33 Top Tips for Elderly People in Hospital

Transcription

1 Mighty Oak Press Ltd 1

2 33 Top Tips for Elderly People in Hospital Are you going into hospital? Do you have an elderly relative in hospital? Elderly people can be particularly vulnerable in hospital. These 33 top tips help you: stay as well as possible remain in the loop with information check that correct procedures are followed make sure the right assessments are done before you re discharged You ll also find a brief introduction to care fees funding, including NHS Continuing Healthcare. If you re being transferred to a care home, it s vital to know how this works. Mighty Oak Press Ltd 2

3 The legal bit While every reasonable effort has been made to ensure the accuracy of the information contained within this guide, neither the author nor the publisher can be held responsible for any consequences arising from decisions made based on its content. This guide does not constitute financial, legal or medical advice. Consult a solicitor, independent financial adviser or health professional for advice on specific issues. This guide remains the copyright of the publisher, Mighty Oak Press Ltd. All rights reserved. No part of this guide may be reproduced or utilised or transmitted in whole or in part in any material form (including photocopying or storing in any medium by electronic or mechanical means and whether or not transiently or incidentally to some other use of this publication), except by a reviewer who may quote brief passages in a review, without the written permission of the publisher; nor may this publication be otherwise circulated in any form of binding or cover other than that in which it is published and without a similar condition being imposed on the subsequent purchaser. Thank you for your respect for copyright. For more tips and information on elderly care issues, including advice on how to get the NHS to pay for care through NHS Continuing Healthcare funding, visit Mighty Oak Press Ltd 3

4 Table of contents Introduction 5 Someone on your side 6 Information and communications 7 Financial matters 9 Personalised care 10 Avoiding additional hazards 12 Practical matters 13 Eating and drinking 14 Discharge procedures and assessments 15 Ongoing care 19 NHS Continuing Healthcare 21 Mighty Oak Press Ltd 4

5 Introduction In an ideal world, your stay in hospital would be a nourishing experience. Sadly, though, for elderly people that s often farremoved from reality. Hospitals can be disorientating and can sometimes put your health at greater risk. These tips will, however, help you avoid many problems and stay as well as possible while you re in hospital. Although these tips flag up potential problems, our aim is not to worry you. It s simply to make you more aware of some things that you or one of your family members can do to make your stay as pleasant as possible. It also highlights some of the procedures that hospital staff should follow. It means you ll be safer while you re there and safer when you come back out. Mighty Oak Press Ltd 5

6 Someone on your side 1. It s a good idea to have a family member or friend with you when you arrive at hospital and to visit you regularly while you in there. If you normally live in a care home, one of the care home staff may be able to accompany you at the start. Having someone with you can help smooth out any problems and it also lets members of the hospital staff know you have someone looking out for you. If you re a family member, let the nursing and medical staff know that you want to be kept informed about your relative at all times, however trivial any updates may seem. Make sure they know you d like to be involved in all decisions (assuming your relative is happy for you to be). If you re the patient and you don t have a family member or carer who can come with you to hospital, find out if someone from a local support group can help, e.g. a local Parkinson s Disease Society group or Alzheimer s Volunteer Group. You could even ask if a local specialist nurse is available, e.g. a Parkinson s specialist nurse. It s always worth asking. 2. If you re the patient and you re able to use a mobile phone, take one with you into hospital. As recent reports have shown, elderly patients are sometimes ignored in hospital. It s helpful to be able to call your family (or your care home) and raise concerns or ask for help. Make sure the phone numbers you need are already programmed into the phone. Ask whoever comes to visit you to charge the phone, if possible, each time they visit. Mighty Oak Press Ltd 6

7 Information and communications 3. When you re admitted to hospital you should be given the name of the matron or lead nurse on your ward, the name of your own main contact/care coordinator within the hospital and details of how to make a complaint if you need to. The paperwork from the hospital should also state the name of the Chief Executive. 4. One of the difficulties about being in hospital is finding a balance between asking for things and when things are not right asking for them to be put right and knowing that your welfare is entirely in the hands of the staff you may be complaining to. Families often have to strike the same balance in care homes, too. 5. If you need further help and advice about hospital care, it might be worth contacting the Patients Association helpline: The Patients Association is an independent charity that highlights the concerns and needs of patients. (Care To Be Different does not have any specific affiliation with this organisation, but you may find it a helpful resource.) 6. You might find that obstacles are put in the way of you speaking to a consultant or doctor in charge of your care and that you really have to push to get a proper health assessment done and to see a copy of it once it s done. (You are entitled to see it.) Keep pushing. See page 15: Discharge procedures and assessments. Be aware also that when people talk to you about doing an assessment, they Mighty Oak Press Ltd 7

