The Rehab hospital that pretty much isn’t.


I will preface this by saying that this is our experience of the bay that my mother was in between the 16th December to the 5th January 2016. I have fished on Facebook for other peoples’ experiences and so far no-one has a bad word to say about the place. It seems to me that people who had specific problems like knee injuries are treated. Mum’s problems are global and they do not have the right approach to help people like her. She would have deteriorated and ended up in a nursing home, rather than back in her own home if it hadn’t been for my intervention and her own determination. 

 
“Well, welcome to our ward! We were expecting you yesterday, but you didn’t arrive! Did you get lost?”
Patient transport just hadn’t turned up at Kingston Hospital yesterday to transfer Mum to Tolworth rehabilitation unit, and so altogether Mum had spent 13 days in a hospital bed, and the chair next to it, with no diagnosis apart from that she needed rehabilitation. A previous X-ray some months ago had revealed a ‘probable’ crush fracture in the pelvis, but this time her X-rays were clear. No fracture.
There did not seem to be any reason to me why Mum should not be rehabilitated back to the state that she was in before her admittance, that is, able to live on her own, with her dog, with a lot of support from me and from a carer for a few hours a week. Mum could shower herself, dress herself, got to the loo, make a cup of tea, warm up a microwave meal, and let the dog in and out several times a day. She had an Age UK alarm which she could press if she fell, which sometimes happened. She is not depressed, has a nice home, a loving family and plenty of visitors, grandchildren and great children. She does quite a bit of exercise at home: she has hand weights, leg weights, a Pilates ring, stretch bands and pedals. She has a life very worth living.
I had heard good things about Tolworth Hospital, and had great expectations that she would get a thorough assessment, and a programme of physiotherapy which would help her get back home, maybe better than before. Mum has plans to get off the zimmer.
This is Tolworth Hospital’s entry in the NHS yourhealthcare.org

The Cedars Unit at Tolworth Hospital has 35 beds, providing nurse/therapy-led rehabilitation for adult patients in Kingston.
Patients are either admitted from home or from a local acute hospital, (such as Kingston Hospital) and include patients requiring stroke rehabilitation and those who require short term care such as intravenous fluids or medication, blood transfusion.
Patients are admitted who require rehabilitation, with an individual programme of care to enable them to fulfil their rehabilitation potential and independence. This includes the physical
, psychological and social aspects of rehabilitation with the ultimate aim of each patient returning to their own home.



Sounds good. At a council meeting a few months earlier I had heard a local doctor speak about the council’s plans to rehabilitate people like my mum. He made physiotherapy and rehabilitation for the elderly sound like a priority. At the time this was part of the alternative plan to the accommodation provided by Hobkirk House, a rehabilitation home which the council were closing because at 40, it was deemed too old.
The ward sister who took Mum’s history from me told me she was not normally on the ward, and gave me some advice. “You must make sure you speak up for your Mum.”.
Hmmm.
My heart had already sunk a little as I recognised one of the physiotherapists as being the community physio who visited mum at home at my request three times back in the summer. I thought a physiotherapist could help with mum’s back-ache, give her advice on exercises, and maybe work out what was going on with Mum’s gait, which was awkward and twisted. Her balance was poor.
I thought I knew what physiotherapists were. I thought they gave exercises, manual therapy, ultrasound treatment, massage. Here’s what it says in the Chartered Physiotherapists web-site.

Physiotherapy helps restore movement and function when someone is affected by injury, illness or disability.
Physiotherapists help people affected by injury, illness or disability through movement and exercise, manual therapy, education and advice. 
They maintain health for people of all ages, helping patients to manage pain and prevent disease.
The profession helps to encourage development and facilitate recovery, enabling people to stay in work while helping them to remain independent for as long as possible.

