Discussion - care of and rights of vulnerable people.

looksee

I am using the term vulnerable in its broadest sense, to include elderly and disabled people and anyone who depends on others for their care. If anyone wants to propose a better title please do so.

A discussion about individuals' rights started in another thread. It was broadly relevant to the discussion but could be discussed in more depth without reference to the specific cases mentioned.

The discussion is essentially how a balance is found between the rights of the cared for person to have his or her preferences respected, accommodating the concerns of the family and carers and the obligations of a hospital or medical provider to 'impose' care.

The relevant posts are:

Future Teashock The decision rests fully with your dad and no one else( unless he lacks mental capacity).

It is a fundamental point of law enshrined in the Constitution that all forms of treatment can only be carried out with the consent of the patient.

CiDeRmAn In truth, capacity is always assumed but it is not simply defined in one area and then untested in every other.
And I'm speaking as someone who is working in the field of vulnerable adults, capacity and consent as well as the development of appropriate documentation to ensure consent is not just asked but also informed, through the use of easy read, tailored documents.

A person can want something but it is not always possible to give them their desire.
If someone wants to be nursed at home but their complex needs are simply too much for a care package to manage, some convergence between the wish and the available resources must be found.
It's often best for this to happen with a clear picture of all the options coupled with a family meeting that will always include, where practicable, the person concerned.
I know this all sounds quite clinical but that's kind of my field and I'm sure there's a more family friendly version of it.
When I was managing an end of life case the family had all sorts of expectations but I was able to maintain the wishes of the resident front and centre, but I was also able to keep the family involved in every step, even if it was only to give them status reports and support visits.
In the end, after the gentleman passed, the family were very satisfied with the whole experience and it all went on to support the development of our revised approach to end of life care .

Future Teashock If an elderly patient states "I reject your residential care suggestion, immediately remove all consent to all your treatments, and demand to be discharged against medical advice.." , the hospital would be in severe danger of not accepting the wishes of the patient. I have personal experience in this area.

gctest50

It'd be worth remembering that every night an elderly patient stays is worth €813 - €1000


" Hospital specified in the 5th schedule

Single Occupancy Room : €1000

Multi Occupancy Room :€813

Day Case : €407"




The drive and enthusiam of the cnm, hospital etc may not be quite as pure as it seems

CiDeRmAn wrote: »

..........

If someone wants to be nursed at home but their complex needs are simply too much for a care package to manage,.......

.

I'd imagine if you handed someone 7000 euros every week they might care for you

I'd also imagine they might like to prolong this arrangement for as many weeks as it is reasonable

.

looksee

My personal reaction to this would be that, assuming I was in possession of my faculties - and my family would know that - as an elderly person if I wished to leave hospital and take my chances at home, then I should be allowed to do so. So if there was a likelihood that as a result of going home I would miss the option of being resuscitated, of having a stroke or a heart attack, then so be it, I would accept that risk.

However, if I were completely bedridden and there was no-one willing or able to take care of me, then I would have to respect other peoples' concerns and accept that I had to stay in residential care.

Each case is different. Patients have rights, carers have rights, hospitals and medical people have obligations. The situation has to be open enough so that each situation can be dealt with as appropriate.

CiDeRmAn

This topic is literally what I'm doing in my current post, in the hospital in work in.
I and the team discuss and generate policy and procedure around capacity and consent.

It is absolutely the case that capacity is assumed.

It is also the case that a person refusing treatment had that right.

However, the HSE, myself and others would be found wanting if we didn't ask and check if this person had capacity, if we had reason to suspect otherwise.

We would also ensure that the initial information on treatment was delivered in a format that was understood by the patient and their family, where applicable.

If the person still refuses in-patient treatment this would not be the end, was there would be a new conversation about outpatient treatment or treatment in the home.

If the patient still declined treatment those wishes would be recorded and respected.

I have been involved in all of these scenarios as a nurse and as a nurse manager.

No one is forced to do anything.

gctest50

CiDeRmAn wrote: »

.............

No one is forced to do anything.

Here we have an Irish nurse in Ireland not forcing anyone to do anything






And I'm sure there would be many more ways, bit of the fear, uncertianity and doubt when no-one is around etc

CiDeRmAn wrote: »

If the patient still declined treatment those wishes would be recorded and respected.

.

And how was the event in the picture above recorded ?



"Kneeled on non-verbal autistic pts sternum to assist them"


Interesting it they picked on the non-verbal craythur, she couldn't complain if she wanted to


Wasn't the only one, wasn't once off :






tldr : reminder to select care carefully

looksee

gctest50 do you have personal or family experience of the care system that has produced this acutely cynical attitude towards care?

gctest50

looksee wrote: »

..........

that has produced this acutely cynical attitude towards care?

What's cynical ? Good care is outstanding

You need to keep aware of these things and events

You also need to be aware of that 7000 euros per week a hospital receives while someone is there

.

looksee

You have picked out a very small number of outliers that made headlines because they were so exceptional. Yes of course we need to be aware of the bad apples, but all over the country the norm - the boring, unreported, norm is people working hard to care for other people with skill, professionalism and concern for their wellbeing.

I am not sure of the relevance to this discussion but according to the Independent in June of this year

The average weekly cost of caring for a resident in a nursing home is now €1,615 – up from €1,592 last year.

Figures revealed the highest weekly cost per resident is in the HSE-run St Finbarr’s Hospital in Cork where it is as high as €2,182.

Where are you getting the €7000 figure from?

Obviously there are many aspects to residential v home care but the topic at the moment is what rights elderly or incapacitated people have in terms of choice of care, whether those rights are always respected and the extent to which it is appropriate to go against personal preferences in the interest of giving care and maintaining life and health.

CiDeRmAn

The example posted is an example of the worst practice we have seen in this state, and it served as an engine of change throughout the HSE and those who provide care for vulnerable children and adults.

It wasn't that this kind of criminal behaviour was widespread, but that the rules needed to define what the minimum best practice standards are and ask they are monitored and evidence based.

And that's where I come in.
As a compliance officer and in standards and audit development in my hospital, a major service providing long term residential care to vulnerable adults both in campus and community settings.

It's very unfair to suggest that it is representative of care standards in Ireland.
It's very unfair to post it in a forum where people are facing the need to use such places in the near future, to support their loved ones.

It serves no purpose except to make the poster feel superior and those reading it in their thrall.
I'd go so far as to suggest it is the worst kind of trolling.

If you want to post that stuff, see if it'll wash in After Hours.

This forum is for support and advice, and those posts are neither.

I'm a mod on this forum but not here regularly.
So I'll leave the moderation to Looksee.
But you have my two cents.

Edit: For a loved one, on medical respite, I had to pay €1000 a week in a local nursing home, as well as pharmacy bills, doctors and consultant visits as well as laundry bills. Would have come to €2500 for the two weeks.

CiDeRmAn

gctest50 wrote: »

What's cynical ? Good care is outstanding

Good care is the minimum expected of the staff paid to provide care and support for those we trust to them.

gctest50

looksee wrote: »

You have picked out a very small number of outliers that made headlines because they were so exceptional.

......

No.

I picked it out because it is one of the few cases of abuse where there is video evidence of it

looksee

Mod: Enough. gctest50, I have deleted your response post as it is repetitive and off topic, and several of your points are just too cryptic to make any sense. Please do not post in this thread again.

The topic is - from the opening post:

The discussion is essentially how a balance is found between the rights of the cared for person to have his or her preferences respected, accommodating the concerns of the family and carers and the obligations of a hospital or medical provider to 'impose' care.