The Same Old Story

I was being sent to one of our regular nursing homes – I'd been to 'Rose Cottage'* a few days earlier for a patient who 'wasn't eating' and had a low blood sugar. This time it was for a patient with chest pain.

It's not the worst nursing home that I go to – the place is clean and tidy, some of the nurses speak good English and the patients aren't beaten. But it's still not as good as it should be; the normal problems of the staff not knowing about their patients, and the usual cold cups of tea siting just outside of the patient's grasp render it an impersonal and borderline neglectful place.

We arrived to find that our patient was a 93 year old female, bedbound and only recently discharged from hospital. She also had dementia although more of the 'pleasantly confused' type. I have found that there are two main ways that dementia manifests itself in nursing homes, the 'constant screaming, scratching and crying' type, and the 'pleasantly stoned' type where the patient is dotty but fairly happy.

This tiny little bird was of the second type, she looked at me as I walked in the room and gave a big toothless smile.

Our patient had been discharged from a good hospital less than 24 hours ago. She had been in hospital because, even though she is bedbound, she managed to break her hip. While in there she caught a chest infection but had since recovered enough to go home where she would continue to be nursed.

Fat chance of that.

The nursing home staff had called the GP who had decided that the patient should go to the hospital. Like most out of hours GPs he saw us arrive, threw a letter at me and ran off.

For some reason they don't like talking to other medical people they can't bamboozle in person.

The doctor had decided that the patient needed to return to hospital – Fair enough, at the end of the day it's what I'm here for.

“She has chest pain”, the nurse told me.

I asked the patient if this was true.

“Only when I cough”, she was just finishing her course of antibiotics and this was to be expected.

It was obvious that the patient was dehydrated, the heating in the room was high and a full cup of water sat out of reach.

“She hasn't been eating or drinking”, the nurse told me.

“Would you like a drink?”, I asked the patient.

“Yes please”, she replied.

So I did what nurses are supposed to do with patients like this – I helped her have a drink of water. At this point the nurse scuttled out of the room to 'photocopy the notes'.

I noticed that she had a recent cut and some bruises to her arm that were undressed – probably nothing as she does have frail skin, but I made note of it anyway. I lifted her to the trolley and, wrapping her up, took her back to the hospital.

“It's a Rose cottage special”, I said to one of the doctors. She replied that she could tell that from a distance without needing to speak to me. The charge nurse who I handed over to spotted the cut to her arm before I had chance to mention it, which puts me in a good mind about the sort of care she'll get at the hospital.

So she returns to hospital where he will probably get another chest infection, and this one might kill her.

Even while the patient is in hospital the care home will be charging in the region of £500 a week for the empty bed. Is it any wonder they call for an ambulance at the drop of a hat? I would imagine that a care home with all it's patients in hospital would be very good for the shareholders.

At the moment I'm looking very seriously at the Commission for Social Care Inspection and their Expert by Experience as I'm getting fed up of tackling things on a case by case basis – I want to change things for the better permanently, something I just can't do in my current job.

*Not it's real name, although some people may well get the reference.

Over at Mental Kipple I have my review of Sunshine – I think it's the last time I'll be invited to a press screening…

21 thoughts on “The Same Old Story”

  1. i like to think that i am one of the caring ones, i chose to do the job of elderly care and i love what i do, but as there seems to be such a demand for carers, it is a easy job to get, and therefore you do get a lot of people doing the job because they need the money, especially a lot of foreign people that come to england for work. and a lot of them have no empathy. it breaks my heart to read such stories, but unfortunatley it happens too much

  2. And it may not be as easy to spot elder abuse as child abuse.My mother had MS, so fair enough the she wasn't elderly, but the fact that she was (for all intents and purposes) paralysed from the neck down made her situation very similar. The combination of Medicaid/Medicare and her insurance would only pay for 9 hours of care in her home, which I know sounds like a fair amount, until you realise that more often than not the carers never bothered to show up and if they did, they didn't do their job properly and a few of them stole from her on a regular basis (we found out later that the agency never carried out background checks and one of the carers had SEVEN prior convictions for credit card theft).

    My mother ended up developing a rather large bed sore, which necessitated the surgeon's removing her tail bone and taking out about a grapefruit-sized chunk of material from her body, requiring her to enter into a nursing home so that she could be turned every two hours like clockwork until it healed. I was in university in a city two hours away at the time, so there was no way I could continue with my studies and provide that level of care.

    In the state where she lived, nursing homes are required to have available the past several inspection reports. There are also organisations that will send them to you and let me tell you, some of them make of harrowing reading, especially when you are considering sending a loved one to one of those facilities.

    I spent two months reading reports and visiting various homes up and down her state. I discovered that it was useful to bring along my boyfriend, as he could do the business of being polite and making eye contact with whomever was showing us around, which left me free to hang back and observe aspects of the home that they probably rathered I didn't see.