 
This physio had been very lacking in understanding when I phoned to postpone a visit, once because Mum wasn’t well, and the other time because she had had a recent fall and was shaken up. “Well you are being very unreliable. You’ve got one last chance. You are stopping me from seeing other elderly people who need my help.”. She came again, said she could do no more for Mum, and if I needed her again, to call…….She did give mum some exercises to do, and refused to change Mum’s zimmer frame. I had been convinced that the frame she had was too low and was giving her back ache. It was only when I phoned up some months later to say that mum’s osteopath said the frame was too low, that I was allowed to drive in to Tolworth hospital and choose a taller one from their racks of hundreds of zimmer frames. Mum’s back ache diminished as a result, in spite of, not because of, this particular physiotherapist.
But while the ward sister was taking Mum’s history from me, Mum was already involved in a chair based physio game where the patients were saying their name and doing some exercise. Wonderful, I thought. Some social and physical activity, just what mum needs.
That was the only time in nearly three weeks that she was there that this took place.
I thought it would be a couple of days before a proper assessment was made and a programme of exercise tailored for Mum was put into practice, so I was not surprised when not a lot happened for a few days. I was worried and had slightly lower expectations as it was coming up to Xmas. I had little hope of her getting out in time for Xmas.
At this stage Mum had gained weight in Kingston hospital, and could not stand up without considerable pain. She had had a catheter since the second day in Kingston Hospital, and consequently had little need to move. So she didn’t.
The wards are long, three bays being about 8 to 10 feet wide each. There is a tv at the end by the window. Mum was at the end by the nurses desk, and she couldn’t see the telly at all.

There was often a wait for the loo as there didn’t seem to be enough toilets, or showers for that matter. In those circumstances a urine catheter is a good idea.
But the wards are clean, and the food is very good. The nurses are nice.
Mum complained of not being able to sleep.
“It’s not noisy here Mum is it?”
it all seemed pretty quiet to me.
One evening I came in at about 7pm. A very nice young woman was dispensing hot drinks. She smiled at Mum. “Coffee, white, no sugar!”
“Yes.”, said Mum. “You know me now!”

“Mum, what are you doing drinking coffee at this time of night? No wonder you can’t sleep!”

“Well, they come round and give it to me!”

“Why are you giving people coffee in the evening? Do you drink coffee in the evening?”, I ask the pleasant young woman, who has stopped smiling and whose eyebrows are now knitting a bemused pattern across her forehead.

“No, I never drink coffee in the evening. I wouldn’t sleep…”

“So why?….??”

“Because this is my job.”.

“Well please don’t give this lady coffee at this time any more. I am sorry, but I do think it’s a silly thing to do.”

“Ok. Sorry.”

She went to give coffee to other people’s mums.

“What did you say that to her for. She was nice!”, said Mum.

“Well she is stopping you from sleeping.”

“Huh.”
She was waited on hand and foot of course: the staff were lovely and very solicitous that she should not fall. The hospital was like a little safe cocoon.
 
They have a wonderful contraption on the ward in Tolworth which helps the nurses push the patients from their beds to the toilet and back in great style. She found this quite amusing.
   