8 should, first and foremost, be talking about a health needs assessment. See page 21: NHS Continuing Healthcare. 7. At the end of your treatment, you may be told you re being transferred from hospital to a rehabilitation or convalescent unit. This sometimes happens between an acute episode of hospital care and admission to a care home or returning to your own home. It s a good idea for you (or a friend/relative) to contact your hospital care coordinator to let them know. No matter what a doctor or nurse might have told you about what s happening, one department may not know what another is doing. Mighty Oak Press Ltd 8

9 Financial matters 8. Going into hospital may affect your benefits either positively or negatively. It s a good idea to check your position. Visit for links to organisations that can help. Your carer s benefits may also be affected. You might find the following links helpful, too: Direct.gov info on benefits: port/hospitals/dg_ Plus, additional advice for Northern Ireland: Scotland: nefits_index_scotland/faq_index_benefits/faq_benefits_hel p_for_elderly_on_leaving_hospital.htm Mighty Oak Press Ltd 9

10 Personalised care 9. Admission form this should be completed when you arrive at hospital or before. Be sure to record your needs and say what you want the hospital to be particularly aware of. If you have a specific or chronic health condition, tell the nursing staff what the implications are for you, what you find difficult (including turning in bed) and what you need help with. Make sure they know what issues are important and what needs to be monitored. Also, make sure they know if you need help eating and drinking or getting to the toilet. 10. Make sure members of the nursing staff are aware of the timing of any medication you take (especially if you have something like Parkinson s Disease) and whether you need to take medication with food. There s also a good chance you ll have blood taken for testing at some point while you re in hospital, so make sure the nursing staff are aware if you take Warfarin. Don t rely on them knowing anything about your medication already. It s a good idea to take your own supply of medication with you in case you have to rely on it. Make sure all your doses and timings are clearly written out and give this to the nursing staff. It s also a good idea for you, your family or your care home to record your weight before you go into hospital and again when you come out and to make notes about any concerns you have about your care. 11. If you re having an operation, make sure everyone involved, especially the anaesthetist, knows what Mighty Oak Press Ltd 10

11 medication you re already taking. Ideally, medics should know this already but never assume they do. 12. Before you agree to any treatment from a doctor or nurse, make sure they re aware of any other health problems you have that might have a bearing on their decisions. Also, make sure your other health issues are not ignored. Sadly, it s not unusual for one health issue to be treated in isolation, while the other issues begin to worsen. It can be immensely frustrating. 13. If you have or are at risk of pressure sores, ask for an air mattress. The hospital should provide one and, when you re in bed, nursing staff should also turn you regularly if you re unable to do this for yourself. Similarly, if you know that falling out of bed is a risk for you, insist on having cot sides on your bed at night. Hospital floors can be very hard. Mighty Oak Press Ltd 11

12 Avoiding additional hazards 14. It sounds obvious but... If you re about to be examined by or receive treatment from a doctor or nurse, and you believe they may not have washed their hands or sterilised their equipment properly, insist that they do so. The single most important thing here is your health and wellbeing. 15. When you first get to the ward, take time to assess how you ll be able to get to the toilet. Also, make sure you can reach the call bell from your bed. Mighty Oak Press Ltd 12

13 Practical matters 16. Take your own specialist walking aids and any other devices that you may need, unless you ve specifically been asked not to. Make sure your name is on each one. When you leave hospital, make sure you ve been supplied with any new walking or mobility aids you might need, plus any new medication. 17. Make sure you have sufficient continence products, if you need them, including when you leave hospital. You should not be charged for these. If the hospital suggests fitting you with a catheter, and yet you don t normally have one, question it. They may be suggesting it simply because it makes things easier for the nursing staff. It may, however, not be the best thing for you or your bladder health. Mighty Oak Press Ltd 13

