How the NHS "helps" the seriously ill elderly

Even clued-up people have great difficulty getting any help at all out of it

Today I phoned two GPs and asked them how soon my parents were likely to die. Do I hate my Mum and Dad? On the contrary, I adore them. My beloved and devoted parents are in their late eighties. January 3 this year was their 64th wedding anniversary. It was also two years almost to the day since they were forced to live apart.

In December 2004 they seemed fit and well, living comfortably and independently in their home of 40 years in the Midlands. We are a close and loving family and spend a lot of time together; I had noticed nothing seriously amiss. Then Dad fell over and cracked his head on a windowsill. There was a lot of blood. We spent Christmas Day gathered round his bed in an A&E unit 20 miles away. The hospital was hideous: uncaring, unkind, understaffed.

Dad had a chest infection and was very confused. He was also going through alcohol withdrawal – it turned out that his GP had known for a year that he was alcohol-dependent, but had been unable to convince him to get help.

We moved Mum in with me, 15 miles from her own home in the opposite direction from the hospital, while we all got over the shock. Another was to follow. Her forgetfulness was dementia. She asked the same question six times in 30 minutes. I had to label my kitchen cupboards and write out for her every night where she was and what was happening the next day. My sister Pam and I juggled our jobs with caring for Mum and visiting Dad, a two-hour round trip.

Exhausted by the distance, we got Dad moved to a private hospital in our town. He improved mentally and physically and was having physiotherapy to get him back on his feet. But soon his consultant told us that he no longer needed active medical treatment and his insurer declined to go on paying. We moved him to a short-term private nursing home. He deteriorated; his confusion returned, he repeatedly tried to get out of bed and fell, he developed leg ulcers and got MRSA. He became wheel-chair-bound and doubly incontinent. Then they too declined to keep him and advised us to look for a long-term nursing home.

Complete strangers to the welfare state, Pam and I turned to the internet to try to establish what financial help might be available. The answer seemed to be none, if my parents had substantial savings, which they did – Dad had astutely, or so he thought, raised 50,000 pounds recently via an equity release on their house and put it in the building society for their future care needs. So Pam and I visited six nursing homes in and around our town, all of them costing well over 600 a week. In four of them the smell of urine hit us as soon as the front door was opened. Dribbling residents were ranged round three sides of a sitting room while giant TV screens blared at them incessantly. Of the remaining two, one had a high turnover of foreign staff.

The only one that looked remotely civilised enough for a former international sales director was also the most expensive – more than £900 a week. We filled out a hugely detailed financial statement of his assets and income, confirmed that he was self-funding, and moved him in. Winter turned to spring. We moved Mum back to her own home, got her a referral to a memory consultant and, after much phoning, form-filling and investigating, found an agency to supply carers to visit her three times a day.

I tentatively contacted her social services office, having read on the internet that everyone is entitled to a needs assessment even if they are self-funding; they sent an ineffectual chap who told us little beyond agreeing that she was self-funding. I got back on the internet to find out what benefits she might nonetheless be entitled to; there were one or two, it transpired.

I called in on Mum as many weekday evenings as possible on my way home from work; Pam visited Dad as many afternoons as she could. At the weekends one of us collected Mum and took her to have lunch with Dad at the nursing home; the other one took her home again afterwards, a 90-minute round trip each time. Mum’s daily carers were variable and the agency was unreliable. Mum lost a lot of weight. My sister and I rang her every day; she was tearful and confused. We rang each other eight times a day: Have you seen Dad? Can you get to Mum – the agency can’t find anyone to visit tonight. Have you phoned their solicitor? Can you get to their building society? Have you rung Mum’s GP to organise a medicines box from the pharmacy (a friend of a friend told us about this)? Can you buy Dad more pyjamas? Who’s collecting Mum on Saturday? Have you rung social services? Can you look for a gardener and cleaner for Mum? Have you paid her chiropodist’s bill? Can we get together to fill out these funding forms tonight? Who’s taking a day off work this week to get her to the memory clinic?

We put our own lives and families on hold and irritated our work colleagues with the long list of phone calls we had to make day in, day out. It was relentless, depressing and utterly exhausting – and that was with two of us to share the load.

