A 90-year-old woman was left languishing in hospital for more than a month amid staff shortages in social care, and even after being discharged her nightmare has continued, says her frustrated family.
Nurses at Salford Royal Hospital, where she had been since October 28, believed that home is the best place for the elderly woman, according to her family.
But hospital staff and her loved ones alike were hamstrung by the inability of social care providers to give the Salford patient the support she needed to leave the ward.
READ MORE: The reasons why so many people who are 'medically fit for discharge' are still in hospital beds
The 90-year-old suffered as a result of a region-wide concern for hospitals, admitted by Greater Manchester health bosses last week.
People who are ‘medically fit for discharge’ are being forced to wait in their hospital beds.
They are unable to be discharged for a number of reasons, leaders have said, including:
- The impact of Covid meaning some patients’ conditions have become more serious and they need longer recovery time in hospital
- Increasing number of patients with complex needs requiring more support once discharged
- Workforce capacity/capability to discharge (a level of seniority is required to discharge patients confidently and safely)
- Patient, carer and family choice.
But medics are also reporting that another significant factor preventing people from being discharged is the staffing crisis within social care.
Shortages at care homes leave no place for patients to safely go once they are well enough to leave, and diminished staff working within the community cannot cope with the amount of patients needing help at home.
The inability to discharge patients is part of a picture of overcrowding in the region’s hospitals, where beds are ‘more than 90 per cent full’.
For the elderly widow in Salford, who the Manchester Evening News is not naming for her privacy, the blockages are causing extreme distress.
She used to receive three visits per day from social care workers when she was in her own home, but that offer was quickly rescinded a few days into her most recent admission to Salford Royal Hospital, says one of her two daughters.
“My mother is blind and deaf, she’s a fall risk so she does need help at home. She has been admitted to hospital on several occasions, typically for falls. During one of her stays, she caught Covid-19 and had to remain in hospital.
“On October 28, she was admitted again with what was thought to be a mini stroke. Around four days later, she was ready for discharge, but 48 hours after she went into Salford Royal her care package had been stopped.
“Even the nurses are saying it’s not doing her any good being there, and the doctors tell us the best place for her is her own surroundings.
“Every time she gets stressed she suffers from delirium. She’s so frightened of going into hospital, the admissions set her off again.”
In Salford, the number of people whose discharge is being delayed has risen as much as 42 per cent.
“We do track those numbers of patients on a daily basis and have been doing that for a while now since last winter,” Chief Accountable Officer Steven Dixon told a board meeting of Salford Clinical Commissioning Group at the end of November.
“The number of patients waiting to be discharged from hospital, and where there are delays, has started to increase, probably from around July, August-time.
“There will always be people waiting in a hospital bed to be discharged, that is normal. So as soon as someone is medically fit for discharge, they appear on a list and are discharged hopefully into their own home or into another part of the community.
“What is important is the length of time people are in a hospital bed, after they are ready to go home.
“There are more delays in discharges from hospitals. Ordinarily, typically at Salford Royal there would be around 120 people in a hospital bed ready to be discharged on that day.
“That is the normal number for Salford Royal.
“At the moment, the daily numbers are 160, 170. So there are around 40 to 50 people experiencing more delays than we would expect and would like.”
The entire hospital and social care system is so stretched, says the officer, that there are a host of reasons for the delays, including lack of domiciliary care workers which would help out patients like this 90-year-old widow.
“Those patients are waiting to be discharged to a number of settings,” explained Mr Dixon.
“Most of them will be discharged to their own homes - they are the most simple discharges to arrange because those people do not necessarily need any statutory support or any support from any other part of the system. Those patients do get discharged on the day.
“On the other end, there are patients waiting to be discharged to another bed, they might have complex physical needs - they may need to be discharged to a spinal unit, a renal unit, or a mental health bed. Those numbers are relatively small.
“Where we are seeing an increase in delays to discharge are those people who are waiting to be discharged to their own home, but they do need some support wrapped around them. Either from domiciliary care or other statutory organisations.
