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Diabetics in Care Homes -Safe discharge from hospital

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Bigley

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My youngest son died a sudden death in a County Council Care home December 2005.
He had been a diabetic from the age of 13yrs until his death age 39yrs,
Unfortunatley he went into end stage renal failure early 2005- he also ended up with a left below knee amputation due to Necrotising Fasciiitis early Septmber 2005- he had been complaining about pain in his left heel since april 2005 - although blood cultures were done on several occasion which grew Staph Aureus the infection was always put down to being in his perma cath.
Whilst he was in Hospital from late August until November 2005 he had several other hospital aquired infections. He was discharged to a local Council run rehabilitation home early November2005 on the advice of his Orthopaedic Consultant who said he was at great risk of acquiring a serious infection and dying.
His diabetis was very unstable due to frequent infections. Late November he developed a further infection - this time in his Perma cath prior to this infection being found he had become very hyperglycaemic- the staff at the Care Home- didn,t get him medical attention even though his blood sugar was so high it did not record and was very high until they did get medical attentionwhen his temperature became raised. On Diagnosis of this infection in his perma cath
he was sent to the Regional Dialysis unit. He was in Hospital for a further three weeks.
On return to the Care Home- from his notes which I acquired due to there having to be an inquest into his death they showed that he had been unwell most of the week once again showing the obvious signs of hyperglycaemia- drinking lots of fluid- which normally is OK but he was on fluid restriction of 500mls due to renal failure- extra fluid increases blood pressure!! He vomited during the night of the 17th December and refused Food, medications and insulin at breakfast time on the 18th December. The staff said the had asked him if he wanted a Doctor and he said no he was tired and wanted to sleep-( no record in his notes of being asked if he wanted a doctor!!) by Lunchtime he was dead- Post mortem Blod sugar 65.5 mmols-- Ketoacidosis.
According to the care home manager the staff had training in Diabetis and knew how to recognise Hypoglycaemia and Hyperglycaemia. When Questioned at the inquest asm to what the protocol was for geting medical help- she could not answer.
Commision for Social Care Inspectorate reports for November 2005 showed four members of Staff waiting for training in diabetis and again April 2006 four staff were awaiting training in diabetis.
Unfortunatley the coroner could not Point a finger of blame at any person or Authority re his death.

Lessons to be learnt from this- Please if you have diabetis take good care of yourselves.
If you are admitted to hospital get the staff or your relatives to let your diabetic Consultant know= my son was to ill to even see to this and i have serious issues with the limited visits from the Diabetic Specialist Nurse= On one occasion she took him a new Blood sugar monitor and explained it to him- He was hyperglycaemic that day!!
I have been totally shocked by the standard of Care in ther hospital- the lack of Safe discharge and
the attitude of the Care home.
If anyone has had similar experiences- i would love to know- especially if they have any ideas as to how to get the goverment to accept that all Care homes have at least one member of staff per shift able to take blood sugars and to know when to obtain medical help.
 
hi there,
i am very sorry for your loss, i do find this disgusting and hope you can get some answers,take care
amanda
 
sugarless sue said:
Were the staff in this care home registered nurses?
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No they were not registered nurses- he was assesed by the hospital as not needing continuous health care. I had expressed my concerns about his memory to several people but no one took any notice. He was even issued bythe bed capacity manager with seven days notice to leave- He had been made homeless due to ill health and the consequent mortgage arrears.his flat would have been unsuitable anyway as there were stairs to negotiate

Staff even went to look at a room in a hostel for the homeless- which they told me was unsuitable as he would not be able to manage the Fire doors. It came out at the inquest that it was unsuitable because there were drug addicts residing there!!!
 
Which part of the country are you in Bigley? To be a Care Home there should be a registered nurse on duty or at least on call for the Home.If carers are giving out medication then they should be at least NVQ?SVQ Level 3 i.e trained in medication.This is a very sad situation indeed.
 
