How would you define fear?
There are phobias, snakes, spiders and what-not. Fear of heights and open spaces, flying and claustrophobia.
Front-line staff will be familiar with trypanophobia… fear of needles. There are others who are terrified of speaking in public.
How about a fear of going home? Hard to imagine? Home is a safe place. The place we head for when the going gets tough. But, not everyone.
For some, who have had a spell in hospital and especially, the older and frail, going home is something to worry about.
The fear of losing independence. Physical independence, social and psychological independence, practical independence and financial independence.
In the up-sum; how will I manage. The fear of not being able to cope.
How will I manage to get upstairs to the loo.
How will I manage the steps at the back door.
How will I manage to lift the kettle, feed Timmy the cat.
How will I manage to lift a hot dish out of the oven.
How will I slide to bolt on the back door and get to the front door to open it.
How will I manage to get dressed, or ready for bed.
All the things that you and I take for granted. Take them away and there is a lot to be fearful about. Not least, will the care-package, that’s kept me going, be cancelled after a week in hospital.
I got to thinking about these fears after reading an excellent and beautifully presented report from The Red Cross; Home to the Unknown.
Thinking about the 65year old who was discharged from hospital with osteoarthritis and frailty, exacerbated by a stay in hospital. She stopped eating and drinking to avoid having to make her way up the stairs to the loo.
An OT’s solution was to construct a lift-shaft in the middle of the sitting room. The lady in question didn’t feel up to the disruption. I don’t know what happened to her.
Don’t think this is, exclusively, a problem for the elderly. Beth, 36, took and overdose, was treated as an in-patient and on discharge, was recommended to contact the ‘post-release MH team‘. She did and they said she didn’t need help.
Beth ended up calling the Samaritans 40 times in the 2-3 months, after leaving.
Adult social-care staff are trying to provide a service, standing in the ruins of what care once were.
The Red Cross are associated with urgent, crisis, chaos, war, disaster and refugees. With the exception of ‘war’ it’s hard to see, in some parts of the country, the situation at discharge is anything less than urgent, crisis, chaos and disaster.
Refugees? About 900,000 people used to get care and support from local council services. The eligibility criteria have been raised, now they get no help.
They are refugees in our care system.
The Red Cross are reshaping their strategy and hoping to do more to help the NHS and social care work together. Fill-in the gaps. The Academy already feature some of their work and the Red Cross are up-for doing more.
They should, they are good at it.
Unplanned hospital stays are disruptive but the journey home should not be. Being medically fit for discharge isn’t enough. The trajectory of long-term recovery is a vital consideration.
The Red Cross can stand at the cross roads, in A&E, to help sign-post the journey home, on the day, or in the future and make sure it is safe and sustainable.
As the report says;
‘… patients were often confused about how the system shared information about their situation… assuming data was shared… confusion about which parts of the system were responsible for what and how they communicated… confused about who to talk to when they got home…’
The Red Cross don’t take sides and they don’t point a finger but they are there to hold people before they fall…
… help make going home a joy.
Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.