Official Nee Naw Reopening
Right folks, this blog is back in business! And what better way to get things started but with my favourite topic, a rant about care homes?
The call went something like this:
Me: “Nee Naw Service, what is the address of the emergency?”
Care home worker gives an address which is not the address the phone is registered to. This is not unusual for care homes as they sometimes go via a switchboard. But I can’t get a match for the address she gives me. Computer says no. Computer says address does not exist. I try to get her to spell it, but she just keeps repeating the address. Then she gasps, and says “No, actually, it’s…” and gives me the address the phone is registered to which has been sitting in front of me all along. Great. Several minutes wasted.
Me: “What’s the problem?”
Care home worker: “She’s dying!”
I type “dying” into the computer and a similar uphill struggle ensues whilst I try to get this woman to explain what she means by “dying”. Unfortunately, it seems like suddenly “dying” is the only word she knows and that if she repeats it to me over and over again, all will become clear. It doesn’t. After all, someone with terminal cancer is dying. Someone who has just had their jugular slit is dying. A lot of the patients who ring with stomach ache *think* they are dying. If you want to be philosophical about it, we are all dying! The ambulance is halfway there by the time I manage to establish that the patient has actually stopped breathing. Not so much dying as dead then. But not necessarily irreversibly dead, if this has just happened. I press on with getting CPR started.
Me: Does anyone there know how to do CPR?
Her: Yes
Me: Have they started?
Her: No
Me: Are you right next to her now?
Her: Yes
Me: Right, get her flat on her back on the floor, remove any pillows and kneel next to her and look in her mouth for food or vomit.
Her: (instantly) Okay.
Me: Do that now.
Her: (instantly) Okay.
I can still hear her breathing at the other end of the phone so I know she hasn’t done it. We have to be very careful about calling the callers liars so I just press on with the next line - “Is there anything in the mouth?” thinking that she won’t be able to answer the question until she does it.
Me: Is there anything in the mouth?
Her: I don’t know.
Me: Have you looked?
Her: No. I am in the next room, I can’t see her.
Me: (Thinks: But you said you were with her! And you just said you were doing the instructions, you great big liar! Do you think I am telling you to do these things for fun?) Okay, go and do it now. Come straight back to the phone and tell me what you find.
Line goes silent. Caller goes away. Caller doesn’t come back. Five minutes pass. Two ambulances and a FRU approach scene, lights blaring. Caller still does not return to phone.
The FRU is a minute away by the time she gets back.
Her: “Cancel the ambulance! She’s fine! I put her on the floor and she complained and told me to get off her. I must have been mistaken! She was just asleep.”
Strictly speaking, ambulance service procedure is that if the caller says “cancel the ambulance”, we cancel the ambulance. However, there are exceptions to this rule and I decided that this was definitely occasion to make one. I had absolutely no trust in this care home worker who didn’t know her own address, could not answer a simple question and who appeared to have great difficulty in telling whether her patients were alive or dead. I noted what had been said on the ticket (since really it is the dispatch desks who should be making decisions such as sending an ambulance even when the caller says one isn’t needed) but finished the ticket as a complete call, rather than one which had been cancelled midway. Dispatch evidently agreed with me, and none of the ambulances were cancelled.
I kept an eye on the ticket, and nearly an hour later, one of the ambulances was off to hospital with the patient on board. Next, what should appear on the ticket, but blue call details! That means that the patient is in a very serious life threatening condition. The crew had established that she had actually had a seizure of unknown cause and now had a very rapid pulse, very low blood pressure and a GCS of 11 (ie. semi conscious). (Medical types - any idea what was wrong? All the other obs were normal and there was no mention of an ECG).
So, in summary, due to this “care” home’s incompetence, there was a delay of minutes reaching this critically ill lady, CPR was almost performed on her whilst she was still alive (which would have given her broken ribs to add to her problems) and she was almost denied medical aid at all because the care home went from thinking she was dead to thinking nothing was wrong in the space of five minutes!