 They have a little gym in the unit. Mum was taken there once during her stay.
I visited every day. There was no physiotherapist around at the weekend, which was what I expected, but in the week, there were one or two on the ward, watching people walk along using their zimmer frames. Mum was still not up on her feet by her second week.
Every weekday I had asked the same question. “What physio did you get today Mum?”
And I got the same answer, from her, “Nothing. The physio came and tapped me on the shoulder and asked me to stand up, and when I stood up I was in pain, and he told me to sit down, and then he left me. That was it.”
I encouraged mum to stand up and sit down as much whenever she could, holding on to the hospital trolley for balance. Sometimes she was in more pain than at other times and could not do it.
By that second week I could see what was going on, which was nothing. Nothing like what the Chartered Physiotherapist website led me to expect. I was getting quite upset, and very worried for Mum’s future.
Muscles atrophy with rest. Circulation deteriorates. Mum’s ankles were puffing up, so they gave her more bed rest so that she could keep her feet up more, so that fluid would stop pooling in her ankles. She still had the catheter, even though I had asked at arrival whether this could be removed. I was told that Mum’s problems were far too serious to warrant the removal of the catheter. I insisted that they try, as Mum’s bladder although a bit unreliable, generally works ok. She is prone to retention at times, but after a while she can piss like a horse.
The lady in the middle bay opposite beckoned me over.
“What sort of a place is this?”she asked. “Do you know?”. At first I thought she was suffering from dementia, and didn’t know where she was, but this proved far from the case. She was very dissatisfied with her treatment, and she was arranging for her family to take her home and get her a private physiotherapist.
“You know dear, without help at our age, our bodies will just decline! I can’t just sit here and hope to get better! I have to get out of here. Or slowly but surely, I will die. I have been here for three weeks. Fortunately I have the money to pay for private care. Thank God.”
I was then summoned by the gentleman visitor to the bed opposite Mum’s.
“Do you know what’s going on here?”, he asked. A sadder story emerged. His partner had already been in Hospital for five weeks, having been taken into casualty after collapsing suddenly. There now seemed to be nothing wrong with her except a gradual physical deterioration. “Is she getting any physiotherapy here?” I asked, “No.” he said.
“They” were saying that she was going to be put into a nursing home at £5,000 a month, which amount would be drawn against their home. He could live in it till he died, but then the money would go to the state. Five weeks before, the couple were managing for themselves.
During the time Mum was there I saw that lady decline from being able to sit up to spending her days lying in bed. Mum was worried about her, but couldn’t talk to her because the wards were so wide.
“What is this, some sort of holding place for elderly people?”, he asked me.
“It’s supposed to be for rehabilitation.”, I said.
“Well there’s not much of that going on. And they won’t let me take her home. We are trapped here.I ‘ve been told she is safe here, but what’s the point of being safe if you are so miserable? This isn’t life, it’s existence. Jane can’t see the television, can’t talk to anyone. It’s awful.”
At the end of the ward, near the telly, there were two ladies who were in bed all day.
The lady right next to Mum was pretty self-sufficient, and pottered around, spending much of her time in the day room.
I said I wanted to see the Sister. “I am very worried about my Mum. The more she does nothing the more her body will get used to doing nothing and she will just deteriorate. I thought there was supposed to be some rehabilitation, some physiotherapy going on here! Look at all these people, just lying here, without any intervention!”
I was upset and hustled in to the sister’s office.
The sister said that Mum’s safety was paramount. That because she said she was in pain, the physiotherapist would not get her up and moving. Supposing she did get up and fell? Then that would put the safety of the staff at risk.
“But is that all you do here? Just watch people walk? What do you consider rehabilitation? I would have thought you could do something with my mum. Get her legs stronger, get her body ready to move again. The longer she just sits there, the less likely she is ever going to be able to walk again! She wants to be back in her own home, not spending the rest of her life being lifted about! You are supposed to be helping her to get back to how she was before, not supervising her decline. And no-one, not here or at Kingston Hospital has ever told us what is wrong with her!……….It it was you or me who arrived at A and E not able to weight bear, you would hope someone might be interested to find out why! “.
“Hmmm, said the Sister, and we discussed Mum’s case a bit more. The effects of over medication, the falls, the vertigo, the falls, the pain, no fracture….
“Well, she has Sacral Insufficiency then. She won’t ever get much better.”
“OH”.
I just have to pretty much ignore this news.
The head physio arrived. He listened to me too. “I see, well we could get some chair based exercises for your mum sorted out. I will get X to come by and give her something to do. She’s not on at the moment, she will come round tomorrow.”
“Please do! If she can’t stand she should still be having some form of rehabilitation to help her. She has arms and she has a spine she can use, which should be exercised. She should not just be sitting doing nothing. You must be able to do something for her.”. Tomorrow was the only afternoon I wasn’t visiting.
X never came. She was the physio who had been round the house. I didn’t expect much and she didn’t even meet my expectations.
But, I had spotted a few of these scattered around the ward.

    
 
Mum has a set at home, and uses them daily. “Could Mum not use a pair of those pedals?”, I asked the Head Physio.
Yes of course she could, no problem!
And so she was set up with a set of pedals that had been lying redundant so far as I could see, and she used them, and she stood up and sat down again for most of the day.
“For goodness sake Mum, if they come and ask you if you can stand up, don’t say you are in pain, or they will leave you to it. Just get up and get on with it.”.
Within a couple of days Mum was on her feet again, and the physios wheeled a wheelchair behind her as she walked up and down to the Xmas Tree at the end of the corridor. Arrangements were made for her discharge.
She could walk, so she was out. They also gave her a chance to go without the catheter, and there are no retention problems. The Sister, who was nice, said about Mum’s discharge plans, which were basically that I would move in with Mum for 6 weeks, that it was good to give her a chance of living in her own home.
I’ve just asked Mum about the staff. She said the nurses were very good, but how the physios got away with doing £@*k all, she didn’t know. They had a gym full of stuff that they didn’t use. And it was only because I looked out for her that she got the pedals, and mobilised herself out of there. Her opposite neighbour is still in there, desperate to leave.

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