Heartbreaking when 'the system' fails the elderly

Christmas and the New Year have gone so quickly this year – they seem almost a distant memory!

I was working for most of Christmas and I ended up picking up a couple of extra shifts over New Year too as Jo had gone off sick – too much chocolate hamper indulgence I reckon!

It was my first Christmas on the ward – actually, it was my first Christmas in a hospital and I must say, I have really enjoyed it. Don’t get me wrong, it’s awful to think that people are so poorly that they can’t be at home with their families, but the hospital was decked out with decorations and the staff were all in good festive spirits, despite not being at home with their own families. 

But it’s not all sadness and illness. I have to walk past the maternity wing on the way to the ward and it was wonderful to see all the new Christmas babies starting their new little lives – I mentioned it to Matt when I got home and I think he’s broody now (I found a crumpled up list in the bin with potential baby names on it – we will not be calling any child of mine Bacardi after his favourite tipple)

Despite it being Christmas, the ward was pretty busy. We had some new admissions, mainly patients who had fallen and were awaiting a package of care for home, and a couple with really nasty infections. The families were brilliant though and made sure they came in to bring presents and share a bit of the festive spirit (no Bacardi).

Apart from one lady. She didn’t have a single visitor all over Christmas. I thought my heart was going to break every time I passed her by and saw the longing and loneliness in her eyes as she watched visitors come and go. Christmas Day was the hardest, her eyes filled with such hope every time a new face popped into the bay and then her face crumbled when she realised they weren’t visiting her. 

I couldn’t be sure, but I was certain that her next of kin details had been filled in, so when I got a spare ten minutes, I decided to take a look. I needed more like an hour to read through her notes, they were full of failed care home placements and little mention of her family. Her name was Irene and she had lived in three care homes so far. She had a number of complex care needs, including unstable Type 1 diabetes and advanced Parkinson’s disease and each of the homes had failed to meet her needs. Which meant she kept being admitted to hospital while ‘the system’ decided what to do with her. Her only family was a daughter with learning disabilities, who Irene had cared for all of her life, but who was now living in a supported living house in the community.

I thought my heart was going to break.

Irene was still with us at New Year, still no visitors apart from a couple of care home managers who had come to assess her for yet another move. Neither felt able to meet her needs and felt she required a nursing home, yet her assessment had been completed and she was deemed not to have nursing needs!
Steve could see that it was upsetting me so we had a good long chat about it. He guided me through the things that I could and couldn’t influence and then advised me to focus on the things that I could. I couldn’t change the tragedy of Irene’s life, of having to raise a child on her own after her husband had died and I couldn’t change the circumstances that meant she had at least two medical conditions that were complex to manage.

To be fair, I couldn’t see anything that I could change, but Steve nudged my brain along in the right direction. I could arrange a new assessment so that Irene had a chance of going to a nursing home that could meet her needs and I could spend a little time getting to know her so that I could advocate her wishes.

I felt right proud when Steve said ‘that’s my girl!’ 

So, I busied myself really delving into Irene’s medical history, the challenges she had faced and the challenges she was yet to encounter. Her progressive condition of Parkinson’s meant that she would more than likely need nursing care very soon and the instability of her diabetes also meant that, to keep her as safe as possible, she needed skilled nurses to help her to manage it.

Steve arranged another assessment and made sure that we were both available when the assessor arrived. It was scary to think that a decision that was so important to Irene was sitting in our hands, but I tried to use that fear to fuel my fire. Steve advised me not to become emotional and try to stick to the clinical facts, but in true Florence style, I couldn’t quite manage it! I needed to get across to the assessor the impact of each failed placement – how it was having a negative effect on Irene’s mental and physical condition – and how it was preventing from her settling anywhere long enough to receive visits from her daughter who she still loved and missed greatly.

We must have done something right because the assessor agreed that she now met the criteria for nursing care! I was so relieved that I had a little dance around the office!! (Steve told me to stop though when I swept the remaining chocolates off the desk with my twerking butt…)

Irene’s still with us, but now there’s a whole new list of care home managers booked to do their assessments. Steve and Irene have asked me to make sure that I am available for each of them so that each manager gets as much information as they need to decide whether or not they can care for Irene.

My lesson for this year?

Don’t waste time focusing on the things you can’t change, instead focus on those you can…