Advice needed - emergency dementia care

[cornish mackem]

Local Authority have an obligation as defined by the Care Act to offer an assessment of needs. If it's identified that the person has urgent needs, such as current care being withdrawn or no longer being available they should meet that persons needs immediately whilst awaiting a full planned assessment.
Sounds like local authority are passing the buck. They usually stop doing so when you mention the Care Act.

Been involved in cases where there has been an assessment and plans for emergency carers are agreed for the future should the main care giver be unable, such as them being admitted to hospital. Might be worth seeing if local authority will do this,

This stuff is my job now and the reality is very different to what people get to what they should get. The demand on services outstrips supply by an unimaginable way.
The idea of a rapid response is a thing of dreams sadly.
The default answer we have to give is a rubbish one, “ admit them to hospital as a place of safety if nothing can be arranged “
Putting someone in ED who already doesn’t understand stuff must be terrible for them and let’s not forget how difficult for the already manic department to manage. We only take old and demented people to hospitals as a last resort ( actually, we only take anyone as a last resort) but needing a social admission is more common than you would think.
We in the south west have been at crisis point since pre pandemic so nobody can blame that on COVID.
There will be about 20 ambulances waiting outside Plymouths Derriford at the moment and possibly the same in Truro . All waiting to get their patients into the hospital and that hospital can only do that when 1 leaves .
Patient flow is being halted by lack of social care providers and its them very same people who stop hells bells dad being taken in.
It’s proper shit down here currently with no sign of an improvement

As mentioned before the paramedics or the volunteer if not family. They absolutely should be able to sort something quickly though for a respite bed. In my region tge caters trust tend to do cater assessment and would look at potential need for emergency respite. It’s referred to as CRESS.
In Devon it may well be different. The LA website has some info but not a huge amount.

Breaks for carers and replacement care

Contact us to request a carers assessment. We will look at your needs as a carer and support you to take a break or find replacement care.

www.devon.gov.uk

I’m not sure what the block booked bed set up is like in Devon but we couldn’t get someone in one today as an emergency in Cornwall . It might take 1/2 a day to talk to someone

 

[Georgewhitt]

This stuff is my job now and the reality is very different to what people get to what they should get. The demand on services outstrips supply by an unimaginable way.
The idea of a rapid response is a thing of dreams sadly.
The default answer we have to give is a rubbish one, “ admit them to hospital as a place of safety if nothing can be arranged “
Putting someone in ED who already doesn’t understand stuff must be terrible for them and let’s not forget how difficult for the already manic department to manage. We only take old and demented people to hospitals as a last resort ( actually, we only take anyone as a last resort) but needing a social admission is more common than you would think.
We in the south west have been at crisis point since pre pandemic so nobody can blame that on COVID.
There will be about 20 ambulances waiting outside Plymouths Derriford at the moment and possibly the same in Truro . All waiting to get their patients into the hospital and that hospital can only do that when 1 leaves .
Patient flow is being halted by lack of social care providers and its them very same people who stop hells bells dad being taken in.
It’s proper shit down here currently with no sign of an improvement

I’m not sure what the block booked bed set up is like in Devon but we couldn’t get someone in one today as an emergency in Cornwall . It might take 1/2 a day to talk to someone

It can be soul destroying sometimes down here.
Working a recent night shift, there were over 300 jobs either waiting for an ambulance, or waiting at hospitals to deliver patients in our region.
A quick count showed roughly 70 units stuck in hospitals, and all the time there are more calls coming.
Somehow we manage, but more resources would be nice.

 

[Scorer]

This stuff is my job now and the reality is very different to what people get to what they should get. The demand on services outstrips supply by an unimaginable way.
The idea of a rapid response is a thing of dreams sadly.
The default answer we have to give is a rubbish one, “ admit them to hospital as a place of safety if nothing can be arranged “
Putting someone in ED who already doesn’t understand stuff must be terrible for them and let’s not forget how difficult for the already manic department to manage. We only take old and demented people to hospitals as a last resort ( actually, we only take anyone as a last resort) but needing a social admission is more common than you would think.
We in the south west have been at crisis point since pre pandemic so nobody can blame that on COVID.
There will be about 20 ambulances waiting outside Plymouths Derriford at the moment and possibly the same in Truro . All waiting to get their patients into the hospital and that hospital can only do that when 1 leaves .
Patient flow is being halted by lack of social care providers and its them very same people who stop hells bells dad being taken in.
It’s proper shit down here currently with no sign of an improvement

I’m not sure what the block booked bed set up is like in Devon but we couldn’t get someone in one today as an emergency in Cornwall . It might take 1/2 a day to talk to someone

Will be under pressure everywhere sadly.
14 years of services going downhill unfortunately. Public satisfaction with NHS and largely also social care was at a record high in 2010, ( 70% approval) and now at a record low.( 24%).

