I was appalled by this story in the Guardian this morning that residents entering some nursing homes are being required to have feeding tubes fitted as a condition of admission – this comes in a report from the Royal College of Physicians which recommends that artificial feeding should be used ‘as a last resort’ which seems perfectly obvious to me.
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In all the years that I’ve been working in the field of care for the elderly and more specifically in the last few years in a specialist mental health team, I have to say I have never come across this in any nursing home that I have been involved with – so the report came as a complete shock to me.
The article goes on to state that
A recent national confidential inquiry into patient outcomes and death (NCEPOD) investigation found 19% of those undergoing the procedure had it fitted inappropriately. “They described it as futile,” said Burnham. Almost half of those who died (43%) did so within a week.
While a nasal tube is safer than a device fitted in the abdomen, a so-called PEG, the best option for patients is normal feeding wherever possible. “‘Nil by mouth’ should be a last resort,” says the report.
The speculation is that the time taken to feed a resident who has higher needs and requires more personal attention is lacking and that is why the procedure might be done.
Any adherence to the Mental Capacity Act would hopefully be able to regard all such procedures in a more patient-centric way and certainly it would flag immediately as a possible deprivation of liberty (although not necessarily as there are differing circumstances in all cases) which would at least require a lay and a medical opinion to authorise – through the assessments of a Best Interests Assessor and a Medical Assessor.
Even prior to an admission to a home, I wonder if a medical procedure of this kind would not need some kind of ‘best interests’ decision to be made and that being the best interests of the individual rather than the management needs of the care home in question.
Honestly though, I’m amazed this news isn’t on the front pages of all the newspapers this morning. For me, it is one of the most scandalous stories I’ve read in a long time.