"Sad standard of elderly care"

Ward 12 – University Hospital Wishaw/Home Assessment Team

After a fall at home, 91-year-old sustained a fractured femur, cause of fall was not investigated (GP was contacted following discharge due to continuing complaints of dizziness, vertigo was diagnosed and medication prescribed). She was kept mainly on bed rest with catheter insitu. Rehabilitation was minimal. Staff cited short staffed, clock calendar was constantly on the same date, TV was on twice and appeared faulty.

On Christmas day, there was apparently a shortage of meals and ladies did not get meal, they stated nurse calls were not answered and they were left in toilets unattended for long periods. On one occasion catheter bag was full and night bag not attached, causing backflow of urine and pain and consequent UTI. Visiting had to be booked with rigid times, this was restrictive for family work times. She had visual hallucinations, staff were informed and stated they hadn’t seen evidence of this and did not investigate this could have indicated delirium/dementia/depression. A marked deterioration in cognitive abilities was noted by family following admission.

With no discharge meeting or communication with family, we were informed in the morning that a home assessment visit was to take place that afternoon, family were at work, there were no keys to access home or clothing, we were told they would wrap her in blankets, this was not acceptable it was the end of December, with sub-zero temperatures. She received an assessment in hospital where she was assisted up some stairs and deemed able to climb them. She was mobilising with a zimmer and supervision at this point.

The next day we arranged for clothing/keys/family member and home assessment visit was to take place. Family attended hospital with these to find belongings stacked on bed, she was being discharged with no communication with family, she was deposited home.

Home Assessment Team (HAT) would assess and provide aids/care. She was now trapped within house, unable to leave/access bed without assistance. Shower/bath could not be accessed this subsequently caused an infection requiring referral to GP. Family had to access low divan base on Hogmanay to ensure she could safely access bed. HAT team provided a strap to lift her leg in, this proved difficult and painful due to arthritic fingers and joints locking. An Alert medical bracelet was supplied. Carers were allocated to assist in morning, a family member had to stay over to ensure they could gain access as key box had still to be installed. Family had to support other activities shopping/laundry/ housework/preparation of meals/medication management etc. Family liaised with Continence service, GP visited and made referrals for Audiology and Westmarc for wheelchair. Podiatry and hairdresser visited. A carers assessment was never made, there was minimal communication with family who all had commitments- work/family/illness.

This was feasible over festive period when family were available, but not sustainable in the long term. After 4 weeks, there was apparently a meeting which family were not invited to where a decision was made to stop care. A meeting was arranged with family for Friday, no one arrived we were informed we would receive a phone call on the Monday this did not transpire. As family/carers we were not valued as equal partners in the care process neither were we engaged in any part of the plan. We have previously attempted to discuss issues but we were told she could wash and dress herself so did not require care, this has not been the case, there are issues with personal care, dressing lower body, continence and assisting with meals she cannot transfer microwave meal to plate due to arthritis and attempted to transfer tea to another room using trolley where most of it was spilt causing a falls hazard and also issues with medication management. She uses a zimmer, has visual and auditory deficits, arthritis, AF, (anticoagulant prescribed), hypertension, baker’s cyst, previous fracture, vertigo, continence issues, dyspnoea deteriorating mental and physical health and is a high falls risk.

Physio has commenced and this will hopefully give her confidence to mobilise and work towards gaining some independence back to allow her to live in her home for the foreseeable future. Family initially had to take annual leave to ensure she had the care and support required to sustain this. Prior to work in the morning family now have to provide assistance with personal care, leave lunch, and after work to prepare a meal and assist to bed. Previous communication with HAT, they informed us they were 100% successful in getting clients independent. I would dispute this and their criteria for assessment, duty of care and communication with families support expected has been remiss, quality family time eroded. Our aim was to ensure she would be supported to make informed choices, be assisted to maintain as much independence as safely possible and not to be made feel like a burden to family this sadly has not been the case.