Dementia and Hospital Stays

Today, Community Care reports that the Alzheimer’s Society has called for patients with dementia to be discharged earlier from hospitals as this would save a significant amount of money.  They conducted a survey of 1300 carers of people with dementia, about 650 nurses and 500 nurse/ward managers to find that 86% of managers said people with dementia spent longer in hospital that others admitted with the same medical conditions and 49% of carers said hospital stays had been longer than they had expected.

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There are other figures there but to me there is an obvious reason for these figures. Firstly, most ward managers always think people are in hospital longer than necessary. I am working with a man who is currently in the local acute hospital’s general medical ward. He fell and broke his hip. He has been ‘ready for discharge’ four times – on each occasion as I have arranged his discharge – I have been told that he has deteriorated further and is unwell. But on each of those ‘almost’ occasions, I have received all the delayed discharge paperwork and have created no small amount of work to try and set things up for him.

Currently there is a wish to rush people out of hospital. Where I work, there are very few dementia residential placements in local homes. We meanwhile have no provision for block purchased intermediate care placements – no wonder then that there are some delayed discharges but I wouldn’t expect ward managers to say anything other than that because often they are at the sharp end and cannot understand the implications of poor commissioning decisions.

I would also imagine that with some people with dementia there might be issues of capacity to explore more fully before a discharge can be planned and possibly more risk assessment in place to ensure safe discharges home. I’m not saying it is right that people with dementia have longer in-patient stays but I’m also not sure that the Alzheimer’s Society calling for £80 million to be saved by discharging people with dementias a week early is anything other that attention-grabbing without a further look at the reasons.

I would say if there were any call for the funding that could be saved by acute hospital stays when they are not necessary, it would, in our local area anyway, be better served in more longer term planning about the need for beds specifically for those with dementia and also perhaps a more substantial mental health liaison team that works specifically with older people with dementia as seemingly the funding for the liaison work doesn’t stretch very far into the ‘older’ age group.

One of the more worrying aspects highlighted in Community Care is that

The report also identified problems with staff training with 54% of nurses saying they had not received any pre-registration training in the illness. Of particular concern to carers was a lack of help with eating and drinking which was often linked to deterioration in patients’ physical health.

We had a brief discussion in our team not long ago about care of dementia patients in general hospital wards. It is understandable that time and capacity is an issue that there is not more time but perhaps having more specifically trained additional members of staff to provide care as opposed to nursing would be a way to improve the conditions for those in hospital.

The ideal is a safe and satisfactory discharge of course but often there are many contributing factors that lead to a more thorough plan being made for discharge than some patients who are able to make those decisions themselves entirely. The lack of placements and decent intermediate care will also always be a factor in delaying discharges from hospital wards.

2 thoughts on “Dementia and Hospital Stays

  1. I can recall a when an elderly gentleman currently living independently on his own was admitted to our ward for a hernia repair. He had a diagnosis of Alzheimers and was on medication for this. Following his operation and the general anaesthetic he became even more disorientated in time, place, person, unable to retain information and seemed quite freightened and scared in this foreign place, his brain still hungover from anaesthetics. It took this gentleman approx 3 weeks to return to his ‘pre-admission functioning’, waiting for the anaesthetic to ware off, fluid balance to return to normal. He couldn’t have been discharged sooner, if he were asessed after week 1 he would have been deemed not fit to live independently and in an EMI for the rest of his days, he needed the 3 weeks so that his future living arrangements, big decisions about the rest of his life could be fairly and accurately done. Yes the management didnt see him as an ‘acute surgical’ patient and wanted him carted out early, but he now lives independently at home again, if the pressures on the ward for beds may have been more drastic this man may be stuck in an EMI for the rest of his days when he really hadn’t deteriorated to that point yet.

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