14 Eating and drinking 18. If you need help eating and drinking, ask who will be responsible for helping you. If you have difficulty swallowing or are at risk of choking, make sure nursing staff are aware of this and ask what they will specifically do to help you in this regard. 19. Take specific foods and nutritional supplements with you that you know will help. If you are in bed all the time and not weight-bearing, it s important that your bones stay healthy. Drinking lots of water will help. Eating leafy greens can also help in many cases, but unfortunately hospital food does not always accommodate this. When you leave hospital (when you re discharged) you should also be assessed for your ongoing nutritional needs. 20. Make sure you have a good supply of drinking water available by your bed at all times, and take bottled water if you need extra peace of mind. It s not unusual for people to develop urinary tract infections and other serious problems in hospital because of the lack of attention to helping people drink. Mighty Oak Press Ltd 14

15 Discharge procedures and assessments 21. The hospital should have a clear discharge policy and is obliged to provide a safe discharge for you once you re ready to leave. You should be asked about your situation to make sure that, when you re discharged, you ll be returning (or moving on) to a safe environment with the support and services you need. This should also take account of any difficult family dynamics, where relevant. If you cannot be discharged from hospital safely then it is clearly not safe for you to be discharged! 22. Find out who your discharge liaison nurse or discharge coordinator is. This person will be the link between the hospital and other members of your care team. If there s a specialist nurse available for your condition, it s worth finding out who it is. Ask them for advice on your care and rehabilitation. You can often get in touch with them through a local support group or charity for your illness. 23. If you re sent to a Discharge Lounge at the hospital on the day you re leaving, make sure that the staff know if you ll need help eating, drinking or getting to the toilet while you re there. Otherwise you could be left unattended. Also, make sure you have suitable clothing in which to go home. The hospital should not send you home before you ve had a chance to get dressed properly. Many hospitals like to discharge people in the morning to free up beds for incoming patients that day. It means that the Discharge Lounge gets used as a kind of holding bay, to help balance capacity with demand for beds. However, it Mighty Oak Press Ltd 15

16 means patients can find themselves in this room for many hours. 24. If you need transport when you leave hospital, the hospital should arrange that for you. 25. If you need ongoing care in another location, such as a care home, you may be given forms to sign relating to care funding/care fees and your financial status. Don t sign anything or divulge any financial information until a full assessment for NHS Continuing Healthcare has been carried out by the NHS. This looks at your health needs. You (or your representative) should be fully involved in this and be given full opportunity to appeal any decisions made if you don t agree with them or if you feel that the assessment has been rushed or carried out at very short notice. The NHS is obliged to provide you with information about how to appeal. Before any assessment, you and/or your representative should be given enough time to pull together all the information you feel is necessary for a comprehensive review. See page 21: NHS Continuing Healthcare. 26. Do you have suitable clothes in which to leave hospital? If you arrived at hospital in an emergency, do you have your house keys to get back into your home? And do you have enough cash on you, should you need it? 27. You should be discharged from hospital only when: A full assessment for NHS Continuing Healthcare has been carried out, with you (and your family, carer and/or representative, if you choose) fully informed and involved at every stage. If you are being transferred to Mighty Oak Press Ltd 16

17 a rehabilitation hospital/unit, you may be assessed once your current acute needs have reduced and your ongoing health needs are clearer. A multi-disciplinary team has been involved in the assessment, including your doctor(s), nursing staff, specialist consultants/clinicians, physiotherapist, speech and language therapist, occupational therapist, social worker, etc, as relevant. Your health needs have been clearly identified. You have a proper care plan drawn up and appropriate ongoing care has been arranged for you. Any additional support for your carers has been arranged, as needed. Funding for your ongoing care has been arranged appropriately. 28. While these things are being organised, there are clear Delayed Discharge procedures that the NHS has to follow. (Delayed Discharge is sometimes referred to as Delayed Transfer of Care). However, many people find they are put under pressure to leave hospital before proper ongoing care has been arranged. This is in breach of the law. You are entitled to stay in hospital free of any charge until it is completely safe for you to leave. 29. You may hear the term bed-blocking referring to someone occupying a hospital bed after the hospital has given permission for discharge. The NHS will tend to blame social services for any delay (bed-blocking) for not organising ongoing care fast enough and yet the NHS may not have carried out the correct health needs assessments. Social services is under pressure to get you into ongoing care as fast as possible, and you may find that Mighty Oak Press Ltd 17