At Easter the nursing home rang – Dad had internal bleeding and an ambulance had been called. Another understaffed, uncaring hospital, another nightmare. He was pushed, pulled, prodded, hauled about. Somehow he survived and returned to the nursing home. The saintly staff wept when they saw the condition he was returned in – confused, dirty, and with his leg ulcers opened up again because the dressings hadn’t been changed.

I grabbed the chance of a week’s holiday. The day I arrived home Pam rang – Mum had had a fall at home and was on her way by ambulance to the same hospital that Dad had left three weeks before. It was just as grim. We watched the A&E clock tick round hour after hour while the staff gossiped at their station with their backs turned.

Eventually an X-ray showed a fractured pelvis. Our hearts sank. They put her to bed in a disgusting mixed ward. A nurse rang me late one night to say that my church mouse of a mother was trying to kill the other patients and could I go immediately. She was incoherent and trembling; I put my arms round her and we sat for four hours, into the small hours, in a cold corridor while a nurse phoned other wards trying to find the antipsychotic drug that they thought she needed. We were both crying. Nobody explained what was happening. (Much, much later I was told that she had a urinary tract infection that can induce psychosis in the elderly.)

Fit from years of tennis, Mum recovered physically and returned home. But spring turned to summer and her memory worsened. We went back to the internet and found another agency to supply live-in carers – mainly wonderful South African women who cooked her fresh food and played Scrabble with her. She put weight back on (but not before her own mother’s engagement ring slipped off her thin finger and was lost) and I felt confident enough to skip some weeknight visits, although I still phoned her every day.

Meanwhile, Dad was calmer at the nursing home. We found a wheelchair-transport charity that took him midweek to Mum while her carer cooked them both lunch. They were permanently distressed by their enforced separation but at least we knew that they were secure and well looked-after. Then the money ran out. By January 2006 they were broke – or, in the distasteful social services jargon, wealth-depleted. The 50,000 pounds had gone on nursing home and carer fees, as had the money we raised from Dad’s few stock holdings and an income bond.

Their only asset now was their house, their only income their state pensions and Dad’s two small occupational pensions. By the time we discovered (from the internet again, of course) that social services will step in when savings diminish to 20,500, they were already well below that and fast approaching the next threshold of 12,500. Both social services offices said they were now contributing the maximum, yet Mum and Dad still had a combined monthly short-fall of about 2,300 pounds. Moving Dad into a cheaper nursing home was unthinkable; he’d been shunted around enough. We appealed to the charitable trust that runs Dad’s wonderful home, and mercifully they agreed effectively to waive his top-up. Mum’s dementia appeared to be temporarily stalled with the aid of a memory drug, and she was secure and calm in her own home; my sister and I were managing between us to top up her finances to pay her live-in carers. By last autumn we were back on an even keel.

Then the next crisis hit. In January Mum had two strokes in succession and was taken back to hospital. She got a bed in another appalling, old-fashioned “Nightingale” mixed ward. She had lost the swallowing reflex, couldn’t talk, couldn’t walk. After four weeks on intravenous fluids, a stomach tube was inserted to feed her by. My sister and I bounced between Mum’s hospital and Dad’s nursing home. He was desperate to visit her but the hospital was unsurprisingly in the grip of a superbug and we couldn’t risk it.

Mum was gradually shunted to the farthest end of the ward from the nurses’ station. Sometimes she was hoisted from the bed to a chair and left unsupervised; once when I visited, in February, she was in the chair in bare feet and just her nightie, next to an open window. Mostly she had her eyes closed; occasionally she would look at us, but it was impossible to know if she knew who we were. Then the hospital started to ask what our plans for her were; they couldn’t do any more for her and she was bed-blocking. We had to decide between a nursing home and her own home. If we moved her into a nursing home, social services would then require us to sell the house after 12 weeks to pay for her care; as the house is jointly owned, Dad, too, would then be deemed to be self-funding again. At a combined rate of up to 1,800 a week for their nursing home fees, the money would soon be gone. We toyed with reuniting them in their own house, although we’d need to install a downstairs bathroom and hoisting equipment for Dad. He is wheelchair-bound, doubly incontinent and increasingly confused. He hasn’t seen Mum since her strokes, and we believe he would be devastated if he were faced daily with the reality of his adored wife’s pitiful condition. Better, we think, to keep him in the caring environment that has been his home for two years.