I am so sorry for your loss.
Don't get me started on care-homes though. I have a severely disabled brother, with cerebral palsy and epilepsy and he lives in a nursing home now. I was stunned recently when my brother had a new type of fit....in fact he had over 100 that evening and my husband and I had to fight to get a doctor even to come out to him. The manager of the nursing home actually tried to send me home and I told her I was going nowhere. She then leant over my brother, mid-fit, and said to him "Don't do that, Paul". I was astounded. My brother does not have epileptic fits " on purpose" and in fact when the ambulance arrived, the paramedics could not believe that the home had not sent for them sooner. We had a high-speed journey to A & E and I feared for my brother's life.
There are many caring staff in care-homes but there is also a lot of gross negligence, in my experience.
We have made a formal complaint about the dealing of my brother that night and I wish to God the 24-hour-care that my brother needs could be done by me or my family. That is not an option, as we are not nurses and he needs professional nursing.
"Care" homes are sadly not always caring homes.
 
Good for you,choc,throw the book at them,that is just astonishing!!Sounds like your brother was in status epilepticus,did they give him anything to try and stop the fits do you know?
 
Yes,Sue, at A & E, he was injected with diazepam and the fits stopped almost immediately. The paramedics were brilliant and I have yet to come across a bad paramedic.
Another member of the so-called "care" staff at the nursing home said my brother was coming out of each fit too quickly for them to be "proper" fits. I could have hit her. It never fails to amaze me the ignorance surrounding epilepsy. Just because my brother doesn't go unconscious, the care staff doubt his having epilepsy at all,yet the neurologist says the brain damage my brother has is so severe(caused at birth) and this causes him to have a whole range of epileptic fits.
When we found non-prescribed tablets on the floor and down the side of my brother's chair the Christmas before last we were fobbed off with ignorance over the administration of them to my brother. The fact it made him have severe hallucinations and made him weepy, temporarily incontinent and delusional had my family close to breaking point with worry over his well-being, yet the staff could shed no light on this. We are convinced he was being "given" something that he should not have(one carer said sometimes they give drugs to residents to "keep them quiet" but that was then denied when challenged by us).
Sorry to rant but this subject makes me very emotional. This is the third care-home we've tried and this latest one was our last hope. Finding placement for someone with epilepsy AND cerebral palsy is SO difficult. I can't tell you the times my mum and I have wept over the whole situation. All we want is for my brother to be happy and cared for with the same dignity and respect as an able-bodied person.
I sometimes think prisoners and illegal-immigrants are treated better than our severely disabled people in this country.
Moan over.
 
sugarless sue said:
Which part of the country are you in Bigley? To be a Care Home there should be a registered nurse on duty or at least on call for the Home.If carers are giving out medication then they should be at least NVQ?SVQ Level 3 i.e trained in medication.This is a very sad situation indeed.
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The Care home is in Northamptonshire- It is classed as a rehabilitation home- it does take service users with learning disabilities. You would have thought that after one episode of hyperglycaemia that they would have been aware that it could happen again.
From his notes from the dialysis unit on his return from the Regional dialysis unit there was no insulin available for him- He had had to return to the regional dialysis unit on the day of discharge because his potassium levels were high- that meant he had journeys amounting to 120mls that day!
he was obviousley tired and confused when he returned to the Care home. I also found out that his perma cath tip had grown e coli- results sent to the ward on the day of his discharge. when i enquired who was informed I was told it wasn,t necessary as he had not shown any signs & symptoms of infection before discharge.
I have Concerns re his treatment whilst in the local hospital- but have ben told by the CSCI that the care home accepted him and it was their responsibility.
When the Hospital first asked this Care home to take him they said no- because it was to expensive
yet they accepted him when they found out his flat was being sold and he would be self paying!!

