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.

OP, I saw a service called Driving Miss Daisy, we considered it for an elderly relative for hospital visits. It’s a car service with driver and sometimes their spouse! They pick up, stay with, chat & entertain a client. To hospital, to lunch, to shopping. It seems quite lovely & you said your aunty had money to pay for the company?

My relatives care home would just phone an ambulance/patient transport and they'd be in the care of the NHS…
In my opinion they were sent to hospital far too frequently, the hospital stays achieved little, in fact they always returned in a much worse state showing significant deterioration after each visit but it didn’t seem possible to say no to hospital admissions. Afraid of being sued I expect.
Once on the ward it was horrible, lots of screaming and shouting and the same frequent flyer patients, or maybe they just didn’t go home. Dementia is the cruelest end.

I had no idea this was the case! I assumed that once in the care home they provided wrap around care for appts etc (even if it was at extra cost).

Sorry nothing helpful to offer @itispersonal but to say this stuff is a minefield.

Also a teacher, and they would not. My daughter was hit by a car (she's fine). Ambulance and then family to support at hospital. No one was with her when we arrived.

TBH I’d have felt sorry for any HCA having to look after my Dm at that stage of dementia, when she wouldn’t have a clue what was going on, or why. On the occasion when it was a fairly nasty cut on her hand, she wouldn’t even keep still for the medic trying to dress it, kept walking about, and once the dressing was finally on, she promptly pulled it off! Ditto any more applied by care home staff. But the cut healed well enough anyway.

On that occasion the medic trying to attend to her evidently didn’t have a clue about dementia - she asked me more than once to tell my DM to keep still for a few minutes…as if I hadn’t already repeatedly tried in vain….🙁

Jesus! I was a school welfare officer. I had a student have a bad accident at school once, his mother was was working a few hours away that day, other family too far. Me and one of the office staff went to hospital with him and stayed with him until his mother arrived (and for a while after, she was in such a state, bless her).

There would have been no way on Earth that I would have left a child of any age alone. We had other members of staff calling us and offering to come and swap if we had to go home for childcare etc, no one would have wanted him to be there alone.

No because they're then under the 'care' of the hospital. The only exception is if the person is detained under the mental health act then someone from the hospital/care home where they are detained may have to go.

Ish - certainly there are ambulances available for transport but essentially in most of these types of circumstances it's a taxi with a trolley who'll check if the patient's been given their regular pain relief/paracetamol before taking them to hospital.

Once requested this will generally arrive in 2 hours, but routinely upto 12 hours. Patients will then be taken to A&E and booked in - they will pass on the handover of what the care home staff reported - i.e. "they fell yesterday but today they've got knee pain, today they're really struggling to walk due to pain".
The patient then gets moved to a waiting area - anything from the normal waiting area at the front door of A&E, or straight into one of the A&E teams on a chair/trolley. But essentially there would never be the staff allocated to sit with the patient, reassure them they're safe/prevent them from walking out.
In terms of why no body generally stops frail older people from walking out of hospital - range from 'it's a hospital, that's a completely normal everyday sight' to 'it's not a prison they can leave if they want to'.

This year there's an additional change coming in, and it's active in the area i work - the 45 minute rule. Hospital staff now only have 45 minutes to take a handover, after 45 minutes you just tell reception that you're leaving and patient is left at the front door. There are no exclusion criteria. This would include the most confused septic patient who doesn't even know their name, has awful observations, immediately life threatening presentations - if handover not taken in 45minutes then they're just left for A&E to work it out later. (the idea for this is that ambulance waits are becoming so long this is the lesser of 2 evils (patients with immediately life threatening symptoms - struggling to breath/had a stroke/sepsis/meningitis falls with open fractures are sometimes waiting over 4 hours now - so to reduce the 'abandonment' of these patients at the home unseen by anyone, now instead we're abandoning them in a hospital.

This is why partly why some proactive managers/members of staff take it upon themselves to arrange a taxi or drop patients off at hospital themselves - often they'll have enough anecdotal knowledge to recognise a resident needs to be seen in A&E for an xray etc, they know if they call 999/111 they'll be waiting 2-4 hours for the ambulance that might just drop the patient at the front door, they'll then be waiting 4-8 hours to be reviewed by a Dr in A&E. Essentially you can save the 2-4 hours by taking them yourselves. Unless it's an actual emergency i.e. broken leg can't move, sepsis too weak to stand, massive head inj cant control bleeding - then the ambulance crew don't actually do anything extra beyond taxi service - so why delay by several hours if you don't have to.

They get taken by NHS patient transport.
They have the appointment.
They get brought back by NHS patient transport.
The information from the appointment likely gets lost/ not passed on.

Ime, the CQC are useless - we made a safeguarding complaint about the mental health trust. They just told us, they delegated it back to the mental health trust!