“That is becoming more complicated because it does link into the pressures we are seeing in the system at the moment. Not just in social care, but this issue does link into social care and the shortage of workforce in domiciliary care.
“That is causing us some operational difficulties in trying to get domiciliary care support to some of our people that are waiting to be discharged.”
Earlier this week, the family of one of those 170 patients was in turmoil as they waited on tenterhooks every day to find out if their beloved mother was coming home. All they want is to ‘make her comfortable’ in her final years.
“There’s just no care packages available,” continued the 90-year-old patient’s daughter. “The care system seems to have broken down.
“There’s very mixed messages. Yesterday, one doctor told us that she could be discharged on Friday. The day before, they were telling us it could be weeks.
“I’ll believe it when I see it. It’s like we’re banging our heads against a brick wall. It’s incredibly frustrating.
“My sister has become her primary carer, she used to be allowed two visits a day but that has now been cut down to one.
“My mum feels like she is being punished, she’s lashing out at my sister because she thinks we don’t want her to come home. She can’t understand why she’s not allowed home, she feels like she’s in prison.”
The patient’s son-in-law added: “She can’t come out of hospital until there’s a care package in place, but the private providers which have the contracts with the hospital say they have run out of staff.
“I don’t blame the doctors and nurses, I blame the appalling social care system.
“She is stuck in hospital and she doesn’t need to be. She doesn’t have a lot of money but she’s happy to pay what she can towards her care to get herself out of hospital.
“She wants to go home and is blocking the bed of someone who really needs it.
“Enough is enough, realistically she doesn’t have long left, it would be nice if we could make her comfortable at home. It’s what she deserves. But it’s like they’re just waiting for her to die.”
The Manchester Evening News approached the Northern Care Alliance NHS Foundation Trust, which runs Salford Royal, on Tuesday evening, November 3, for a response to the 90-year-old's circumstances.
This morning, Friday December 3, the trust responded saying that the patient has now been discharged.
A spokesperson for Salford Royal said: “Due to patient confidentiality we can’t go into the details of [the patient’s] care.
"[The patient] has been discharged from hospital with the appropriate package of support from an external care provider. We wish her well for her onward recovery.
"We are in touch with [the patient's] family and they have been assured of ongoing support from our services, including district nursing.”
But the nightmare has continued since the patient was discharged, claims her family, and 'could leave her facing yet another hospital stay'.
The elderly woman was sent home from hospital on Thursday evening with a care package of two visits from the staff of a private care company - one in the morning, and one at lunchtime.
On Friday, a carer did not arrive until 'late morning, between 10.30 and 11am', says the family.
One of the 90-year-old's daughters was there to meet the carer for the first time, only she then had to get her mother out of bed, checked and dressed for the day herself, as the carer did not arrive 'for hours'.
When the carer did come, it was discovered that the patient could have a 'bladder infection' and 'had been fitted with an incorrect/incorrectly fitted catheter'.
"She was catheterised before she left hospital, it hasn't been working and she has been left lying in a wet bed until 9 when her other daughter came in to check on her and wait for the carer to come," explained the son-in-law.
"Is that the morning visit or the lunchtime, or is someone trying to combine them as a way to save time?
"The carer didn't come and that's caused a lot of distress. She needs some continuity in her life - you can't just leave someone in bed until the middle of the day, without checking if something has happened overnight.
"Now she's got a bladder infection, which is likely to give her more delirium. For her to be sent home with an infection and what we're told is the wrong type of catheter, it's just basic, it looks like she has been rushed out.
"This has been living hell for her. And lots of people will be in the same position. We're worried she could die at the hands of the NHS."
The trust said: “We’re satisfied that the care provider and her family have agreed the pattern and timings of future visits. We’ll be in touch with her family to offer clarification and reassurance to them around the issues they’ve raised regarding the catheter.”
Have you been caught up in the NHS and social care crisis? Email our health reporter at helena.vesty@reachplc.com.
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