What can we do now so we don't become 'bed-blockers' in the future.

Community Hospitals are rare indeed these days. But they are not, and have never been, dedicated for rehab in the proper sense.

Casdon

Cottage hospitals have been rebadged as community hospitals or local hospitals, or wards in general hospitals have been designated as rehabilitation wards, so beds do still exist. However, there are a lot fewer of them because due to the lack of funding in the NHS many thousands of beds have been closed.

I do wish we could be more positive and call them recuperation wards. People may not even need to go into hospital but just recuperate from something and then go back home. These could also be used as a stepping stone from hospital to home.

Having said that I think the second part is happening in our local large town.

Fleurpepper

Community Hospitals are rare indeed these days. But they are not, and have never been, dedicated for rehab in the proper sense.

Sorry Fleurpepper, I didn't see this before I posted. I think you are right. Many basic things need to be more available locally with the hospitals really dealing with the extreme needs.

Rishi has just mentioned "Virtual Wards" in his interview with Laura K. Being monitored online at home sounds good but what happens in an emergency?

DD has a key safe so that it's easy for family to get in for childcare etc. I don't think it's just useful for the elderly.

There used to be two 'convalescent homes' near us. Seems daft that something similar isn't being put into action.
On a personal level, I try to keep as fit as possible by exercising, eat as sensibly as possible, don't smoke and drink rarely these days. It's not exciting but I feel I'm doing what little I can to help myself.
I recently met up with an ex colleague who happily told me that she 'likes a drink' (an understatement!), and never eats any fruit or vegetables. She prefers a pill for everything and thinks the NHS is for exploiting to get as much as possible for herself. I left feeling like Sam Eagle from the Muppets.

I realise now how thoughtful and far-sighted my dad was, 20 years ago, as he booked himself into a care home for ten days after an operation, as he did not think mum was up to looking after him at home. In the event he made such a good recovery that he was ready to go home in under a week. It did not cost a fortune and saved everyone a lot of worry.

It's difficult, because you could take the best care of yourself and then still end up in hospital because of a fall, for instance. My inlaws are very elderly now (91 and 95) and my MIL has had two prolonged spells in hospital - and then in our local community hospital - until they could get a car package in place for her to come home. My FIL had a fall between Xmas and New Year and spent over a week in hospital, meaning MIL had to go into emergency respite care - but because she has been in there for more than a week, her care package has been withdrawn, meaning that we now have to go through the whole process of getting it reinstated. God knows how long that could take.

I do have some treats, of course I do but I tend to eat 8-12 a day (mostly veg) and cycle around here, up some hills, from spring through to autumn.

I do need to keep my muscles strong and that was easy up to this autumn, when I was lifting heavy garden stuff and indoor furniture. All done now and I need to remember to use my hand weights that are laying on the floor by my chair and my hand strengthers

Bone strength is a very big and important factor, that battle between osteoclasts (bone degraders) and osteoblasts (bone builders) I know about that important impact exercise, star jumps, thumping down stairs and this winter I put my rebounder (with a T bar for safety) in the hall and do around 40 in and out jumps at a time, good for my bones and gives me some cardio

My mum had a severe stroke and she was slim and so was every person in her stroke ward. My bmi is likely to be higher because I have muscles, which are heavier. My muscles support my bones and protect my body structure

What can we do? - vote appropriately in the next election, so that we get a government who understands that word "service" does not signal an opportunity to pursue their dogma of competition and jobs for the boys.

I have both a key safe and an alarm pendant. I have never had to use the latter thankfully, but as I live in the country it feels good to know it is there.

There has been a reduction in community hospitals - when I was in social work I spent quite a bit of time making sure that people had rehab on leaving hospital; when I left it did not feature at all.

When I was first in social work in hospitals - longer ago than I care to contemplate! - most surgery (e.g. hysterectomy, hip replacement) resulted in a 2 week stay in a convalescent hospital. I don't think we need to go back to that, but we need to be able to offer this for those for whom it is appropriate.

Calendargirl

Convalescent homes would be good, but no money to run them. Our largeish hospital, 20 miles away, was where you went for operations, but then transferred to our little cottage hospital to recuperate. This was of course many years ago.

So much better than nowadays, but cottage hospitals no longer exist round here. Also where elderly folk might spend their last days was often there, cared for by local doctors and nursing staff, made visiting for family and friends so much easier,

There is money to run them - if the government (any government) chooses to invest in public services. You may have noticed that this current one doesn't! Nor the one before it. Or the one before that one!

