Wake up and smell the coffee with Ronald Reagan circa 1981.
Correct me if I am wrong here (really I mean that) but isn't this model of care pretty much everywhere except western Europe.
Currently, the residential homes in the UK are little victorian townhouses with lots of steps. The staff is comprised of care assistants. Once those patients deteriorate and age enough to the point that they are confused and /or cannot mobilise they get sent into hospital and wait 8 weeks for a bed in a nursing home. The minute a patient becomes confused suddenly or mobility deteriorates they are sent into hospital.
The nursing homes here are wee little old victorian townhouses with lots of steps. They have RN's on duty 24/7 as well as care assistants. But, they do not take patients on IV fluids of any kind, they cannot give IV antibiotics and if a patient needs a chest xray they get sent into hospital. Many of them
Is it really any goddamn wonder why are acute medical hospital floors in the NHS are 75% nursing home patients who are very demanding but not acutely ill? Their relatives expect them to be cleaned and fed and entertained constantly. They don't seem to realise that the hospital is only staffed with just enough nurses to barely keep on top of all the IV meds for the 25% acutely ill. The hospital is the worst place for any medically stable but dependent elderly person to be. Duh.
Are they really just figuring out now that this set up is bad and that they need to "modernise"?
They should have figured it out in '81. No excuses. The NHS should have planned for his and implemented something before Reagan was shot and anyone ever even heard of Madonna. Here we are in 2009 and suddenly they wake up? Fucktards. And nurses are taking the heat for the elderly getting poor care? Christ.
I worked in a "long term care" facility- in lets say- Maryland many many (more than 10) years ago. It was set up very similiar to what is described in this article.
Ground floor was physio, OT, patient entertainment, restaurant etc.
Floor One: residential care with 60 beds.
Floor Two: EMI with 60 beds
Floor Three: nursing home with 60 beds
Floor Four. 30 beds. Skilled nursing unit for patients needing IV antibiotics, blood, IV fluids, Peg feeds, complex pressure ulcer management etc. This was to keep extreme geriatric patients out of the hospital unless absolutely necessary. Hospitals are the worst place for medically stable but extremely geriatric dependent patients. The hospital staff cannot cope with acute patients and nursing home patients at the same time. They are not staffed too cope.
Floor four had another 30 beds. This was ultra skilled nursing care: long term patients on ventilators etc.
The local area was full of such homes. They were known as nursing homes.
Sometimes patients needed to get sent to hospital. But 24 hours a day we had a respiratory therapist on staff at the facility. The GP's and specialist doctor surgeries who were responsible for the patients did daily rounds and always had one on phone duty to give the nurses any orders required We had a guy with a mobile x-ray machine and we could get one done 24 hours a day. We had a phlebotomist who came in to get the bloods that needed to be taken every morning. We had our own pharmacy.
If a patient became confused we checked their temperature and dipped their urine...maybe got the doc to order a chest x-ray from our in house chest x- ray guy. When elderly people become confused it is sometimes due to an infection. We could start IV antibiotics and fluids right then and there if that is what the doctor wanted. Other problems like extreme bradycardia and ecg changes would warrant a call to 911 and transfer to the local hospital a&e. It was the doctors decision. But we even treated DVT's at the facility. he gave IV heparin infusions. The skilled unit also functioned as a stepdown, rehab area for hospitals to discharge elderly patients too. If they couldn't care for themselves at home once they recovered they stayed with us and moved downstairs. We took patients who paid privately and medicare, medicaid patients as well as insurance patients.
When a residential home patient became unwell but did not require hospitalization they were moved to the skilled nursing floor. If their cognitive or mobility issues continued to deteriorate, which is what happens to most elderly people whether or not the decline is accelerated by a disease process, then they moved onto the nursing home floor at this same facility.
The NHS may be looking at this model of care but I doubt they will want to fund it and staff it properly.
At work in the NHS we get many many phone calls from angry family members of our patients. "The residential home won't take 99 year old granny back because she can't walk now AND IT IS ALL YOUR FAULT BECAUSE YOU LET HER LAY IN BED." Umm. Granny had a massive stroke. Anyway Granny will wait 6-8 weeks for a nursing home and develop a pressure ulcer and hospital acquired chest infection. Much of the time we are not staffed in away that allows us to bathe and feed granny at any point without killing KILLING our acute patients. Sorry. We (frontline staff) did not create this situation nor can we control it. We aren't the ones who want it to be this way. We want a controllable workload so we can do basic care for our dependent patients as well as deal with all the other things getting thrown our way.
We get patients from residential homes who are sent in due to confusion, diagnosed with a urine infection, given oral trimethoprim and stay in the hospital for 6 weeks because the residential home "cannot cope". Yeah it does take this long to sort out another place for them to go on discharge.
Elderly people will deteriorate cognitively and physically. A disease process that you or I would get over quickly will accelerate this decline in elderly patients and most of the time they will not get their former level of function back. The nurses did not do this to your gran.
The current system in place for dealing with our elderly patients is a total fail and it cannot function in the 21st century as the geriatric population explodes dramatically. We may be keeping people alive more now but not always at a level where they can function independently. Don't blame the hospitals and for god's sake please don't blame that lone RN running between 15 acutely ill patients and trying to care for multiple elderly and dependent patients between giving IV drugs etc.
The system is not set up in a way that they can manage the rapidly growing aging population.
Look at the system.
Is it any wonder why our elderly community is suffering? Who still believes that their suffering and lack of care is down to uncaring nurses who require dignity lectures? Some people just need to be slapped and then thrown off a fucking cliff you know. If only these older out of touch nurses would focus on the real problems rather than indulging in the nursing profession's greatest pastime-eating their young. If only....
Personally, I would love to turf the acute patients and drug users out of my face and sit with and nurse sweet granny all day. But you would never know it when I am at work and running past these poor elderly patients at 10 miles an hour, ignoring their cries because my pregnant heroin user just shot up in the day room and collapsed on the floor at the same time that some one else has started with a lethal GI bleed.
Am I wrong? Am I way off base about nursing and residential homes in England? Am I wrong about the ones overseas? Let me know. One can still be provincial even if she has lived all over the world. Seriously.
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