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 mother was sent to hospital from her care home without her hearing aids, phone charger, glasses, handbag. My brother was in California at the time and I was at home in London 70 miles away with covid. I had to ask a very kind and understanding neighbour to go to the care home and collect these essentials and deliver them to the hospital. You'd think they'd have some sort if check list?

When my dsd goes to hospital (alas regularly) her carers take her and stay with her the entire time though she is funded 24/7 1:1 care so this may be the difference. Thankfully she’s not needed to be admitted though can be there 12-18 hours per episode. Years ago my dh or his ex would have taken her but now she’s not at home this works well - the carers text us to keep us in the loop but nothing we can can do nor the doctors really alas

You have to pay a carer from an agency to go with her

I feel like people are being unfair to care staff here.

IME, care homes have the exact number of staff needed to run the shift. By this I mean they have the exact number of staff needed to complete normal, rota'd duties.

When you add phoning 111/999, waiting with a resident for an ambulance to turn up, phoning relatives who never answer the phone the first time, packing bags, and reassuring a frightened, confused resident, you add a massive amount of pressure to the staff, who still have at least 12 other residents who need medication, food, personal care, etc. to look after.

And yes, care is expensive, but you need to remember you are not just paying the carer's wage, you're paying for the admin staff, training, IT infrastructure, holiday pay, sick pay, building maintenance and rent, heating and fuel costs. insurance etc. £1500 a week is a bargain for what you get. Can you imagine finding a hotel, all inclusive, with a 24/7 maid/butler service who will literally wipe your arse for you, for £1500 a week?

If people want better care, they need to be prepared to pay properly for it, but as we see so many times, on so many threads, they're just not.

I was a senior manager. I know exactly how it works and how it works in the best run establishments. It isn't the fault of staff, managers and owners need to make proper provision. It certainly can be done on £1500 a week.

Well yes that will be the difference. She has 24-7 funded 1:1 so of course they should be where she is

In the case of someone who just has funding to share care with many others then those other people will be left uncared for if staff accompanied one resident to hospital.

For planned appts bank staff might be booked for unplanned emergencies it’s much more difficult and expensive to do that. From the care home POV the duty of care passes to the NHS when they get to hospital. The very long waits in A&E in limbo with no one responsible are where it breaks down. A care home might have been willing to spare staff for an hour or two but not for an entire shift when it won’t be a rare event. You might as well argue that perhaps A&E need to pay some care assistants to tend to people in waiting areas.

People think that care homes can afford it because fees seem expensive but when you think it is including accommodation, all bills and food as well as staff pay it actually isn’t. Compare it to a cheap hotel without any care and you will see what I mean. Council funded residents barely cover the costs there is no money to have extra floating staff for hospital visits.

I don’t own a care home but I know someone who does and I see the other side of it in my NHS job. It’s not easy at all to run a good care home with social care rates as they are and wages and NI going up and now bans on foreign workers. The whole system may well fall over

No. I don't think the care home always has the staff to deal with this. But something should be in place should this situation arise. But it's usual to call a relative.

BTW the county council block funding for an ordinary residential bed in my county last year was actually £650 per week and even nursing was under £1000. Is anyone surprised that care is crap if that is what is being paid. It is no secret that places survive by cross subsidy from higher private fees. If you have no ability to attract private residents or live in a poor area where people don’t have expensive houses to sell to pay fees you are buggered.

I think the problem is staffing levels, the home can’t spare a carer. So they’d have to get in bank staff or ask someone to come in and do an extra shift.

I would consider contacting care agencies thst do home care/ bank staff and ask. Trickier for emergencies but I’m sure they could cope with routine appointments.

The problem is that staff shortages in the care sector are so great that there often genuinely won't be anyone available to take on an ad hoc, open ended shift. Sometimes there will be, but if none of the bank staff are up for it and an agency isn't forthcoming, a carer can't be magicked up out of thin air.