I COULD WRITE A BOOK ABOUT HIS CARE- OR SHOULD i SAY LACK OF CARE
 
I COULD WRITE A BOOK ABOUT HIS CARE- OR SHOULD i SAY LACK OF CARE
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Well you should! It's about time these so called care homes were exposed.I am totally shocked by your story and Chocs,these are more like 'don't care homes' than care homes.I thought the regulations had been tightened up ,they have up here anyway.I am so sorry for the loss and pain you have been put through.
 
hya,
it is disgusting,a while ago my mum got a care assistant job in a local home ,on her first night with no training she was told she would need to do medications and would be alone most of the night, my mum was horrified as she didnt know much about meds and ended up in tears as she couldnt accept the responsibility,needless to say she didnt stay and did report them,it is so frightening that this happens anywhere and there certainly needs to be big changes made
take care
amanda
 
I can't believe the regulations are so different between countries.Here carers are not allowed to give medication unless they have had training.SVQ level 3 at least.It must have been very upsetting for your mum,poor thing!
 
sugarless sue said:
I COULD WRITE A BOOK ABOUT HIS CARE- OR SHOULD i SAY LACK OF CARE
Click to expand...

Well you should! It's about time these so called care homes were exposed.I am totally shocked by your story and Chocs,these are more like 'don't care homes' than care homes.I thought the regulations had been tightened up ,they have up here anyway.I am so sorry for the loss and pain you have been put through.
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.

I am still trying to get answers after the inquest- There legal representative says I cannot take it to the second stage as to much time has elapsed from my first complaint which was done May 2006. This was done informally as i still was in the process of aquiring my sons notes- Originally I was told that the inquest would deal with any issues I had about his care- this turned out to be untrue.
The first complaint just covered my general concerns as i did not want anyone else to go through what I had.The Complaints Manager had no knowledge of Staff training - he thought they just had Health and safety and fire regulation training.this turned out to be untrue when i asked further questions of the Care home manager.
Inquests are useless in cases like this.
Supposedly i was informed of the results of this first meeting two days after it- unfortunatley i did not receive a copy of his response until late December 2007- two years after my sons death.
I have pointed out that i didn,t get a copy of the investigation into my first complaint and have never had any information as to the time limits for bringing complaint- the response i got was that the legal representative was awaiting instructions- that was a month ago!!
I shall be emailing him tonight as to why I have not heard from him.
I am also going to speak to my MP as regards my sons lack of safe discharge from hospital and the lack of proper protocol within the care home.
I urge others who experience problems to follow the complaints proceedure right through to stage 3 if necessary. I know that this is time consuming- but hopefully will lead to better care for our loved ones.
I am doing this in spite of me having my own health problems due to ageing- degenerative spine,
prolapsed discs and possibly knee replacements in the near future
 
I just wondered if anyone knew of any articles about how diabetis- Hypoglycaemia & Hyperglycaemia
can affect memory. I have tried to point out that asking someone if they require a doctor when like this is pointless.
I will tell you of another incidentwhilst he was in hospital just a fortnight after his amputation.
Whilst I and some friends of my sons were visiting his renal consultant arrived at his bedside
" A if you don,t behave yourself you won,t be going home you will be going up there- pointing to heaven and all those can go- pointing to bottles of squash on his locker. A,s friends andI could tell all was not well with him. On acquiring his notes I found that my sons blood sugar was 1.8mmols.
I inntroduced myself to this consultant but he gave me no explanation as to why he spoke to my son in that manner.I was just coming to terms with this deterioration in my sons health
I questioned him at the inquest about whether a diabetic who was severley hypoglycaemic would remember the instructions. He said yes they ensured that they absorbed the info by getting them to repeat it parrot fashion!! the only instructions written in my sons notes re this visit was that his fluids were to be restricted to 500mls daily- no mention that staff should ensure that visitors only took in certain fluids.
My son was repeatedly recorded in his notes as being non compliant with Medications etc. as he was down as an unstable diabetic is there any wonder. He was left to order correct meals etc even when hypo or hyper.
I have lost faith in the NHS even though I was a trained nurse and did Neonatal special and intensive care for twenty plus years.
The whole experience has certainly been an eye opener
 
I am so saddened to read of your son's treatment, Bigley. It really is disgusting. My brother was told if he didn't stop having fits he wouldn't be allowed to come home for a family celebration tea planned.How cruel is that?
My faith in the NHS is pretty knocked too. I can't recommend any articles that you require but I hope someone else can help you there.Although I don't know you personally I wish I could give you a supportive hug.
 