 

[cornish mackem]

Will be under pressure everywhere sadly.
14 years of services going downhill unfortunately. Public satisfaction with NHS and largely also social care was at a record high in 2010, ( 70% approval) and now at a record low.( 24%).

We need some more of them claps

 

[Georgewhitt]

We need some more of them claps

Aye, that'll sort it

 

[HellsBells]

This stuff is my job now and the reality is very different to what people get to what they should get. The demand on services outstrips supply by an unimaginable way.
The idea of a rapid response is a thing of dreams sadly.
The default answer we have to give is a rubbish one, “ admit them to hospital as a place of safety if nothing can be arranged “
Putting someone in ED who already doesn’t understand stuff must be terrible for them and let’s not forget how difficult for the already manic department to manage. We only take old and demented people to hospitals as a last resort ( actually, we only take anyone as a last resort) but needing a social admission is more common than you would think.
We in the south west have been at crisis point since pre pandemic so nobody can blame that on COVID.
There will be about 20 ambulances waiting outside Plymouths Derriford at the moment and possibly the same in Truro . All waiting to get their patients into the hospital and that hospital can only do that when 1 leaves .
Patient flow is being halted by lack of social care providers and its them very same people who stop hells bells dad being taken in.
It’s proper shit down here currently with no sign of an improvement

I’m not sure what the block booked bed set up is like in Devon but we couldn’t get someone in one today as an emergency in Cornwall . It might take 1/2 a day to talk to someone

I was amazed she was only waiting two hours to be seen in A&E tbh. But that’s still two hours when you guys could be out picking up other cases.

Thank you and @Georgewhitt for the job you do. It must be soul destroying at times.

 

[Georgewhitt]

I was amazed she was only waiting two hours to be seen in A&E tbh. But that’s still two hours when you guys could be out picking up other cases.

Thank you and @Georgewhitt for the job you do. It must be soul destroying at times.

@cornish mackem is the Man marra.

All I do is send him there mate.

 

[70s traveller]

It can be soul destroying sometimes down here.
Working a recent night shift, there were over 300 jobs either waiting for an ambulance, or waiting at hospitals to deliver patients in our region.
A quick count showed roughly 70 units stuck in hospitals, and all the time there are more calls coming.
Somehow we manage, but more resources would be nice.

I knew most of the ambulance workers when still at work so heard about the daily problems within their job. Plus how management of the service was gradually heading downhill. My wife also spoke to them every day via phone & heard about internal resources issues directly. A lot of the experienced crews couldn't wait to get out. My involvement ended 8 yrs ago so I don't assume it has improved.

The demand on services outstrips supply by an unimaginable way.
The idea of a rapid response is a thing of dreams sadly.
The default answer we have to give is a rubbish one, “ admit them to hospital as a place of safety if nothing can be arranged “
Putting someone in ED who already doesn’t understand stuff must be terrible for them and let’s not forget how difficult for the already manic department to manage. We only take old and demented people to hospitals as a last resort ( actually, we only take anyone as a last resort) but needing a social admission is more common than you would think.
There will be about 20 ambulances waiting outside Plymouths Derriford at the moment and possibly the same in Truro . All waiting to get their patients into the hospital and that hospital can only do that when 1 leaves .
Patient flow is being halted by lack of social care providers and its them very same people who stop hells bells dad being taken in.

Dementia care & assessment also requires suitably qualified staff which adds to delays but I totally agree that demand far outstrips the numbers of suitable resources. Which offers no reassurance to relatives.

 

[cornish mackem]

I was amazed she was only waiting two hours to be seen in A&E tbh. But that’s still two hours when you guys could be out picking up other cases.

Thank you and @Georgewhitt for the job you do. It must be soul destroying at times.

We have the 2 worst A+Es in the country with Derriford and treliske iirc. NDDH isn’t as bad for ambulance waits outside the hosp .

I knew most of the ambulance workers when still at work so heard about the daily problems within their job. Plus how management of the service was gradually heading downhill. My wife also spoke to them every day via phone & heard about internal resources issues directly. A lot of the experienced crews couldn't wait to get out. My involvement ended 8 yrs ago so I don't assume it has improved.

