Ship of Fools: Care, treatment and spending on the elderly

Thread: Care, treatment and spending on the elderly Board: Oblivion / Ship of Fools.

To visit this thread, use this URL:
http://forum.ship-of-fools.com/cgi-bin/ultimatebb.cgi?ubb=get_topic;f=70;t=027400

Posted by no prophet (# 15560) on :

There's been a debate in some provinces (you can google it, not that important) about whether the elderly should have 1 or 2 baths per week when in long term care, among other things.

quote:
from above link
Some seniors in Saskatchewan care homes receive only one bath a week, soil themselves waiting for help to go to the bathroom and are forced to wake up as early as 5:30 a.m. and get ready for bed as early as 5:30 p.m.

In many parts of western Canada, the shortage of beds in long term care can mean that when a couple finds one of them infirm, often after falling or other medically significant incident, that the 'geriatric assessment unit' (of whatever it's called) determines that returning home is not possible.

The next step is to get the person out of the expensive hospital bed and into some other placement. The first bed that comes up is the one. Thus, we have situations of married couples who find one them placed up to 200 km from each other, and in different communities than their children and relatives. We also have the situation of couples in separate long term care facilities both distant from family.

Does this happen where you live? I know the headache and heartache of elder care. Of my wife and my parents, only my father is living. It took 14 months to get a placement for him close to us.

I get concerned additionally because we're reopenning the euthanasia issues in Canada, with Quebec recently passing a law about it. The scenario of elderly being placed away from supports and loved ones, and then having the option of requesting euthanasia seems rather troubling to me. I wonder if we should instead just be up front about it, be honest, and inform the elderly that they must maintain health and independence and simply not complain about the fiscally necessary arrangements if they fall ill or have other problems. They should accept the placement where the system can accommodate them with the option of a peaceful and happy death if that scenario depresses them or otherwise harms their health.

Posted by Chorister (# 473) on :

No it doesn't. But I live in a rural, relatively prosperous area. People are assessed and sent to places which best meet their needs. If a bed is not available in the immediate vicinity, then one will be found within 10-15 miles.

However, there are strong rumours of closure of some of the larger units - so this good state of affairs may not be the same for ever.

Posted by Belle Ringer (# 13379) on :

My Mom got one bath a week.

She said when she needed a toilet at night they would come put her on the toilet and come back an hour later to get her back into bed. An hour sitting on a toilet at 3 AM waiting for help to get up, because of staffing levels.

My dad was tied to a wheelchair because the staff thought he might fall if they let him walk, so he had to wet his pants regularly because there weren't staff enough to toilet him when needed.

They were in one of the best nursing homes in USA, according to my physical therapist friend.

Posted by Sioni Sais (# 5713) on :

quote:
Originally posted by Chorister:
No it doesn't. But I live in a rural, relatively prosperous area. People are assessed and sent to places which best meet their needs. If a bed is not available in the immediate vicinity, then one will be found within 10-15 miles.

However, there are strong rumours of closure of some of the larger units - so this good state of affairs may not be the same for ever.

IIRC you live in Devon which has an older population than most counties in Britain (some other southern counties may be higher, but not by much).

That ought to have two effects. The first is one of available resources: care costs money and if elderly people are not earning they won't be contributing so much to the Exchequer. Many don't earn very much. On the other hand, there are a lot of older people and a higher proportion of them, compared to persons of working age, vote. Typically they won't vote for poor care for themselves and many see the state as having a duty of care. What's more, younger people won't vote for this once it dawns on them that all these old folks aren't going to die any time soon, and there's every chance that you will be retired with living parents.

Posted by cheesymarzipan (# 9442) on :

(Basing this on second hand knowledge of grandparents and friends grandparents)
I think in the uk, you would tend to get a placement at a nursing home near where you lived because things are funded by the local authority where you live - of course you might well still be distant from children/relatives who have moved away, but a married couple might well end up together.

Posted by Mere Nick (# 11827) on :

Are old folks in the UK who need a nursing home assigned a place instead of the old person and their family picking one out?

Posted by Belle Ringer (# 13379) on :

From the OP article: "more money is needed to fix the larger issue of severe understaffing and the physical condition of facilities."

A decade ago I saw an article (by an actuarial firm) saying based on increasing life expectancies and decreasing size of workforce due to low birth rates, by the time I'm 90 just about the entire workforce would have to be in elder care if elders are to get the kind of care the last generation were able to buy.

It's not just about more money to fix understaffing, it's about demographics-caused long term understaffing no matter how much money they come up with. Some whole other model is needed.

Posted by Macrina (# 8807) on :

When I was working in care homes regularly it was often quite difficult to persuade people to have baths. EVERYONE got a daily wash top to tail twice a day with warm soapy water but they'd come from a generation where daily bathing/showering did not happen and so often it was hard to reason them into it.

"Please have a bath, come on you'll feel better for the hot water."

"I already had one last Wednesday."

Was a fairly common exchange.

I am hoping that as the current generation near retirement our care facilities will change to reflect that now we DO bathe daily as a culture and that to deny this to people is wrong. Certainly where it was possible we made every effort to shower someone every day if that's what they wanted. Showers were much easier than baths and IMHO got people cleaner. On the whole I think care faciities if they are properly staffed are healthier for people than remaining at home and socially isolated. It would be ideal if everyone had dedicated family who could care for them, but we very often don't and being realistic about that is better than ignoring it.

