elderly in hospital

Good article by Allison Pearson in the Telegraph as well: ListenDarling

Well said, Geraldine. The points you raise should help discussion which, I would hope, will help attitudes move on and standards of care improve.

Fantastic article Geraldine and your point about the vibrant personalities of senior people in hospital not being noticed is spot on. Nursing staff make assumptions about the people they are dealing with, little knowing the contribution these elderly people have made to the improved conditions they are working or living in. The elderly woman I was in the next bed to, who was left to soak her bed despite frequent requests to staff to come and help her, had been a Jewish resistance fighter in the war, helping to smuggle refugees out of Germany, through France and into England. The cries in her sleep, when she was talking aloud to her each of her children in turn, made we weep - she was reliving her fear of being captured and constantly reassuring each of her children that they would be safe. Her daughters explained this to me while we sat chatting during visits time. What a privilege to have a mother who had done so much for people she didn't even know - a true heroine .... and to be reduced to those hospital circumstances!

It used to be that nurses were also seen as heroines and angels - helping people they didn't know with true compassion.

It is so distressing to turn up on a hospital visit to see our loved ones looking old and frail, not because they are ill, but because their hair hasn't been combed and tidied, they can't get to their dentures or specs, they haven't had a proper drink or meal, or no-one has bothered to talk with them all day. Some lucky patients have relatives coming in on a rota basis to care for them, especially at meal times, but some wards don't allow you in until the afternoon. If they have such rules, they need to demonstrate that they are looking after their patients properly, and not doing crazy things like removing an uneaten meal without checking why it was not eaten, and taking remedial action.

A great article Geraldine - I valued the way you moved from personal experience to a thorough, insightful and comprehensive overview. Thank you.

I'm now going to read bagitha's link .........

A poignant article, bagitha.

Sadly compassion, kindness, respect and empathy can rarely be taught in the classroom.

Two very good articles. How sad that they needed to be written!

Love the Telegraph article bags. Wouldn't it be great if nursing staff could prove their vocational values before being recruited?

Agree that both articles are very good.

The problem that many of us face when raising concerns about care is that there really is nowhere to take the issue. My mother was in hospital last year - after suffering two collapsed vertebrae. In great pain, left unable to walk, bed sores, etc etc. Hugely unpleasant for her. These were issues that we could raise and deal with on a practical level. What we could not do anything about was the ward that mother was on. Lots of patients were in final stages of dementia (mother has all her marbles) and therefore very confused and upset for much of the day and night - lots of wondering around and constant calling out in distress. Additionally, one patient had severe hearing loss and other mental health problems and could only be 'quietened' if she was able to sit and watch the television. Only television was in room at the end of the ward. Unfortunately, this poor lady did not have any hearing aids and the volume had to be turned up to its maximum. The door to the television room could not be closed because this lady could not be left in the room on her own (as she got very upset). The television was on from early morning until after 11.00 pm. My mother and a couple of the other ladies in the ward just could not cope with the constant noise level and were often reduced to tears. At visiting times, it was impossible to hear yourself think let alone talk about anything. When we asked if would be possible to turn the television off, or at the very least down, we were told by nursing staff that this poor lady did not have anything else, and no-one to visit her and therefore perhaps everybody else could put up with it. Realise that there are difficulties with finding beds etc but it was truly horrendous and almost a form of torture for my mother.

Don't know how this kind of situation can be dealt with 'compassionately'.

GKAL has put her finger right on the nub of the problem, when she points out that Matrons were incredibly strict, of course they were.
They themselves had come up the hard way starting at the bottom in the service.
Matrons had responsibility, with accountability, something which is sadly missing today.
They knew every trick in the book, & it was the pinnicle of their chosen profession.
Not as it is today where nurses start uny courses, & the top of their aspirations is senior admin, with short hours & top pay.
This is why there is such a clamour to fetch back the "Matron" sadly it will not work, no one nowadays would accept the sort of discipline that is required, it has been tried in a few areas, but quietly dropped.
Perhaps we all have the attidude that "jacks as good as his master"
The rot seemed to set in during thelate 60s early 70s when the old hierachy was crushed by the RCN who brought in the closing of private boarding arrangements for all nursing staff, removing Home Sisters, & at the same time it enabled the closing of nurses accomodation, & schools of nursing (lots of money saved.
the older ones of you who were in nursing in the 50s onwards might amplify

There is a solution that I've tried out on nurses and solves staffing shortages as well as funding problems in the NHS in England.

