Out patient is in her late eighties, she's demented, she's frail, she's bedbound and she has a pressure sore.
She's in one of the nursing homes that we are familiar with – one of the big-chain 'don't care homes'.
The reason for us being called is that time-honoured reason of “Not eating or drinking”. Unlike some previous visits the reason why she isn't eating isn't because the staff are trying to feed a corpse.
We have been as gentle with her as possible, trying to make her comfortable and warm on our trolley. When we wheel it out to the ambulance every bump in the floor makes her wince. It also makes me wince.
The home has sent the normal type of escort 'carer' with her, the “I don't know her, I've only worked here for two days, my English isn't so good” sort of carer.
One day I'm going to leave my job and inspect nursing homes – I will be feared for my ability to make these 'nurses' cry as I point out their many flaws adn get them to do their job properly.
I drive as carefully as I can, but there are too many idiots in my area that insist on walking out in front of my vehicle forcing me to hit the brakes.
One day someone will do this when I'm nearing the end of a tiring thirteen hour shift, I won't see them and they will regret their attitude of 'ambulances always stop'…
We reach the hospital, it's busy and one of the lead nurses take the hand-over from my crewmate. This is where we meet the difference between good nursing and excellent nursing.
Hospital trollies aren't the softest things to lay on, especially when you are so frail you can't change your own position. So the nurse decides to put her on a normal hospital bed, but there is none in the department. She phones one of the wards and arranges to borrow the bed from them.
But there are no porters to go and fetch the bed – my crewmate and I volunteer to go and get it.
By the time we return to the department the patient's daughter has arrived – we explain what we are doing and she thanks us.
We settle the patient into the side-room, she's wrapped up warm again and the bed has a special mattress to help prevent any more pressure sores. Her daughter and the escort watch over her.
I take the escort aside, “Now is your chance to do some one-on-one nursing. Ask the nurses here for a mouth care kit, make sure she is turned every two hours. Sit with her. Look after her“.
I'm impressed with the lead nurse – she has reduced the time they have to deal with the patient before she 'breaches' the government's four hour target. But in doing this she has actually cared for the patient.
Shame there isn't a target for that.
7 thoughts on “Frail”
In my years doing agency nursing worked in many good and bad nursing homes, I can totally understand with what you mean. The waiting room to die nursing homes and the lets make the most of whats left nursing homes, total difference, and the former should be banned
it is precisely because of these sorts of anecdotes that the Whereforcare.co.uk website was founded, so that those who have experiences of care homes ( I would say paramedics rank highly up there) can write reviews to help those looking for care to make the right decisions. It would be great if you would take the time to review care facilities you have experienced.
4 hour waiting times in A&E- a well intended measure of quality in our healthcare system that has become a managerial target and abused to the point of corruption. I agree with your implication that we as clinicians need to ensure clinical priority takes precedence over managerial priority and is not distorted by it.Outcomes and processes are familiar to us, but we are not good at getting involved in the balances to make sure our targets/ quality measurements dont become distortions to other parts of the service.
oh how we all wish that every home was like that. Unfortunately they are few and far between and it sounds like you were very lucky. Good on them for getting it right…..
If she was bed bound she should have been on a pressure mattress to start with. I agree with you that some care homes are appalling, I still remember a man we had referred to us as 'dementia – no medical needs' by another home. I suppose he didn't have medical needs if you ignored the bedsore on his lower back that was so large you could fit your fist in it. And they clearly had ignored it. I'd just like to reiterate though, not all care homes and nursing homes are appalling. Although as soon as we can find someone to buy either the business or the property Manchester will be down one of its final homes which will accept challenging behaviours. After 20 years my folks have decided its just not worth the fight anymore – the fight with social workers, the fight with inspectors who are straight out of college and have only ever seen an old person on paper, never in the flesh, the fight with the local authority and primary care trust to get the 60 000 we are owed and the fight to defend nursing homes against the never ending character assassination that goes on in the media. It's a shame because now 21 more elderly people with serious mental health problems are going to either be shoved in hospital beds where they will be drugged and ignored or bunged in an entirely unsuitable home where they will cause chaos and will end up drugged to keep them quiet but hey, those who are constantly trying to trip us up, catch us out, prove us wrong will be happy because they'll have achieved their aim – the closure of another of those capitalist monstrosities, a private nursing home. So well done them, I hope they'll feel a warm glow inside when they visit George and find he's been shoved in a side ward and is so doped up that he can't speak and doesn't know his own name.
My Father (90yrs) has just spent 4 weeks in hospital.The ambulance crew were fantastic even having to cope with my Mum who got car sick (she was facing backwards and the disco lights and sounds were going).
Resus were fantastic.
The ward crew were for the most part – let me say that as an emergency VN l was not impressed and they knew it.
Anyhow he got out and is now in a convalescent home. He has a max of 6 weeks in it while he is assessed etc and so far apart from one minor mishap has it has been excellent.
l realise it is not a “long term” nursing home, they do have a block for dementia patients but l do not know how long they have there however…..
One of my biggest praises is over sleeping tablets. In hospital they were giving them to my Dad.
He was allowed them for the first 2 nights at the home then told
“You can have a mug of hot milk, and we will give you a mug of hot milk every hour until you fall asleep but you are not having any more drugs to sleep.”
He now gets his hot milk sleeps pretty much all the way through only waking if he gets to hot or cold in the night then if he can not get back to sleep they get him another mug of hot milk.
Anything that worries us we can check up on knowing it will be sorted.
They have done wonders on his legs that were water filled stumps and his ulcer has almost gone as has his constant pain with the legs. They will need more work but the work done has saved a hell of a lot of future trouble.
The serious rash that was starting to open into a nasty sore between his legs thanks to the hospital has gone.
So it has restored my faith in homes after all the media coverage, l realise this is only a short stay one but all l can say is… BRILLIANT 🙂
We now have vulnerable adult forms in Wales (for the welsh amb service). A bit late for some, sadly but better late than never. I don't know if the Scottish or various English services have them.How ad that the people who gave us a chance to have a good life under democracy should be discarded so easily.
Quite disgusting really