Post No18...Winter Pressures in hospitals – why avoiding hospitals is important for the elderly.

Introduction:

Before getting going on this post, it is worth noting how much the NHS and its staff do for us as a nation. The staff heroically work long hours in challenging conditions, with more needing to be done to support them at government level. Anyway, rant over…

At this time of year, we would have all heard news stories of what is widely known as winter pressures within the NHS. However, what the news reports do not tell us, is that the NHS is under severe strain all year round, but it is true that the issues become more acute over the winter.

A major by-product of winter pressures is bed blocking, which is a serious issue for many UK hospitals. In this post I am going to focus on why bed blocking occurs, whilst looking into some of the small ways we can help prevent it, and why this is important to the elderly.

Why does bed blocking happen?

Bed blocking is the term used to describe a patient who is medically optimised to leave the hospital, but for other reasons, is unable to do so. There are many things that can cause bed blocking, but in respect to elderly patient’s one reason can be the lack of availability in care homes or staff from domiciliary providers.

In the winter, care homes become very busy, many of them fill up or meet their quota for safe admissions in any given period, which can cause delays in discharging. Also, many community hospital facilities have sadly been shut down; places that, historically, helped support patient flow from acute hospitals into the community.

In winter, rates of infection and falls tend to increase in the elderly, both of which can easily require a hospital admission. As demand increases, discharge planners find it hard to keep up due to lack of space or staff in the community, leading to more bed blocking within the hospital wards.

Once in the hospital, elderly patients can also be at risk of Healthcare-associated infections (HCAI’s), which can subsequently prolong the stay further and worsen the issue.

Bed blocking is never going to be an issue that can be easily resolved, particularly in the winter months, but there are a few things elderly people can do to try and prevent an admission in the first place.

Preventing a hospital admission

Preventing a hospital admission is important for elderly people, as much as it is for the hospitals, during the winter. Many admissions are simply unavoidable following a bad fall, infection, or a medical emergency, but some could potentially be avoided by considering the following:

1)     Respite care

Having a relationship with a local care home can be a good way of avoiding a crisis. If the primary carer needs a break, or if a person’s health is deteriorating to the point where they are not safe at home, then seeking a respite stay may help avoid the acute setting. If a person has stayed at the home before, then the admission process can be very quick, again possibly preventing the requirement for a hospital stay.

2)     Domiciliary care (care at home)

Domiciliary care is another way of getting help prior to getting to crisis point. Again, having a relationship with a domiciliary agency would be useful here, as they may be able to arrange an emergency care package that enables the person to remain safely at home.

3)     Technology / call bell systems

If a person lives alone and falls, they can sometimes remain on the floor for many hours, known as a long lie. Long lies can worsen the effects of a fall, both physically and mentally. Using a call bell system to notify a friend or family member could potentially reduce the time of the long lie. Call bell systems can also be used if a person suddenly starts to feel unwell or dizzy, notifying the family at the earliest opportunity, which may prevent a fall from then happening.

4) Keeping hydrated

Dehydration can lead to elderly people falling, developing UTI’s, or sometimes to more serious conditions. It can also lead to temporary confusion and memory loss, so keeping hydrated is a key way of keeping yourself fit and out of hospitals.

5)     Staying on top of medications

By making sure the correct medication is being taken at the correct time, people can remain much more stable in their health. Missing medications can lead to confusion and potentially also to falls, which could consequently lead to a hospital admission.

Why is this so important?

Winter pressures bring massive operational stresses onto hospitals and their staff. Waits to get into A&E, patients not in the correct wards or bays, HCAI’s and discharging holdups can mean a prolonged stay and a potential disruption to patient care.

This is not a good thing for older people, who are at a higher risk of muscle wastage than younger people, meaning prolonged time in a hospital can be very difficult to recover from. When a person’s mobility is heavily reduced, caring for them at home can become difficult, and either a care package or care home may need to be considered as a result. This risk is heightened the longer the persons remains in the hospital.

With many care homes full to the brim in the winter, discharging can become difficult, and over Christmas many care homes will not admit into the home, further extending the stay. With longer stays come prolonged risk of Healthcare-associated infections (HCAI’s), which can be fatally strong, causing pneumonia and other serious illnesses.

Winter pressures, on a wider scale, have a huge impact on an emergency crew’s ability to respond quickly to new 999 calls. This means longer wait times for those in dire need of hospital treatment, and even if they do make it to the hospital, there may be no room for them to enter for the urgent treatment they need.

Conclusion:

Trying to stay out of hospital during the winter is extremely important, because prolonged stays are much more likely during this period. By utilising community services like care homes or domiciliary providers, falls prevention teams, and being as proactive as possible in future care planning, is a good place to start when it comes to avoiding a potential crisis / hospital admission.

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