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 am sorry this has happened OP, it's awful.

I'm afraid this is recognisable to me, too. Older folks in my family received utterly shocking treatment at the hands of the NHS.

It's a shame that the new Labour government don't seem to have any brave or practical ideas to sort out health and social care.

While the bedsores indicate possible failings in care at the hospital, as so many have mentioned it's just not that simple when an elderly person has a fall. It's well documented that this can be a precursor to serious decline. And while there may have been good reasons for you not to visit, this does mean you weren't there to see what actually happened, either in the hospital or the previous few months.

Elderly people can hide or compensate for cognitive decline very effectively when at home and in their usual routine, but any break from that can be catastrophic. My mother is in the fairly early stages of dementia and medication helps. She recently decided to go on holiday for a week to visit family, and despite being happy to be there and being around familiar people, we are all aware that it has taken a tremendous toll on her already failing cognitive ability. This was without the added stressors of injury or the distress of being in hospital. She won't be able to go away again. Only her familiar surroundings and routine are keeping her relatively stable.

My father had a fall a few years ago and broke his shoulder. He was in A&E for a few hours then cared for at home but the aftermath was shocking. Even at home the shock of the fall and break in routine, plus taking painkillers, resulted in weeks of delerium, refusal to eat or drink or toilet, refusal to get out of bed, saying his final goodbyes, complete incontinence. That was about five years ago, aged 77, no particular cognitive decline, UTI or other issues and a small, very clean fracture requiring a sling but no plaster and the truth is he's never fully recovered since. It was just the effect of shock and stress for a person of that age.

I think your anger is understandable but there's more going on here than sub-standard hospital care. It's time to be realistic that this is what happens to old people when they are taken out of their familiar surroundings and routine. Spend time with her now because (hastened by poor care or otherwise) nature is taking its course.

Is there a reason you didn't just pack her up and take her home at any point during those 5 weeks?! What can they do restrain you? Even if they phone social services you could have easily proven she was looked after.

So sorry to hear this OP - sadly we had a near identical situation with my grandparent so this is not an isolated case. All you can do is raise a complaint and ask for an investigation to be conducted, but from experience nothing will come of it as they cover for each other and parts of the investigation we were told can take over 12 months and the family won’t necessarily be told the outcome.
I know it isn’t the case for everyone, but our experience of NHS care of the elderly has been nothing short of a disgrace and unfortunately hasn’t always been through staff shortages, some of it has been through sheer neglect.
I hope your grandmother can get some rehabilitation - keep her moving, get her nutrition levels back up and hopefully she can recover - just do whatever you can to keep her out of hospital as from our experience, GP went drastically downhill with every hospital stay.

Anyone criticising OP and family for not providing more care during the actual hospital stay - does that mean you accept and elderly people with no family to help should receive substandard care?

Agree. I am not white. I’m a doctor who has worked with many amazing nurses from Ghana, Nigeria and the Philippines to name a few. However, staff do need a good grasp of English, that is common sense.

I have been a patient recently and had a telephone appointment with a nurse who could speak very little English. She had no experience of the procedure she was discussing and admitted that she was just reading off her info sheet.

The appointment was a complete waste of time and a waste of NHS resources. It was not a good position to place the poor nurse in either. She was clearly recruited in a time of need and was not adequately trained in the job she was tasked to do. It is not racism to point that out. We could understand very little of what each other was saying. That is not acceptable, esp when discussing complicated treatments..

Many hospitals have signed up for John’s Campaign, whereby for instance they allow visitors 24/7 for patients, who are breastfeeding, or have learning disabilities, or mental health problems or dementia.

Have a look at the hospital’s website to see if they have signed up for John’s Campaign.

I am not criticizing I'm simply pointing out that hospitals are NOT prisons and they simply cannot hold people against their will.

The main thing missing here is good communication. At the point of discharge, an open discussion can really help. An explanation of how an admission at this age can be destabilising. Elderly people can deteriorate after being away from their home environment. They may take a while to build up their muscle mass again. They might need some physio or an OT assessment at home. The pressure sores needed to be identified and a care plan created with clear follow up.

In the absence of this, an elderly loved one arrives home in a distressed state with pressure sores. It’s awful for everyone. A good discharge discussion could help so much.

