NHS & SS under pressure affecting our older parents welfare

[SeniorAngel]

Sorry this is a long one...

Just thought I would share my experience of NHS and Social Services and their care/management of my 92 year old mother. Before I do, I must say that generally I find both very good, but when they get it wrong - they really get it wrong!

Mum has had Dementia for about 3 years, but somewhat atypical in that she can quite effectively 'hide' the symptoms very well when she knows she is 'in the spotlight'! This goes for Doctors visits, or any 'official' seeking to do an assessment, and she can just about keep the facad up for the time involved, usually 1/2 to 1 hr. So good, she has managed to fool many, who can't understand what my brother and I see and experience on a daily basis. She lives at home and is fiercely independent. She tends to experience hallucinations, paranoia and can become delusional coupled with extreme confusion, usually early ion the morning and around mid to late afternoon. I try to see her as much as possible, and we get around 10 calls a day each on a regular basis, and the conversations can be surreal and combative on nature, however she can also be very sweet on occasions.

I move on....

3 weeks ago we had a call as Mum had fallen on flagstones late in the day and had been rushed to hospital with a suspected broken shoulder which proved correct. When visiting her in hospital I noted that her confusion had become much worse including total confusion as to where she was + more vivid hallucinations etc. She spent much of her time walking around the ward complaining that someone had taken all her furniture as she thought she was at home. It was evident that the trauma had exacerbated he symptoms. Whether it is temporary of more permanent is still yet to be seen. After two weeks the ward were keen to see her discharged, but I was very concerned that someone in her state AND with a fractured shoulder would not cope at home, even with the intended 3 times a day re-enablement team visit suggested by the social services team, but I was overruled!

I had to take her home, but not before creating a fuss to make sure that a visit was arranged that evening (it was not going to happen before!).
Early the next morning, I had a call from Mum, very weak voice, distressed, in a lot of pain, and in bed! ...and she had locked all the doors with the keys left in the locks!

I rushed over, and found that she had managed to unlock the door, but she could not remember how - and ambulance was called and they put her on Morphine to reduce the pain, then whipped her straight back to hospital!!!!!!

I took great care to make sure that the team looking after her knew the history, her issues and the events leading up the the readmission, but was horrified to find out that each new shift seemed not to know the details that I had taken great pains to recount. That included doctors, as well as a new team when she moved wards!!! 3 times so far!

So, today I found out that the discharge team was making arrangement.... arrgh!
It is patently obvious to me that a 92 year old lady with a recently broken shoulder, who has advanced dementia cannot cope at home with a simple 3 times a day 1/2 hrly visit! - between time she could be in serious problems.

What are these guys on? YES, I am fully aware that the NHS and SServices are under huge financial pressure, but you don't discharge someone like this (unless it is to respite or community hospital) until their mobility improves.... and then do a reassessment!

I am aware from sources inside Social Services that care placements are now being routinely resisted due to the cuts, but this flies in the face of their legal responsibilities and 'duty of care'...and it's only going to get worse in my humble opinion!

Rant off!

 

[Haylett]

Bravo, bravo, bravo Senior Angel. Don't rant off. Your experience mirrors that of many of us here and needs to be said. Every branch, every team within the NHS and SS seems to need to conduct new assessments; there is still no real interface between NHS and SS; every new budget announced seems simply to be a case of robbing Peter to pay Paul i'e. it isn't added in to the existing pool of resources but the focus merely shifts around. Carers save the economy Bns but precious little is given back by way of practical common-sense support.

So much has been written about the need to support carers. To give carers a voice. Equal Partners in Care (EPIC). Parity of esteem. After two decades of caring, I know at grassroots things are NOT better. The economy is struggling, there is duplication at every level of the NHS and SS and there is very poor care in the community with LAs doing little to take bad care agencies to task.

Poor wages for paid carers are part of the equation but it isn't the whole story. We've had wonderful carers to help us who via SDS are locked to council pay rates (better than agency rates but not brilliant) and I couldn't have wanted more caring, more compassionate people to help me. They earn the same low rates but they care about what they do, and they hold themselves personally accountable. Why are there good nurses who are wonderful - yet all of us can probably tell you about diabolical nurses who bully their patients and colleagues and drag standards down.

All I can advise, is for you to hold firm, make sure you have Power of Attorney in place so you can insist on "rights" to be heard. Document things that go wrong, keep the care profile current so that you can print out and pass on yourself. Praise to the skies where it's due because those who work fingers to the bone to deliver good care desperately need it. Make sure the Chief Exec knows.

Do as much as you can for yourself, don't rely on The System, because continuity is dropped more often than the British Relay team baton.

 

[supporter1]

Sorry to hear that your mum has been unwell. As for the NHS and the SS .. hmmm

well I will not go over what happened with my dad but it was just dreadful and that was several years ago now so I can only imagine the situation in the SS and the NHS now.

Good luck and be strong but be prepared to be ignored as the SS and NHS often do not really want to hear what family have to say ( That is my personal experience and I hope that many other members have experienced things differently ). I think I would have it noted on the medical records that your very concerned about discharge arrangements.

 

[handyjack]

Hi Senior Angel,, saw your post and felt I had to reply. Just a bit of background info on myself, I now work for the NHS on a Complex Discharge ward. Most of the patients we have are suffering from dementia. We do our best to rehabilitate them and get them well enough to leave hospital. Our hands are tied as far as discharges are concerned though, usually by Social Services (sometimes by families) Yes we too are under pressure from other wards who struggle to find bed space for patients. We struggle to discharge patients, and won't discharge them if it's felt it's unsafe to do so.
Social Services, have a lot of input to the discharge team and decisions are usually agreed between all parties concerned, but always with the best interests of the patient. (you tell me what Social Services think someone's best interest is, because at times, it's completely different to mine)

One big problem we have is when the patient has been recommended for discharge to a care home or nursing home. In this instance , families themselves can hold up the discharge whilst finding a home for their loved one. A lot of the time this comes down purely to monetary considerations by the family. I've known families who say they can cope, but having worked in a nursing home (previous to my present job) I can honestly say that few families successfully manage to cope as their loved ones condition worsens.

We have had "unsafe discharges" in the past, but in these cases the decision had been made by Social Services and not the discharge team.