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Care home patients tube fed 'to save time'

  • 12 Comments

Elderly and infirm patients may be put at risk in care homes that force them to be fitted with feeding tube in order to cut costs and save time, according to a new report.

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Many homes are refusing to take patients who do not have feeding tubes inserted into their stomachs, the study claims.

The report by the Royal College of Physicians says although the homes claim to be acting in the interests of the patients, the real motive may be to reduce costs and staffing levels.

The report comes as the college issued guidance calling on doctors and nurses to view artificial feeding as a “last resort”.

An audit of 719 PEG procedures published in 2004 found 19% were “futile” and did nothing to prolong life.

This suggests large numbers of patients are being tube fed inappropriately.

A 2008 survey showed the previous year 39,000 people in the UK were artificially fed outside hospital, either at home or in residential care.

Dr Rodney Burnham, who co-chaired the working party that produced the guidelines, said increasing numbers of care homes were refusing to take patients not fitted with feeding tubes.

“We come down very strongly on any blanket refusal on those grounds,” he said. “They may cite patient safety but there could be a hidden agenda on grounds of staffing or costs.”

He was unable to say what proportion of homes imposed the PEG rule, but added: “It is fairly widespread, because every hospital and every nutrition team you talk to will have had that experience.”

  • 12 Comments

Readers' comments (12)

  • I think tube feeding is inappropriate anyways, unless necessary. Not all elderly people need to tube fed, its unecessary if those who can feed themslves, need to have tubes for no good reason. This would only cause so much stress to the patients. All this is really about is cutting costs, which is really wrong because patients regardless of whether they are elderly or not, should be put first.
    Its wrong doing this just to safe cost and time. Why won't someone do anything about this because its just so wrong. I have strong opinions and views about this subject. No patient should be refused accessed to care or treatment just because of not having a feeding tube, which is unnecessary.

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  • Why is this happening? We are caring for human beings here, people like you and me. No one should be forced to be treated like this.

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  • TA Nottigham
    People who are living with dementia is increasing and will continue to increase over the next decade. (as the elderly are living longer) Unfortunately one of the disadvantages of living longer is the increase chance of suffering from some form of dementia. There are many types of dementia and different levels, from mild to severe. Severe dementia can be a cruel and debilitating illness, for the person themselves as well as their families and carers (paid workers and unpaid family, friend carers). Dr Rodney Burnham who stated “They may cite patient safety but there could be a hidden agenda on grounds of staffing or costs.” I presume has evidence to state that staffing costs is the issue and that he has looked into why care homes are insisting on this 'PEG' rule. Is it 'no one listens to Managers of care homes opinions/views on risks!'
    Of course each person that has a diagnosis with dementia will have different abilities and disabilities e.g has the person forgotten how to swallow..which often happens in severe dementia...
    I am aware of many instances of when SALT assessments have been carried out...and suggestions on how to manage safely a persons assisted feeding has been contradictory with the assessment (risk).
    Shouldn't all people be assessed and an individual risk assessment be carried out... not only to ensure the safety of the person who may need assistance but to ensure that the staff member is not placed in an impossible unsafe position...of being asked to assist a person to eat and drink who is clearly at risk from choking.


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  • This is abhorent practice. Who is assessing these patients, who is referring them, who is giving them or their relatives deceptive information in gaining consent, who is carrying out these procedures?? Isn't this a form of battery and a criminal offence?? I hope there is a full investigation. If someone can be suspended for offering a prayer, this is totally a different kettle of fish altogether. It is was one of my relatives, I would be suing.

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  • Surely any decision to place a PEG is made by a consultant, at least it is in our hospital. This article makes it sound as if its the care homes themselves who are making decisions. A decision to 'PEG' a patient is not undertaken lightly, this is minor surgery after all and, in my experience, if it will not improve quality of life, the procedure simply isn't done in many elderly, dementing patients. And if the decision to PEG is taken, there are many other factors taken into account, eg, the safety of the patient's swallow, their medical condition etc. Also, some families place NHS staff in an impossible position by demanding that their elderly relative be fed, even if that patient may be patently unsafe to feed orally with all the risks of aspiration etc. explained to families, they will quite often push for artificial feeding. Care homes do not take patients fed by NG tubes as these are not considered a permanent solution. I doubt very much that this situation is as black and white as reported, and I doubt very much that reduction in staff is a reason for taking patients with PEGs. After all, it usually requires a trained nurse to undertake PEG care and set up feeds etc. whereas a health care assistant can usually feed a patient safely with training. Where is the cost saving here?

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  • MY HEART SINKS. Why do we think that we can get away with this terrible attude to our fellow human beings. Its shocking to think that this is happening in this day and age.. Im getting old and Im scared to think of what will happen to me in the future..SANS EVERYTHING.

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  • if it is true that PEG tube insertion procedure is being carried out for reasons other than for the clear benifit and clinical need of the patient then the decision maker ' medical officer' should be investigated under the protection of vulnerable adult procedures.

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  • As a nurse working in a nursing home I find this article very offensive!! A a home we have never even considered this pattern of thought and indeed quite frankly the way things are going there will come a time when nurses will no longer want to work in care homes because of the slating we seem to get at every turn by other professionals as well as our so called peers!
    At present I care for 4 residents with PEG tubes and they were admitted with them.....one pt is currently aiming for the goal of having it removed.
    So PLEASE be careful not to tar us all with the same brush!!

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  • I can honestly say I have never in all my years of working in the NHS (over 20years) ever had a nursing home refuse to take a patient because they are not PEG fed. Working in stroke care, the insertion of a PEG is sometimes a necessary part of the patients care but even this is not done lightly. Ng feeding and regular SALT assessments are implemented first before the decision to PEG is made-and the final decision is always made by the consultant, after discussion with the MDT,it is NEVER for convenience and never will be!

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  • I find this article very difficult to believe. There are very few people with PEG tubes in the care homes in the area in which I work as a District Nurse. There seem to quite clear assessment & acceptance criteria for people to have these devices inserted in our local hospital.

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