Think that doctor needs to go back to medical school!

Symptoms of hypo:
If a person does not or cannot respond by eating something to raise blood glucose, the levels of glucose continue to drop. Somewhere in the 45 mg/dl range, most patients progress to neuro-glyco-penic ranges (the brain is not getting enough glucose). At this point, symptoms progress to confusion, drowsiness, changes in behavior, coma and seizure.

Hyper:
Left untreated, hyperglycaemia may result in diabetic ketoacidosis. Diabetic ketoacidosis is a serious condition due to a lack of insulin. This causes the body to try to find energy from other sources as it cannot use the glucose in the blood. Ketones and acid form as a result. The condition is characterised by vomiting, drowsiness, smell of acetone (like pear drops) on the breath and can result in coma.

This article is about human insulin,don't know if he was on that but makes interesting reading re memory loss.
http://www.epolitix.com/EN/Forums/Insul ... 084E87.htm

To put another point however,the Human Rights Act(please don't flame me!!but groan if you want!!)
is a big issue in caregiving at the moment.Any consenting adult that is noncomplient with their medication or treatment comes under this and it is their right to refuse even if it makes them worse,that is their choice!!
 
chocoholic said:
I am so saddened to read of your son's treatment, Bigley. It really is disgusting. My brother was told if he didn't stop having fits he wouldn't be allowed to come home for a family celebration tea planned.How cruel is that?
My faith in the NHS is pretty knocked too. I can't recommend any articles that you require but I hope someone else can help you there.Although I don't know you personally I wish I could give you a supportive hug.
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Thank you for your support- what gets me is that there is Obvious negligence and they just stand shoulder to shoulder and deny any responsibility.
There is no redress.
My last lot of complaints letters to the local hospital has gone AWOL noI expect they think that the longer they are at answering , the more likely that you will give up.
I even took his notes for his Diabetic Cosultant to read- he just said he couldn,t see what else the staff could have done!!this from someone who saishould be concerned about poor quality of care!!
 
When my mother-in-law was in a care home, my wife Ann would take her out in the wheel chair. NHS wheel chairs are not designed to be wheeled with a patient, as there is a strong tendency to slump or slide forward, so their feet drag on the ground.

When Ann requested a strap, she was told it contravened human rights to strap them in ... It resulted in a nasty scrape from the ground, & a bleeding foot.

Surely its NOTHING to do with human rights, but simple common sense.

A redesign of wheel chairs is long overdue.
 
IanD said:
When my mother-in-law was in a care home, my wife Ann would take her out in the wheel chair. NHS wheel chairs are not designed to be wheeled with a patient, as there is a strong tendency to slump or slide forward, so their feet drag on the ground.

When Ann requested a strap, she was told it contravened human rights to strap them in ... It resulted in a nasty scrape from the ground, & a bleeding foot.

Surely its NOTHING to do with human rights, but simple common sense.

A redesign of wheel chairs is long overdue.
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All the wheelchairs should have foot rests to stop feet touching the ground and it is only contravening the Human rights(restraint) if you use a strap when the wheelchair is NOT moving,if the patient is at risk in moving wheelchair and it has been documented as such then using a strap as a safety precaution is allowed.I was horrified at how the nurses placed people in wheelchairs with the foot rests still forward,the potential for injuring legs is massive!
 
sugarless sue said:
All the wheelchairs should have foot rests to stop feet touching the ground and it is only contravening the Human rights(restraint) if you use a strap when the wheelchair is NOT moving,if the patient is at risk in moving wheelchair and it has been documented as such then using a strap as a safety precaution is allowed.I was horrified at how the nurses placed people in wheelchairs with the foot rests still forward,the potential for injuring legs is massive!
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The foot rests aren't much use when the patient slips forward. The pusher can't see the feet, & they can scrape on the ground. The legs need supporting, & the back needs to recline to maintain a balance & allow an elderly pusher to manage.
 
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