a&e and and e hospital emergency admission older elder dementia carer carers

Marj had a fall at the end of last year and needed to go to hospital. It reminded me of the extra support we need to give elders at such a distressing time. Our loved ones need extra reassurance if they live with dementia too. Here are my tips…

The hospital teams were great. They were reassuring and careful with Marj, not at all patronising which we both appreciated.  We were lucky this time since Marj didn’t break anything or hit her head. While it was sometimes hard to know what was going on and there were some communication challenges, A&E cleared Marj for discharge the same day.

If you need to accompany an elder relative or friend into A&E (or any ward), you’ll want to help them feel reassured and supported. The following tips will help:  

a&e and and e hospital emergency admission older elder dementia carer carers

Before getting in the ambulance

  1. Medicines – gather all meds together and take with you as it can take a while for the pharmacy to clear and prescribe (thanks @dementiawho). Also take a copy of the latest prescription. A list of all meds and allergies should be kept in this tub in the fridge for the emergency services to find. It’s a well known protocol championed by the Lions Club. You can get these tubs from your local GP or carers organisations.  
  2. Extra blankets – ask for them, especially if the patient is on blood thinning medication. Ambulances, windy A&E receptions and hospitals can be chilly places. Marj was allowed to take her fleecy blanket with her. Also a good idea to take a
  3. Extra pillows – take an extra one or two as sometimes there aren’t enough for every ambulance or bed, especially if an achey back or sore leg needs more than one (thanks @shirleypearceot).
  4. Hearing aids and spectacles – make sure they go with the elder and make sure they are noted.
  5. Water – supply a small bottle in an attempt to support hydration. Also be prepared for this not to be offered to your elder by the over-stretched health team.
  6. Continence aids – it’s always better to use what is preferred and familiar.
  7. Food – be ready to take tempting food in, if eating is permitted. Your elder may miss a meal time. If your elder has diabetes, this will need particular attention.
  8. Your contact details – make sure the medics have only the contact details that they can reliably reach you on. Don’t be tempted to give your home number if you rely on your mobile phone. Sod’s law says they’ll call the wrong number. You may be asked whether you have Lasting Power of Attorney LPA.
  9. Help – let friends and relatives know when you can, you may need back up later. Ask one person to ring another for you and so on (a phone cascade). Take something to read while you’re waiting around.
a&e and and e hospital emergency admission older elder dementia carer carers

While in hospital

  1. Be there – hold your elder’s hand, chat and reassure.
  2. Advocate – if your elder is uncomfortable or in pain, you may be the only person who can tell. You’ll need to speak up for them. Politely state the situation and what you need to make it better.
  3. Hydrate, nourish and warm – if eating and drinking is allowed, encourage this to help your elder stay well and strong. It’s likely that while you’re not with them, they’ll not eat and drink at all. Hydration helps the drugs work and the body recover so carefully help tip water into their mouth. Highlight any dietary requirements like soft meals.  MyCareMatters has a great one page summary that is easily completed and printed for sticking above the hospital bed. It’s free, I’ve done one for Marj. Find out where the linen store is in case you need to get another blanket.
  4. Familiarisation – bring photos or ‘life books‘ to reassure and look at with family and staff (thanks @juliagapowell)
  5. Physio – ask about this if your elder has a long stay and encourage your elder to participate. Bed bound immobility may lead to physical decline and reduced confidence. Get a copy of the exercises prescribed if you can or take a photo of the exercise instructions with your phone. You’ll need to encourage your elder to continue their physio at home.
  6. Gather information – your elder may not be in a position to hear or understand their health status. Be prepared to ask for more information on their behalf that could affect your elder and those caring for them.
  7. Keep spirits up – a hospital ward can be a depressing place and lead to maudling, depression even. Be kind to other patients too, they may not get any visitors.
  8. Preparation for discharge – keep asking about the expected hospital discharge date (EDD) and encourage staff to help you plan for it as soon as possible. Understandably the hospital will want to discharge your elder as soon as possible but if your elder’s health has deteriorated significantly, returning home might not be easy for you all. Your elder will no doubt feel able to look after themselves, but they’re very likely to need help until fully back on their feet. If this is the case, ask about ‘reablement’.
  9. Reablement – Don’t agree to discharge until you know your elder will be safe at home. Staff have a duty to support you with this if needed. Reablement support is only available in the short term, especially if the elder is a ‘self payer‘ (ie has savings above £23,250) but it’s a useful stop-gap while you find private home care or a care home. If necessary, prepare the home before your elder is discharged, by fitting hand rails and other mobility aids.  You’re likely to need an Occupational Therapist’s help with this.
  10. Eligibility for ongoing care – in hospital it’s (slightly) easier to find out about other ongoing support potentially available after discharge. Knowledgeable professionals may be nearby so ask about Continuous Healthcare (CHC) and whether your elder is eligible. You can still ask about CHC after discharge too.
  11. The GP report – get a copy (or a photo) of this before you leave if you can. The earlier and more detailed the information you have on outpatient treatment, the better for recovery. Again it’s easier to gather this information while you are physically in the hospital.
a&e and and e hospital emergency admission older elder dementia carer carers

