My father, who has lived independently for many years - and, indeed, was walking 10 miles a week until recently - suddenly had a series of health issues and, within four months, had become a frail elderly man who was confused, wanting help, and fighting against what was happening to him.
It rapidly became clear that this previously very independent individual could no longer live at home and needed to be supported within a specialist dementia unit.
As an only child and my father’s next of kin, I have been alongside him from the moment he was admitted to hospital.
I have watched how older people have been cared for in two hospitals and a nursing home. My observations have led me to identify implications for leaders in ensuring the dignity of older people.
‘We are expecting older people to go through a major life change and seem to be forgetting that a major life change cannot be accommodated quickly’
There are some fantastic, caring people who will go the extra mile, regardless of how busy they are. Donna, Roger and Peter, who I came across in two hospitals, stood out - every time they dealt with my father, they showed real respect for him as an individual. They had amazing communication skills that recognised his needs and why he was becoming agitated and frustrated. At all times, they strove to maintain his dignity, even though he was not always aware of the undignified position he was putting himself in. They showed great understanding of older people and what is important to them from a dignity perspective.
My father, despite his memory loss, still remembers Roger who, for three days, gave him a bath and made sure he came out of the bathroom with dignity, dressed, shaven and looking cared for. He talks about Peter who helped him with all sorts of activities of daily living.
Donna, as a ward manager, was a great role model because not only did she run a well organised ward but also she spent time delivering care, showing great sensitivity and compassion. She focused those energies on my father and took time to understand where I was coming from and what a difficult situation it was to have a relative many miles away in hospital.
I cannot criticise the care my father received in either hospital. He was treated with dignity and respect, and had his food and medication on time (when he was prepared to take it). However, I can see it would be very easy for older or vulnerable people to be lost in big, busy wards.
It is very difficult to navigate through the system of discharge from hospital into a nursing home. Having worked in the health service for many years, I thought I understood how the system worked. There was plenty of information and lots of people willing to help - but how all the bits joined together was quite baffling and it took me weeks to get to grips with the different aspects of finding a care home, funding rules, what benefits are available, how to get a council tax rebate and how to sort out pensions. The list goes on and on.
I eventually worked my way through the system and now my colleagues ask me for advice about how it works. A simple route map for individuals who need to move from hospital into a care home is needed.
Taking these observations into consideration, I concluded that there are four implications for leadership.
First, we need to make sure ward routines allow sufficient time for older people to do what they have to do in a dignified way. We need to be aware of the vulnerable individuals in wards who need that little bit of extra time and can’t be rushed with their activities of daily living.
Second, we need to focus on discharge planning and understand the very complex pathways and routes from leaving a hospital to going back home or into a nursing home.
Third, we often talk about delayed transfers of care. Yet, when we think how quickly people’s lives change, we are expecting massive change for these older people in a very short period of time.
My own father went from being fully independent and self caring to needing to go into a specialist dementia unit within four months. He felt he was being moved very quickly through the system and wanted me to ask if he could have another two months in hospital before he went to a nursing home because he felt it was all too quick. He had already been in hospital longer than needed. I felt very guilty about having to say no and arrange a move into a suitable placement as quickly as possible.
We need to be mindful that we are expecting older people to go through a major life change and seem to be forgetting that a major life change cannot be accommodated quickly.
My fourth message is that we need to be very careful around language, particularly around delayed transfers of care, or about people with dementia. I am becoming increasingly sensitive to language because my father is somebody who has dementia, and was a delayed transfer of care. Words like “bed blockers” or “some loopy old man” are completely unacceptable.
I even wonder if the term “delayed transfer of care” is appropriate because we are talking about people, not widgets. We need to humanise our language around older people and consider how we refer to those whose discharge is delayed and who have conditions that are life changing.
Julie Burgess is chief executive officer for Heatherwood and Wexham Park Hospitals Foundation Trust