Hospitals

In the run up to publication of my new book Carers and Caring; the One Stop Guide; how to care for older relatives and friends I am sharing some of the practical solutions learned from research and experience. If you think any problems have been missed you can email me and tell me, and I’ll make sure they are covered in the next edition and online on my website at www.juneandrews.net. 

 Hospitals

Being a carer for an older person in hospital became much more difficult during the pandemic. What became clear was that, in the absence of support from family and friends to visit, the experience of hospital was extremely difficult. 

The advice given here is based on how things would be in normal times when visiting is more open. Over recent years it had become easier to visit friends in hospital and it has been made clear that visitors have a positive contribution to make especially when the patient is older and confused because of delirium or dementia. 

Just as the NHS has always understood the importance of parents for children in hospital, so we now understand the importance to carers of always having access to their older friend or relative during a hospital stay. The family or other carers know the patient and can interpret what they are saying or explain whether there have been any recent changes in their behaviour. The carer also knows from non-verbal behaviour what the person is communicating when it doesn’t make sense to anybody else. Their outcome is hugely influenced by this contact. Visiting was always open for children, but now it has been extended to older people.

It would be best to try to avoid a hospital admission if you can. Sometimes you can’t avoid it. What do you do then? 

Emergency department

The hospital admission often starts in the emergency department. Try to stay with the person for as long as possible to help with answering questions and to keep them cheerful. Patients can be waiting in the emergency department for a long time before a hospital bed is available, and if allowed you may be able to make sure that the person has something to eat or drink. You can even help them to use the toilet. The nursing staff are very busy with emergencies and so your help will be appreciated. It is a very noisy place, so if you’re able to supply headphones with some familiar music or a story it can help distract the person from what’s making them ill and from the chaos round about them. 

In the ward 

Once they have been admitted to the ward, it will help the patient to settle in if they have some familiar things with them. Gifts of flowers are no longer allowed in clinical settings but bringing magazines, photos and cards for people to look at has two purposes. It gives them something to do when you are not there, but also it signals to those caring for them that they do have friends and family. These materials can be a topic of conversation even when you are not there.

Eating and drinking

There is always a danger that a person in hospital will become dehydrated. Staff are very much more aware of this these days, but it’s still the case that the person might be asleep for a long time and not think to drink water when they wake up. Dehydration can make an older person confused or increase underlying confusion that already exists. When you are visiting, do everything you can to encourage the person to drink.

Eating the right things is an important part of getting well, and in response to this hospitals have introduced protected mealtimes. This means that patients are protected from visits from staff or examinations during the time when they should be eating. Usually visitors are also excluded during this time, but you can make a special case to come in and help the person you care for to eat their meal. Sometimes, if they do not eat the food it is taken away. In hospital you are expected to eat at mealtimes so there is limited availability of food in between. When you are visiting you may be able to remedy that.

Pain relief

There is no need to suffer pain. In hospital the nurses will come round at regular intervals and offer medication. They give medication that has been prescribed for that time. However, in between times they can usually offer extra for ‘breakthrough’ pain. Very many older people do not like to disturb the nurse and ask for it. Or, if they’re asked by the nurse, they will say that they are fine because they think it is bad to take too many medicines. Sometimes the nursing staff will have to be persuaded or reminded that the patient is uncomfortable even though the patient is not prepared to admit it. If you’re visiting, you can help with this. Because you know the person, you may realise that they’re in pain when no one else notices it. If staff seem hesitant to provide pain relief you can certainly ask why. 

Confusion and agitation

An older person in hospital may appear confused and agitated at times. It is vital for the care staff to understand whether this is normal for them or something new that has happened since they came to hospital. The causes can include urine infection or chest infection, and sometimes it is a question of dehydration, lack of sleep or stress from the unfamiliar surroundings. When a patient is ill like this it may be that they now have delirium (see ‘Delirium’ in this series). This is a clinical condition which requires treatment including hydration and oxygen, and removal of the underlying causal factors. 

The agitated patient who cries out and walks around can cause huge stress for other patients, so there is a danger that they will be sedated in the interest of their neighbours. This sedation might not be in the interest of your older relative, however, and a solution such as finding a single room would be better for their health. Talk to the staff if you think this form of chemical restraint is being used. It might still be concluded that this is the only option, but it should be discussed with all concerned.

Helpful things to do

There is a long list of useful things that you can do when visiting. If busy staff don’t have time to let the patient do things slowly, such as washing and dressing, you could offer to help. Find ways of having open visiting. Make rotas with friends and family to make sure the person has someone with them as much as possible. Take the person for some exercise and get them into daylight if you can. Have a memory book or communications passport that allows their likes and dislikes to be recorded. Check ankles for swelling and encourage them to put their feet up. Take them to the toilet and wash their hands. Wash their face. Find a way of letting staff know ‘who’ is in the bed. Try to get the staff to see you as an extra pair of hands, but also don’t hesitate to challenge if you spot things you don’t like, such as reddened skin where the person has been sitting too long, or meaningless loud music and chatter that no one is listening to from a TV that no one can see.

Leaving the hospital

Frail older people may be offered a ‘home visit’ to see if they are well enough to go home. This happens if the staff have doubts. Sometimes the person is nudged towards care-home care without trying to get them home with support first. You may have to fight for this, and you might be doing it against the clock because of the pressure to free up beds. If your relative is in a clinical setting that is not good there is not much you can do to improve the hospital, but your presence can improve or modify the behaviour of some of the staff and the patient’s progress through the system. Sometimes when things go wrong it is not from carelessness, but not knowing what is needed. Don’t hesitate to make it clear to them.

There is much more about supporting people in hospitals in  Carers and Caring: The One-Stop Guide: How to care for older relatives and friends - with tips for managing finances and accessing the right support  available from all good bookshops in May 2022

Three hints:

1.     Think about hydration and pain

2.     Use visiting times to make a practical difference

3.     Support the staff, but challenge them when needed