To do what was done in reverse in the 1980s, where nurses were recalled to university to train and only half of them were replaced on the wards, with the other half replaced by medically untrained Healthcare Assistants that now actually do the direct patient care in hospitals.

There is no training as standard in the specific requirements of the elderly and nurses do not do the direct patient care, which is done by the HCAs who are doing more and more basic medical tasks.

So recalling all university trained nurses and midwives to university to retrain as Junior Doctors in so short supply, because the NHS were working them to death with 100 hour days and do not seem to have trained up / employed new doctors enough to cover the return to sane working hours, safe for doctor and patient.

This is funded by converting all university nurse / midwife training to Junior Doctor courses and not starting any more university nursing / midwifery courses. Paying the trainee Junior Doctors a full Bursary and no Tuition Fees.

The return to ward based training of nurses from old State Enrolled Nurses, so as to give an apprenticeship. To begin with all nurses and midwives would have to be foreign nurses, with a strict employment criteria of good spoken English globally understood. Old trained SENs would be the trainers and Matrons.

Matrons teams of old trained SENs / Foreign Nurses (ward based trained only) to walk all hospital wards as a whole hospital direct supervision to maintain consistent care.

All new training to include palliative care and the special requirements of elder care.

Retrain all NHS salaried Healthcare Assistants in elder care so to forever end hospital bed blocking of the elderly who could be looked after in their homes or in hospices.

Ending the present Do Not Resuscitate Orders, used too often to withdraw treatment on those incorrectly called terminal (it is an inexact science) and treatment includes being given food and water. Full palliative care in a hospice should be done, including being helped with meals and drinks. And a proper end of life care, instead of the hideous DNRs that means being in a living death from overdose of morphine to bring about a chemical coma and left to dehydrate and starve. As it can take weeks to die of thirst, this is also not good for funding.

Also nurses trained on the ward would do the whole job as of old, instead of the NHS having to employ two people - a nurse and a Healthcare Assistant in the hospital.

Ending nurses stations and all the bureaucracy that takes hours away from direct patient care, that do not exist abroad. The only seats by patients when doing direct patient care.

The Sisters being like supermarket floor-walkers ensuring nurses are doing direct patient care when on duty and not form-filling, computer tapping, sitting behind a nurses desk well away from patients desperate for help.

Austerity should have brought these changes, instead none of this is being addressed and nursing falls ever lower in basic standards. The nurses and HCA are being made redundant anyway as more and more hospitals go bust.

As the elderly are two thirds of the 'clients' of NHS hospitals, is it not about time we started to demand this of government, who demand all public sector savings but spend ever more where it is not needed, and none where it is.

Some fanciful ideas are put on a make-believe party on my New Party page and policies on the drop down menu on my personal website
www.staffordshire-vote-english.org

The other party is real, but I can't find much about health. It is more about not wasting money on Europe and all that.

I remember feeling put out a few years back when my DM was in hospital and wasn't aided to have a shower (which didn't seem too much to ask).

Well, afterwards I worked out that there were about 30-40 patients, and one senior staff nurse and maybe two other trained nurses. Probably 3/4 of patients would need assistance to shower or bed bath. Say 30 mins to do that (though as my DM was over 80 probably more). Sooooooo say 25 patients at half an hour each would take a nurse 12 and a half hours!!!!!!!!!!!!

So really 2 of the staff would be taken up wholly with this work in a day.

Leaving 1-2 trained staff to do medicines, consutlants wardrounds, answer phone to enquiring family, filing, writing up reports etc etc etc.

There were care assistants but still there wasn't nearly enough hours in the day to do all the work required.

The problem is more the lack of staff than their standards of care imo.

I worked in the NHS (not a nurse), trained in the early 70s. Also occasionally in 2003-5.

I think all this stuff about bringing back matron is silly. And the tales that nurses cared so much more then. Staff now are brilliant and believe me get to treat probably 100 times the patients they did 30-40 years ago. It is a totally different ball game.