@LadyBracknellsHandbagg not hyperbole sadly, lived experience.

That your Mum received excellent care, which should be the norm, is remarkable.

Not every NHS trust delivers the same standard of care for our vulnerable elderly though.

I am genuinely pleased that you and your family were not subjected to the neglect experienced by too many of our aged relatives.

It is endemic.

I would love to say this isn't the norm but it is. Get the GP to run some bloods for things like magnesium and Vit D - it caused devastating symptoms in my Mum during Hospital stays - she came out we used creams and supplements to boost her and it made immediate differences. Lack of magnesium for e.g. can cause delirium, loss of ability to form coherent sentences, lack of mobility etc.

Get some help with physio from GP/District Nurse team - they can refer and it is appropriate to have some so you can keep her home longer etc.

Focus on Micro meals and 4 or 5 times a day, if she will tolerate fortisip then that can be prescribed to.

Bed sores are considered neglect and you need to report them back to the hospital, they need treatment and investigating. GP to get referal to District Nurses who can come in and treat etc.

While you are at it I would speak to adult social services to get an assessment for what she needs at home and kit the home out so she can cope - ramps, handles, loo seats, bath aids, perching stools and even commodes if no dowstairs loo she can use. I know she is in incontinence pads at the minute but with help you may be able to reduce this - they are often to reduce the needs of patients in hospital - ie not always ringing the bell

This old lady DID have family who could help, but seem to have chosen not to. If people did their bit for their own loved ones, staff would have more time and capacity to care for ones that have no family.

Often older people enter hospital when they are on a downward trajectory, falls are a a huge sign. Obviously environment won't always help this if they are spending long periods in bed and becoming deconditioned etc or possibly with other confused individuals. Knowing hospitals and how bad bed situations are I don't think they would of kept her without concern about her managing at home. We had the opposite trying to discharge loved one who wasn't ready.

I don't think violence towards nurses who are likely incredibly overstretched is the right answer but you need to make your concerns and complaint known, things won't change . Also how quickly she has declined could she be suffering with delirium. Hope things improve with her OP

Oh and this sounds ridiculous but get her some decent fitted to the foot slippers and use them. Vastly reduces falls from flimsy or no slippers and toe stubbing etc

My elderly mother, recently deceased, had numerous hospital admissions in the last months of her life. She would spend up to 4/ 5 days on a trolley in a&e each time before being admitted to a ward. Because she had delirium she was usually kept right up beside the nurses station.The lights never dimmed and the noises never stopped.On one occasion when she did get admitted to a ward she was sent back to her nursing home without her salt reports which would have stated she needed level 4 thickened food.She was given free fluids in the home and aspirated, back to a&e where she spent another 4 days on a trolley.
Our elderly care is an utter disgrace.

We had a similar experience with my nan. She was 92 and lived independently, mobile, coherent and no problems with continence. Went into hospital for a few days observation after a fall where she was dropped by the HCA when being transferred from bed to a chair. This caused a huge wound on her leg, severe bruising and other injuries. The family weren’t told of this, it wasn’t until a day or so later we found out.

Due to her injuries, the hospital decided Nan needed rehab so they sent her to another hospital, over 30 miles away where her rehab consisted of 15 minutes with a therapist twice a week! It was difficult for family to visit and the deterioration was rapid and noticeable from that point.

They also stopped giving her her levothyroxine which was needed as she’d had a total thyroidectomy!

My nan went into hospital for observation after a fall and came out 4 months later immobile, incontinent and extremely distressed. Elderly care is this country is abysmal.

Sadly this is going to get worse. Think of population and how the working age is going down. It's a disaster. Not enough beds and not enough people to safely staff them. Alongside many other issues with attracting staff to nursing and other professions. They got rid of nursing bursary so this hugely reduced the amount of students they are getting. I've been nursing for 14 years, always thought this would be my lifelong career but no way, the stress is not worth it. I'm so sorry your mother had to go through that.

We had to recently remove an elderly relative from hospital, as she would have died under their 'care.'

She had two bedsores, medication was left untaken/unchecked, not eating for days at a time, and several other distressing things. We were told that there was nothing to be done to help her, and she would simply decline. Once in private care, she's recovered and started thriving again.