    I realise that most people don't have the luxury of having that amount of time to find a good nursing facility (un/fortunately enough her condition was such that the hospital could blag to the insurance carriers about her need to stay with them a while longer) and in the end we only found the home that we did out of luck. I'm only saying that it took me THAT long to find somewhere to find some place that I felt was safe enough for her (I should probably add that I may have been overly cautious, as the last time she was temporarily put into a home – when she broke her hip – a staff member tried to rape her).

    In the end I was lucky enough to not only find a home where her physical needs were looked after, but where she also felt at home spiritually and mentally. The staff did an excellent job of making sure that residents could attend one of the church services if they wanted to (including assisting those less ambulatory), organising social and seasonal events, taking them on outings, etc. and would call me if they felt my mother was unhappy for whatever reason. Many of the nurses developed a deep bond with my mother and wept like children when she passed away. I can not express the gratitude that I felt for how well they looked after her when I couldn't be there myself.

    It does take a special person to be an excellent carer (one of the earlier posts mentioned the ideal person spec for the job) and we were lucky enough that the home was near a university where many of the staff members were studying to become nurses, physio therapists and doctors and already had most of those qualities.

    I know that we could spend hours discussing horror stories, but I think that we have to admit too, that the job of a carer can be a VERY demanding one (both physically and emotionally). In many instances their job is considered to be a low- or non-skilled occupation and is compensated accordingly. If you've ever had a loved one needing that level of care (and have had to provide it yourself!), I'm sure that you would agree that it is most certainly NOT a low-skilled job and deserves the compensation and attention in the recruitment and hiring process to match.

  3. Your post describing the care your mother received made my blood run cold. I am a nurse by profession and have worked as a carer as well and you are absolutely right in that it is not a low-skilled job. It seems too often now that management seem to have forgotten the 'care' part of the job description 'carer' and it really does make my blood boil when I hear of people being abused, even if simply by carers not doing their jobs properly. I don't think pay is so much the issue as anyone going into caring or nursing doesn't do it for the money (or if they do then they shouldn't be in the job in the first place) but more careful screening needs to be done with all applicants. All care agencies (within the UK), whether it be the NHS, private nursing agencies, Social Services etc. etc. are now required by law to do a CRB check to see if prospective staff have any kind of criminal record. And as a minimum, all staff should have at least an NVQ2 qualification. The problem with this is that the NVQ is not an entry requirement, it can be taken whilst 'on the job' and it can be 'fudged' to an extent. I have an acquaintance who, knowing that I have NVQ 2, 3 and 4 actually asked to borrow my work so that she could copy it! Needless to say I refused.As a post script, this is a subject even closer to my heart as I have MS and have recently been retired on health grounds at age 42. I hope my health doesn't deteriorate to the degree that it did with some of my ex-patients but what if…….

  4. Quite a while ago I heard on the radio about a home which demanded payment from the relatives of a 90 year old resident who had died ,because she didn't give in her notice.The “Nursing Process” and “Project 2000” were the start of the rot.

    A friend of mine did “back to nursing” but left again soon after because no one could understand why she wanted to look after people properly.

    It's not hard.

    Keep patients clean, warm and dry.

    Feed them decent food, helping them if they can't feed themselves.

    Give them plenty of fluids, helping them to drink if necessary.

    If they are in bed turn them regularly so they don't get pressure sores.

    Have empathy and compassion.

    Be gentle.

    Inform patients about their treatment and try to allay their fears.

    Understand their worries and address them where possible eg.who is looking after their pets, paying their bill etc.

    Make sure their medicines are given to them correctly.

    Respect their wishes and beliefs (within reason).

    Talk to them, treat them as you would like to be treated yourself, do not make assumptions about them. Treat them as people not numbers or diseases ( I once heard myself referred to by a consultant as “The bowel”).

    Have a sense of humour.

    The clue is in the word “caring”.

  5. I think elder abuse is as large of a problem as child abuse – it's just less talked about. It is hard as a healthcare provider who has only a short contact with patients to judge others who deal with the same patient for long periods. I enjoy transporting elderly patients – they're often fascinating and funny people. They can also be a pain in the bum.. While I don't condone the violence or neglect, I can imagine the frustration getting to people. You do need to be a very special person to want to do that job, I'd say.There just needs to be better oversight to weed out the good and caring ones from the mean and spiteful ones.

  6. Having worked last summer in the homecare department in Inverness I got a good idea of what it would be like to work permanently in social work. A nightmare. Although I'm only speaking for Scottish social work I would imagine that it is like this in most places. The fundamental problem is that although the staff want to do the best for the clients that they deal with, often the main obstacle is money. There were many things that needed doing, but couldn't because our budget was not big enough, which meant that our work was substandard and so the clients suffered. Added to which there were staffing problems, so being able to carry out all the care that was required was extremely difficult at times, and sometimes had to be cut, albeit on a temporary basis. I was also thankful that I wasn't one of the people needing the care. What I'm trying to say is that you'll find the same sorts of problems in social work, namely a lack of money. But good luck if you do decide that that's what you want to do.

  7. Please do the expert by experience thing. Its something that does influence change.. And elderly care is an area severely lacking in EbyE's.

