NHS’s ‘Virtual Wards at Home’ keeps older people out of hospital but doesn’t meet need for long term care

Many older people manage quite well until a health crisis takes them into hospital. Now the NHS is rolling out ‘Virtual Wards’ where hospital services are given in the person’s home or even in their residential care home, to keep them out of Hospital. The Virtual Qards started with a small pilot Project in 2009 and now the concept is gradually being introduced into different parts of the country. They are intended to address the acute need only and will not replace the need for long-term care and support, either in the person’s home or in a care home. But there still remains a good deal of uncertainty and confusion about ’navigating the system’ from hospital or Virtual Ward to care either at home or in residential care.

A Virtual Ward at home would have suited my elderly relative a few years ago, when a health crisis took her into a local Hospital. Jean (name changed) had lived independently for years she became frail in her late 80s. She found it difficult to walk and had symptoms of Parkinson’s disease. Her daughter contacted Social Services who put in place domiciliary care, as well as making some modifications to her house, such as grab rails in doorways. It worked well until late one evening when she ‘froze’ in place and literally couldn’t put a foot forward, standing on the spot and hanging on desperately to two chair backs. She pressed her pendant and paramedics raced to her home, then had to call me to bring the front door key. She was taken to A&E by ambulance, I followed by car, and we spent the night in a curtained cubicle, her on a hospital bed and me on a hard chair. When she was seen by a doctor at 6.30am she was admitted to the medical assessment ward and over the following weeks a series of investigations revealed she was suffering from degeneration of the cerebellum. Although she was grateful for the care she received in the hospital, Jean didn’t like being there, mainly because of the lack of privacy. She was especially disturbed to be woken at night by someone with dementia standing over her bed and staring at her.

Then followed a meeting with her consultant who said it was clear that she couldn’t go back to her own home, even with a care package because she simply couldn’t manage, and he recommended a move into residential care. ‘You might even find that she seems to improve there,’ he told us, ‘She will have the company of others, and carers on hand to help.’

The Ward Sister told us that hospital’s Social Care Liaison manager would talk to us before arranging for a Local Authority Social Worker to meet us and discuss options and finances. It was weeks before we met the Hospital’s Social Care Liaison, and then even more weeks before the LA’s Social Worker was free to come and make her ‘needs assessment.’ The meeting included Jean, and I felt sad that she had to sell the house that had been home for 60 years. But she was a Christian believer who knew her ultimate destination. In the care home we eventually found she led three people to Christ.

From experience with Jean and conversations with others I’d recommend staying close to the hospital team as well as to your relative. Apart from anything else, they need your thanks and encouragement! And you need to be informed at all times so that nothing takes you by surprise and all your decisions are well informed, especially when it comes to arranging for care.

In contrast, in our care homes we have many people who have decided for themselves that it was what they needed. When she was diagnosed with early stage dementia Betty knew that she wanted to relocate to be nearer her son, but that she also needed to settle into a good care home. She’d had experience of her mother living in a care home so knew what to look for. She moved into our home in Wantage and is so contented there that when her son takes her out for visits to his home and family she will stay only for an hour, saying that she needs to get back for tea. She loves being involved in all the home’s activities. Another resident told me that as a child she had been part of the big family, had raised a big family herself, and finding her health declining chose one of our homes to come and live in. For navigating the Social Care System Age UK has a very good website and you can find information about our care homes here.