I was a radiographer and I can remember in the 70s an old chap being wheeled in, he was 93 or something, we all were oooing and ahhhing 'poor old soul' 'hasn't he done well'. It was so unusual to get someone of that age through the door!!! Yes, really. So nurses didn't have a ward full of confused and often incontinent elderly they had wards full of young people with broken legs, people recovering from ops (but these people would be 40s 50s and completely composmentis) so didnt' need someone to comb their hair or etc etc etc etc. The nurses could chat and joke with their patients. The patients could clearly describe their problems and were (usually) made well and after a couple of weeks sent home to a fulfilling life.

Now in Xray there is a non-stop conveyor belt of confused oldies on trolleys (they might not have been confused before being brought in but by the time they have had a fall/ infection/ long term ilness and are whisked in by ambulance they are confused and frightened). What they then need is a full time one-to-one carer to stay with them and make sure their every need is met. Needless to say that is not going to happen. The staff work at a v fast rate - they have to to get through the work - and ime are more considerate and kind than in the 70s. I can particularly remember a snooty doctor's wife who would never sully her hands by touching a patient. Also patients were very deferential to staff, we were thanked constantly, patients werein awe of doctors and didn't expect to know what was going to be done to them or why.

My mother was a nurse so I am v aware of what nursing was like in the past. As stated above the patients are totally different from the old days, healthcare is more sophisticated, that is why the oldies are in hospital, they have been kept alive by modern medicine, previously they died in their 70s.

I don't dispute that there are bad nurses and it is infuriating that this isn't dealt with (we could all put our complaints into writing naming hospitals AND staff for a start) but our aged population is a new scenario and blaming the poor care staff who have to do the very heavy and exhausting work of looking after them isn't going to get us anywhere.

Sorry, bit of a rant there. I agree that something needs to change.

Perhaps we could concentrate on one thing that needs to be improved. For example demand that the quota of nurses to patients be increased in geriatric wards and battle for that.

Though the money to do that would have to come from somewhere. Does anyone have any suggestions as to where this might come from.

I hate to harp back to yesteryear , because not everything was good . The one good thing I can remember was the way the wards were set out --- Long wards with beds down each side , a Sister's desk at one end from which she could see exactly what was happening on the ward . She would notice which patient needed help and just as importantly which nurses were not pulling their weight !! . On hospital visits in recent years I have been appalled at the way nurses are always to be found chatting and laughing at the nurses station , on several occasions asking the whereabouts and the progress of a particular patient and no seemed to know !! .So yes I would like to see some kind of action from gransnet and/or members , I wish I had the know how to do it .

Good article from the Kings Fund here: www.kingsfund.org.uk/time-to-think-differently/blog/how-must-we-change-care-systems-meet-needs-future-patient

As an retired nurse, I think the best way to bring care back into nursing is to reinstate the SEN role. They were often down-to-earth, caring, hands-on nurses who always knew their patients well.

Sadly, the changes came about from the time of Margaret Thatcher, who brought in internal markets. All emphasis then switched to saving money, so where you would get one Sister over a ward, instead you would have a staff nurse and one a sister over several wards.

I too, like everyone else, dread having to go into an NHS hospital. I have very modest private health insurance fom Saga.

But the care of young patients isnt that brilliant either. DD was seriously injured in a car accident last year. She was in hospital 10 days and had 3 operations. The care she had in hospital was excellent but she was discharged from hospital only hours after recovering consciousness from her third operation, a very large (6in x 9in) skin graft on her arm plus an equally large wound on her leg, the source site for the graft. She was on massive doses of antibiotics and pain killers.

For the first fortnight at home DH and I were providing 24 hour nursing care as she needed help at night as well as during the day. The dressing on her leg often came off in bed at night so we would have to re-dress it, and change all the soiled bedding and her nightware. She was very unwell just from the effects of the accident and her injuries on her system and being in theatre for nearly 12 hours over 10 days and couldnt get to the loo or wash and dress unaided yet every day we had to take her to the hospital or GP for some form of after care.

