to codeine.
I fainted three times, once with injury. Turns out codeine has a contraindication of virtigo and fainting. I'd check any elderly persons meds for that drug and get it changed.

Many wards operate a 'protected meal time' visiting system ie no visitors during meal times. This can make it difficult for visitors to know if their relative has eaten.

Staff don't always notice that someone hasn't eaten for several meals if there isn't a process for recording if meals have been eaten.

Turning a frail person without risking injury to the patient or person doing the turning takes training. It is not something to be approached without knowledge.

Years ago I was outside a day unit. Not in uniform as didn't wear them but did have a lanyard on and was smoking in the designated smoking area.

Some nice soul going into the building shouted out 'yeah love have a fag, fuck the patients that need you. Hope no-ones dying'.

I took literally 5 minutes 10 hours into an unexpected double shift because of staff calling in sick for the shift after mine and was shaking after a serious incident where staff were assaulted and Police had to be called. They'd literally just driven off with the offender in the Police car.

I don't smoke anymore and it was years ago but back in the day when smoking was more common that was another tired trope 'staff outside smoking fags instead of looking after patients'.

Some people don't really want NHS workers to take breaks, eat lunch, talk to each other unless about the patients, smile or laugh unless it's with a patient...

They may have been students, not nurses, so would still be learning.

Yes, I watched my Dad, Mum and DH in hospital over the last 8 years. Some pre-Covid. Despite my and the family’s vigilance, the standard of care was awful to see.

They all died after a decline that began with going into hospital.

Elderly care (or lack of it), in hospitals, needs to seriously addressed. 😡

It is awful. I remember 20 years ago, when my grandmother was dying, the elderly patients couldn't feed themselves properly, staff would return to take a nearly full plate away.
My mother and I could visit at dinner time, geriatric ward, to spoon feed patients.
My grandmother always had beautiful hair, it was filthy arriving at the hospice.
I still think about those patients.

I do think lots of older people go downhill dramatically in hospital. Unfamiliar environment. It’s exhausting as so noisy and they are forever being woken up. I used to work in a care home and people would come back in some shocking states from hospital. Unwashed, teeth not brushed, ointments not applied, the hospital don’t want to risk another fall and can’t spare the staff for commodes so tell them to go in a pad / nappy which is also distressing if you are continent.

That said even with the best care often when family are going into hospital and doing lots of care. sleepless nights in an unfamiliar environment, a bit of damage from being on the floor and often there is a downturn in abilities so it’s hard to know if it’d of happened regardless.

I do wonder about logistics of an ambulance with x ray. That can pick you up, check for breaks, pop in bed to rest and refer to reablement team. I have met a lot of people who were doing really well then had a fall, hospital stay, then needed substantial care. I’do think it’s something older people should be thinking about/ talking about rather just accepting the slow conveyer belt of NHS care.

I’m sorry OP that you are going through this. I have sadly a lot of experience of NHS and elderly care (my elderly relative passed away after being in and out of hospital from falls and dementia). I must admit sometimes it wasn’t amazing but on the whole it was great care. The nurses (particularly then student ones who seemed to have a bit more time) were so lovely with her, sitting and brushing her hair, painting her nails and chatting with her.

One patient would get distressed being alone so they would let her sit at the nurses station with them.

Im sorry your family member hasn’t recieved the same care but sadly falls can really make the elderly deteriorate quickly. It’s almost a good thing though as slow deterioration is absolutely horrific.

Not the person from the quote, but its a catheter inserted into a peripheral vein, they’re used to give fluids, medications, take bloods etc. Others are more ‘invasive’ peripheral catheters like a PICC.

You're right, a lot of patients lose their abilities simply because they are in hospital and perceive themselves as ill and give up. I think it's a combination of age, exhaustion and being in an environment where everything is done for you. In rehab facilities they have to be encouraged to care for themselves where they can. They can come in with a fractured leg and lose the ability to use their arms. If not checked this soon develops into helplessness. OP I hope you sort things out for everyone concerned.x

Hospitals are often neglectful of the elderly who really require a family member to be with them at all times to advocate for them and encourage them, to keep them mentally resilient.

From experience, they are not encouraged to drink every half hour because the drink often has to be handed to them and the staff don’t have time. Patients often can’t reach for a drink.
Food is often brought to their bed table, and taken away untouched when they don’t eat. Sometimes it’s not even cut up. It’s unsurprising she lost weight.

But your GM falling asleep (as your uncle described for 3 days) would have dehydrated her and sent her bloods awry, leading to confusion.

HUGE 🚩…. a patient sleeping and unresponsive. The bedsores would have developed then due to a failure to move and likely sitting in wee.
But just being unmoving jn one position would have done it due to the blood supply in an elderly person being more sluggish so the tissues aren’t as well perfused.

MASSIVE FAILURE on the hospitals part and the ward needs reporting for total abrogation of care.

