as featured in the Care Home Professional & Care England’s Care Agenda November 2021
A hospital admission for anyone, regardless of the level of vulnerability and particularly during a pandemic, is not usually associated with outstanding achievements in a social care setting. For a registered manager and the staff supporting that individual, the fear of the potential consequences and the dread of bad news weighs heavily on everyone’s shoulders.
This dread became reality in August 2021, when Alice, a resident at Fixby Lodge in Huddersfield became unwell. Alice is 23 years of age, has severe learning and physical disabilities – she is also blind. She is unable to communicate verbally and relies upon staff to interpret gestures and noises to make her needs and emotions known. As with many people in Alice’s position, the skill and the dedication of staff in interpreting and responding to people with such complex disabilities is something very special and generally not understood by people outside of the sector.
Alice’s health deteriorated rapidly over a few hours and it became apparent that she was having difficulty breathing. The staff suspected that she had a chest infection and therefore called for medical advice. A paramedic visited the home and Alice was subsequently taken into hospital with a suspected chest infection and possibly sepsis. She was reported to be gravely ill.
A single member of staff was allowed to accompany Alice and remain with her during her hospital stay. The manager and the team rallied to ensure that Alice had someone with her all of the time so that all of her needs would be responded to whilst in the hospital. Despite comprehensive support plans and a hospital passport, the subtleties of understanding Alice and her complex underlying conditions require an in depth knowledge and understanding that can only be gained from knowing her well and learning her particular nuances over time.
Back in the home, the manager continued to ensure that the home remained staffed to the required numbers and in such a manner that the staff team and other people supported remain settled and informed about what is happening. The manager relied upon the staff at the hospital to pass on information relating to Alice – we all know how busy hospitals are and to obtain those updates by telephone from the medical staff can prove very difficult. The manager spent significant amounts of time calling the medical staff to obtain information directly when it wasn’t entirely clear what was happening from the information provided to staff at the hospital. All of this information was being communicated back to the family of Alice who were understandably highly anxious, though massively grateful for the updates and also for the necessary reassurances and comfort that the manager was providing them. This in itself meant that the manager was communicating with staff and family 24 hours per day at the peak of Alice’s ill health.
The staff supporting Alice at times felt frustrated and alone. Supporting someone who is so ill and vulnerable on a very busy medical ward during a pandemic is a lonely and worrying experience. Staff members who are used to working with a very close-knit team who are extremely responsive in the care they provide felt unable to function in their usual way because of the restrictions of not having that team around them. To have to wait for a significant length of time to provide personal care; to ask to have medication administered when it was overdue; to intervene when medical staff attempted to administer medication orally, when in fact A receives this via a PEG; to advise medical staff how to use the cough assist and suction machine; and to feel like they were in the wrong for challenging when needed and making sure that the care and support that Alice received was safe and of the highest standard possible; all added to the stresses that the support staff were feeling during their long twelve hour shifts in the hospital. The staff members who supported Alice understandably required the constant support and reassurance from the manager of the home that they were doing the right thing, though as with all outstanding carers, the intrinsic and instinctive knowledge of providing the best possible support for the individual they know so well is the absolute confirmation they need.
The manager and the staff gave up their own time to ensure that Alice was well cared for. The manager of the home gave up her weekend break with her husband to be there to support her team, the family and of course Alice. The most subtle of things make a huge difference to us all as individuals. Staff took in extra pillows to make Alice comfortable and a radio as there were none available in the hospital.
From being gravely ill, Alice rallied around despite her complex health needs and was subsequently discharged after just a few days in hospital and some intensive IV antibiotic treatment. It was a massive relief to all, but even then there was work to do. Alice was discharged with a DNACPR in place which no one had knowledge of, including family. There had been changes to her medication which hadn’t been communicated, and in fact was dispensed the wrong medication from the hospital, and no follow up referrals had been made to physiotherapy, as per the discharge notes. It was therefore down to the manager and her team again to challenge and to rectify the errors that had been made, all of which were eventually resolved.
The point of this article is not to blame or complain about the health care that Alice received whilst she was a patient in the hospital; without the intervention of the medical teams, she would very likely not be alive today. The aim of telling Alice’s story is to highlight the hard work that care home staff and their managers do every day and how the partnership between Health and Social Care is absolutely critical in providing the most effective and best possible support to people with complex needs and the most vulnerable of those in our society. The knowledge and professional commitment held by social care staff is demonstrated in this one example as being at least equal to that of those medical professionals that are so acclaimed in the public eye. Equally, without her social care staff Alice would not likely be with us today.