Dementia care & assessment also requires suitably qualified staff which adds to delays but I totally agree that demand far outstrips the numbers of suitable resources. Which offers no reassurance to relatives.

There’s never been as many ambulances on the road . This isn’t an ambulance problem 1 bit. If ambulances only did ambulance work, you could make redundancies.

@cornish mackem is the Man marra.

All I do is send him there mate.

Behave ya daft puddn

This is the bit I don’t understand - if we don’t get anything from 3.30 onwards today then he’s at risk. He’ll be home alone, potentially wandering with none of us nearby.

Like if he didn’t have kids, or we were on holiday, what would happen? How do social services find out, where is the safety net for people like this?

(On hold for SS for 1.20 now).

The safety net idea does happen but adult social care will not be knocking on doors asking if you are ok. People do fall through the net, lying on the floor for days, dead in bed for years etc happen too frequently.
Families are fragmented, people / kids move away , some people don’t want help until failure too but the sad bit is that we can not rely on the state and should we?

 

[70s traveller]

There’s never been as many ambulances on the road . This isn’t an ambulance problem 1 bit. If ambulances only did ambulance work, you could make redundancies.

I was aware of the issues within the service & knew of the delays relating to ambos awaiting release of their patient & the accompanying staff. I won't name persons directly involved in matters that were in process or the issues relating to admission/triage. All I'm now aware of is the timescales of ambulance waits.

 

[Georgewhitt]

We have the 2 worst A+Es in the country with Derriford and treliske iirc. NDDH isn’t as bad for ambulance waits outside the hosp .

There’s never been as many ambulances on the road . This isn’t an ambulance problem 1 bit. If ambulances only did ambulance work, you could make redundancies.

Behave ya daft puddn

The safety net idea does happen but adult social care will not be knocking on doors asking if you are ok. People do fall through the net, lying on the floor for days, dead in bed for years etc happen too frequently.
Families are fragmented, people / kids move away , some people don’t want help until failure too but the sad bit is that we can not rely on the state and should we?

Another issue that I see is levels of service throughout the South West change from county to county.
We cover Cornwall and Isles of Scilly, Devon, Somerset, Dorset, Bristol and Avon, Wiltshire, and Gloucester.

In some areas, mental health desks close at 10pm.

In some, the Police refuse to deal with any mental health calls, and pass them to Ambulance.

Different Social Services for each County.

It is all very fragmented, and like @cornish mackem says, it means the Ambulance Service is papering over a lot of cracks, as well as trying to be an effective Emergency Service.

 

[70s traveller]

In some areas, mental health desks close at 10pm.

In some, the Police refuse to deal with any mental health calls, and pass them to Ambulance.

It is all very fragmented, and like @cornish mackem says, it means the Ambulance Service is papering over a lot of cracks, as well as trying to be an effective Emergency Service.

Agreed, I encountered several cases of Police handlings of such matters & others where MH issues were involved. That's without mentioning the Emergency Services

 

[Georgewhitt]

Agreed, I encountered several cases of Police handlings of such matters & others where MH issues were involved. That's without mentioning the Emergency Services

I'm not blaming the Police, as they are issued with protocols that they have to follow marra.
As do we. We have strict, if not rigid, protocols we HAVE to follow. And rightly so.
We are dealing with peoples lives and have to adhere to them.
It is just that in most cases, when the protocols clash, it is the Ambulance service left to deal with it. We know that, and we do it willingly, but it can often hamper our ability to react to other genuine medical emergencies.

 

[70s traveller]

I'm not blaming the Police, as they are issued with protocols that they have to follow marra.
As do we. We have strict, if not rigid, protocols we HAVE to follow. And rightly so.
We are dealing with peoples lives and have to adhere to them.
It is just that in most cases, when the protocols clash, it is the Ambulance service left to deal with it. We know that, and we do it willingly, but it can often hamper our ability to react to other genuine medical emergencies.

I know direct handlings are restricted in cases for the right reasons, certain issues can be specific so have to be handled correctly. I'm not negatively laying blame anywhere because I was told (when at work in patient care environments) about following guidelines, I totally sympathised with those that had to be first at an issue where a prompt initial patient decision was required over a person - like Police & Ambulance staff have to

 

[Georgewhitt]

I know direct handlings are restricted in cases for the right reasons, certain issues can be specific so have to be handled correctly. I'm not negatively laying blame anywhere because I was told (when at work in patient care environments) about following guidelines, I totally sympathised with those that had to be first at an issue where a prompt initial patient decision was required over a person - like Police & Ambulance staff have to

And there is the difference marra.
A guideline is just that. A guideline.
A Protocol is rigid. It's not a guideline. It absolutely must be adhered to. Every word uttered in a 12 hr shift is recorded, and regularly audited, from which you recieve regular positive or negative feedback.