18 they assume you will be paying for your own ongoing care without checking whether you should be funded by the NHS. You can read more here about the Delayed Discharge procedures that should be followed by all concerned: ssets/documents/digitalasset/dh_ pdf. The current coalition government is talking about making the NHS responsible for patients for up to 30 days after discharge, as a way of improving discharge planning and reducing readmissions. However, there is nothing in place as yet. Mighty Oak Press Ltd 18

19 Ongoing care 30. If you re coming out of hospital and going into a care home for the first time, and you start paying care fees through means-testing, the value of your property should not be counted for the first 12 weeks of your care. Visit for more information about care fees. You ll also find our practical guide, How To Choose A Care Home. 31. Don t let anyone force you into making a decision about going into a care home. Be sure this is what you want and that you have visited the care home first. Choosing a care home needs careful thought. No matter what anyone in authority might tell you, it s not simply a question of taking the first available place, There are some crucial things to understand first, as they may impact greatly on your finances and your enjoyment of life. You are entitled to occupy your hospital bed until a full package of care including a care home place you like has been arranged. Going from hospital into a care home for the first time is likely, by definition, to show that you have health needs. Otherwise you would be able to go home! This is a useful point to remember in any assessment for NHS Continuing Healthcare funding. See page If you have mobility problems or speech problems, make sure you see the hospital physiotherapist, occupational therapist or speech and language therapist. Find out what help will be available to you after you leave and make sure you have a clear written programme of rehabilitation or a care plan. Insist on this happening. This kind of Mighty Oak Press Ltd 19

20 rehabilitation is vital and, sadly, it doesn t always happen even if you re told it will. If you normally live in a care home, the care home staff will need to know about your rehabilitation needs. It s not always easy for a care home team to stay in the loop in this respect and the care home needs to be sure it is still able to look after you. 33. The hospital might change your levels of medication. Make sure you know what these are before you leave hospital. Your GP and/or care home team will need to know this, too, and they rely on a letter from the hospital. Before you leave hospital, ask when exactly the hospital will be writing to your GP. You may be given a letter to take with you. If not, find out when exactly that letter will be sent and who is responsible for doing that. Mighty Oak Press Ltd 20

21 And finally... NHS Continuing Healthcare If ongoing care is being arranged for you, the NHS is obliged to carry out an assessment of your health needs and to consider whether you re eligible for NHS Continuing Healthcare funding. This funding covers 100% of the costs of being in a care home or receiving a package of nursing and personal care at home. Health service members of staff or the hospital social worker are supposed to apply on your behalf for NHS Continuing Healthcare, but this does not always happen. You may find that the hospital social worker talks about an assessment and is talking about a Section 47 financial assessment, not a health needs assessment. No financial assessment should be done until an assessment for NHS Continuing Healthcare has been carried out. The assessment for NHS Continuing Healthcare should take place with your full involvement and that of a family member as your representative, if you wish. Your representative should be invited to attend and input into the assessment with you, and you should be given copies of the decision-making criteria plus all notes made during the assessment and any added afterwards. You may be asked to sign the notes; however, you are not obliged to do so. If you do decide to sign them, make sure it s clear that you re signing simply to say you attended the assessment and not that you agree with any subsequent outcome or funding decision. Mighty Oak Press Ltd 21

22 The assessment should be carried out by a multi-disciplinary team and should consider ALL your health needs, plus the way that one health need might impact on another. Some families find that no assessment is done at all. If you find that the hospital is putting you under pressure to vacate your bed and leave, and yet you have not been informed about or involved in this assessment for NHS Continuing Healthcare, the hospital is acting outside the law. Documentary evidence of this assessment is essential. The NHS is responsible for funding all of your ongoing care until the proper procedures are followed and you have been also given the opportunity to appeal any decision to deny NHS Continuing Healthcare funding. Legally, you can only be discharged from hospital when appropriate funding for ongoing care has been arranged. When you stand your ground and you explain that a proper assessment must be done first, you will have the upper hand. It is then in the NHS s interests to act swiftly. If you leave hospital without the proper assessments having been done, you can still go through the process retrospectively at a later date, but you will have lost your bargaining tool to get things done quickly and to get funding sorted out properly. Always ask the hospital all the questions you want to ask and remember... No one can make you feel inferior without your consent. (Eleanor Roosevelt) For more information about care fees and other matters to do with elderly care, visit Mighty Oak Press Ltd 22