Reablement. If you need time to get the right post-discharge care in place, do ask about this. You shouldn’t be expected to give up your own job to care for your elder (unless you want to).

At hospital discharge

a&e and and e hospital emergency admission older elder dementia carer carers
  1. Documentation – around discharge time may be the only opportunity you get to see the/a consultant. Find out when the consultant does their rounds and be there if you can, especially if your elder is deaf or has dementia. Make sure you have all have your questions written down ready.
  2. Contact details – make sure you have the phone numbers (direct if possible) of anyone that you may need to refer to after discharge. Whether for questions about recovery or for arranging care.

Last but not least, make sure you’re getting all the financial help you’re eligible for.

Extra help in Buckinghamshire

The Bucks Healthcare Trust looks after over 0.5m patients a year, many of whom rely on or are themselves a carer. The Trust has recently welcomed Carers Bucks staff and volunteers into the Stoke Mandeville, Amersham, Wycombe and Wexham Park hospitals. This Carers Bucks hospital team are trained to help identify carers at admission and sign post them to further help.  This help includes anything from blue badge applications, benefits, reablement (what it is and how to get it) to mediation in what can be intimidating circumstances. They’ll continue to support carers after hospital discharge too.

The team are on hospital sites most weekdays.  The team leader is Ruth Marriott and Carers Bucks can help you reach her if you call them on 0300 777 2772 or email mail@carersbucks.org.  They’d also love to hear from more potential volunteers. I hope this valuable service is provided by other NHS Trusts too.

Lastly, here’s an excellent 30 page document from Age UK that goes into more detail on hospital admissions, when you have more time.

Look after yourself and when relatives and friends offer help, accept it. Stay fit and well, love

MaudMumlogo  

PS If your elder has a dementia diagnosis, hospitals can be extra stressful. Clutter, bustle, featureless corridors and confinement to a room or ward can increase agitation. Shiny floors can appear wet and pools of light, dark corners and patterned decor can look scary. Hospitals that have made wards more dementia friendly report lower incidents of aggression and use of antipsychotic drugs (Julian Hospital 2012 and The King’s Fund 2015). Hopefully more wards will become dementia friendly soon.

PPS these tips from a Facebook friend are good too:

  • Buy hearing aid tethers, so hearing aids don’t get lost
  • Buy parking permits from parking services, they’re cheaper if visiting frequently
  • Take your own anti bacterial hand gel
  • Take a basket for the bedside table, for moving personal belongings easily
  • Label phone chargers and cables
  • Make your own notes whenever you see a doctor (likely to be a different doctor every time)
  • Recuperation or rehabilitation in a care home can speed recovery after discharge, if funds permit.