David Johnson: The elderly deserve better care than being derided as ‘bed blockers’

A geriatrician holds the hand of an elderly woman with arthritis.

A geriatrician holds the hand of an elderly woman with arthritis.

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PATIENTS medically fit to be discharged from hospital, but who cannot leave because their social care needs cannot be met, are costing the NHS an enormous amount of money.

These patients are often referred to as” bed blockers” or Delayed Transfer of Care (DTOC) patients and cause many problems for the NHS.

A report published by the think tank, ResPublica, recommends that a fast-track care fund should be set up which will allow for the transfer of medically fit patients to more appropriate residential care providers.

Hospitals are not good places to be if you don’t have to be in them. Hospitals are fantastic at providing care when you are ill, but are not good at looking after those who are medically fit for discharge.

Despite this, relatives often feel that their frail loved ones are simply not ready to go home.

The responsibility of caring or organising care puts a great degree of strain on family carers and a move to a short-term, convalescence bed in a residential care home could provide much needed expert care in private and dignified surroundings.

The need to create bed spaces at times when hospitals are full, and resources limited, often means that medically fit patients are moved around the hospital as a space becomes available.

A 97-year-old lady was recently admitted to a hospital in the region and after a short period of treatment was deemed fit to be discharged. An agreed package of care that supported her discharge from hospital with a view to prevent a return visit was, however, delayed.

In the three or four days it took to agree the care package, she moved wards almost every day and even ended up on a maternity ward.

This particular patient was deemed medically fit for discharge and was taking up a much needed bed in a much needed area, but she was still incredibly frail and vulnerable.

Being in hospital, away from the stability and security of her home was unsettling in itself, the consequence of the bed moves caused much upset and confusion to a very frail lady whose longer term recovery was not helped in any way.

She would have been known as a “bed-blocker”, a problem, someone who had a Delayed Transfer of Care (DTOC). The image of a patient that has a status of “medically fit for discharge” is of someone fit and well and raring to go home, but reality for our elderly population is somewhat different. 

A move to a stable, supportive, home-like environment with qualified and consistent carers would, in this case, would have contributed towards a quicker recovery.

As the report suggests, it would also have saved the NHS a considerable amount of money as the current system is estimated to cost the NHS over £3bn over the next five years.

The answer to the problem is not a simple one. Care workers receive relatively low pay. The recent rise in the minimum wage and the austerity driven, long-term reduction in social care funding has created what could be described as a perfect storm in the residential care sector.

It is acknowledged that the Government has allowed local authorities to increase council tax by two per cent in order to pay for social care. Some local authorities have adopted this and are passing it on to providers.

Even with an uplift, however, real costs are going up by around seven per cent and a number of providers in the region are reported to have either closed or have put businesses up for 
sale.

Austerity measures, along with the advent of the National Living Wage, are affecting the viability of residential care

With occupancy at high levels, to the point where we can’t admit a great many more people, and rising costs, the only option organisations can take, in order to remain viable, is to look at reducing costs.

The biggest cost in any care home is the staff and any reduction in costs directly affects the quality of care for vulnerable, elderly people.   

As a consequence, quality providers are really struggling to support publicly funded places.

The recommendations highlighted in this report are very welcome within the sector and a Fast Track Discharge Fund would be a fantastic step forward in providing adequate levels of funding for some of the most vulnerable members of our society in an environment that is experienced and able to provide the best type of care for them.

This initiative, the report suggests, would save the NHS billions of pounds over the next few years, which will be money that can be spent elsewhere in the Health Service.

Alongside this hugely important financial saving, caring for elderly, vulnerable people in the right environment, at a time when they need it most, has got to be the right thing for our society to do. Surely they deserve this.

Dr David Johnson is a Principal Lecturer working within the Department of Social Work, Social Care and Community Studies at Sheffield Hallam University.

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