Anyway, A & Es can provide 1:1 care. We heard a sister (?) telling someone on the phone, last time we were there in Majors with DD1, that they had no patients on 1:1 care. When I’ve been there with DD2, among the mental health patients, there are some of them, including her with 1:1 care in the daytime. However, they probably don’t have enough staff for all the elderly, needing 1:1 care.

We have been going regularly to A and E with DD1 for 17 years, and it seems to us, half the patients in cubicles look like elderly people from care homes, with visible head injuries - and they look lost! We always feel sorry for them.

The company I worked for would have made us go to our next call.

Oh this is terrifying. Another thing for me to worry about as an old person who will have zero relatives!

I've always gone with DM to a&e as she was a frequent flier due to epilepsy following a bad stroke. Care homes may only have a couple of staff on overnight on each floor and so they can't be spared to go to a&e. I'd also prefer to be there to advocate for DM as I know her medical history in detail.

Does your aunt know how to request patient transport so she could get home that way?

I’m a nurse and in my experience the only time this happens is if someone is funded for 1:1 care for disability, mental health, elderly challenging behaviour. If where they come from they have a 1:1 carer, then they often stay the full time with the patient. Caters that are responsible for the care of multiple patients in a setting then it would be a no as they are factored into staffing of multiple patients in their setting

I can’t believe they went with her / that doesn’t happen in my experience

sadly but true

It's so frequent for care homes to have to send a resident to hospital that they can't possibly staff it. They might have 3-4 residents going to different medical facilities on any given morning or afternoon. If staff are out and there's another medical emergency then there's no one to sort it. Your aunt was safe in hospital so was no longer a priority.

I hope things get easier soon.

That’s not remotely the same thing.

No care staff have ratios/ staff needs this is t part of their role tbh your lucky they accompanied her. My grandad was sent in a ambulance and we had to meet at hospital, but had we not been available hospital would be responsible for him. If no one came social care would get involved.

Its not even just finances, there quite often won't be a staff member available. We struggle to staff care homes just for the normal shifts.

I had to do this for my dad. Care home would ring, tell me they'd had to phone an ambulance and then would ring back to confirm he was on his way to hospital.
I'd cancel my (NHS) clinics - sorry patients - and join him in A&E. He had v little language, little understanding, on a good day he could consent to a cup of tea .

I did a 4pm-4pm shift and then 2w later I did a 30hr 10am-4pm but that time DH came in for half an hour before school to let me go and get breakfast.
I ensured dad drank, got appropriate medication which the care home had sent in (because it took 35hrs to be admitted to a ward where they took responsibility for feeding and medicating him. Ensured he got food (he couldn't ask for it, or feedhimself), Discovered that it took 2 mins between him having a drink and needing a wee. (I gave him a drink, figured it would take 15 mins at least to go though, nipped out for a wee myself and came back to finish him wandering around A&E in an un tied gown, chuntering at people and v distressed because he needed the toilet and nobody understood and then having a wee on the floor by the nurses station.).
There was no care. There were too few staff and they were too stretched. 8 years ago they would have found an HCA and provided him with a 1:1. But not now.

I have a parent in a care home for the past 8 years with Alzheimers.

At the beginning when we'd take her for appointments the hospital staff would ask her to confirm her name, address, DOB etc

One time she was going for an MRI and my sister and I were with her (Her mobility was bad and it took both of us to work with her) we explained to the machine operator that mum had Alzheimers and wasn't really capable to being left alone, even in the room. My sister asked if one of us could even stand at the door and reassure mum with our voices. We were told no.

It still stays with me hearing them ask before they slid her into the machine what her name, address was... despite us having told them, but that was nothing compared to her crying her eyes out and shouting for her mum. 😞

I lodged a complaint after that with the hospital, the health minister asking for further dementia training etc and the hospital sent me back a long response weeks later saying they had plans in place for every member of staff to have dementia training.

But yes, any time there's an emergency either my sister or I are called and we go to meet the ambulance at hospital. During covid the care home was locked down and mum fell and needed hospital - it was the only time we saw her face to face in 8 months.

Im so sorry to everyone who has had similar experiences.

When my late mum fell and broke her hip in the care home no one even went in the ambulance to A&e.

Yes. A dementia patient can't go alone or even in a hospital transport. Family might choose to go but in the two care organisations I've worked in they would definitely accompany. If staffing ratios don't cover it then the manager would go or make up the numbers so someone else to go.

My local hospital expect residents without capacity to be accompanied. The hospital does their bit, they have a special nurse on duty who can help and advice in a&e or on a ward.

We do have integrated health and social care so maybe that makes a difference.

Yes they can. It is up to them when charging £1500 a week to make provisions for these events which aren't rare. I've seen it done and it can be done.