Would you expect a care home to stay with care user when going to urgent care/ a&e

[itispersonal]

Anyone in the know - have an elderly dementia aunt in a care home. Had a fall 2 weeks ago no fracture but had a moon boot. Stopped weight bearing on foot over the last few days and knee swollen a little bit. Care home and a carer took aunty to urgent care but called my elderly mum to come and be with her as they couldn’t stay due to staffing! 10 hours later after being transferred to OOT drs and then to a&e they are back home.

mum has been in tears it is too much for her, she can’t push the wheelchair, help her physically or emotionally. I went to help later in the afternoon but couldn’t help with transport as couldn’t get wheelchair in car. And hard for me to help aunty move.

should care home be staying with aunty? What would happen if my mum didn’t go? Aunty has children but they aren’t involved, and aren’t emotional attached if aunty is at the hospital on her own. Whereas my mum and I are.

My DM (90 plus with dementia) had to be taken twice to A&E. One of the staff would accompany her initially, but they’d phone and ask whether one of us could go and take over, since obviously it would leave them short. On one occasion an adult dd was the only one able to go, and on the 2nd, late evening, dh dropped me off at A&E and drove the care assistant back to the care home.

However we lived close to both hospital and care home. Presumably some residents would either have no family anywhere near (or none at all) or nobody physically able to take over.
OP, if your DM finds it so physically challenging, IMO she’s entitled to tell the care home that unfortunately she’s unable to do it.

As someone with managerial experience in a care home, staff don’t have to stay, the care is transferred over to the hospital, if they are unsafe in anyway then they need to allocate a 1-1 staff to support. With that being said, morally we always liked to ensure someone is with the resident, if staffing levels allow we would send staff or call the family and ask someone to go with, sometimes though neither is possible unfortunately

It's the reality of things. As a teacher you would know that if a child you taught needed to go to A&E you would first call a parent as it wouldn't be possible to just leave the other 29+ children in your class to accompany just 1 dc to A&E.

Patient transport only drops at door. A resident will need a escort for appointment not only for support, mobility and going to the bathroom but will need to know what the doctor says and what treatment is needed, which is the responsibility of the care home. As a carer in the past I've escorted many many residents to appointments.

I’m a radiographer & where I work we see a mix of care staff & family accompanying care home residents. I assume the care home will ask family to attend where possible & step in when that’s not possible. Attending A&E with a resident will be a logistics nightmare for care homes as they could be there for many hours, may involve staff from night shift having to be relieved by the day shift etc. Much easier to delegate to family where possible.

But the child doesn't live in the school and the parent is still responsible. It’s completely different 🤷‍♀️

But if a child had to go and the parents were unable available. A member of staff would stay with the child until a parent came. They wouldn’t be left

A friend of mine was a nurse in a care home. She accompanied a resident to hospital one night, so as to leave the care staff for the other residents. The owner told her off, as they considered the resident to be in safe hands with the paramedics.

I would expect DD1 to have staff go with her to hospital, as she’s funded 1:1 all her waking hours. They have a fleet of minibuses, although she has a Motability car, so transport should never be a problem. She needs to be under supervision 24/7, and hospitals usually have no comprehension of the care she needs, despite her having a medical condition!

We go to most scheduled appointments, although we meet her and her careworker there - it’s usually a 3.5 hour drive for us.

One to discuss with the NH but for example …

www.nhs.uk/social-care-and-support/care-services-equipment-and-care-homes/care-and-support-you-can-get-for-free/

There can be an appropriate adult allocated at the hospital if available, or failing that the care home sends a fact sheet of info about the patient and they are in hospital.

Surely it depends on the definition of unavailable?! Of course the child wouldn’t be left alone but there would have to be rapid response from parent to pick up, not a ‘finish a shift, I’ll be there when I can’ response?

Do the council now manage your aunt’s money? Could you speak to them if you have time and explain the situation and that being the emergency contact is too much for your DM? They may be able to use your aunt’s money to pay for care staff to accompany her to appointments.
It really isn’t feasible that one of the staff to leave the home for X hours to stay in hospital with your aunt and leave the home short staffed. It would be dangerous for the remaining residents.

@itispersonal . Do you mean they ill/injured child would be watched at school until a person collected them or that a member of school staff would actually accompany them to A&E until a person took over?

Ideally both the dc and the elderly adult would be taken and accompanied to A&E as soon as they needed to go but unfortunately that is not usually what happens.

It's crap that your Aunt's dc don't help and you are worried about the impact on your own mother. It could be worse, you might be needed to drop everything at a moment's notice to deal with your mother's A&E emergencies too.

It was in the contract when mum went into the care home: we could choose to take her to appointments ourselves or pay extra for them to do it.

Without such a prior arrangement, I can understand them asking a relative to take over. I’d be interested to know what would have happened if your mum had said she couldn’t do it.

When I worked in a care home we could accompany residents to pre-arranged appointments but unplanned, emergency visits, we had to hand off to family where possible and paramedics/hospital staff where not.

The home always had the minimum number of staff they were legally required to have. To send one to A&E for 10 hours would put every other resident and the remaining staff into an unsafe situation.

No.
The patient will be attended to by the medical staff in A&E.

They would actually take them to a&e.

yes that is my worry, it will be my
mum who is going to a&e due to the stress of it.

