How do we change the way NHS care for PWD in hospital?

[Lawson58]

This is something I have thought a lot about @Splashing About. From my very first week as a student nurse back in the 70’s I have seen quantity valued above quality of life. I do not want this to happen to me so I have done my own POA for health and specifically stated that if I need life extending treatment and am unable to give consent due to lack of capacity that consent MUST be withheld. I have had conversations with family and friends re this and just hope that if I get Alzheimers like my mum they will remember.

It's like the old saying that too many times we are prolonging dying, not living.

I completed an Advanced Care Directive for myself last year. I thought it was going to be confronting but it wasn't. My children are my decision makers and it has made it so much easier to talk about 'little' things that I might not have mentioned to them previously. And personally I feel better for having done it.

And there are some brilliant books out there that don't hold back and worth a read.

 

[Louise7]

I’d rather they spent money on caring for quality of life than trying to preserve it endlessly. She was given a pacemaker which has stopped her dying. I now visit someone who would naturally have passed away but is trapped in a bed, incontinent, slowly starving, distressed and unhappy. The pacemaker was put in a year ago and we’ve had a dreadful year.

Mum was fitted with a pacemaker just over a year ago, and we looked into this prior to it being fitted but there was no suggestion that a pacemaker would prevent her from dying. Mum had an intermittent arrhythmia and was breathless and having unresponsive episodes. The pacemaker just provides a 'shock' when her heart rate drops below a certain level but this won't prevent her from dying - the whole body shuts down then, not just the heart. Obviously she still has dementia and the pacemaker won't make any difference to those symptoms but Mum is now much brighter and no longer breathless so the pacemaker has improved her quality of life. Had she been at a later stage of dementia we may have decided not to have it fitted but we consulted with cardiology and were satisfied that they would not have recommended a pacemaker if they didn't think that it would improve her quality of life and would simply be prolonging her life unnecessarily. The family has health & welfare LPA so ultimately it was our decision though. It depends on the actual heart problem but did the cardiologist/doctor actually state that the pacemaker would prevent your Mum from dying? If not then it may be worth you having a conversation with the GP so that they can explain the actual position.

 

[Palerider]

My mum went to a dementia ward. The dementia ward had a day room decorated like a 1950s dining room and everyone was encouraged to go there for meals and not stay in bed. My mum was agitated and couldn’t cope with the bustle and noise so she was given a side room.The last one wouldn’t have happened if it had been busy. Not many used their day room but the intention/option was there. There were not enough staff but they were lovely. So far so good.

The staff were mostly fantastic however care was disjointed and lacked planning because they didn’t ask us...they decided what was needed...we gently disputed their opinion and plan but deferred to their professional knowledge. Plan failed. This went on for ten days until they listened to us (I may have been emotional and fierce at this point) and new plan put in place and we were discharged with new plan quite quickly. This stage was grim.

They don’t have enough staff to provide social care. Hospitals are trying to reserve their beds for people who need nursing care only. The big problem is patients who cross over that and need both e.g. dementia and learning disability. My sister is LD and when in hospital they have to provide a one to one HCA/carer who ‘specials’ her. Hugely expensive but under disability discrimination this has to be provided. Inequitable care for vulnerable patients includes dementia

Wasted money: Mum was given loads of food and fortified drinks every single day. Most went in the bin. At some point I wish they’d accepted her choices. She’s now happily surviving on custard, ice cream and milk.

I’d rather they spent money on caring for quality of life than trying to preserve it endlessly. She was given a pacemaker which has stopped her dying. I now visit someone who would naturally have passed away but is trapped in a bed, incontinent, slowly starving, distressed and unhappy. The pacemaker was put in a year ago and we’ve had a dreadful year. This is not an easy thing to write (or read I am sure) but I do strongly believe we as a society uphold the right to life but not quality of life. For myself on a personal level I would refuse that pacemaker at a point when my quality of life is so poor. Let me die naturally when the time is right.