And this is why no member of my family will end up in a care home, even if I have to move in and look after them myself. I appreciate there are a lot of care homes that aren’t like this, and plenty of care home workers who are caring and skilled, but incidents like this are far too common for me to ever take the risk.
on May 7th, 2008 at 10:15 am
I always find the care home debate an interesting one. Obviously I spend lots of my time in care homes and I was having this discussion with my mum - she won’t put my grandma in one and I wouldn’t put her (my mum) in one because they wouldn’t be able to think of anything worse. but for myself I don’t think I’d mind by the time I got to that age IF I COULD AFFORD TO GO INTO A GOOD ONE. It seems to me that “good care” is completely linked to “cost of care” - round here at least. Admittedly there’s no excuse for not knowing the address etc but a care home (assuming it’s residential rather than nursing) is not required to give any medical input - and the staff may be no worse than if the same elderly person was actually with a relative. Or on their own with no one to call an ambulance at all until they were found dead in bed. (And difficult to know what was wrong. As someone with a resting pulse of almost 100 and a BP of about 95/50 I live in terror of being carted off in an ambulance after a car accident when there’s actually nothing wrong with me! Not with a GCS of 11 though. My guess would be a vasovagal and just taking a while to recover with an underlying infection. But just a guess…)
on May 7th, 2008 at 10:33 am
I’m always surprised by the “not required to give any medical input” bit. I know this isn’t the fault of the staff themselves - what can they do if they don’t get the training - but given that they are constantly around people who are not in the best of health, you’d think they’d be required to at least know first aid and be able to identify when someone needs medical help. Not to mention whether they are dead or alive.
on May 7th, 2008 at 11:05 am
Hey welcome back Mark! I was missing your blog and getting bored with actually having to work instead! I think the 2nd ambulance should have taken your caller to examined from the neck upwards…
on May 7th, 2008 at 11:25 am
Glad you’re back, good story. Well, not good in that it actually happened, but you know what I mean.
Is there any reliable way to find out whether a given care home is any good (other than call up the local ambulance station…)? Is there any way you can put in a compliant, or since it’s not a NHS care home is there nothing you can do?
on May 7th, 2008 at 11:28 am
Yeah, all care staff should know at least basic first aid… In a nursing home, you’d hope that the nurse/s themselves should be able to provide basic life support, and certainly the ones in my home would (I’m a resident, not staff) - but an overcrowded, understaffed home would be pretty unlikely to have adequately trained carers, who may or may not give two hoots for the welfare of their residents.
on May 7th, 2008 at 11:53 am
Mark, welcome back glad to see you’ve sorted things out, hope all is well with the new house.
The driving instructor
on May 7th, 2008 at 12:41 pm
Oh, welcome back! This is scary, I checked your blog this morning just in case you’d changed your mind and come back, and lo and behold, what do I find when I get home this afternoon? Yay!
That said, that was a truly frightening story… how can these people care so little?
on May 7th, 2008 at 1:13 pm
Mark- Lovely to see you back! This is such a sad situation and happens here in the US as well, I know. Again, welcome back!
on May 7th, 2008 at 3:26 pm
Welcome back!
I’m dumbstruck by that caller. Hope the patient turned out ok in the end.
on May 7th, 2008 at 3:49 pm
Hi, welcome back, i’m glad you got back to posting, your stories are always and interesting read.
Unfortunately here in italy a even high “cost of care” doesn’t guarantee you anything, you often read in the news about caring homes that are little more than lagers…
M
on May 7th, 2008 at 4:33 pm
First of all great to see you back!
Given the sometimes excessive ammount of regulation the government like to place on the NHS and other government organisations, I am suprised there does not even seem to be a basic framework to ensure that care homes can provide adequate care. While of course I understand that every carer is nto going to be a medical professional I do not think it is too much to expect that they would be given basic training in things like First Aid and at least being able to call an ambulence and describel the more obvious symptoms in a clear and accurate way. If they must use poorly trained agency staff (given that this one did not know the address that sounds likely) they should have someone available they can grab when something out of the ordinary does happen.
on May 7th, 2008 at 4:35 pm
A rapid pulse and low BP to me suggest shock - and there are many causes of that.
on May 7th, 2008 at 8:01 pm
Delighted that you’re back. We missed you. Care home debate is only going to get hotter with the way demographics are going - not encouraging.
on May 7th, 2008 at 11:36 pm
good to see you back. was the carer even able to speak good english
on May 8th, 2008 at 12:19 am
Thought I’d delurk to say welcome back - I’ve missed you
on May 8th, 2008 at 3:03 am
Welcome back.