So we took Mum home. We bullied, cajoled and pleaded with assorted authorities to provide a hospital bed, a hoist, a pressure mattress, incontinence supplies, the food bags, visits from district nurses. My sister and I and her carers were taught how to administer her food, water and medicines via an electric pump and the stomach tube. She had a catheter but pulled it out twice, so now it stays out. I have acquired other skills too nauseating to describe.

The NHS has accepted her for continuing care, meaning that it takes over all the payments from social services, which should be cause for celebration; however, at the time of writing it has yet to devise a means of paying her live-in carers, as it seems it is against the rules for the NHS to make payments to individuals. The only suggestion forthcoming to date is that my sister and I might like to set up a company to which the NHS could make the payments. We being oddly disinclined to give ourselves this extra little burden, a stand-off has been reached. We are therefore still topping up the care package to the tune of 130 a week, although we are promised we will eventually be reimbursed by the NHS. My eyes water at the thought of the red tape that is going to involve.

So now I have two parents in a condition that can only be described as pitiful. My once-immaculate and elegant mother is shrunken, withered, bedbound, incontinent, unable to communicate, fed through a stomach tube; she has no teeth, her cheeks are sunken, her skin is grey, her eyes, when open, are rheumy and unfocused. She pulls her knees up to her chest and claws at her blankets.

My handsome, globe-trotting businessman father is in a wheelchair, confused, incontinent, speaks with difficulty and has recently had shingles that swelled up his face and closed up his eyes. They are both being kept alive by modern medicine far beyond the point of decency, humanity or dignity. Where is pneumonia, once called “the old man’s friend”, when you need it? You wouldn’t, you really wouldn’t, do it to a dog. I’m crying as I type these words, but if I had the courage I would pick up a pillow and help my mother towards that better life promised to Christians. Both their GPs are sympathetic to their, and our, plight, and both have agreed in principle to let nature take its course rather than strive officiously to keep them alive, but nature is taking its time. Hence my phone conversations with them today. Beyond reaffirming that agreement, however, they cannot help me.

I am so angry that we have arrived here. I am angry with Dad for not telling us about Mum’s dementia. I am angry with Mum for not telling us about Dad’s drinking. I am angry with myself for being powerless to make it all better for them with a wave of a magic wand. I am angry with the NHS for the disgraceful treatment of both my parents in two large hospitals. I am angry with the Government for its callous underfunding of care for the elderly. I am angry with social services for the apathy, the lack of help, the misleading or contradictory information that repeatedly dribbled our way. I am angry with God for drawing out their end in this demeaning way. If He does it to me, I shall sue.

Every single thing we have learnt about the care our parents have needed and its funding we have discovered slowly and with difficulty for ourselves, and often too late. (Example: when Dad’s nursing home fees had virtually wiped out the 50,000 he raised via equity release for them both, we approached his social services office for a financial assessment, and only then did they point out to us that the building society account was – most unusually – in Mum’s name, and so the money should never have been used for Dad’s fees. Our mistake, we hadn’t noticed – but we were amateurs, and we needed help, and none was forthcoming.) There is no quality to their lives, and little to mine and my sister’s for the past two and a half years that we have struggled to do our best for them. But the very, very worst thing is that our golden memories of two wonderful, loving parents have been all but obliterated by the sheer, unmitigated, unending misery of their last months on this earth.

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Now it's the Ambulance service of South Australia in a mess

We have recently heard of the dire state of the Queensland and NSW services

AMBULANCE officers claim crews are not reaching life-threatening emergencies on time because of chronic staff shortages. In another potential industrial relations headache for the Rann Government, the union is planning to refuse non-urgent patient pick-ups and implement overtime bans. Free rides for patients are also being considered.

The Ambulance Employees' Association says crews reached life-threatening emergencies within seven minutes in only 20 per cent of cases during the past three months - a breach of national guidelines. "I'd say the ambulance service staffing was in crisis," Ambulance Employees' Association secretary Phil Palmer said yesterday. It's a mess - a huge mess."

The SA Ambulance Service maintains the response times are similar to the equivalent period last year but concedes several strategies are being examined to increase staffing levels.

