"My late father's hospital care"

My late 91 year old father was admitted to QEUH, Glasgow, for 4 weeks and spent his last 2 weeks in Ward 5A.

He lost his ability to swallow but kept pulling out NG tubes, therefore he was nil by mouth for almost 3 weeks. He couldn't tolerate insertion of a urinary catheter, finding it too distressing. He had spells of delirium and became a high falls risk due to BP issues, necessitating being nursed in bed and unable to use a commode.

Despite the best medical support it soon became mutually agreed that my father would likely continue to decline and that the focus should be on minimally invasive interventions and comfort care.

Five days before he died I asked nursing staff to request a Palliative Care referral, as myself and other visitors were witnessing episodes of distress and agitation related to dry mouth, pain, and loss of dignity through being unable to get to a toilet.

Three days before he died I spoke to Medical staff who were unaware of these episodes and told me they didn't feel my father was "at that stage" of needing a Palliative Care referral.

A Palliative Care referral was then made the afternoon preceding the morning that he died. He was finally administered Midazolam via syringe driver by Medical staff due to an increase in agitation overnight, literally 5 hours before he passed away, with me by his side. 

What I would like to know is this: what part of being asked for a Palliative Care review for a distressed and dying 91 year old man, is so difficult to act on?

My own thoughts and experience is that it's a combination of poor communication between staff groups, a lack if ownership, and a (wrongly) perceived notion by some medical staff that involving the Palliative team in some way implies that the existing medical care isn't good enough. I'm lucky enough to work extremely closely with the Palliative team at my own place of work, and have recommended patient referrals be made to them as a way to enhance ongoing medical care and, most importantly, to care for the person and not just the clinical presentation.

My father was 91 years old and, up until the day he was admitted, he lived completely independently at home on his own. It was hard enough to watch him fade away through (unavoidable) lack of nutrition and to lose his independence, but to witness his distress and agitation at his loss of basic dignity will forever haunt me and makes me question if I could've fought harder for the Palliative Care he rightfully deserved.