It is a good thing because it ensures absolutely the best patient care.

But sometimes different agencies protocols clash.

When that happens, @cornish mackem and his crewmates pick up the bits.

 

[70s traveller]

And there is the difference marra.
A guideline is just that. A guideline.
A Protocol is rigid. It's not a guideline. It absolutely must be adhered to. Every word uttered in a 12 hr shift is recorded, and regularly audited, from which you recieve regular positive or negative feedback.

It is a good thing because it ensures absolutely the best patient care.

But sometimes different agencies protocols clash.

When that happens, @cornish mackem and his crewmates pick up the bits.

My mistake in terminology of my previous post.

I'm fully aware of the difference beween guidelines, protocols, NHS and Trust policies because I was involved in revising & creating one or two to include new handling equipment that I'd recommended & advised the purchase of that related to multiple departments. My 26 years of NHS employment, dealing with Trust Directors, Budget Holders & Heads of Service taught me that. It was something I was surprised at the depth of when I was initially involved the drawing up of a business case. You're very correct in the fact that everything has to be trialled & agreed right up to the legal service before it can be incorporated into usage Most persons aren't aware of what goes on in the background of the healthcare world over the quest for best care. At one stage I was forwarded by the Trust to handle an inspection (alone) by an Inspectorate which was terrifying because one wrong word during demonstrations could have created massive problems. It was fun afterwards but very, very nervewracking.

 

[cornish mackem]

Agreed, I encountered several cases of Police handlings of such matters & others where MH issues were involved. That's without mentioning the Emergency Services

Mental health , adult social care, maternity services , district nurses, gp , ooh gp and care line all have the ambulance service as their default when they can’t cope or don’t want to manage the complexity of working in multi disciplinary community services. That’s why so many of ambulance staff now work in Those services.
Most gp surgeries have paramedics down here. I know 1 that has 6 as they can’t recruit GPs or nurses. I’ve worked in primary care and home treatment teams now for 7 yrs and Only do the occasional shift in green .

 

[Georgewhitt]

Mental health , adult social care, maternity services , district nurses, gp , ooh gp and care line all have the ambulance service as their default when they can’t cope or don’t want to manage the complexity of working in multi disciplinary community services. That’s why so many of ambulance staff now work in Those services.
Most gp surgeries have paramedics down here. I know 1 that has 6 as they can’t recruit GPs or nurses. I’ve worked in primary care and home treatment teams now for 7 yrs and Only do the occasional shift in green .

Care lines are the ones that really irritate me.
They sell themselves as care, when in reality what they do is see an alarm activation, call the patient, and if they get no reply they call for an ambulance and register it as a "welfare call".
They are not "Care Lines" at all.
They should at least have a team of first responders to react to the alarms in the first instance, and then call for an ambulance if required.
The money they make from vulnerable people, then simply dialling 999 is obscene.

 

[RichB]

North Devon. Biddeford.

Question for you if you don’t mind - in this situation, if you pick up someone and realise that there is a spouse with dementia who is going to be left behind, what are you supposed to do?

We were lucky that the volunteer for his outreach project arrived as the paramedics were there, and took him away but if they weren’t, what’s the normal protocol? (So we know for next time).

That was exactly my worry. I think the answer is supposed to be that the GP sorts out some “Response and Recovery” team. But they didn’t.

It just feels like there are so many holes in this safety net.

Hi. Sorry to hear the hassle you had but unless things have changed or it's a local agreement arranging an emergency care home bed is nothing to do with a GP.any times I tried to do this as it's meant to be the on call social worker who deals with it and it's always a nightmare to get hold of them and usually there are no beds.
Best thing would be to set up a plan in case this happens again with his social worker.
Good luck

 

[luvulongtime]

Sounds like you need to get carers allowance for him and employ a carer ?

aye 75 quid a week for 35 hours ffs that's what i got when me dad died and i had to stop work for 2 years to look after me mam until i managed to get her into a home, when covid happened everyone on benefits got extra 20 quid (to blow on cider and crack) those on carers allowance got fuck all