"My Father's Care"

My father is in his 90s and frail, he was admitted to the burns ward via ED following a fall at home. 

Prior to admission he was independent at home with carers X3 a day. 

He was on a low potassium diet and ate soft foods.

My wife and I live 300 miles away and we visited two days after he was admitted.

We spoke with the OT about my father’s abilities and to the ward dietitian about his dietary needs including his need for level 7 easy to chew foods.

We've no issues with how his burns have been managed but we've been really disappointed to see a steep decline in his overall function.

He didn't engage with the physio and the OT and he has now been bedbound for eight weeks. We've tried to persuade him to try and sit out in a chair or try to get on his feet when able. It seems like all attempts by the AHP team have stopped.

He was catheterised on admission and at first this was a relief for him as he's on diuretics (not sure if he is still on them) and it meant he didn’t have to get up to the loo. He's unsteady on his feet and having to use the toilet would have been impossible for him.

However now eight weeks later we understand the catheter is now out and he is on an incontinence pad.

He's not incontinent, just unable to get to the loo. He would need help with a bottle or bed pan.

I was distressed when my father asked to go to the toilet/use a bed pan during a recent visit. I asked a member of the ward staff to help. They acknowledged affirmatively and I went back to sit with my dad. After five minutes nobody had come to help. I went back to the nursing station. The same staff member was still sitting there, chewing gum, and I asked why someone hadn’t come to assist. They told me that they couldn't do it, as two members of staff are required. While I was speaking to them a passing member of staff then asked if they wanted them to come and help. The original member of staff had made no attempt to get someone to help them, they just sat at the nursing station. Meanwhile my father was getting very distressed and worried he would soil the bed.

They showed no empathy or concern for my father's pride or dignity.

It appears that since he has an incontinence pad that some staff feel it's ok for him to feel like he is wetting or soiling himself. This is totally humiliating and degrading. Help was not forthcoming and there was no empathy whatsoever.

One member of staff mentioned that he is buzzer happy and rings for assistance often. When I visited, he felt he was a burden and was worried about pressing for help in case he just had flatulence. This leads to the risk that if he did need to go he would end up soiling the bed rather than ask for help. Lying on an incontinence pad can’t be helping his skin integrity.

He was nasogastrically fed at one point as his oral intake was poor. He's continually asked for the type of soft meals he has at home, and we were assured by the dietitian. They are not unusual foods – cottage pie, fish pie etc. On one visit he was served an omelette covered with gravy – who would ever have gravy on an omelette? No wonder he didn’t eat it.

When I visited, he was served mashed potato, gravy and carrots. The carrots were too hard and there was no protein component to the meal.

A member of staff told me that there is a texture modified menu available, but he doesn’t seem to be offered this regularly on the ward. They said that only some staff offer him this and others don’t - why not if that is his need?

He'd normally eat his main meal in the middle of the day and then a soft sandwich in the evening. When my wife spoke to the dietitian, they mentioned that snacks were available however my father has not been offered these snacks.

He's now being fed by staff when he can feed himself if sitting or propped up in bed.

On several occasions when I've visited or spoken to him he's been emotional and crying. He feels that his dignity has gone and that he's become totally dependent on others. I've asked on several occasions whether he may have become depressed, but I do not feel this has been taken seriously or investigated.

He mentioned that he's been washed and cleaned up after going to the toilet without the curtain being pulled round. This is not appropriate for anyone.

When I visited, he asked me about his medication. He's not sure if he's on the medication he was on at home and seems to be getting extra tablets. He just wants to know what he's on as he worries.

He has poor hearing and makes affirmative noises when asked if he understands or has heard what people are saying - this is not always the case.

He mentioned that he may be moved to another ward, but he didn’t understand why. He didn’t understand or hear properly what was being explained to him.

My father is now ready for discharge to an assessment bed with a view to going to a nursing home, but I thought it was necessary to provide this feedback in the hope that his remaining time on the ward is more dignified and that he is treated with empathy as well as providing important learning for the ward team.