The constant need to keep getting her up and dressed and into cars to sit in crowded waiting rooms when she was still unwell hindered her recovery and we had a constant worry that this travelling around and sitting in crowded public places could lead to her wounds being accidentally damaged or that they would pick up infections. On one occasion we had to take her to A&E, to have a side effect of her drugs treated which wouldn't have arisen if she had been in hospital. It was appalling, she should really have been kept in hospital another week if not two.

I am still amazed how we managed to protect her wounds from further injury and avoided picking up any infection. Neither DH nor I have any medical experience and DH has medical problems of his own that were exacerbated by the worry of caring for DD.

What would have happened if we hadnt been able to drop everything to stay at her house and care for her I do not know.

Your story is appalling Flickety Could you now write to your MP and the hospital to complain. If the patient isn't at the hospital to receive the treatment they need, any improvements won't make an iota of difference.

That's truly shocking, Flickety. Words fail me - I'd complain to the highest level. It's unacceptable that all the good work which is undoubtedly done in hospitals by the surgeons and nursing staff is being compromised by the indecent haste with which patients are discharged.

Flickety, I do hope your DD has recovered well by now. I have to go into hospital next year to have a kidney operation, and I am really worried and scared about it. It's not as if I haven't been in hospital before but the older I have become I have noticed the caring bynursing staff has become less and less., I think this is partly down to the nurses being so short staffed, they simply don't have time to do their jobs to the best that they should. But it doesn't help your own confidence when it comes round to your turn to need treatment.

I stopped reading at the end of page one as my tears were preventing me from seeing the print. This is all so appalling, what can we do?

If Ann Clwyd MP can't get what she thinks is satisfactory care for her husband as he lay dying, what hope for the rest of us. I (and all my family) have had wonderful care in hospitals in different parts of the country. Some of us have received neglect t and carelessness and what can only be described as total lack of compassion, sometimes in the same hospital on a different occasion or on a different ward. The key seems to be not long lists to check about maintaining patient dignity etc but a recognition on the part of all staff that the patient is what the job is about.

Flickety B - yes, your bum barely hits the bed and you are on your way out. This is how waiting lists are kept down - never mind good patient care.

Conditions that resulted in a week in hospital are now day cases.

Some of this is good - people like to be in their home surroundings and often recover better there - but the speed with which people leave hospital now borders on negligence. And the complete lack of interest in how you are going to manage when you get home is now the norm and reflects blinkered thinking - we've done our acute bit; now go away and sink or swim.

On a more trivial note I was was sent home from A&E in October with leg in plaster and crutches only to get home and find I could not get into the house, on or off toilet etc. No-one asked any of these questions or offered help to get equipment etc.

We didnt complain because it was only a year later that we really realised how bad things had been. At the time we were so in shock from the accident, and concentrating on caring for DD who was in a pschologically fragile state as well as having the serious injury she had that the ability to stand back and say 'This is treatment is unacceptable' completely left us.

Also having between 2000 and 2010 been responsible for the wellbeing and care of three different elderly households in my family and been in and out of hospitals with them in places as diverse as Margate, Swindon, Portsmouth and Oxford, I knew that the hospital care DD was getting was good and when the discharge decision was made the consultant didnt threaten me that if I didnt take immediate responsibility for the care of her he would just dump her outside her home and leave her there, and that happened with one of my uncles.

Another hospital refused to undertake the mental assessment needed to confirm that another relative had dementia because if they had they could not have discharged her as they did back home to live with her husband who did have a diagnosis of dementia, both had physical disabilities and Social Services saw no need to visit the home as part of the discharge assessment.

The hospital 'forgot' to ring me to tell me when she would arrive back home and I arrived at the house to find she had been home for two hours stuck in a chair she couldnt get out of, with no walking frame to help her get to the toilet or get a drink. I managed to get the instant loan of walking frames and elephants feet to raise the height of my aunts chair from the local Red Cross but Social Service considered that two disabled people both with dementia could manage at home with carers coming in three times a day for 30 minutes. Needless to say that lasted for about three days with GPs, Paramedics and Community Psychiatric nurses being called out at a rate of about three a day. They then moved into a care home but by then they were so traumatised it was six months before they had fully recovered.

It is not just the care in hospitals that is so poor it is the premature discharges to grossly inadequate home care that is just as bad.