Posted by M. (# 3291) on :

Mere Nick asked:

quote:
Are old folks in the UK who need a nursing home assigned a place instead of the old person and their family picking one out?

I think it depends on whether the person is paying themselves or whether the local council is paying. Certainly, my brother picked the one my mother was in - but then, mum was paying. The local council rented blocks of rooms at the same place, so I presume if mum had not be able to pay herself, she might well have still gone there.

M.

Posted by Leorning Cniht (# 17564) on :

quote:
Originally posted by M.:
I think it depends on whether the person is paying themselves or whether the local council is paying.

I understand that you are supposed to have a choice if the council is paying, but that there is a maximum amount that the council will pay, so some places will be out of your price range, and the council has to deem it suitable for your needs. (And there has to be a vacancy.)

I don't know how this works out in practice.

Posted by Boogie (# 13538) on :

My Mum was in a small, friendly nursing home. There were 12 people there. The staff were just great.

We cared for Mum ourselves at my brother's farm until we could cope no more. So we knew just how hard work they did - and how difficult it is to keep bed sores at bay, yet they did.

When Mum was dying we brought her back to my brother's farm for the last 3 weeks of her life so that she could be with us. We all lived there for the duration to support each other and share the burden(6 of us). We never stopped praising the nursing home for the amazing job they had done. Three of the staff came to her funeral and cried genuine tears.

It's not all bad news out there in nursing home land.

Posted by Belle Ringer (# 13379) on :

quote:
Originally posted by Boogie:
My Mum was in a small, friendly nursing home. There were 12 people there. The staff were just great.

That's fabulous! Some of us have talked about getting a big house together, or a property with lots of separate small houses, but I've never heard of a small facility commercially available.

Posted by Arethosemyfeet (# 17047) on :

We're very fortunate here to have a care home on the island, adjacent to a small block of sheltered accommodation. There are 3 residents in the home currently, I think, but the facilities could do with some updating. It also gets used for other elderly folk on the island who need a few days tlc after a fall or an illness but don't need to be in hospital.

I can't imagine what the cost per resident is for the council of keeping the home out here running, but then the same is true of all our public services. We're very well looked after considering our population.

[ 08. June 2014, 14:30: Message edited by: Arethosemyfeet ]

Posted by Moo (# 107) on :

A friend told me about the arrangements she made for her mother about twenty years ago.

There were several women who took in a total of six women who needed care. It was not an approved facility because, although it was perfectly safe, it did not conform to regulations written for much larger facilities. For example, the water heater was in the bathroom, which is against regulations. However, the water heater was turned on only when the bathroom would be used. The bathroom was kept locked the rest of the time.

My friend chose this home because the women who ran it genuinely cared about the ones they took care of. They enjoyed their work.

The residents were healthy and happy. This seems to me to be much better than some large facilities where the residents are essentially warehoused.

Finding a set-up like this is another problem.

Moo

Posted by Jengie Jon (# 273) on :

quote:
Originally posted by Mere Nick:
Are old folks in the UK who need a nursing home assigned a place instead of the old person and their family picking one out?

I can answer that as my sister and I ended having to put Mum into care briefly while Dad was in hospital last year. If social services are paying then there is a fairly short list of homes where they will place people. If you are paying then they will give you a list of homes they have inspected, but the choice is up to you. As we were paying this meant we could move Mum to a home near my sister which would also cater for Dad until he was able to care for himself.

Jengie

Posted by Gareth (# 2494) on :

There are a lot of variables in this when it comes to care for vulnerable adults in England. I work with disabled adults, and the law & services are the same.

The Acts of Parliament clearly make local authorities responsible for delivering care: but then they are allowed to start messing about.

First, they assess how much care a person needs; then they quantify that into a code; then they turn the code into a cash amount; then they give that cash amount to a care agency. Each of those four steps reduces the care given.

The fact that I can earn a living just by forcing local authorities into complying with the law and assisting people so that they have a wash more than once a week is credit to politicians' ability to promise to deliver - and then withhold.

Posted by Heavenly Anarchist (# 13313) on :

I worked in a care home as a 17 year old in the late 80s, before I was a nurse. It was a lovely small one, 10 residents, though it soon bought the house next door and expanded to 24. Even when larger it was still a very caring place and our residents had baths according to their own requests, some weekly but others daily. Our clients were a mix of private and council funded and were treated equally.
My Mother was disabled most of her life due to a genetic bone disorder that eventually left her with a permanently broken hip and she lived her last few years in a care facility which combined a care home with a block of small residential flats. This meant she was able to live independently whilst having the nursing care she required to bathe, dress and mobilise. It was a wonderful place.

Posted by Chorister (# 473) on :

quote:
Originally posted by Mere Nick:
Are old folks in the UK who need a nursing home assigned a place instead of the old person and their family picking one out?

It depends on the need. There are specialist nursing homes catering for particular needs eg. elderly confused, Hodgkins disease. Therefore, a particular home may be strongly recommended, because the staff there are experts in that particular type of nursing.

Posted by Ethne Alba (# 5804) on :

Here in the UK we have adult placements for people with learning disabilities and some mental health needs. I seem to recall seeing that some councils have brought this concept in for elderly care as well.

Anyone had any experience with this?

UBB.classic^TM 6.5.0