Hospital asking us to be with MIL 24/7

[HamCob]

MIL has vascular dementia with Alzheimer's. She is usually cared for at home by FIL who is 83 though recently it's been getting too much for him-but that's for another thread.

She was admitted to an elderly care ward at the hospital on Saturday with a chest infection. Due to her lack of capacity and erratic outbursts the hospital have insisted that a member of the family is with her 24/7. They have provided a chair next to her bed and my DH and his siblings have organised shifts but they also have full time jobs to work around.

I just wondered if it's normal/reasonable for the hospital to ask this?!

I wouldn’t have thought they can actually insist on this. I thought due to COVID visitors weren’t allowed in at the moment! My 100 grandmother had to have a pacemaker fitted and 5 nights in hospital without a single visit.
What if she had no family?
Have to say I think it’s a bit odd and if you refused they’d just have to come up with a better plan!

No they can't! They will try to manipulate you into doing so but no they have the duty of care for her whilst in hospital. She will most likely need one to one nursing so they want you to look after her so they don't have to loose a member of staff/ have an overtime bill. But you absolutely do not have to provide it. Be firm.

Having said that it may be worth thinking about post hospital options for her. If she is requiring this much support it may be more than her husband can realistically cope with.

@Smartiepants79

I wouldn’t have thought they can actually insist on this. I thought due to COVID visitors weren’t allowed in at the moment! My 100 grandmother had to have a pacemaker fitted and 5 nights in hospital without a single visit. What if she had no family? Have to say I think it’s a bit odd and if you refused they’d just have to come up with a better plan!

They initially told us that she could have a room but someone had to be with her 24/7 as she couldn't be alone in the room. Fair enough so we asked about a place on the ward. They recently told us that this would mean no visitors due to Covid rules and that they had no places on the ward! After a lot of pushing they found a bed this afternoon but then we've just had a phone call to say DH needs to go back!

@Dobbyafreeelf yes absolutely. We are trying hard to persuade FIL that nursing cate is the best option going forward. He's slowly coming round.

It is reasonable yes. Usual no.

I can only speak from the point of view of the other patients & staff on the ward in similar circumstances (I worked on an elderly care ward for several years).

Through absolutely no fault of their own some patients with dementia can exhibit behaviour that is both disturbing & potentially harmful to other patients. For a broad example - we had a lady who walked from patient to patient feeding people. No harm in that you might think - but forcing a drink on someone with swallowing difficulties who is nil by mouth is clearly life threatening. Other examples I could give would be of violent outbursts from dementia patients towards other patients (again totally not their fault, they possibly think they are at home & the other patient is an intruder).

The best way to help in these situations is for the hospital to provide 1:1 care for a patient who needed watching 24/7. However the reality on the ward I worked on was often 1 trained nurse & 2 HCAs to care for 16 patients. No extra staff available for the 1:1 - even when the patient was written up for one.

Most patients required double handed care (so 2 HCAs to wash, dress, toilet etc). Sometimes asking a relative to come in & help was the only way of ensuring everyone's safety.

However, in those circumstances MIL would have been given her own side room with a fold up bed provided for the relative.

@Dobbyafreeelf

No they can't! They will try to manipulate you into doing so but no they have the duty of care for her whilst in hospital. She will most likely need one to one nursing so they want you to look after her so they don't have to loose a member of staff/ have an overtime bill. But you absolutely do not have to provide it. Be firm.

Having said that it may be worth thinking about post hospital options for her. If she is requiring this much support it may be more than her husband can realistically cope with.

It's not the overtime bill. It's the nobody at all booking the shift.

So many times 1:1 shifts were put out as available. Rarely were they filled.

@CoffeeRunner

It is reasonable yes. Usual no.

I can only speak from the point of view of the other patients & staff on the ward in similar circumstances (I worked on an elderly care ward for several years).

Through absolutely no fault of their own some patients with dementia can exhibit behaviour that is both disturbing & potentially harmful to other patients. For a broad example - we had a lady who walked from patient to patient feeding people. No harm in that you might think - but forcing a drink on someone with swallowing difficulties who is nil by mouth is clearly life threatening. Other examples I could give would be of violent outbursts from dementia patients towards other patients (again totally not their fault, they possibly think they are at home & the other patient is an intruder).