  8. The biggest thing that has opened my eyes since joining the ambulance service is the lack of care in so called “CARE” homes and the lack of nurses in “NURSING” homes…….it's enough to make you want to die before you get to that stage and your happy or old and with a very good family looking after you! :-s

  9. Disgraceful.Can nursing homes really charge even when their resident is in the hospital?

    I'm a support worker in a home for people with learning difficulties and mental health problems. One of our people went into hospital recently and had to stay for a number of night. The hospital had to pay for an agency LD/MH nurse to look after her 24/7 because, as funding for 1:1 support (which she has in the home 24/7) stopped as soon as she went into hospital, the company wouldn't pay for support staff to stay with her.

    The result? Anarchy in the ward. The resident couldn't understand why she had been left, displayed all of her challenging behaviours (biting/screaming/swearing/breaking things), and had to be sedated many, many times. Didn't matter how much experience the LD/MH nurse had, she didn't have experience with this particular person.

    Ah, sorry. Off on a tangent there. My original point – They can still charge for a bed when their resident is in hospital? They can charge that much for a bed when treating the resident like that?


  10. Tom ,I, like yourself care deeply for those who are unable to look after themselves .A “for instance” I always give pain relief (usually morphine) to broken hips etc. Do you see all paramedics do this?? Just because people can't scream does not mean they can't feel pain.

    I pray that I will not end up like that, to make sure I don't I have a living will, so no jumping on my chest !!

  11. I couldn't agree more with every sord you have said. It shouldn't be difficult, but it would appear to be impossible in some places. I don't think it's just money either. I have seen places with very little cash do wonders with patients and environments by having the right attitudes, some motivation and a sense of responsibility.Not long ago a survey asked what people would like as an 11th commandment if there was to be one..the answer was overwhelmingly 'treat others as you would like to be treated yourself''s that simple really.

  12. Isn't it so sad that when you are an elderly person and you need to go into a home you probably won't get the care you deserve.I pray I never have to be in the situation with my parents, it seems to me it is just the money they are interested in……..why are people in the job if you don't give a damn ?

    My mum was a ward sister in a geriatric cottage hospital and she left nursing totally as she was not able to have as much 'hands on' as she wanted, she loved all her patients but they just kept throwing more and more paper work at her…….something has got to be done , it makes you scared to get old

  13. We get so many to theatre with broken hips.You can tell the ones from nursing homes.I've had to clean patients on the ward so as to take them to theatre,severe conjunctivitis and incontinence usually.And plenty of double consenters whohave no idea whats going on.

  14. My Nan had to go into a nursing home when both the mental and physical symptoms of Parkinsons became too severe for my parents and community nurses to deal with. She wasn't in there long and I only had chance to visit her there once. It was pleasant enough but the nursing assistants didn't seem to really *care*. I know it's a provocative subject but (having seen the care three elderly grandparents received near the end of their lives) if I'm ever in that position, I'd rather be euthanised.

  15. It makes me scared to get old too, done that work for many a year, now when visiting them again in a professional capacity, just get dirty looks from staff who have been there for years, well I did report them to the care commision after all.Normally there to see fractured femurs, chest infections or severe dehydration and malnourishment. It'a just shocking what some of these frail, elderly people go through.

  16. please don't tar all 'care homes' with the same brush. As a nurse who has worked in one, we do sometimes give a good standard of care. One of the problems seems to be that in this compensation culture in which we live, we have to call an ambulance for the slightest thing to avoid being sued.Whilst i appreciate what you are saying about drink being left out of reach, I have also seen this happen in hospital, though never on MY shift!

  17. The thing that disgusts me the most whan I go to a care or nursing home for a patient is the complete lack of sympathy that the care staff have for the patient. Its as if they are relieved to get the patient off their hands for a while. There's a guy in home near here who regularly gets chest pains. Although they have never come to anything and may well be part of his SD the care staff insist on giving him copius sprays of GTN. Then they wonder why his BP ends up in his boots and he complains of the pain in his head and call 999.A close second is their inability to send a carer with the patient. It's a regular thing to have a row with a care home manager when they say that they have no one to send with the patient. Come on people, this patient will be in A&E for a while, the nursing staff won't be able to sit with her all the time. Would they allow their grandparents to travel to a strange place, with people they don't know, to have things done to them that they may well not understand for hours on end? Their care responsibilities do not end at the door. The responsibility is to the patient (or client as they call them).

    The care industry in this country stinks.

  18. Although the standard of care in some residential and nursing homes is deplorable they aren't all like that. My family owns a nursing home with very high standards. The residents are well cared for, their interests, likes and dislikes are catered for and the standard of nursing is fantastic. Residents come in from the fankly crap local hospitals dosed up to the eyeballs to keep them quiet and riddled with bedsores and the nursing staff carefully and professionally wean them off the drugs and treat the bedsores. Don't judge all care homes / nursing homes by what you see in the media, nursing home bashing might be the media equivalent of this season's Prada handbag but they are like hospitals and hotels – standards vary from the the flea ridden hellhole to the 5 star.

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