I think because care is so poorly funded people confuse the issue of letting someone pass away when it’s the right thing to do ...with someone dying because it’s easier than funding their care or we are negligent in that care. I’m not proposing the latter. I’m proposing we stop blindly sustaining life and instead hold planned meaningful conversations and work out how to live the best one. Provide the right care, fund it and accept that will not always mean heroic medical care. Sometimes it means loving social care. The current situation is failing people.

Some significant points @Splashing About, letting nature take its course is often the end solution after having tried different treatments. I suppose the issue with that is when do you stop seeking treatment and does that mean we allow someone to suffer if there is a treatment that could alleviate their ill? I think society has come to expect too much from medicine and also there is a growing world population, this isn't unique to the UK. I agree with your viewpoint, but there will be some pwd that will need hospital admission for fractures or serious infections or other medical needs in someone who maybe has early to moderate dementia, where qualty of life is possible to achieve with treatment.

I think the other problem is that we now live with a health service that has become legally dominated. Practitioners dare not treat in case they are sued unless it is clear not to treat. But even here the boundary can be blurred, especially when those concerned cannot reach agreement.

These are some of the problems that need resolution. Certainly, my mum would have wanted treatment in the early to moderate stages of her dementia as she did have a good quality of life, but now as she is advancing she very clearly isn't where she once was. I don't have LPA for health and welfare, and I worry that some of the decisions made may not be appropriate.

But certainly some of what you have raised needs to be addressed in making better outcomes for everyone concerned

 

[Jaded'n'faded]

This is a great thread - some excellent posts here.

The problem of 'how do we cope with all these people who have dementia?' is a worldwide one. Countries are trying different things and dementia villages/communities seem popular, where lots of PWDs are concentrated in a small area but living independently for the most part, but dedicated services are concentrated in those areas too - nurses, doctors, OT, PT, etc..

For hospitals, I really think the separate pathway for PWDs entering A & E is the way to go. Sticking someone on a trolley in a corridor for 8 hours, in a busy, noisy A & E, with bright lights, people rushing around, children crying, etc, etc, is pretty much guaranteed to bring on the heeby-jeebies in any PWD. We all know this - it's pretty much the worst situation you could put them in. So why do it? By the time a doctor is seen, the person is probably in a state of high anxiety/agitation, which is not gonna help! Instead, we could have a dedicated space, quieter, with carers of some sort to arrange tea/food, toiletting, etc. while people waited to be seen by the medics.

Similarly, when people are in hospital, PWDs are often treated like non-dementia people and that just isn't enough. Patients are expected to keep quiet, behave themselves, not disturb others and keep themselves entertained. And to ask for the things they need. A PWD can't do any of that. Effectively, when in hospital, half the care they would normally have is gone, as evidenced by the sad experiences detailed on this thread. Maybe they could have dementia carers in hospitals - staff whose job it was to visit all the patients with dementia (whatever they were in for) and make sure they were being properly looked after. Would that work?

 

[Louise7]

I think a key improvement that would help when those with dementia go into hospital is for staff to adopt 'person centred' care rather than treat everyone with dementia the same. Mum has had several hospital stays and at no point has there been any attempt to 'base line' her normal behaviour on admission. For example, Mum had severe side-effects from medication but these were considered to be due to dementia, she was unable to stand up/walk following a fall and this was considered to be due to dementia (she actually had a fractured spine). She was deemed to be doubly incontinent due to dementia when in fact it was just that the staff were not taking her to the toilet regularly. When she stopped eating/drinking this was deemed to be due to dementia when in fact she was being over-sedated and was too drowsy to eat/drink. Despite family informing the staff of the above they took no notice, even writing in Mum's notes that family 'think that they can gauge Mum's pain better than anyone else but we have a check list'. Yes, but they weren't completing it properly! It's very difficult to get your voice heard when staff are adamant that they know the patient better than their family does.

