Cost of home care for 88 year old

cepheus

To be fair I am just dealing with the paperwork and technicalities. Some of the others have been active in terms of organising, hymn's, flowers, clothes etc. they are also very sympathic to the death itself; but they see my protests as being an emotional rather than rational reaction which only increases the frustration. I get the feeling he undertaker was not too pleased at not receiving the death certificate quickly, there is a lot of pressure to conform.

clemmatis

Ah. I see. I was just left to do it all, not that there was much to do. I was though very lucky in my undertaker, he couldn't have been more helpful. I suppose the upside of having to do it all was that there was nobody to tell me I was being "emotional" -- I certainly was!

John_Pierpoint

troubleinparadise wrote: »

The doctor certifying should list: 1) the disease or condition that led directly to death 2) the intermediate cause 3) the underlying cause.

I think it is very important that relatives should be on their guard against the medical profession fudging the figures, especially now that hospital acquired infections kill three (?) times more people than motor accidents.

http://www.medicine.ox.ac.uk/bandolier/booth/Risk/HAI.html
http://www.dailymail.co.uk/news/article-505798/How-doctors-lie-death-certificates-hide-true-scale-toll-hospital-infections.html

WASH YOUR HANDS CAREFULLY VISITORS PLEASE ON THE WAY IN AND OUT - THIS HOSPITAL CAN BE A DANGEROUS PLACE.

When my mother died Aspirational Pneumonia was the sole cause of death on the certificate. What actually happened was she had a stroke that left her incontinent. So she was discharged with a catheter and a bag for her water works. She managed with care at home with this arrangement for 4 years; but eventually had to go back into hospital with an infection of the bladder causing confusion. Technically she seemed to recover after treatment with antibiotics, but on the geriatric wards there was very little stimulation, other than being got out of bed and into the adjacent chair and then being offered meals.
On a Sunday I am not sure what happened BUT in those days (not now!) the details of the care were hung on the end of the bed. The care instructions were clear enough and well laid out for any "bare foot doctor" to follow and included monitoring more frequently than 10:00 and 19:00.
In reality my mother must have been slumped in her chair apparently asleep, until someone discovered she had stopped breathing with a blood oxygen well into the dark red (for "brain damage" danger) band of the chart.

I had a "robust" discussion with the powers that be along the lines of "I bring my mother in here with a bladder infection you turn her into a vegetable and then you tell me to take her away again".

It came as no surprise to me, when the press discovered that hospital deaths rise at weekends.

cepheus

My Father went through a similar routine in the same hospital 5 years ago. He starts to recover after treatment (in his case the underlying which was emphysema shouldn't have been terminal) then soon after the consultant is satisfied with progress and starts talking about nursing homes he went downhill quickly and never got out of hospital. I didn't have any other evidence to suspect an hospital infection in his case though.

John_Pierpoint

It can be "just one of those things" especially with the very old and let us be honest all of us ask ourselves questions like:
Did we do our best?
Could we have done better?
Should we have realised?
Why didn't we........?

It is the "finality" of the situation, plus the gap left in our lives, that hits home.

margaretclare

When I was a student nurse we often saw cases where an individual would 'just go', for no apparent reason, except for the illness/surgery they were being treated for at the time. Some senior nurses had a 'sixth sense' and would say 'I don't like the look of him/her'. Usually they were right. I was too junior at the time to question, but it happened a lot.

margaretclare

I had a "robust" discussion with the powers that be along the lines of "I bring my mother in here with a bladder infection you turn her into a vegetable and then you tell me to take her away again".

And anyone who is expected to live permanently with a catheter in situ is IMHO simply asking for ongoing infection which can track upwards from the bladder to the kidneys. The internal and external sphincters of our bladders (circular muscles that open and close) are not designed to be kept open all the time.

John_Pierpoint

It is a difficult trade off. Independence versus health. She had a very good health visitor and managed to maintain something of her former social life getting about the place with use of the furniture and a zimmer frame and toddling off to the day-care centre etc.

Most care homes usually take out the catheter and that explains why they often smell of "P"

margaretclare

John_Pierpoint wrote: »

It is a difficult trade off. Independence versus health. She had a very good health visitor and managed to maintain something of her former social life getting about the place with use of the furniture and a zimmer frame and toddling off to the day-care centre etc.

Most care homes usually take out the catheter and that explains why they often smell of "P"

Being catheterised can cause the bladder to become over-sensitive. DH and I have both found this following surgery which involved catheterisation, and it has taken ages to get back to normal. Also, you mentioned 'being slumped in a chair'. With a catheter in situ it is impossible to sit properly. It's like sitting on a golf-ball - very sensitive and painful! Catheter care is defined as 'nursing' not care, and therefore, if a care home has no qualified nurse 24/7 there is no one who can take care of it.

cepheus

I did contact the coroner again for clarification on the death certificate, he wrote

the cause of the death was due to the cancer that your mother was suffering
from which was using a general deterioration in your mothers health. Although
the doctor believed there was some infection this was not related to the
insertion of the stent and not felt to have contributed to the death even were
the infection to have contributed tothe death this would have been a natural
event.

Consequently, it appeared to me that the cause of death that your mother
suffered from was natural. Finally it did cross my mind to consider if the
doctor was wrong in her statement that to the best of her knowledge and belief
that there was no infection in your mothers biliary tree after insertion of the
stent. However, in the circumstances where bile duct flow is obstructed within
the liver and biliary tree, infection is always present simply due to the
stagnation of bile flow, which again is a natural event. In view of the doctors
firm view that this had not occurred I accepted the doctors certificate.

after explaining that I was only interested in an accurate death certificate, that her condition had improved substantially immediately after the operation, and the consultant told me she was “failing to respond to antibiotics”, I received the following reply:

...it is quite within my powers to change a cause of death after an inquest.
however I have not immediately taken this course as I do not wish to cause
unnecessary distress... I would be grateful if you could tell me whether or
not you would like me to hold an inquest.

So I need to decide whether to go forward with this. Is it worth it, or am I being unreasonable?

It caused more distress to me that they seemed to be fobbing me of, but if any relatives found out I was still going on about this they would go crazy, or think I was.


Here is a piece about incorrect recording of death certificates in the Telegraph