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

Fleurpepper

Casdon

nanna8

There are also palliative care hospitals here for those who haven’t got very long to go. There are probably not enough of them . The one nearest to us has a very good reputation and they encourage family to visit and make their patients as comfortable as they can.

We have them in the UK too, they are called hospices here. They aren’t fully NHS funded though, and as in Australia there aren’t enough of them.

Are they funded at all by? We have an excellent one near us, and several friends have been looked after to the end so well, but it is, from what I gather, totally funded by Charity donations. Which is so so wrong.

Some of them are partially NHS funded, some not at all, it’s down to the individual health bodies in the local area deciding if they wish to support them or not.

Yes Witzend, we have done the same. Having watched elderly relatives going through years and years with so little, or even none at all- quality life- this is the obvious answer.

We have both gone one step further actually, and intend to take matters in our own hands, as it were, with support from a reputable Association abroad. In the case of dementia though, it is very complicated.

Not exactly the point of the thread, I know, but one thing dh and I have done is to add a paragraph to our Health and Welfare powers of attorney, to state that if we should develop dementia, or any other condition where we are unable both to care for ourselves, and to speak (with full mental capacity) for ourselves, then we do not want any life-saving or life-prolonging treatment. We ask for palliative care only.

Other than things already mentioned, I hope to be able to avoid ‘bungalow knees’ by continuing to use stairs for a long time yet. My mother was still well able to manage them when she finally moved to a dementia care home at 89 - I do realise that she was very lucky - in that respect anyway - though.

Casdon

nanna8

There are also palliative care hospitals here for those who haven’t got very long to go. There are probably not enough of them . The one nearest to us has a very good reputation and they encourage family to visit and make their patients as comfortable as they can.

We have them in the UK too, they are called hospices here. They aren’t fully NHS funded though, and as in Australia there aren’t enough of them.

Are they funded at all by? We have an excellent one near us, and several friends have been looked after to the end so well, but it is, from what I gather, totally funded by Charity donations. Which is so so wrong.

Aveline

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.

On a personal and practical level the individual can do a lot - like being very careful in the home environment to remove obstacles that might contribute to a fall. Becoming carers for our family (I am one). Or we can be neighbourly and keep a check on the vulnerable in our locality and lend a helping hand where necessary. And I believe people are doing this.

Ultimately though bed-blocking is not something we can fix. Patients need a safe environment when they are discharged, be it care-in-the-community, care home, or rehabilitation. Which all needs funding, and staff. So in this respect, it really is up to the government to fix it. If they are not going to sort out the structural problems of society - what is government for? People can only do so much on a personal and voluntary level, but we can't build care homes, nor recruit staff, provide occupational therapy or medical aid.

nanna8

There are also palliative care hospitals here for those who haven’t got very long to go. There are probably not enough of them . The one nearest to us has a very good reputation and they encourage family to visit and make their patients as comfortable as they can.

We have them in the UK too, they are called hospices here. They aren’t fully NHS funded though, and as in Australia there aren’t enough of them.

There are also palliative care hospitals here for those who haven’t got very long to go. There are probably not enough of them . The one nearest to us has a very good reputation and they encourage family to visit and make their patients as comfortable as they can.

Each time my elderly mother fell, she was discharged home with a six week care package. Carers came into her three or four times a day. With the final fall she was discharged to a beautiful care home (I think this is luck of the draw) and stayed there three months at the expense of the NHS. She moved into another lovely care home after that where she lived until she died, but she was self funding by then.

Message withdrawn at poster's request.

HeavenLeigh Who said it was as simple as eating sensibly etc? I didn't. But statistically you are less likely to suffer from other health problems if you look after yourself, and that includes some cancers. There is no way of ensuring you never get ill, but there is a lot you can do to reduce your chances of becoming ill

I am absolutely with you on 'a couple more days in hospital' - and not just for the elderly. I have experienced this with both DH and DD, both suddenly suddenly booted out of hospital, because the beds were needed. In both cases there were no assessments as to whether there was any support structure at home, there wasn't, other than me, or whether I could cope and in each case, once outside the ward doors we might as well have fallen over the edge of the world, as we never saw or heard from any health or care professionals, other than follow-up clinics or if we sought the help ourselves.

In each case, a couple more days in hospital would have made a lot of difference.

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.