It is also a very dangerous position to take to assume that changes in behaviour are all due to dementia and I really worry about those in hospital with dementia who don't have anyone to speak up for them.

Maybe they could have dementia carers in hospitals - staff whose job it was to visit all the patients with dementia (whatever they were in for) and make sure they were being properly looked after. Would that work?

I think it might help in some hospitals. In my Mum's case the hospital dementia team were very good, and supportive towards family, but the medical team were dismissive of them and wouldn't follow their advice, such as when they recorded that Mum appeared to be in pain. The dementia team also wrote general advice for the nursing staff such as pointing out that Mum's feet were dirty and asking them to wash them but that's a basic care requirement so it shouldn't have needed someone else to point it out to the ward staff. I'm not sure what the answer is. It seems that hospital care has moved away from treating all patients with dignity, as human beings, regardless of their age or disability. The family are doing what we can to highlight these issues but the hospital are reluctant to accept failings or put improvements in place for vulnerable patients, simply stating that all of their staff have had dementia training. An on-line training package is however no substitute for care & compassion towards patients and their families.

 

[Splashing About]

Mum was fitted with a pacemaker just over a year ago, and we looked into this prior to it being fitted but there was no suggestion that a pacemaker would prevent her from dying. Mum had an intermittent arrhythmia and was breathless and having unresponsive episodes. The pacemaker just provides a 'shock' when her heart rate drops below a certain level but this won't prevent her from dying - the whole body shuts down then, not just the heart. Obviously she still has dementia and the pacemaker won't make any difference to those symptoms but Mum is now much brighter and no longer breathless so the pacemaker has improved her quality of life. Had she been at a later stage of dementia we may have decided not to have it fitted but we consulted with cardiology and were satisfied that they would not have recommended a pacemaker if they didn't think that it would improve her quality of life and would simply be prolonging her life unnecessarily. The family has health & welfare LPA so ultimately it was our decision though. It depends on the actual heart problem but did the cardiologist/doctor actually state that the pacemaker would prevent your Mum from dying? If not then it may be worth you having a conversation with the GP so that they can explain the actual position.

My mums pacemaker is continuous. It keeps the heart beating which would have otherwise stopped.
https://niemanstoryboard.org/stories/katy-butler-shows-the-bitter-side-of-medical-intervention/
https://www.alzinfo.org/articles/people-with-alzheimers-more-likely-to-get-pacemakers/
https://www.medicinenet.com/script/main/art.asp?articlekey=179735

 

[Lawson58]

My mums pacemaker is continuous. It keeps the heart beating which would have otherwise stopped.
https://niemanstoryboard.org/stories/katy-butler-shows-the-bitter-side-of-medical-intervention/
https://www.alzinfo.org/articles/people-with-alzheimers-more-likely-to-get-pacemakers/
https://www.medicinenet.com/script/main/art.asp?articlekey=179735

And my husband has a defibrillator in place which at some stage may have to be turned off to allow him to die. Shocks from a defibrillator can be very painful so to leave it on would be quite a cruel thing to do. It regulates his heartbeat but if it starts to fail, the defibrillator kicks in to restart it.

 

[RosettaT]

My OH was basically written off when he was in hospital due to his diagnosis. Everything was 'down to his condition' no it wasn't!. He was refused rehab to start with, the statement was 'he has dementia, he can't take instruction'. It was the hospital SW who stood her ground and told them he could, she had seen him do it. After being in rehab for 3weeks they had done nothing with him. I spat my dummy and they told me he couldn't stand let alone walk. I requested I be present at the next session and within 10 mins he had walked 30 mtrs. It was the way they approached him that was the problem and he's not difficult by any means. He was then 999'd back to the main hospital with a suspected stroke, it wasn't, it was another infection but another 4 weeks lying in bed removed all his mobility again and they told me he would vever walk again. Welll guess what, 4 mths later with private physio he did, with aid.
They need to treat people as individuals not assume. In fact we are waiting a second assessment for him as he is atypical alzheimers.

