Thursday, May 26, 2011

Care of the Elderly

This is a post I have wanted to write for a very long time. It's something I care about passionately.

I have always been fond of the elderly. As a teenager, I used to visit a local old people's home at school. Having no grandparents of my own, I was endlessly fascinated with the stories they had to tell of lives lived in a world that seemed so different from my own. The downside was the inevitable (it seemed) mental decline of people in care homes. Ladies (they were mainly ladies) who started off relatively sparky and witty ended up demented and forgetful. At fourteen I was unable to cope with this and remember making a vow never to end up old.

At eighteen I spent four months as a volunteer caring for an elderly lady called Janey. She was 87 when I knew her, confined to a wheelchair and needed help with pretty much everything. She was sharp as anything though, and despite our age gap we formed a firm friendship, so much so that I was absolutely devastated when she died 18 months later. It was the first proper experience of loss I felt, and I think I felt it more keenly because, I'd met her so late in her life, she was such a vibrant person, and I would love to have known her better.

Those experiences were a great grounding did I but know for the way my life has panned out in recent years. I have spoken frequently here about my mother in law, now herself approaching 87. She too, is a remarkable woman, with a list of care needs as long as your arm, but a bright and optimistic approach to life which means she copes with every bit of crap that gets thrown at her. Her mind though it wanders occasionally, is pretty much all there, and I am currently in the process of writing down the remarkable story of her youth, which she recalls with vivid clarity.

Up until two years ago, mil had never been to hospital. Ever. But after a succession of falls we found ourselves in a situation where she was in and out of hospital for several months. Today the The Healthcare Ombudsman have published a damning report about care of the elderly in our hospitals. Everything they have reported: lack of help feeding elderly patients, loss of dignity, inability to communicate adequately with the family, chimed in with our hideous hideous experience of having an elderly relative in hospital. On top of that I have been chatting to a friend, whose elderly mother has experienced similar, and another relative on my side of the family was also dismally failed by the system.

In order to protect the identity of the people I am writing about, I am therefore going to give you three case scenarios. All of which have happened in OUR hospitals.

Case 1) An elderly person suffering from life threatening cancer admitted to hospital with renal failure. Remarkably the drugs this person was given pulled them round enough so they were well enough to go home. The patient was delivered home to the spouse, with inadequate provision for their considerable personal needs, in the middle of the heavy snow last winter. Subsequently the patient's 75 yr old spouse & another older relative sat up in the middle of the night caring/cleaning the patient. The District Nurses were "too posh to wash", and decided the snowy conditions rendered it too hazardous to come over, the GP didn't come near the patient and the spouse was at the end of her tether. The patient should NEVER have been sent home without adequate care provision being in place. But it happened.

Case 2) An elderly person was in and out of hospital for many weeks. During the time spent in the local hospital it was nigh on impossible for the family to speak to a consultant to discuss any aspect of care. Information about the patient's needs were repeated endlessly and fruitlessly to staff, and ignored. Often the patient was sitting without a blanket when visitors arrived, usually on a continence mat as little care was taken about toiletting the patient. In time the patient was moved to a community hospital where at least the nurses had time to care properly, but before Christmas there was a clearout and the patient was sent home with a catheter without discussion with the family. Pleas from the family that the patient was simply too ill to come home, as the correct care package wasn't in place were swept aside. As a result the patient was seen by the GP on Christmas Eve, emergency doctor Christmas Day, the District Nurse a few days later, and was readmitted to hospital on January 2.

Case 3) An elderly patient with alzheimers was admitted to a hospital a considerable distance from where they lived. The family tried discuss the care package with the social care team in the hospital and found it impossible. The patient also spent time in a care home before coming home, and wasn't being seen by her own GP, so continuity of care was very difficult. When the patient eventually came home, to the 80+ year old spouse, it was with 20 different medications. None of which the patient or spouse were capable of administering. The carers who were looking after the patient are unable to administer ANY drugs without a dosset box provided by the local chemist's. The system doesn't allow time for those kind of procedures to be in place, when people are sent home, leading to all kinds of difficulties for the family.

On top of those case studies, these are things I have witnessed for myself with other elderly patients, who have been in the same ward as mil at different times.

1) when she was in the first ward where people are sent to be assessed before being placed on a general ward, I saw an elderly man who had had a fall and was in considerable pain, being sent home, where he clearly lived alone, even though he looked in no fit state to care for himself. Not only that he asked the nurse for pain relief, which never seemed to appear. He was groaning so loudly as he got dressed I wanted to go and help him. Perhaps I should have done. No one else did.

2) A lady with cancer shared a ward with her. She was thin as a pin, and also in considerable pain. I talked at length with her daughter, who ironically was a nurse. Do you think she looks ready to go home? she asked me. No, I really really didn't.

3) All the elderly women in the ward mil was in sat on continence mats. A lot of attention was paid to weighing them, measuring their blood pressure and taking their temperature. Ticking boxes in other words. Very little was paid to making sure they had time to go to the toilet/were reminded to do so, and as a consequence many had accidents. That is a basic care need. I was appalled to see the lack of consideration for people. If it was your mum would you want that for her? I longed to ask.

