Looking for beds

Something of a theme on my caseload at the moment is one of ‘delayed discharges’. I have three people in hospital medically ready for discharge and am waiting for residential or nursing placements to ‘pop up’.

It’s a warped kind of waiting game with no beds being available locally and people increasingly being shipped further and further out of London or at least towards the suburbs as the hospitals become desperate for beds and the lack of resources becomes painful.

One of the three has been on the waiting list for a local residential home for months. Another has a devoted wife who has constantly cared for her husband for decades through his progressively deteriorating dementia and another – well – the hiccoughs are proving to be way too many to detail succinctly..

But the result is the same – people who have strong local attachments, families and spouses are having to be placed outside the local areas.

It’s a subject matter that I have personally brought up again and again – going directly to commissioners when necessary but there is no aspect of my work where I feel ‘less heard’. Of course, placements can’t spring up overnight although some people imagine they can – and the brutal truth is that a placement usually only becomes available when someone dies.

That’s why the dementia residential placements locally have been so sparse – often they are taken up by people who could be very well physically and this means that those who need the beds are waiting longer and longer.

A part of the problem is that there was a feeling that ‘Extra Care Sheltered Accommodation’ – namely sheltered accommodation with additional 24 hour support on site – would ‘divert’ some people from residential care. In fact, the extra care sheltered properties, which we were told when they were established would be an ‘alternative’ to residential care, are not – at least in the local area I work (and it really could change from borough to borough) – not geared to meeting the needs of those who have 24 hour support needs. This is a particular issue at the moment as they seem to be incredibly reluctant to take anyone who doesn’t fit in to the ‘kind of person they want and would be ‘easy’ to manage’ making it more of an alternative for sheltered housing than for residential care.

I would love for there to be a widespread rethink of residential and nursing care provisions in the context of meeting individual needs. Prior to my qualification, I worked for about 7 years in a small group home for adults with learning disabilities and there was a massive focus on individuals and meeting particular needs. Of course, the funding is massively different level and that will always be the ‘sticking point’. There are vast amounts of funding available for younger adults compared to over 65s – simply because there is not the money there to provide the same levels of funding. Local authorities are not able to pay high care fees and the cheapest fees often involve large care homes. That isn’t to say they can’t involve personal care but more often than not they don’t – and certainly not where they need to be.

For every problem I find though, money is the answer – unfortunately – and in these times of shrinking budgets, we are left to provide what constitutes poor outcomes. I’d love to imagine a world where some kind of charity or donor could set up some smaller group-home like care structure for older adults too but the costs are way too high.. maybe that’s a project for the future..

Working in central London probably exacerbates the problem in some sense that the housing prices and land costs in the area that I work are particularly high – definitely favouring residential redevelopments for bankers as opposed to more substantial community resources.

But there is something incredibly cruel about ‘shipping out’ the older and the frailer to outlying areas. I know there is a move towards less residential care services but that isn’t the answer as there will always be some need for the provision.

6 thoughts on “Looking for beds

  1. Interesting post. It’s the same here, although we do have more places for the elderly than for younger people. There are still waiting lists for those with high care needs, and they tend to get pretty poor care. You know, there are care homes with demented people where there are two nurses to 80 or 90 patients at night.

    As for shipping out of area, I’m not sure if it happens to older people, since I’m not too familiar with those. It does happen in learning disabilities/mental health/etc. Even for moderate needs, you may need to move to a town near the city you come from. For more specialized services, like autism, intellectual disability with mental health problems, etc., you may need to move to another city. Nijmegen, my city, is in the south of Gelderland, and the letter I’m due to send to service agencies, will go to agencies in southern/central Gelderland and the northern/northeastern parts of the two provinces south of it. I used to even search for services in the entire country, but changed my mind regarding location when my social worker wanted to look only in the Apeldoorn area, the city where my parents used to live but moved out of. Now if we had to choose a region anyway (there is no bureaucracy dictating that here), let it be Nijmegen. At least my boyfriend lives in this area.

    • Thanks for sharing that. I guess I always assumed things worked better elsewhere. It shouldn’t need to happen – the shipping out, I mean, especially in a city the size of London but unfortunately land prices have become an issue as well as cost of care (it is more expensive in London, generally).

  2. Have you concidered using Tele Care products for those that would benefit from them. These products enable people to return home by providing 24hr ‘safety net ‘for them as they would alert Care Line if there was a problem. These products combined with a package of care sometimes is all that is needed. If the appropriate equipment is used it can prevent admission to a residential home. Just a thought.

    • Telecare can be used to help people stay at home for longer, perhaps but when someone needs 24 hour care, it is very rarely enough. Especially if we are looking for nursing care.

  3. Interesting insight, thank you.

    As you know, this subject is very close t my heart and many many others too.

    CanI please ask, if these perople are in hospital waiting for discharge, have they all had the compulsory continuing healthcare assessment, mandatory at discharge?

    If so, did they and their family fully participate, fully understand the process and if foudn ineligible, fully invoke the appeals procedure until exhaustion before involving social services for placement.

    Has the registered nursing contribution been assessed separately, only after the full CHC assessment?

    The last comment on 2nd November idicates that they need 24 hour nursing care.

    If finance, budgets, funding is the perenial never ending problem, and it appears that Health NEED, is the reason for the hosptialisation and future care requirement, has this happened as part of the now ingrained process, directions and responsibiltiies?

    Do social services not ‘push’ for health to take over the finance?

  4. Thanks for stopping in. I do appreciate your comments and insight. Everyone who is considered for nursing care now has to have the continuing healthcare assessment. We are not able to consider nursing care without it. That’s why it’s called compulsory!
    The comment above was not referring to particular instances as much as the comment that Telecare while invaluable, cannot always replicate ongoing residential care, let alone nursing care.
    I don’t want to go into too many details about individual instances but we are obliged to ensure that the assessments are completed. When someone is on a ward, it is more appropriate the nursing staff there will complete the CHC assessments however we might add a contribution but as it is an assessment of health need, the medical staff have a much greater weight.
    Incidently, I am currently trying to organise a community assessment for continuing healthcare and am encountering enormous resistance from the family who want to take the direct payment route. I would love them to but I am obliged legally to refer for continuing care assessment if I believe the need is primarily health.
    As you may know a little more about my personal situation, you will understand the dilemma this puts me in, personally.
    I assure you, I am trying to create a more coherent post about working through the continuing health care system which I hope will be a useful resource. I just need to pull different pieces of information together.

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