 

[myss]

Hi @woodbank

I’m sorry to read about your mum’s experience in hospital. I too wonder what happens to the people who have nobody to help them. I hope she’s feeling better now.

I know a lot of people feel the same way as you that something needs to change about the way the NHS treat people with dementia. My dad’s experience in hospital was better than your mum’s while he was on the ward as they do have a system to deal with people who cannot easily feed themselves (it’s called red plate and the patient has a picture of a red plate above their beds to alert staff that they need assistance/ reminding to eat and drink).

The worst thing was they kept trying to discharge dad as “medically fit” even though he couldn’t do anything for himself, although he’d been independent before his stroke, to live on his own in his bungalow.

Some staff were better than others at understanding how to communicate with people with dementia - usually because of personal experience.

It'll be interesting to see what ideas other have to say about how to make things easier for PWD.

My dad was taken to A&E early on NYE's morning so we were expecting a below par service due to the time of the year plus we heard that it was understaffed too. But he was eventually admitted 24hrs later, and went through two different wards.
With this experience, two things would have vastly improved my dad's stay: better communications between departments and listening.

Better communications: I would have said this was needed with my local hospital before my dad's stay. There's been times when I've been there for my own appointment, I'm sent to go to another department and they don't have the necessary details for me to get what I needed to.
I told everyone about my dad's advanced stage of dementia but at the scans and x-rays needed to assess his injury, he was being asked to pose in a way that he obviously had no chance of understanding. We only got to know about this because a family member happen to there just as he was going off to another x-ray and accompanied him. The hospital was given full contact details from the outset.

Listening and appreciation: I've heard of this point before from other posters other than woodbank with the line 'if I hadn't been there, **** would not have happened..'.
My dad could sleep a lot of hours to the point that he would miss mealtimes but whenever he was awake, he could eat the equivalent of about 2-3 meals in one go. Furthermore his injury meant that he could not feed himself.
I know I was initially told that he would get a healthcare assistant on a 1-to-1 basis - I believe this was something they had to apply for. The only person I saw was a nurse who was also looking after five others in that ward. Plus when dad was fed, he was only fed the one small meal. We had brought lots of bananas (Dad's favourite) and soft food down for him and it was on a table by his bed. None of it touched by the staff there. He was the skinniest I had ever seen him at in there.

I didn't expect red carpet treatment for him (as much as I wanted him to get it) but we were given the impression that he would be taken care of in a way where he would get the extra attention needed as he can't do things for himself or let others know about things himself. If it wasn't possible, then tell us so and we'd try think of a more workable solution.

 

[Lawson58]

Firstly just a brief comment about a separate area for PWD, the idea being that it would be quieter and things like noise and lighting could be kept to a minimum. OH was in Emergency one morning mid week, a fairly quiet time and it was not busy or noisy except for a gentleman who obviously was a dementia patient. He disturbed everybody, calling out to everyone going past to help him get out of the ********* place. Everyone treated him with calmness and respect but he persisted until staff were able to move him into the paediatric area which happened to be empty at the time.

I have been watching reruns of a show called Hospital which is about the Imperial College Trust hospitals and one thing is painfully obvious. Governments seem unable to come to grips with an aging population who are not just living longer but whose needs are very complex. This seems to clog things up all the way down the line at every level juggling beds and patients with resources disappearing into the great void of 'economics, efficiency and productivity '.

Staff spend hours trying to work out if there is an intensive care bed available so some poor soul can have a life saving operation. Homeless people occupy beds not because they are ill but because there is nowhere to discharge them to. One patient had to be transferred to another hospital because the first didn't have a stroke unit. How does that happen, that a teaching hospital in the middle of London doesn't have a stroke unit?

I don't know how the NHS hasn't succumbed under the weight of increasing numbers of patients and the expectations that they have without an accompanying increase in bed availability and it is hardly surprising that staff at all levels cannot fulfill the requirements or needs of the patients.