Cottage hospitals were ideal for patients who did not need critical care and were no longer acutely ill. They only needed minimum staffing levels and provided facilities for tailored exercise and rehabilitation back into the community, giving people - especially the more vulnerable elderly - the time, space and confidence to get back into the swing of things. Our local cottage hospital had a cafeteria run by volunteers and a small library with books and games donated by the local community.

Now you are pitchforked straight from your acute bed into your home with carers (when they can be found) giving you 15 minutes per call to attend to your needs. Purely anecdotal but according to a couple of hospital porters I've spoken to, there are quite a few (but how many?) patients who are re-admitted to hospital because they simply were not well enough to cope. It would be interesting to know factually just how much money has been 'saved' by doing away with these hospitals and replacing them with 'care in the community'.

Our local cottage hospital still exists but with a much reduced capacity - there are only 29 beds for a population of roughly 500,000 people.

Dickens, during too many years on a forum for carers of people with dementia, I heard of many cases of people being sent home, only too boomerang back to the hospital within a few days, because of e.g. another fall. In many such cases what the person actually needed was a care home, where falls would still happen - even the best can’t prevent them - but at least help would be there very quickly.

I won’t bore you with a history of the NHS, but Convalescent homes run by the NHS were closed by 1980s, because they were full of people who didn’t need health care in hospital. They fulfilled a different, lower healthcare needs function to what are now community hospitals, which do still exist. Community hospitals provide care for people who need rehabilitation and nursing care, those who need rehabilitation but not nursing care (or who have minimal nursing needs that can be managed by district nurses) are discharged home and have community physiotherapy/occupational therapy/reablement. Most patients want to go home as soon as they possibly can, and it’s better for their mobility than staying in any kind of hospital. The number of community beds has been reduced too far due to government cuts, and there aren’t enough resources in the community to re able people for the same reason.
Seriously though, the answer is not to turn the clock back 40 years and consign people to convalescent homes, because any kind of inpatient care disables rather than re-ables.
The problem with designating beds in community hospitals as purely rehabilitation, is that it excludes people who need nursing care in a community setting but don’t meet rehabilitation criteria - eg with long term disabling conditions, terminally ill, awaiting specialist placement etc. there aren’t enough people on those categories to warrant separate wards, and they equally need to be away from the acutely ill patients in general hospitals to receive more holistic care.

I live near a site that was once a highly efficient small hospital. I worked there for a while .In the late 80’s it was shut down , converted into luxury housing and two small rehabilitation units were built in the grounds. They were used continuously and had a good turnover and recovery rate. They were then also shut down as” too expensive to run” and Care in theCommunity was seen s the best way to go . But no extra funding for this was forthcoming, The unit now stand empty apart from one area used for blood tests and some intermittent physiotherapy . Our district hospital 2 miles away is completely bedblocked with people needed convalescent and rehab care.
.A +E is not working and last weekend my friend’s 99 year old poorly mother spent 48 hrs on a trolley in the corridor, as there were no beds available. The rehab units and small community hospitals must be reopened . I know there are staffing shortages , but I noted that there were no shortages in the private hospitals when I was an NHS patient in one. The majority of staff were from Europe -The NHS need to recruit and pay their staff a wage that attracts staff and improve working conditions. TheNHS has survived on staff goodwill and unpaid overtime for years . It’s not the pandemic that has caused this crisis but years of neglect and mismanagement.

To reply to the OP, if we can keep up with technology it’ll help. Sadly and I know of a couple, some people are not confident with online ordering, banking, video calls or Alexa, who can make calls for you if asked. Virtual monitoring will only work if the recipients understand their part to play.

nanna8

Aren’t there rehab hospitals there then ? That is where people recovering but not well enough to go home go here. I’m thinking my mum ,who lived in the UK, was right to totally refuse to go to hospital because she firmly believed they ‘killed old people’. She died in her own home in the end.

Not any more, nanna8

There may be a few, my relative went into a local cottage hospital after having a hip replacement, that was four years ago. Unfortunately, when she went home she had a fall and was sent to a nursing home for so-called care, occupational therapy and physiotherapy, which was never offered. It was to be paid for by the NHS. It was a home for dementia patients and she did not have dementia, an awful experience for her. To add insult to injury, she then got a bill for thousands of pounds.

I know that this is true. However, in these difficult times, we should also remember there is a cost to having the internet and buying the technology.