Could be a subdural bleed (Brain haemorrage). I agree mark, we go to so many bad care homes where there is minimal care and no recognition that the patient (or ‘client’ as they call them there!) is gravely ill, or no CPR when it is required. I have been to a cardiac arrest where the gentleman had been complaing of severe respitarory distress for several hours. The ‘care’ homes answer???….O2?…No….Doctor?…..No…they had given him that well known cure all Chocolate Ensure (Meal replacement milkshake)! It is at this point he breathed his last. It was this poor paramedic that had to try and intubate as the ensure was coming back up as my crewmate bounced on his chest. Not a nice smell! My newbie crewmate was nearly sick when at hospital clearing up afterwards, I announced I felt like a chocolate milksake and walked accross to mcdonalds!!
on May 8th, 2008 at 8:48 am
Hurrah, you’re back!
Are we absolutely positive that it was a care home employee and not a confused fellow-resident? Cos I’m not sure the person you describe could have actually applied for a job by themselves…
I think there is a place for care-homes though, which is why standards need to be pushed high and this sort of thing needs to be reported and reported and reported again until it becomes properly rare.
Firstly, because families aren’t always able to provide care. It’s not always a case of not being bothered. There’s also aspects of physical ability, financial capacity, pre-existing commitments (including the care of other children or adults) and, in some cases, sheer existence.
Secondly, because adults aren’t always able to accept care. I speak from experience here: the first time you have to ask someone if they could help you up off the floor, or fix you something to eat, or help you change your clothes, because you can’t do it yourself… it’s a soul-destroying moment and it makes you feel very, very vulnerable. But, it’s one thing to ask it of a nurse or a carer or a nice ambulance-man who is quite used to it and sees worse every day. It’s quite another to ask it of someone who previously knew and loved you as a strong, independent, capable adult. You feel diminished. You push them away. You go hungry or you spend the night on the floor or whatever because you don’t want that person to lose respect for you when they see you in this state. And when it gets to the point where you have no choice in the matter… then you resent it. And it takes a lot of doing on both sides to make the giving and accepting of help any easier.
And thirdly, because it really is quite stressful to have any extra adult in your home. This stress can only increase when you are responsible for that adult’s round-the-clock care needs. If you are lucky, then you might be able to arrange two weeks a year of respite care. That’ll be in a care home. If you suddenly are sick… well, if you suddenly are sick, you’ll just be expected to get on and cope anyway, but perhaps if you are hospitalised… then emergency care will have to be arranged and that’ll be in a care home too. They need improving, even if none of us intend to use them.
on May 8th, 2008 at 6:41 pm
Welcome back Mark, you’ve been sorely missed.
Another brilliant, thought provoking post - I just hope I don’t end up in that kind of home when I’m older.
on May 9th, 2008 at 4:33 am
I work for a Health Care Agency as well as the NHS and I REFUSE to go to with my agency care homes because the majority of them are money spinners. 1 pad per resident per day is something i’ve come across
There is a place where you can complain, http://www.csci.org.uk/complain/share_concerns_and_complaints.aspx is the Comission for Social Care Inspection and there is a section for complaints; also for complaining to the local authority.
WELCOME BACK!
on May 9th, 2008 at 3:37 pm
Sadly not that unusual.
GREAT to have you back by the way!
I count myself lucky that I get to torture the ‘nurses’ at the crap nursing homes (and praise the good ones).
on May 9th, 2008 at 8:26 pm
Welcome back. I’ve never commented on your blog before so just wanted to say that I missed it while you were away.
And as for care homes, well I could moan all day. In fact I was recently sent to a similar job to the one you described. When we arrived no one was doing CPR and then it turned out the patient was alive anyway! It’s a mystery to me how these people get the jobs in the first place.
Steven
on May 9th, 2008 at 11:41 pm
Welcome back Mark…we’ve had our moments, I know, but wouldn’t for the life of me see you gone…
on May 10th, 2008 at 7:44 pm
Very glad to have you back! I have been missing your writings. So called “care” homes are the same the world over, I’m afraid. Here in the US, I think they just watch the patient getting worse while hoping that they’ll get better. Then at 3am, when they are tired of watching, they’ll call us.
I can only hope this vicious cycle will end someday.
on May 11th, 2008 at 12:21 am
My favourite is when you have a carer call with a thick foreign accent and after a few minutes of trying to get the address, you hear them ask the manager stood behind them who speaks perfect Queen’s english, but prefers to delegate to the staff!
on May 11th, 2008 at 8:15 pm
Glad you are back !!
Really missed you and the stories !!
Looking forward to regular updates now