Likely they were stalling her discharge because of the extra care she now needs and knowing they failed her due to the bedsores.
Cynic that I am, her hospital notes would be a revelation to read! Altho you can’t even be sure those are strictly accurate.
My DMIL developed a bedsore after only a v short stay in Hosp.
She fell in hosp whilst getting out of bed to go to the loo because she couldn’t call anyone as the nurses had taken her buzzer to give to another patient. NO record of the fall on her notes!
We got her out within days but she sadly never recovered.
My experience of nursing elderly patients they need someone at their bedside all the time or a ward specific to their healthcare needs.
And to get out asap. They lose a sense of time and space when removed from their home environment.
Wishing you well.💐

When they are in hospital at that age, they aren't encouraged to get out of bed, it is easier to keep them in bed.
Her muscle mass, which will already be lower due to age will have decreased further due to inactivity. Sadly, she will not be able to build that muscle back up. It is just vicious circle 😞

Too late in your case but if there isn't a good medical reason for an elderly person to be in hospital, keep them out!!
If a hospital acquired infection doesn't get them, neglect due to understaffing will aid their downfall 😢

If they’re so against forrin nurses, why don’t they go become a nurse themselves?

most wards also have a limited supply of commodes, so that is not much fun

OP, I'm not surprised you're so upset. I can't tell you exactly what happened or why it happened, but I think it would be worth you/your family contacting PALS about your concerns. They can do a deep dive, review notes etc and let you know what happened to cause the deterioration. If there were shortfalls in the care given, then that would be addressed.

Sorry, this is long:
I'm a nurse. I work as a Sister on a very acute respiratory ward. We have patients of all ages on there, from late teens to very elderly. Some are independent, others are not. Some are on vents or have tracheostomies, some are on very high amounts of oxygen and some are not. When a patient comes in, we do a ream of paperwork for their admission, showing what their usual function is (mobility, washing/dressing/toileting, sleep patterns, eating/drinking etc), and what changes there are currently due to the presenting complaint. We talk to patients/NOK/usual caregivers about what is the norm for that patient. Appropriate referrals are made at that point for physio, dietician, SALT etc.

Pressure damage is taken extremely seriously by our hospital. If a stage 2 is found, we file an incident report (and a referral to tissue viability is done, along with family being informed). Waterlow now replaced by Purpose T (risk assessment), and these need to be done and updated frequently. A body map should be done on admission. I also insist that a new one is done at least weekly for patients (and more often if there are changes). If a patient is transferred to another ward or care setting, we will do one. If someone is sent home with district nurse care, we do one and include it (and other MDT notes/plans in the referral). If we can mobilise people or sit them out etc, we'll do that. Not always easy but we don't like to leave people in bed all day, as they can decondition quickly. Example: Friday, I was in charge of the ward (30 bed, full of course), I was 3 staff down (and they wouldn't send me any). On one side alone, I had two patients that needed assistance of 2 and a Sara Steady for transfers (bed to chair to WC) and one patient who needed 3 plus Gantry hoist (this is for patients over a certain weight) - same patient also needed 3-4 staff to help with turns and personal care. I had a 10min break in 13hrs to stuff some food down me, and did a lot of running!

Anyway, I digress...there are often times where patients will refuse to sit out or refuse to be turned or have their physiotherapy etc (despite having the capacity to refuse it). This is difficult because we explain clearly the importance and rationale for doing this and the risks inherent when this stuff is not done. They understand but still decline. The only thing we can do is document these conversations clearly, inform MDT and family... and then ask again later on. [On the subject of informing NOK, if a patient has capacity and consents to it, then we can give the NOK updates. If they don't consent, then we can't.] Could it be that this care was refused by your DGran? If she is deemed to have capacity for accepting/refusing care then the staff can't touch her (and we would report this to the team looking after the patient). If she was found to lack capacity for this, then care would be given in patient's best interests. This should have been relayed to your family. Sometimes, patients are discharged home and have therapies come in from community teams to work with them. Sometimes patients have to wait many days before a package of care/equipment is in place to enable them to have a safe discharge home

There are also times, where there's a natural deterioration in function/baseline. So new plans need to be put in place. Again, this should be relayed to NOK.

I think that there is a lot to unpick, particularly as your parents weren't entirely sure of what was happening. In your place, I'd call/email PALS. Hopefully they can get to the bottom of everything that has happened. Sending best wishes for a speedy resolution of all of this x

Yep, I agree. We can’t blame money for everything. A lot of it is about culture and morale and that comes down to leadership.

I agree. As I said, I have been a consultant for 20 years and worked in the NHS for 30. I don’t understand why people are defensive of poor care. I see it in a lot of professions, for example teachers not wanting schools to be blamed when things go wrong. We all need to call out poor practice.

Our services are not perfect. Of course complaints need to be directed where it matters and we need to separate ‘entitled’ whingeing from serious health and safety concerns.

However, I strongly believe that there is much that can be done within our current resources. Just simple things like introducing yourself to patients, checking they have understood, showing kindness. I have seen that disappear from so many colleagues of every NHS profession and I don’t think it’s good enough.

When my elderly mother is in hospital , we have had many admissions over the years, I am there every day , usually showering her, getting her to eat even small amounts,taking her to the toilet, getting her to walk or sit in a chair , these are all basic nursing care jobs ( which get people better) that seem not to be done any more by nurses most seem to be like oh ok your doing it and they disappear .
I trained as a nurse many years ago but have seen a huge deterioration in the care provided. I am lucky to be retired and able to do this,I feel for those with no family that can manage this.
It would seem basic nursing care is being lost, it doesn’t need fancy equipment it needs better staffing levels and training.
Don’t rage at the nurses rage at what mismanagement and reduced funding of front line staff does to the NHS because in the end we will all be vulnerable and elderly and deserve better treatment.