When my mum became a ‘bed blocker’, I saw the crisis in care for older people | Ros Coward

The case of Iris Sibley, trapped for six months in a Bristol hospital while her family and health authority hunted for a suitable care home, has highlighted how “bed blocking” is a key term in the crisis currently engulfing the NHS. When this week brought the news that nine out of 10 hospitals are overcrowded, NHS bosses pointed to major problems discharging patients. A&E’s failure to meet its four-hour target has similar causes and the excellent BBC TV series Hospital has highlighted how operations, both urgent and routine, are being delayed because beds needed for recovery are “blocked” by patients who no longer need to be in hospital.

Bed blocking is an impersonal term that expresses hospitals’ problems with resources. For the patients and family, it is much more personal. My mother became a “bed blocker” three years ago when, aged 89 and suffering from dementia, she collapsed and was admitted to hospital. She’d had several hospitalisations in the previous eight years but on the other occasions she’d been patched up and returned home. This time, after two weeks, she was declared stable but unable to cope any more on her own. I was told that a care home should be found, and rather sheepishly that the hospital “needed the bed back”.

We found a home within four weeks, yet it was another month before my mother was discharged

Like our society facing the coming crisis in elderly care, I wasn’t in any way prepared for this moment. Every time my mother had been hospitalised previously we’d seen first-hand what was being cited as the reason for much bed blocking: hospital weakened her, medication was altered, and her social care fell apart and became more difficult to re-establish as cuts hit social services. But in spite of all these mini-crises, we usually managed, eventually, to get her home. This time we had to make alternative arrangements.

The following five weeks were terrible. I was very distressed. I felt guilty. I had nightmares about making my mother leave her home. Contrary to Tory minister David Mowat’s recent comments that families aren’t prepared to care for their elderly parents at home, I clung to the hope that we could find a halfway house to rehabilitate her, or we could find additional social care to keep her at home. But the hospital kept pressuring and I shifted to scouring care homes and taking a crash course in what had become an overwhelmingly important issue: how a care home would be funded.

This was a lot of work, but ultimately it wasn’t me who held things up. We found a home within four weeks, yet it was another month before my mother was discharged. It is hard to pin down exactly why, but in the mix were cancelled meetings with consultants, staff absences and a lack of continuity between various agencies.

Worst of all was the finances. Endless time was spent researching funding and working on the care assessment form that determines the NHS’s contribution to care out of hospital. Despite huge numbers of older people now needing “medicalised” care of the sort previously provided in geriatric wards by the NHS, they are not entitled to full funding in care homes. But getting to the point of understanding entitlements and contributions and being therefore able to finalise the care home arrangements is a struggle. The eventual verdict had been anticipated by the discharge nurse five weeks previously: my mother was entitled to the basic further care element and the rest she would have to pay for herself, with the proceeds of selling her home.

Just as we began to gently prepare my mother for the move, she was abruptly shifted to another ward. She became extremely distressed and confused, and cried for the first time since entering hospital. And her whole care team disappeared – all the people with whom we’d been making these decisions and negotiating finances. The cause of this was again a shortage of beds, but for a person suffering from dementia and who was about to make the most important move of her life, it was awful.

It is not the fault of the NHS staff. In this instance they were uniformly compassionate. But while the staff don’t lack compassion, the system certainly does. Older people needing medicalised social care shouldn’t be pawns in a bureaucratic game where beds, forms and financial targets take precedence over humanity, while the NHS and councils, responsible for social care, desperately try to get the other to shoulder the costs. It’s shameful that resources are so scarce for the care of elderly people that it feels like horse trading to get anything at all.

Care for older people needs to change urgently. When my mother became a bed blocker the promises of the 2011 Dilnot report hung in the air. Dilnot was trying to rationalise the system, cap families’ contributions, and encourage social insurance to fund elderly care properly. Years later I’m shocked to find that nothing has changed. Theresa May talks about making Britain “work for all”, but Dilnot’s suggestions, which could improve life for elderly people and their families, have dropped off the radar.