In my experience as a Paramedic it's extremely rare for care homes to have staff to send with patients. It used to be done years ago but no longer and it's families that are informed about the admission/if they want to meet them at A&E etc. Considering placements seem to be charged at around £800 a week and staff are paid minimum wage you'd think there would be some funding to assist.

If there's no family essentially the patients go to Hospital without anyone to advocate for them - we obviously hand over why they've been taken upto A&E but that's all we can do.

When I started in the role it was normal for care home staff to travel with patients when they had dementia/lacked capacity but it's just not the case anymore - I suspect it's partly due to becoming a much more defensive society/expectations for being taken to hospital to try anything/every test possible are higher (even when even when x condition is diagnosed the patient is too frail for the treatment.

A perfect example of this today - 92yr old booked for transport to hospital for biopsy of a lump found on CT (at families insistence) ?whether it was cancerous. they've already been palliated, they've already have end of life medications prescribed (injectable opoids for pain etc but not being given as they're not in pain at present! Admittedly not expected to die imminently but in the notes they weren't going to be for further surgery beyond biopsy as that's all that could be done under a local anaesthetic as were too frail for general. So essentially patient just being put through a painful procedure which could well result in a complication - infection from surgery, c.diff/hospital pneumonia from the ward with absolutely zero expectation that any treatment would be provided should it turn out to be cancerous beyond what's already been prescribed for them.

The over testing in my opinion only leads to very frail confused people being taken out of the place that had some familiarity & staff who know them - to end up on a ward in Hospital surrounded by strangers/staff who dont know them, plus there's no lounge or dining room they can walk to, staff have such little time/though must not fall in hospital so patients kept in bed/transferred in wheelchairs/trolleys they just decondition with little hope of ever getting back the strength they had before they were admitted 'just in case'.

Sorry bit of a rant, but it always strikes us as totally mad that when you're 40 and need tests because you have severe symptoms/worsening pain/headaches/exhaustion - where you might actually be fit enough to survive treatment/live long enough to have a meaningful benefit - enjoy family/get back to work etc - then you end up waiting months or more. But instead wait 40years till you're 80 with dementia living in a care home and now you're expedited for all tests - have a bad headache get a CT same day, bit of abdo pain - CT/bloods/USS... More complicated then this obviously/more likely to be something sinister when older but you've got to die of something!

No, they don’t stay with them.

And that’s how my dad ended up missing for three days. It was 1 day before anyone realised he was gone.

He had a fall, well, staff found him on the floor. Ambulance was going to take too long, so the manager drove him to A&E and dumped him, basically. Checked him in and left him alone.

I was in hospital myself, having an operation. I was the only family. The manager tried to call me and left a message. But you know, I was under a GA. They didn’t try to call dh.

When I was with it 12 hours later, I checked my messages. Called the care home who just said call the hospital. I did and they couldn’t find him.

He was found by a canal almost 3 days later. He had just walked out of A&E and that was that. It was deemed that that care home had done thier job as they had left me a message and checked him in to A&E.

Police gave no shits. Adult social care gave no shits. CQC gave no shits. hospital gave no shits. That was the care home we moved him to after he was abused in the first one he was in. All his life savings and home went on being treated abysmally (it was too dangerous to have him with us, we tried, he set fire to my house and tried to feed my baby a battery, I was killing my self watching him 24 hours a day).

I am so sorry, what a terrible end for your Father.
Completely negligent of the home in my view and just terrible timing on your side, what were the chances of his admission coinciding with your operation 😢

Isn't this what patient transport non-emergency ambulances are for? Someone would pick up from the care home and return afterwards.

This is interesting, we had a similar situation this weekend. MIL has advanced dementia, and a Deprivation of Liberty arrangement in place. She had a fall at her care home, and was dropped at a&e, and left sat in the waiting room until 85-yo FIL arrived (an hour later)

Her dementia makes her violent and a total flight risk, so a danger to herself and others - why the home felt it appropriate to leave her sat alone in a city centre a&e on a Saturday night is beyond me.

I have raised a complaint, as I fail to understand why their duty of care ends when they deem it appropriate (despite having a legal responsibility handed to them by the council) and they think family should take over even though there’s additional health concerns at play! They hadn’t even noted her dementia to the hospital, they were totally unaware 😳

(we’re 250 miles away before anyone asks why we didn’t go)

There isn't funding for staff to stay so no I wouldn't expect it. No one works for free.

It was just infuriating that no one cared. The care home didn’t even call the hospital for an update, if they had, maybe they would have found out that he wasn’t there (although, it took the hospital 24 hours to work that one out when I called to ask about him).

Social services blamed me for only giving them two contact numbers. There was only me and dh! No other family and his friends all ran for the hills when he was diagnosed with dementia and I asked them for help. Not that they even tried to contact Dh. What other number was I suppose to give?

CQC said they had done their job by just leaving me one voicemail, apparently. It makes me so angry that he never got any justice.

I am so sorry you had that too. It’s absolutely despicable. CCTV showed my poor dad just waking out. Well, walking as well as he could aged 89 with arthritis in both knees and with advanced dementia. He was staggering with his sticks. Not one person stopped him. You could see him just staggering past medical staff to the main road. But still, no wrong doing was found.