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March 19, 2020

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The physical and mental toll of the stranded elderly

As hospitals face what Simon Stevens recently described as the biggest threat to the NHS since it was created, we’re reflecting on the importance of helping those older people who are ready to leave hospital into care at home or in the community as soon as they are medically fit to do so. We’ve spoken with a consultant geriatrician about the risks for older people when they remain in hospital once well.

 “What shocks me is that every winter it seems to come as a surprise to many people that we are in this position – but the same issues arise every year”

“During the winter, helping patients to arrange safe discharges from hospital becomes much more difficult. I’ve been a geriatrician for 20 years and it’s worse than it ever was.  

It upsets me to see patients inappropriately stuck in acute hospital beds. As they wait for a package of care they are at increased risk of infection, all the while deconditioning, losing confidence and becoming institutionalised. And these are frail and elderly people who have a life expectancy of perhaps two or three years, but six months of that is being taken up by delays in navigating a broken system. Sadly, it is not uncommon for them not to make it out of hospital.

Social services have no funding or resource, and don’t always know where the care home spaces are. Illogically, you end up resenting them, but it’s not their fault. The red tape when securing someone a place in care is horrendous: there are multiple forms and questionnaires to complete, which causes a built-in delay. This means people have to go into ‘step-down’ beds, which is just a creative workaround to deal with unwieldy regulations and the split in health and social care budgets. But the patient is still not in the right place for their needs. As well as the impact on the patients stuck in bed, it also means we can’t bring in other patients who are waiting in casualty or inappropriate wards.

One gentleman was on the ward for 250 days, at least 150 of those days were because of discharge difficulties, such as the inability to access the right care and the family having inappropriate expectations. We had multiple meetings with his family, which took up hours of clinical time from a multitude of healthcare professionals, to demonstrate that staying in hospital wasn’t the best thing for him. As expected, he ended up getting an infection whilst waiting for appropriate discharge arrangements.

For the families who have been thrown into these situations, it is difficult and stressful to navigate the health and care system. They are often under the misconception that the hospital is the safest place for their family members to be waiting. Doctors and nurses don’t have the time or resource to support families with this, in addition to fulfilling ever-increasing clinical demand, so we have developed dedicated discharge teams to help find the most appropriate place for their loved ones.

But what shocks me is that every winter it seems to come as a surprise to many people that we are in this position – but the same issues arise every year. Right now, the number of patients ‘in delay’ make up about two or three wards-worth of patients.

  • On average, over the whole of winter (December 2019 – February 2020) 16,112 beds a day were taken up by super-stranded patients
  • An average of 1,981 ambulance handovers a day were delayed by more than 30 minutes (an average of 14% of daily ambulance arrivals)
  • In January 2020, an average of 5,182 patients a day (acute and non-acute) experienced delayed transfer of care, meaning that they are medically fit to leave hospital but is still occupying a bed, resulting in a total of 160,637 ‘delayed days’

Sources: NHS Statistics Winter Situation Reports 2019/20, NHS Statistics Delayed Transfers of Care 2019/20

As originally seen on LinkedIn

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