Its one of thd things I hated most about working in a care home. We were staffed to the lowest legal limit, which means no spare staff to do anything. I got in one morning to find a resident had a fall just before we got there. The ambulance crew were there. I said I was happy to have her ln my list to get ready to make sure she knew what was happening. I was told we didn't need to do that as the ambulance crew would sort her. I went anyway. The paramedics were so pleased to have extra help, they said it never happened in that home usually. It just meant they weren't rooting around looking for hearing aids/clean knickers etc as I knew what she needed and where it was.

Id previously worked in a mental health setting and we'd always send a support worker with the patients. Even if it meant paying extra staff for multiple days and nights.

THIS!
Nurse of 37 years.

DF was in a care home. At the start there were fairly frequent trips to A&E by ambulance, and I'd meet him there. Every time it was for suspected sepsis. GP travelled to care home to see residents, and care home nurse had tests for (eg) uti, so no need for emergency GP visits. No non-emergency hospital appointments as life expectancy and ability to undergo treatment didn't warrant it - also he had made it consistently clear that he wouldn't want that when he was able to.

Your DM cannot possibly be expected to do this. Care home needs contact details updated ASAP, to ensure she isn't expected to take physical care of her sister. That needs to be included in handover paperwork from home to ambulance to hospital. I really sympathise with you, it's an awful situation.

Or the on call comes in.

Depends where you are. My local hospital are quite clear that the home is paid to provide care, if a patients needs that level of care they expect a carer to be present ideally 24/7 but definitely for a good portion of the day.

They really should.

My understanding is that they need to make sure someone is with her, and if family can't/won't help it would be care home staff, but they obviously give family the impression it needs to be them.

I remember my friend being very upset when her mother's care home was very unkind to her because she couldn't stay with her mother in hospital.

Would Driving Miss Daisy be something that might help with appointments OP?

https://drivingmissdaisy.co.uk/

I can’t help but think that’d be really expensive. Even at minimum wage, the wage bill would be £300 plus holiday pay, employer NI, payroll, pension contributions so probably closer to £400. Fixed costs of running the home are still there.

You’d have to be paying £3k + a week for them to be able to fund it.

No it’s not the norm for staff to go- it would mean they are a carer short then what would happen if the persons shift finished and they are still waiting at hospital? Are they expected to stay unpaid?
sometimes they arrange for a carer to take service users to scheduled appointments - if it’s a private care home- they will charge for this

I retired a year ago. We certainly weren't charging £3k a week, we weren't charging £1.5k a week. We still did it.

So basically you are telling me what we did and what organisation is still doing isn't possible. Maybe we were magicians.

Maybe you were, possibly it balanced out over it time or was cross funded by other residents but I don’t think many businesses can afford to absorb regular additional costs of £400 per day.

Bloody hell. Is this in the U.K.? Its not a thing where we are that carers stay in the hospital
If a person has been admitted to hospital then that is beyond the care that the care home can provide and the NHS is responsible. The NHS funds a 1:1 from ward staffing at their discretion if absolutely necessary ie acute risk to self or others but obviously not just for being confused or ill which everyone is.
The only exceptions I can think of are prisoners, people on MHA sections and occasionally very posh people whose 1:1 carer has been paid to accompany them.

I think it's important people realise how limited care homes actually are in what they provide. If you don't have family you're really shafted even if you have cash. (I am absolutely set on euthanasia to avoid this)

My MIL has dementia and is in a care home. She’s had a few visits to A and E over the last couple of years and a member of staff always takes her and stays with her until she’s either ready to come back to the home or admitted.

She’s also had a number of hospital/dentist appointments and these are put in the diary so the staff know she’s going and she is accompanied.

We’re the closest relatives but we are 450 miles away.

She is self funding but many - probably most - of the residents are funded by the council. I’m fairly sure the home don’t differentiate. Many of the residents have no one visiting them. We don’t think the staff know who self funds and who is funded. The manager does but the staff probably don’t.