The ambulance officers' threat of industrial action comes just weeks after its paramedics unanimously accepted a 25 per cent pay rise over three years, starting with a 16.7 per cent "catch-up". Also last month, teachers, nurses, dentists and psychiatrists were locked in industrial disputes with the State Government. The ambulance union now warns:

THE AMBULANCE service is short by one crew every day, and as many as three crews on some occasions.

SINGLE-OFFICER crews in station wagons are improving response times but potentially increasing risks for officers and patients.

A GROWING reliance on inexperienced student interns is adding to the workforce strain.

OVERTIME is now about 40 shifts per week - it blew out to 120 shifts per week in late June.

PROFESSIONAL development workshops for paramedics have been cancelled to free up staff to work on road shifts.

Mr Palmer blamed the ambulance service's inability to maintain minimum crewing numbers comes on years of poor planning, which had resulted in a dangerous blow-out in response times. "Patients with life threatening conditions - cardiac arrest, unconscious collapse, vehicle trauma - are having to wait longer," he said. "This is not only distressing, it is potentially life threatening."

Industrial action will be discussed at a union shop stewards meeting next week, amid new management plans to double the number of student interns placed with single instructors. There are 54 student interns in the system - about 10 per cent of the on-road workforce - and another 32 are due to begin next January. Instructors are expected to reject the doubling-up plan at a meeting on Thursday, because of concerns their ability to supervise, mentor and teach will be restricted.

Ambulance service director of state operations Ray Creen said response times had improved during the past two years, with arrivals at half of all emergency cases within 9.4 minutes and 90 per cent within 15.6 minutes. In the past three months, response times had remained constant compared with previous years, despite a 16 per cent increase in emergency calls to 000. "We are currently looking at a number of strategies to increase our staffing levels . . . to ensure effective and appropriate measures are introduced," Mr Creen said. "One measure we have recently introduced is the establishment of two extra crews to cover peak periods in the middle of the day in the metropolitan area." Mr Creen said the Ambulance service, "among multiple measures", was looking at increasing the number of student interns taken into the organisation each year.

Health Minister John Hill was unavailable for comment but his spokeswoman said the Government had employed an extra 118 ambulance officers since 2002. "Ambulance officers are a critical part of our health system and they are responding to increasing demand for their services," she said. "And recruitment is being stepped up again with a target of recruiting a further 56 paramedics to be deployed on emergency crews over the next 12 months. "The State Government is also recruiting students to ensure we are building a workforce for the future, but they will be appropriately supervised in their roles."

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A new health entitlement for illegal immigrants to the USA

Unsatisfied with thwarting a Republican effort to authorize $3 billion for a border fence, congressional Democrats are trying to enhance the incentive for illegal aliens to enter the United States by removing the citizenship requirement from the popular State Children's Health Insurance Program (SCHIP). The Republican Congress in 1996 passed legislation blocking people who are in the country illegally from claiming benefits from the federal government, and when SCHIP was created in 1997, states were required to verify citizenship. But Democrats want to take that sensible requirement for Medicaid and SCHIP and leave it to the discretion of each state.

This reflects the Democrats' eagerness to offer free services to illegals at taxpayer expense, undermining the principles of both immigration law and good governance. And it is also a step Democrats want to take toward expanding SCHIP, like their plan to expand its coverage to include children from middle-income families that make up to $83,000 per year — a plan encompassing more than 70 percent of American children. (When SCHIP first came into being it was only for families with incomes up to double the poverty level, or $40,000 for a family of four.) Expanding the program will cost $50 billion over five years; expanding it by giving states the option to not enforce the citizenship requirement pushes the price tag up even higher — although just how much would depend on how many states decide to include illegals in the program.

This doesn't come as much of a surprise, of course, from the perspective of either immigration or health-care policy. Recall that SCHIP was born out of a failed attempt at government-run universal health coverage. Indeed, the Democratic expansion of SCHIP will actually allow children who currently have private health insurance to switch to the federally subsidized program, saddling taxpayers with yet another entitlement burden. In the wake of the defeat of the immigration amnesty bill last month, open-borders advocates are attempting to implement their agenda using a piecemeal approach. (Last week, for example, Democrats were looking for support for an agriculture-worker bill that included a path to citizenship for workers in the country illegally.) They should not be permitted to get away with using SCHIP to funnel more taxpayer assistance to illegals.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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