Even where care may be necessary, it must be possible to save a proportion of people having a physical visit. A phone call to check - even a daily one - might mean you sent a carer or didn't. Getting in early enough might mean you extend the time before carers need to attend. Getting gadgets you didn't know existed because you have a regular conversation (at the Recuperation and Independence unit?) can also help.

It is about enjoying as much independence as possible for as long as possible. That means knowing you don't need to do it all yourself. Advice and single interventions can mean you go forward with even better independence. Perhaps educating younger people to "ask early" would help too.

Casdon

I won’t bore you with a history of the NHS, but Convalescent homes run by the NHS were closed by 1980s, because they were full of people who didn’t need health care in hospital. They fulfilled a different, lower healthcare needs function to what are now community hospitals, which do still exist. Community hospitals provide care for people who need rehabilitation and nursing care, those who need rehabilitation but not nursing care (or who have minimal nursing needs that can be managed by district nurses) are discharged home and have community physiotherapy/occupational therapy/reablement. Most patients want to go home as soon as they possibly can, and it’s better for their mobility than staying in any kind of hospital. The number of community beds has been reduced too far due to government cuts, and there aren’t enough resources in the community to re able people for the same reason.
Seriously though, the answer is not to turn the clock back 40 years and consign people to convalescent homes, because any kind of inpatient care disables rather than re-ables.
The problem with designating beds in community hospitals as purely rehabilitation, is that it excludes people who need nursing care in a community setting but don’t meet rehabilitation criteria - eg with long term disabling conditions, terminally ill, awaiting specialist placement etc. there aren’t enough people on those categories to warrant separate wards, and they equally need to be away from the acutely ill patients in general hospitals to receive more holistic care.

Seriously though, the answer is not to turn the clock back 40 years and consign people to convalescent homes, because any kind of inpatient care disables rather than re-ables.

With respect, I would dispute that - at least as a blanket statement.
I spent 4 months in hospital on a ward of, mostly, elderly women. When medically fit for discharge, too many of them said that they wanted to go home but didn't feel confident enough or physically strong enough to cope during the many hours that they would be left to their own devices. One poor lady (in her late 80s) actually cried and pleaded to be sent to a 'convalescent' home because she felt physically "too weak to manage". Purely anecdotal, of course, but when you spend months in hospital you do get to see a wider 'picture', so to speak.

My own late mother, a retired SRN, was in a similar position after an acute illness. A very determined and capable woman who 'knew the ropes' as far as rehabilitation is concerned, was discharged to a cottage hospital because she was too frail at the time to cope alone (I was working abroad at the time). Within under 2 weeks she'd exercised on the re-hab equipment encouraged by the nurses (and other patients), taken little shopping expeditions in the adjacent high street (recommended by the doctor) and felt fully confident and strong enough to go home and manage without any carers, and discharged herself.

I don't think it's a question of turning the clock back again, more of upgrading and re-inventing the concept of rehabilitation to cope with today's challenges. My mother was a great believer in the "use it or lose it" principle and the availability of the appropriate equipment (those 'mock' stairs with a 'landing' were a huge help as she learned to navigate them without her walking sticks) and, just as importantly, the encouragement to participate given by the nurses and other patients, in surroundings where help was available should it be needed, gave her the impetus to get fit in a way that she probably would not have achieved alone at home. Again, this is obviously purely anecdotal, and I'm sure there are those who would be just as happy to go straight home from an acute environment. But one size doesn't fit all, and I think it's a crying shame that, for those who need this kind of rehabilitation, it is largely not available.

Dickens

Casdon

I won’t bore you with a history of the NHS, but Convalescent homes run by the NHS were closed by 1980s, because they were full of people who didn’t need health care in hospital. They fulfilled a different, lower healthcare needs function to what are now community hospitals, which do still exist. Community hospitals provide care for people who need rehabilitation and nursing care, those who need rehabilitation but not nursing care (or who have minimal nursing needs that can be managed by district nurses) are discharged home and have community physiotherapy/occupational therapy/reablement. Most patients want to go home as soon as they possibly can, and it’s better for their mobility than staying in any kind of hospital. The number of community beds has been reduced too far due to government cuts, and there aren’t enough resources in the community to re able people for the same reason.
Seriously though, the answer is not to turn the clock back 40 years and consign people to convalescent homes, because any kind of inpatient care disables rather than re-ables.
The problem with designating beds in community hospitals as purely rehabilitation, is that it excludes people who need nursing care in a community setting but don’t meet rehabilitation criteria - eg with long term disabling conditions, terminally ill, awaiting specialist placement etc. there aren’t enough people on those categories to warrant separate wards, and they equally need to be away from the acutely ill patients in general hospitals to receive more holistic care.