When my brother-in-law and his wife were over from UK in November, we had many a discussion about the health issues in both countries and I think when I get sick, I would rather be here. We have huge waiting lists for elective surgery which is a major problem. If I fell over and broke my leg I would be treated immediately but if I need a knee replacement then I can wait for it and that could take ages. Our Emergency Departments get clogged up by people coming in when they don't need to be there - cut finger, coughs and colds and other minor matters that should be treated at their own clinics or a 24 hour medical centre.

I think that young doctors doing their residencies are extremely overworked to the point where good decisions are not made and I suspect that the same thing goes on in the NHS. Our health system can be free for many but not for all and what it costs you depends on a whole heap of things. Medicines are not free and what you get charged for a medication can vary from one person to another - until you become eligible for Safety Net when it costs you nothing.

The sad part is that PWD can be so different in their needs and in their behavior that I don't think there is one simple answer. I think governments in many countries are reluctant to spend money on restructuring and retraining and let's face it, it's a bottomless pit. And of course, money does have to be spent well and that in itself is another massive issue.

 

[Splashing About]

@Lawson58 I think you make good points about efficiency and productivity. Decisions were made to shut beds and develop better processes meaning patients did not stay in hospitals which saves huge money. I think that’s working well for example in enhanced recovery you can leave hospital 5 days earlier than 4 yrs ago, have ops as day cases etc....

However dementia patients cannot comply with the expectations of early discharge as we all know. Often ill health means tenuous care arrangements break down as dementia worsens. I know they say early discharge is good but not if their care needs are increased by ill health.

Hospitals have got to try and make their workflow fit the capacity that has been allocated so they waste loads of time running around juggling resources and dealing with patients who don’t fit the new workflow requirements. Beds were reduced in my hospital before secondary care was established and ignoring the fact that not all patients can benefit from enhanced recovery programmes. It was untested but implemented.

The consequence is bed blocking as you can no longer move elderly patients to what was a community hospital enabling longer recovery. Care homes have struggled and closed. Ambulances cannot offload so they cannot collect either so long waits for them, for A&E....it’s a right mess

 

[Lawson58]

@Lawson58 I think you make good points about efficiency and productivity. Decisions were made to shut beds and develop better processes meaning patients did not stay in hospitals which saves huge money. I think that’s working well for example in enhanced recovery you can leave hospital 5 days earlier than 4 yrs ago, have ops as day cases etc....

However dementia patients cannot comply with the expectations of early discharge as we all know. Often ill health means tenuous care arrangements break down as dementia worsens. I know they say early discharge is good but not if their care needs are increased by ill health.

Hospitals have got to try and make their workflow fit the capacity that has been allocated so they waste loads of time running around juggling resources and dealing with patients who don’t fit the new workflow requirements. Beds were reduced in my hospital before secondary care was established and ignoring the fact that not all patients can benefit from enhanced recovery programmes. It was untested but implemented.

The consequence is bed blocking as you can no longer move elderly patients to what was a community hospital enabling longer recovery. Care homes have struggled and closed. Ambulances cannot offload so they cannot collect either so long waits for them, for A&E....it’s a right mess

We have just had an example of a hastily implemented program here that though worthy in every respect has no chance of being implemented successfully. Our government announced that it was going to fund counselling programs for those who were so dreadfully affected by the recent bushfires. No one could argue with that but I have no idea of where they are going to find qualified people to fulfil the needs of all those people. And I suspect that the funding will probably be pulled from money that was earmarked for some other area of health.

I just have the feeling that no one knows what to do about the situation and that they are always playing catch up and using band aid fix ups.

There are times when the staff are not informed about a patient's dementia status and this can be pretty disruptive. When my husband was recovering from his cardiac arrest, a gentleman from a small country hospital was admitted without this information and for a while he caused chaos.