The best way to help in these situations is for the hospital to provide 1:1 care for a patient who needed watching 24/7. However the reality on the ward I worked on was often 1 trained nurse & 2 HCAs to care for 16 patients. No extra staff available for the 1:1 - even when the patient was written up for one.

Most patients required double handed care (so 2 HCAs to wash, dress, toilet etc). Sometimes asking a relative to come in & help was the only way of ensuring everyone's safety.

However, in those circumstances MIL would have been given her own side room with a fold up bed provided for the relative.

In NO WAY is it reasonable!!! It's not patients or their families responsibility for the chronic understaffing in the nhs! If you don't have sufficient staff then you need to make noise about it not have unfair and unrealistic expectations of patients families!

One extreme to the other. DH was in hospital for almost 3 months at the start of the year and not allowed a single visit.

I don't see how they can insist, surely lots of people simple wouldn't have someone who could do it. What happens if you leave or don't turn up?

You need to ask for a meeting with everybody involved in her care , and go through concerns and options and call PALS.

Oh believe me the staff DO make adequate noise. However there are thousands of vacancies within the NHS. You cannot simply "get more staff" when there are none there.

It is entirely reasonable of the ward to ask. It is also entirely reasonable of relatives to decline if it is not possible. But asking is absolutely in the very best interests of both OPs relative & the other patients.

There is no magic pot of staff to pull from - not in the Midlands trust I worked for anyway.

And of course this is one of the many reasons staff are leaving the NHS in droves.

@CoffeeRunner

Oh believe me the staff DO make adequate noise. However there are thousands of vacancies within the NHS. You cannot simply "get more staff" when there are none there.

It is entirely reasonable of the ward to ask. It is also entirely reasonable of relatives to decline if it is not possible. But asking is absolutely in the very best interests of both OPs relative & the other patients.

There is no magic pot of staff to pull from - not in the Midlands trust I worked for anyway.

And of course this is one of the many reasons staff are leaving the NHS in droves.

Reasonable to ask yes but not to insist!!!

As well as the above @Dobbyafreeelf asking for a relative to be there 24/7 would be an absolute last resort for any ward I've ever worked on.

It isn't so that paid staff can sit at the nurses station & file their nails or whatever else you may imagine.

It's not possible to insist @Dobbyafreeelf.

If relatives say no, what can you do? Nobody is throwing an elderly patient out on the street I would hope. The staff will manage the best they can. But it isn't necessarily going to be all that safe.

All the best op

No they cannot insist, the doctor and staff need to manage her symptoms and behaviour the best way they can. Family members are not trained to look after her, are they even insured to be there, does the site manager know, we always has to declare visitors who stayed especially overnight. How can a family member be expected to stay awake all night, how will they eat, drink, wash. I would contact PALS and say this is unworkable.

My brother is severely mentally and physically disabled. As a family we've always tried to be with him 24/7 in hospital but as my parents got older that became impossible.

His care plan now states that for any hospital admission carers must be bought in to supervise him at night. This is paid for and arranged by the NHS.

What they are asking you to do is completely unreasonable.

find an MP to do it....one of the ones responsible for the covert evisceration of the NHS

Obviously the hospital can ask or suggest, but they cannot insist. Relatives can just say no. Many will have reasons to refuse and it would not be reasonable to put pressure on them to agree.

My mother has dementia and lives in a care home, she has had to be admitted to hospital a couple of times in the past few years and I have never been asked to stay with her (I would have said no).

I have an elderly DF with Alzheimer’s in a care home. He went in in March. My mum 82 had always cared for him. Due to Covid she’s only her able to visit 30 mins very two weeks which has not been at all helpful to my dad who has apparently been difficult and has hit staff and residents. The home called me and mum in because they wanted an additional £1300 a week for a observer to find his triggers…. We think they were just asking us to foot the bill for an extra staff member - they’ve lost residents in lockdown which will have impacted their revenue stream. So irritating.we refused. Mum now getting PCR tested and visiting more frequently.

No, just no. They can not insist and lm shocked they even asked. Avenues to explore are PALS and then the CCG if they aren’t helpful. The commissioners are commissioning your MIL care and they won’t have factored into in 24/7 family assistance into that