Seriously though, the answer is not to turn the clock back 40 years and consign people to convalescent homes, because any kind of inpatient care disables rather than re-ables.

With respect, I would dispute that - at least as a blanket statement.
I spent 4 months in hospital on a ward of, mostly, elderly women. When medically fit for discharge, too many of them said that they wanted to go home but didn't feel confident enough or physically strong enough to cope during the many hours that they would be left to their own devices. One poor lady (in her late 80s) actually cried and pleaded to be sent to a 'convalescent' home because she felt physically "too weak to manage". Purely anecdotal, of course, but when you spend months in hospital you do get to see a wider 'picture', so to speak.

My own late mother, a retired SRN, was in a similar position after an acute illness. A very determined and capable woman who 'knew the ropes' as far as rehabilitation is concerned, was discharged to a cottage hospital because she was too frail at the time to cope alone (I was working abroad at the time). Within under 2 weeks she'd exercised on the re-hab equipment encouraged by the nurses (and other patients), taken little shopping expeditions in the adjacent high street (recommended by the doctor) and felt fully confident and strong enough to go home and manage without any carers, and discharged herself.

I don't think it's a question of turning the clock back again, more of upgrading and re-inventing the concept of rehabilitation to cope with today's challenges. My mother was a great believer in the "use it or lose it" principle and the availability of the appropriate equipment (those 'mock' stairs with a 'landing' were a huge help as she learned to navigate them without her walking sticks) and, just as importantly, the encouragement to participate given by the nurses and other patients, in surroundings where help was available should it be needed, gave her the impetus to get fit in a way that she probably would not have achieved alone at home. Again, this is obviously purely anecdotal, and I'm sure there are those who would be just as happy to go straight home from an acute environment. But one size doesn't fit all, and I think it's a crying shame that, for those who need this kind of rehabilitation, it is largely not available.

Comprehensive rehabilitation is available still Dickens, there are rehabilitation services in all the community hospitals. There just aren’t enough beds or appropriately trained staff to cater for all the patients who need it, or rehabilitation services in the community for those who are better served by receiving their rehabilitation at home. It’s a resourcing issue. The model isn’t the problem.

The premise of this thread is mistaken: it's not 'we' who are the cause of bed-blocking not 'we' who should fix it. It's the incompetent Tories who promised to fix social care under Johnson and failed to do it. Another Johnson lie. Sunak should fix it.

No point in sitting back waiting for any government to somehow fix everything. That ain't going to happen. This thread, sensibly, asked people to think of practical suggestions.

Grantanow

The premise of this thread is mistaken: it's not 'we' who are the cause of bed-blocking not 'we' who should fix it. It's the incompetent Tories who promised to fix social care under Johnson and failed to do it. Another Johnson lie. Sunak should fix it.

The rather unfortunate term 'bed blocker' has been used for very many years.

I can remember my friend telling me that her father was apparently called a bed blocker at a Bristol hospital and that was about 30 years ago. She was unable to care for him, having a disabled husband too so he remained in hospital for weeks.

Grantanow

The premise of this thread is mistaken: it's not 'we' who are the cause of bed-blocking not 'we' who should fix it. It's the incompetent Tories who promised to fix social care under Johnson and failed to do it. Another Johnson lie. Sunak should fix it.

Did I say we were the "cause"? No I didn't.

This was deliberately but on a chat thread so we could all contribute our lived experience.

If it was only that simple keeping our weight down and eating healthy. Tell that to the thousands that have cancer and have always done this.

Large numbers of care workers left their jobs rather than have the covid vaccine. Quite right too said many people on here but we now see the workforce consequences (the requirement was dropped for NHS staff).

The bar for patients being ready for discharge is often set too low. It may seem heresy to say so, but for many esp older patients already frail when admitted to hospital and with only a same-aged spouse at home - not a rare situation - an extra 24-48 hrs hospital care can make all the difference between coping and not coping at home. This cld and shld be factored into the bed-pricing model

One of the first things I did after DH died was to have a key safe fitted . It has been useful -I have locked myself out twice and particularly when I had a carer each morning after my hip replacement to put on my dreaded white stockings. However I had many different carers and I did change the code once they finished their visits. It is also obscured as I don’t want to make it too obvious that there maybe an older resident alone in the house .
We are living longer but often with multiple health issues. Some are preventable but others not so much. I try and keep myself as healthy as possible both physically and mentally but one thing such as an infection or a fall can have a drastic impact as I have discovered.