The NHS has been hollowed out over the last 15 years - it's no surprise that we're in this situation.

Sorry haven't RTFT, what does the discharge letter say about your Grandma's hospital stay @Krupkrups ?
The ones our hospital send out say why you were admitted, what treatment you received, if they discovered anything else wrong, for example if someone developed Hospital acquired pneumonia, what medications were stopped or started and would also mention any wounds including pressure damage ? There is a term called MASD which describes moisture associated skin damage which can occur when people are incontinent, I wonder if this is what the carers have discovered if they are asking for creams ?
I think the best thing to do is contact the GP and ask the District nurses to visit to assess her skin integrity/wounds so at least you know she will be getting the correct treatment for them.
As another poster has mentioned you can get wards within the same hospital that are night and day in terms of the level of care and communication you recieve, it shouldn't be the case but it does happen.

Late Mum had yet anotgher fall. The District Nurse said they really try and avoid taking elderly people to hospital because they dont do well. We really tried to get some sort of home help but the Dr at the Hospital Day Care Centre wanted to see her and of course she was then admitted and it went down hill from there.

However, I have my tin hat at the ready for this.. we have got to recognise that the NHS cannot keep going in its current state. Everyone wants everyone else to put more and more funds into it to keep it going. There are few other countries in the world who dont expect people to co fund in some way. Its never totally free for everyone.

Add to that the fact that in my experience of looking after two very elderly parents the NHS will throw everything they can at them even when in both cases the parent was ready to go. Their quality of life was awful in the last few years. The care home for my Dad was making £££ and he was just carted off to hospital, patched up and literally wheeled or carried back to the care home.

The sad reality is, very old people are extremely vulnerable and at extra high risk when anything traumatic happens to them. They need, at that point, every possible resource to be mobilised around them, and this includes family. It's unrealistic to demand that the NHS be able to provide perfect care to every old patient, particularly in a country with so many people living into their 80s and 90s.

It may take a village to raise a child, but it also takes one to support an elderly person in their last years of life.

I do wonder what OP's uncle's role in this situation has been; he certainly doesn't sound very capable or helpful.

This old lady DID have family who could help, but seem to have chosen not to. If people did their bit for their own loved ones, staff would have more time and capacity to care for ones that have no family.

What in the name of third-world-level expectations is this now? If people are in hospital, the staff should be caring for them propertly.

That's criminal.

My husband was left unattended in bed in the Acute Stroke Ward the day he had a stroke. No OT check, etc because it was a Saturday.

He tried to get up to the loo - forgot he couldn't walk. Was black down one side from where he'd hit the deck. I recall that his watch broke in the fall, much to his distress.

When he was admitted to the rehab ward a fortnight later, the nurses there demanded to know what had happened to him...They obviously thought that I was beating up an apparently frail old man. (Of course, they hadn't seen him prior to the stroke.) He was 75 at the time.

I explained and that shut down the accusatory looks. It wasn't until later that it dawned on me that the staff at the first hospital had failed to record the fall on DH's records.

At the first hospital, they complained that DH was refusing to eat...The charge nurse seemed quite angry and complained that they'd get the blame if he had a diabetic hypo. Then DH's food was brought in: quiche and peas on an ordinary plate with ordinary cutlery. His left hand didn't work at all and his right hand was shaking.

When I asked whether he'd been assessed by an OT yet - this was mid-week by then - I got blank looks. [Before anyone makes any of the accusatory comments that I've seen aimed at the OP, I was in that ward every single day, but this was the first time that they'd served a meal while I was there.]

A junior doctor was finally sent to see me. When I asked about the absence of OT intervention and the absence of input from the Diabetic Team, the reply was "Well...now that you've pointed it out to us..."

My not so diplomatic response was "Hello?! This is the Acute Stroke Ward!"

The Diabetic Nurse actually found that DH's glucose levels were sky high - a normal response to a stroke, I was told, but not something that had been picked up by the experts in the Acute Stroke Ward.

I gather that they were glad to move DH to the rehab unit so that they could get rid of me.

I really agree with this. I’ve had to advocate against medical appointments for elderly frail people who were essentially dying but they also wanted them in for various scans and tests to keep an eye on things. I do think we need to look at whole patient care and come up with plans. Right now it feels like each department works independently.