Emergency nursing

Have you tried Carers’ or Nursing agencies in your area? I appreciate theybwill be shut on a Sunday, but might have an out of hours service .
Alternatively any care homes in your area who might have personal recommendations?
Can the family cope just for today?
But if the doctor says she needs to be in hospital, even a qualified nurse might not have the necessary facilities at home. So for her own safety perhaps you need to insist?

If the patient has refused then there's not a lot that can be done. She is obviously aware of her own condition and may or may not wait until tomorrow for a further opinion.

Someone who's very ill is usually non-caring one way or the other and will enter hospital anyway.to be treated, or anyone who's in severe pain won't usually refuse.

Unfortunately, if she has capacity, there is very little you can do. You could try 111 and ask for advice, telling them all the details. You may have to wait a long time for a call back as they are very busy. They may send an ambulance, paramedics are very skilled at persuading but if she still refuses then there is nothing they can do.
Local nursing agencies may have an on call service so worth trying but it depends on what the problem is as to whether they will be prepared to take responsibility. In these increasingly litigious days in can be difficult and you can understand them wanting to protect themselves.

Is the patient capable of telling you why she doesn't want to go to hospital. She may have good reason, as emergency departments are notorious for discomfort these days.

Is she capable of understanding the difficulty of getting alternative to hospital nursing care for her?

Thank you everyone.There is someone there at the moment trying to persuade her, the problem being she has already been in hospital three times recently, they send her home, barely able to cope, then she goes rapidly downhill.There isn't anybody that can help physically.Let's hope she can be persuaded. All very sad .

In light of the last post maybe the person refusing hospital care feels she wants to remain home and nature to take its course. She has been in three times maybe, she just wants to be left alone. As long as she has capacity and can make a reasoned decision.......

Yes travel I think that's what she is thinking.But she cannot walk so is doubly incontinent as of today,so needs nursing care.I think if we could have someone coming in regularly, she maybe could stay home.

The same thing was happening with my Ddad.
Living independently but having to be admitted to hospital, then sent home before he was properly "on his feet".
How would she feel about having Respite Care in a local home.
We persuaded my Ddad to do this until he regained his strength.
Quite honestly, he loved it, treated it like a hotel and enjoyed the company and banter with male nursing staff.
Perhaps that could be an option Katyj?

As others have said - if this person is mentally normal and has capacity there really is nothing you can do.

Being unable to walk and doubly incontinent sadly does not mean the lady requires nursing care, but personal care (unless there are other medical considerations)
Incontinence pads or “nappies” or at best a commode is all she would get in hospital and probably have to wait longer for attention in a geriatric ward than at home.
If medical attention (IV anything, injections oxygen etc) is required then at the very least there should be district nurse support and of course regular carers.
I hope you find the support you need.

It does sound as if this lady has made her mind up to stay at home.

All anyone can do now is arrange careers for her. How very sad.

If she doesn't want the medical treatment but does need personal care, that wont be a nurse. It will come under social care not nursing care.

Care agencies won't usually send someone in straight away, it can take days to weeks to get care started.

Might be worth going on your councils website and calling the adult social care number for advice

This might sound awful but sometimes some people have just had enough, and like an animal sometimes slinks off to end their days quietly on their own, she may have just given up with all the poking and prodding of hospitals and wants to be in her own home to end her days It’s nateural to always want to make it right but maybe it isn’t always what the person themselves need or want

If she does want to let nature take its course then that can be supported and she can have "community treatment only" which means things like antibiotics etc but no hospital, and then if things deteriorate support can be in place, but the conversation has to be had then discussed with GP.

If she is acutely ill now and not going to hospital could kill her, she could be eligible for "fast tracked" care at home, but again the discussion needs to be had with her and her GP IF thats what she wants.

P.s. even "fast track" home carers for end of life care can take a few days to set up!

Incontinence pads or “nappies” or at best a commode is all she would get in hospital and probably have to wait longer for attention in a geriatric ward than at home.

Staying home won't get you assessed quicker.

There is also more to it than just providing pads/pans/comodes. they would also assess for pressure wound risk as a result of the incontinence and reduced mobility and if necessary prescribe preventative barrier products or build up suppliments or maybe district nurse referral to keep an eye etc.

It is her choice whether or not to go to hospital and understandable if she doesn't want to. But it is not the case that declining to go will speed up assessments for home care!

After a hospital stay an elderly acquaintance had 24 hour care provided through social services and delivered by Red Cross and Crossroads. This was to be for a 3 week assessment period. The conclusion was that she needed this level of care and a residential home was recommended. She refused to move.

The care period was extended and she paid the costs for a further few months. It was decided that one carer was not enough to provide the care needed. Her daughter stepped in, using her power of attorney, and she was moved to a lovely care home where she grumbles and refuses to mix.
If she hadn't been 'lacking competency' her daughter couldn't have overruled her and she would have stayed at home no matter what!

This is an out of the box idea but ....... would she agree to be admitted if you could go with her and stay overnight? Only talk about the first night. That way you would be with her but have the nursing care. You would need to work out if being alone in the hospital is part of the problem rather than the hospital itself. Also she may feel overwhelmed and not consulted enough on her care once in there. I have been in this position with both of my parents and it is very difficult when someone has capacity but makes what we perceive to be poor decisions. Perhaps a known gp or nurse from the practice tomorrow could help. They will have the words to ask the difficult questions about what she wants for her future and by involving a known professional you will have done your best. Often an intermediary is helpful. If you have to phone for an ambulance again, a different professional may be able to get a different response. Going into hospital and coming home with a care package would be a solution if you could persuade her of that. You both have my sympathy.

You can't promise to stay. It would only be even considered if she happens to end up in a side room.

Its scary enough being in hospital at night without other peoples relatives milling about the bay so won't be considered in a main bay.

I had experience of a geriatric Ward notanan as Paw was in a side room off a Geriatric Ward for four weeks when he had sepsis in August 2017.
I takeyour point about pressure sores and everything else, just saying that incontinence products are available at home and do not constitute nursing care. It was distressing to see and hear patients calling for a commode or to be cleaned up, often waiting upwards of 10 minutes.

Emergency admissions wards can be hell too, short-staffed and under pressure so patients are left waiting for essential care.
I can therefore understand her reluctance if she has experience of this, Katyj.

Her GP must surely have more information that you can access or the surgery can contact, rather than just deciding that there is no more he/she can do.
Depending on your area, perhaps a convalescent home (there are still some in existence) or a local 'cottage' hospital could be the answer. We know people who have been discharged from the main hospital into a ward in the small local hospital where they receive nursing care.

It was distressing to see and hear patients calling for a commode or to be cleaned up, often waiting upwards of 10 minutes.

Thats less of a wait than at home unless you can fund 24 hour care.
The maximum funded care package is 4 times a day double up. (end of life care and reablement can be different). So you could wait 4 hours soiled at home! Or all night!

I was assuming family would be there as I was when Paw was discharged but needed full personal care from me.
(Misunderstanding on my part as I assumed the family would not see her stuck in the short term. )

"There isn't anybody that can help physically"