Perhaps the little country hospital didn't know how to deal with him and shunted him on but he was very mobile on a floor with quite sick people and was quite nomadic! The staff were very good with him but he took a lot of one person's time to make sure that he and the other patients were safe.

It really has got to the stage when I wonder just how bad the crisis has to be before someone does something to resolve the issues.

 

[Elle3]

A few years ago before I knew anything or had any experience of dementia my 21 year old son was in hospital for a 2 week stay following intensive surgery. For his recovery he was placed on a ward with 5 other beds all occupied by elderly gentlemen, one of which I now understand was definitely suffering from Dementia. My son said he totally disrupted the ward day and night, constantly shouting out, repeating questions, being aggressive, pulling out his catheter, getting out of bed and trying to attack other patients, he was totally confused as to why he was in hospital and basically the staff didn't know how to handle him, he didn't seem to have any family or visitors either. This put so much pressure on the staff that other patients were neglected including my son and whilst my son was there three patients on his ward died, one had a cardiac arrest in the bed next to my son and wasn't discovered for more than three hours as the nurses forgot to check on him due to being overwhelmed with looking after one dementia patient, my son at the time said he told a nurse that a strange noise had come from the bed next to him, which had the curtain around it, but she said she would check in a minute, but didn't.

The whole experience was horrific and quite traumatic for my son and the ward was put under investigation. I am not blaming the Dementia patient, I am blaming the system for not giving him the specialist care he required, he should not have been placed on a general ward (neither should my son have been on that ward either, but that is another story).

 

[myss]

The above post reminded me of my dad as he attempted to remove his IV and to strip his bed. We informed the hospital of his late stage of dementia, that he couldn't do anything for himself or show understanding, and that he would need more attention that the average patient. We visited regularly and were fortunate to have two great fantastic carers who went to see him too in their own time, and we weren't told that was an issue in giving him the attention he warranted.

I know I was told on the first ward he was on that the doctor will apply (under DoLS??) for an one-to-one assistant for him but as far as I know it didn't happen and a nurse was in charge of him and five others on his ward too. Perhaps there needs to be a separate ward for those who need such regular attention (not necessarily just those with Alzheimer's) and for communication to/from hospital staff to also be given more attention too.

Edited to add: I'm watching Casualty on BBC1 where there is a storyline about a well-known character suffering from dementia who wandered and was found slightly unconscious in the snow. She's brought to A&E and doctors are telling her husband that his wife had a bleed on the brain, but due to her frailality and other physical issues, the surgeons didn't think it would help to operate.

This was the position my family were in for the month of January 2020, the patient was my dad and his injury was different, however the big difference was that we spent over 3 weeks waiting for the surgeons to make up their minds if to operate or if not - which was likely - what was the alternative. This is what I mean about communication. It can be so much better than it is, even if it is bad news. I so wish we were told sooner and had the time to care for him ourselves - as we had been doing before his admittance.

 

[Lawson58]

When my husband was recovering from his cardiac arrest and prior to his diagnosis of Alzheimer's, as sick as he was, he would try and get out of bed during the night. The hospital employed a one on one carer to watch him during the night which meant that nursing staff could get on with their duties. I can't imagine that it was a cheap exercise and surprising as he was still being assessed for dementia.

So the staff recognised that there was a problem and dealt with it appropriately. Because he was so ill, he was in a room on his own which given the experience of Elle3 's son is better than leaving someone so ill on a ward.

 

[Agzy]

Sadly hospitals are no place for people suffering from Dementia. The staff don’t have the time for one on one care they are stretched. The government need to realise this bed blocking costs the NHS millions. I hope Boris puts this on the top of his priority list and the green papers they were going to publish in 2018 will be.

Couldn’t agree more Bella and, as hard as it would be to do in reality a different admission zone than A&E as everyone and their dog have to pass through and so inevitably congestion and confusion for all never mind those who suffer from confusion as past of their illness. Dont want to see the return of asylums but something more fit for purpose must be a priority for all concerned, staff and patients.

