Feeding Tubes


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.

7 thoughts on “Feeding Tubes

  1. I confess I’m puzzled by this. It’s my understanding that although there is a requirement to have at least one member of staff that is a nurse in a nursing home, in practice they rarely utilise them and avoid situations which involve peg feeding. This is really odd and most disturbing..

  2. This is very shocking? What is the rationale? Are they thinking they’ll avoid aspiration events?? Certainly I would hope they would realize if someone has dysphagia they will still aspirate even if they aren’t being fed orally…that is horrible!

  3. Thanks for all the comments – I don’t really understand how this situation is occurring to be honest. I also find it hard to comprehend the widespread nature of this practice, considering I’ve worked for about 10 years in older adults services and have been involved with A LOT of nursing homes in that period but this aspect seems to have completely come from nowhere to me.
    It is horrific though and I hope that at least it is it highlighted, it can be considered in a human rights context!
    I have had more experiences where nursing homes have refused to take people who have had certain interventions (even if they might have made some of the care ‘quicker’) rather than demanding it as a matter of course..

  4. I endorse all the above comments. I found myself wondering what kind of doctor might comply with a request to conduct an unnecessary procedure and what the new ‘super’ inspectorate – responsible for both hospital and care home performance – will be doing about this.

  5. Once again, welcome to the real world of lack of care in care homes and soon to be the backbone of the so called home care regime, particularly where dementia patients are concerned.
    Thank you once again for commenting on this total abusive debacle, rife across this country.

    Dementia, of course being the main driver for these actions, is of course a disease of the brain and an illness, not a social care problem but a health problem,but it is shunted 99% of the time onto social services as part of MENTAL DISORDERS?

    When it is actually a degenerative brain disease in all of it’s forms, which causes problems with the functioning of the brain that cannot be cured or dealtwith by standard psychosis treatment, indeed it is of a nature that is over and above the social services legal limits being intrinsically a medical/health problem, manifesting itself with mental disorder symptoms but needing a wholly different treatment to address the human rights issue/needs of each person suffering.

    Match that with private care home MARKET need for obscene profit margins / extortionate investment on return needs, therefore that is their drive to CUT costs in any possible way, shape or form = staff cuts,

    Dementia patients are perfect for this abuse, and a growing market too,. GPs/doctors etc being squeezed on budgets, private finance intitiatives, managing their own budgets, budget cuts in SS/NHS, finance restrictions etc etc, ensure creative ways to maintain obscene profits especially from this very lucrative market sector/classification.

    DOLs, COP, best interests, is a mess, the only best interests considered, in my findings, is for the icon of profit, self preservation and money.

    The chasm that exists between, social services and NHS is ever widening, despite multi disciplinary team and integrated working, but soon to be under the NHS wing!where they assess in the first instance for community care, further construction in order to deny continuing healthcare to these patients.

    cb,
    I truly admire you and thank you for, firstly the insight into the social workers world & secondly, allowing my view, from my vantage point and experience to be aired.
    I realise that you and other similar minded people are islands, totally on their own, and having to work within the system that feeds you, rather than against it by raising one’s head above the parapet.
    I have gauged from many studies of social work sites, over the past three years, reading many books on the subject and studying economic and social history that most social workers truly believe they carry out their duties as required and do not question the efficacy of many many directions, guidance & changes resulting in health being shunted/redeifined onto/as social care in order to means test and charge for services that are 100% health needs, therefore the primary need.

    Maybe this blog is a way of assuaging conscience, sometimes writing things down helps to justify one’s existence in this mad world, where one voice cannot change anything world wide, but maybe in one’s own world can ensure that order ensues to make sense of it all.

    Referring /linking in to the RISK thread, this situation re peg feeding, being a health decision, is part of the risk assessment process, organisational or independent?,
    Both as it is a medical decision, therefore social services would not be involved? would they?.

    Picture this scenario:- person in care home with nursing needs, therefore social services can only be concerned with the residential portion, the nhs responsible for the nursign needs under either fudned care portion or fully funded CHC where social services then have no responsibility or input.
    If the person is deemed as a self funder, after 6 weeks, the SS withdraw forever, supposedly carrying out a SAP every 12 months, unlessanyone notifies any change in circumstances! But still only personal care liability, so therefore social services should never be invovled if a fitting of a peg situation is carried out?

    Or am I wrong? Can SS be involved in ‘peg’ feeding tube service user at home or in a care home.

    If someone living at home, & has a peg tube inserted, would it be the responsibility fo the DN to clean it every day, or the SS care services? could the 1/2 hour time limited care giver, give the feed?

    Othewise, can relatives give the feed?& clean out the tube as required making sure it as sterilised as necessary, if so, is that still classed as a nursing need, but given by live-in relative after training, as happened to Barbara Pointon.

    Why is this acceptable, if it is a definite nursing task?
    That sent in carers may not be able to carry out this task, but family are left to do it?

    Taking time to feed a person with middle/advanced dementia is VERY VERY time consuming, & when they inevitably lose their swallowing reflex & cannot take in liquid by mouth the peg feed should then be othe only option, sadly it is now recognised as an easy option to save timeconsuming ‘personal’ feeding prior to the actual need for this intervention.

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