When my mum became a ‘bed blocker’, I saw the crisis in care for older people | Ros Coward

Loneliness is not a bug with a technological solution | Ros Coward

‘Anyone who has spent time with elderly people knows the real issues are much more complex.’ Photograph: Paul Doyle/Alamy

In the UK, four out of 10 over-65s do not have internet access. At a time when so much of our lives is conducted online – the payment of bills, access to information – that should be a real source of concern about potential social exclusion.

But does this mean that by widening internet access, elderly people will feel more socially connected? Or, even, more radically, as a new report suggests, could this be a solution for loneliness in old age?

The centre-right Policy Exchange thinktank makes such claims as part of its forthcoming technology manifesto. It recommends £875m should be spent on training the 6.2 million mainly elderly people who are without basic digital skills.

The report claims these skills would provide older people with a way to stay connected to friends and family, and could therefore ease the isolation of those who live alone, while saving many millions for the NHS and in state-subsidised care home places.

Loneliness among the elderly is certainly a massive problem. Recent research by Age UK has shown that one in three older people are plagued by loneliness, and that this has dire effects on their health.

On first sight, claims about the potential benefit of digital connection for the elderly appear to be backed up by research. The International Longevity Centre recently found that 7.5 million adults have never used the internet – most of them elderly, disabled or poor. Of those who had not been online, 63% often felt lonely, compared with just 38% of those who did use the internet.

But these figures, and their policy conclusions, need to be treated with caution – not least because they may lead to money being invested in a technological fix when the answers are more complex and human. Loneliness in old age doesn’t occur just because older people haven’t learned to use the internet (a problem that will increasingly disappear as a more technologically literate generation ages).

Loneliness among the elderly is also to do with poverty and declining health. On the one hand, financial hardship restricts their activities; on the other, it increases frailty – including the loss of mobility, eyesight or memory, all of which undermine confidence when moving around in the wider community.

It is often these other factors that will restrict access to the internet, even for those who might once have been able to use it. To access the internet, you need money, or skilled neighbours and friends, to fix glitches; you need eyesight to read screens and memory to recall passwords.

Those findings that “prove” that the elderly who are digitally connected are also more socially connected require caution. At first sight, they too appear to be common sense. We have only to think of the incredibly energetic 80-year-olds who are internet savvy, regularly emailing their family and friends, and appearing to gain huge benefit. Yet the truth is that these people are often the ones whose health and financial situation would have kept them socially connected and in the centre of their families and communities, with or without the internet.

Anyone who has spent time with elderly people knows the real issues are much more complex. Of course internet use comes into it. But at its core, loneliness among the elderly still has other causes and effects: missing seeing people regularly, missing casual conversations, missing being able to get out and feel safe. What the elderly value is seeing regular friendly faces, having their basic needs taken care of by real human beings, and being able to walk to places where they can still interact with real people.

It is ironic that these reports highlighting how the internet can solve loneliness for the elderly are running in parallel with reports and academic studies warning young people not to mistake social interaction on the internet with friendship.

This week, research from Australia on loneliness among teenagers showed that the “loneliest” were also the most prone to sharing – or “oversharing” – intimate details on the internet. News stories constantly highlight how teenagers who are suicidally unhappy can be extremely active on social media. Indeed, there are suggestions that internet dependency can be linked to social alienation rather than social connection.

None of which is to say that the provision of basic internet skills for the elderly would be anything other than a good thing. On the basis of social justice alone, promoting universal digital competence is to be supported, and there could be very real and immediate benefits. But we shouldn’t elevate it into something it isn’t – the solution to loneliness and a way of keeping elderly people out of care provision for longer.

It’s a means to an end. The end, in this case, is human contact, human warmth, human kindness. A better way to those ends are services designed to bring about that face-to-face human contact, and communities designed to meet the needs of groups of people who are less mobile and able-bodied than they once were but still crave company.

Loneliness is not a bug with a technological solution | Ros Coward