 

[Tea and. toast]

There are really interesting points raised on this thread. Picking up on some of the points raised by Louise7- it is important not to put down health changes in a PWD down to Dementia. I look after my Dad and over a year ago he had some poo incidents as well as wee incidents at night. He hadn't been diagnosed with dementia at that point but was going through the process. It was found that Dad had mild bile malabsorption so now on meds and retains urine in his bladder and has slow flow. So I am glad I followed up his problems though Dad now has wee incidents sometimes during day or early evening maybe due to his illness progressing.

With regards to how does the NHS care for PWD in hospital and finding a baseline of how the PWD is- one of the local trusts is piloting a Carers passport on a couple of wards so I am not sure if that made a difference or not when my Dad was admitted last year (though I did not have a Carers passport). Dad was blue lighted to hospital with suspected stroke. The stroke team said it wasn't a stroke though Dads speech was garbled and so they did tests to find out what was wrong administered antibiotics did CT etc. They eventually said Dad had probably a seizure due to increased meds he was on for AD or with Lewy bodies. There was also a mention of Delirium.. My brother and I had to leave Dad at 9 pm they had to give him a little sedation as he was agitated and trying to get off the trolley on the assessment ward(he was like this in A n E too). I informed all the staff that Dad had dementia and had night time wee incidents so could they check him.

The next day a Delerium Nurse who had been to see Dad on a ward rang me at home to ask what Dad was usually like. Dad wasn't really speaking eating etc I told him that Dad can hold a conversation (though has confused moments at times) let you know if he wants or doesn't want to do something, feed himself go to the loo etc. So I it thought that was good that the nurse rang me. Then at lunchtime another nurse rang to say would it be possible to visit Dad and bring him some food as he didn't eat his breakfast which wouldn't help his diabetes. I was on a day off work so went to the hospital with lots of bits and pieces that Dad would normally have for lunch.

It was a shock to see Dad who seemed spaced out and looked straight through me at first. They had put Dad in a sideroom next to the nurses station over night. As Dad was keep getting up and standing at the door they put a chair for him next to the nurses so he could watch what was going on in the ward. It took all afternoon for Dad to eat something and they let me stay past visiting time until teatime when I went home to get his meds plus clothes to give to sis ( now in the bad books). So I think the nursing staff did a great job. Not sure if that was a one off. The next night Dad was put put on a 6 bed ward close to the door and was discharged the next day. Dad did recover from the seizure thank goodness.

Dad has had quite a few trips to the local A n E too for falls, not himself UTI? and one TIA since the seiziure. I decided to take home rather than be admitted on one occasion as there was someone in next door being ill with the winter vomiting virus. Also on another occasion there had been a person next door to Dad who was very distressed wanting the toilet, their shoes which they said were lost etc The person probably had dementia and my heart went out to them. Staff couldn't really spend time with the person.

The quickest time in A and E was 4 hours the longest 9.5 hours and on one occasion Dad was admitted on to the assessment ward at the local hospital. I left the hospital at 5 am the following morning. I am not sure what the answer is re A and E but having a recently acquired wheelchair for Dad helps as he has a seat and be moved easily to see nurses for bloods etc before seeing the doctor. I did call the acute team once when Dad had fallen for advice to avoid A and E but as dad hadn't cut himself they would not come out. Just to say I don't contact 111 999 or Drs at the drop of a hat. On occasion I've just assessed Dad if he hasn't hit his head and seen how he goes.

Paramedics did re refer Dad to Falls clinic when they found Dad medically ok ( he had improved from not being able to walk or stand after falling to being able to get up off the chair and walk across the bedroom by the time they came!! ) The consultant said it is Dads Lewy Bodies dementia illness progressing that is causing the falls rather than his postural hypotension and has referred Dad to physio. He said my thoughts on something being wrong with Dads ears/balance wasn't the cause and he didn't want Dad to be put through balance tests. So I did ask the question.
Sorry for the long post.