4) A friend reported visiting an elderly lady in our local hospital over the Christmas period. They were short staffed and using agency nurses, who clearly didn't care at all. My friend wasn't given any information about this lady as she wasn't a relative. Repeatedly she requested that this lady was cleaned after she had soiled herself. Such help wasn't forthcoming. In a modern hospital in a civilised country such lack of care is shocking, and makes me fume.

These are not isolated incidents. They happen all the time, to our grandparents, our parents, and eventually, they will happen to us.

The NHS needs serious reform in this area. I'm glad the Healthcare Ombudsman has issued this report. It's long overdue. Please God someone takes notice.


Lisa Rullsenberg said...

As you know I found your ealier book, Last Christmas, almost too painful to comment on (though I did that privately to you - it was a wonderful book). So 'care of the elderly' strikes a chime with me.

I lost count of the number of times my father went in and out of hospital in his last few years and the inattentiveness he so frequently experienced. The meetings to assess his competence and ability to function at home funnily ALWAYS happened at times when I could not be there and NEVER seemed to chime with what I kept telling them. "Oh he's a lovely man.." they'd say as I would weep and wail yet again that they simply weren't looking at the situation properly.

I'm in a slightly odd position as well since I have now - for several years - worked in a post that involves me seeing a LARGE number of nursing students in training. To be fair, of those I see I have never felt less than sure they care deeply about their patients and work hard to give them dignity and respect. However, I can say that they have all too often recounted events involving colleagues or senior staff behavious that makes me furious (as the events did them, but as trainees and with placements always hard to find, they rarely feel as empowered as guidelines suggest to speak up about these events).

Yes the system is disfunctional. Sadly, we knew that form our all too sharp end experience. All we can do is hope it WILL get better, but I'm pretty baffled how that can happen.

Anne Booth said...

This is completely right. As someone trying to support two elderly parents whilst having four children and trying to work, There seems to be no joined up care, and little or no liaison with or time for families, who, ironically, are exoected to pick up the pieces.

One service I have recently been helped by, and which stands out like a shining star, is that given by Age Concern. Their carer support nurse came out to me a couple of weeks ago when I really felt at the point of breakdown trying to get adequate help, and liaised with social services for me at a time of crisis. But this is a service supplied by a charity in one local area. She told me that my experience was not unusual, and that she met countless carers or semi-carers at their wits end, trying to get adequate help for elderly relatives. So much for the 'big society'. I have at least got her when things go wrong (and I am sure they will many many times - I dread the next hospital admission) but what about those people with no age concern angel to help them? This is a real crisis. It is disgusting how elderly people are treated, left in pain and ignored after long lives. Thank you for this post.

Jane Henry said...

I'm not saying all care is bad. But the majority of what we witnessed wasn't up to scratch. Part of the problem, I think has been the professionalisation of nursing, which in many ways is a good thing, but which has led to a culture where certain jobs (washing patients, toiletting etc) are seen as demeaning. Nursing care should be about the whole patient, ALL their needs, and in hospital, when people are vulnerable being clean and well cared for is a vital need & nurses should be PROUD to do it. I have never felt such satisfaction in my life then the few days I looked after mil after her fall, when I got her clean and comfortable and ready for bed. She was touchingly grateful and it was immensely rewarding. It SHOULD be part of the job. But I think the tick box culture means NHS staff are too busy worrying they are going to get caught out doing something wrong to look at the patient properly.

Also on the medical wards where mil ended up the pace of life was too fast. She wasn't acutely ill, but she wasn't well enough to fend for herself, so the nurses were busy looking after the sicker patients and not looking after her needs. There needs to be a better system where elderly patients have a proper geriatric ward, where they are cared for trained geriatric doctors/nurses. Because their needs are more complicated then your average patient's. In mil's case she is very deaf and at the time very confused, and when she said, yes she was fine they took at face value, despite me telling them till I was blue in the face that she wasn't. It's so frustrating and exhausting. But at least mil has us. I worry about the hundreds, maybe thousands of elderly patients who have no one to fight their corner. That's why I wrote this postxx

Anonymous said...

This is such an important post, on an issue which is very close to my heart. As a doctor, I am fortunate to work with incredibly dedicated nurses and health care staff, but the system itself is too fractured. Roles are being redefined and, as a sister said to me recently, nurses have taken over a lot of the tasks which doctors used to do and therefore no one is left to do basic care. Doctors, in the meantime, are drowning in paperwork and admin duties.

In addition to this, communication between teams and colleagues is often non-existent. I could tell you stories which would chill the blood, but I would almost certainly be struck off for unprofessionalism. Somtimes, it's better not to know.

I was involved in a bedside procedure recently, which ended up being rather unpleasant and messy. I started to clean up the patient and the nurse said to me "oh don't bother with that, it's not a doctor's job."


I was also reprimanded by a registrar for changing a patient into a clean gown, because he was covered in urine and faeces. My registrar asked me (in an extremely sarcastic tone) what my job description was. I told him it was to care for the patient (in an equally sarcastic tone).

Your post (and the comments which follow) are some of the reasons I seriously question my career choice.