"A+E Care for older people with dementia"

My father, who is over the age of 80 and is affected by Dementia suffered a violent episode at his home which left my 80 year old mother in fear of her life and so she called 999. The police and ambulance attended and when I arrived myself and an 18 stone police officer had to drag him bodily to the ambulance, all the time he was abusive and violent. He attended Queen’s Hospital A&E. This was the third time that mum has had to call 999 in the last year. I arrived shortly after the ambulance he had been taken to ‘Majors’ he was still very aggressive and had just been given a sedative injection. I was told by the person in charge of that area that if this did not work by 22: 00 hours he will give him some more. I was then left alone to make sure he did not get off the trolley he was still screaming and shaking the bars on the trolley, violently threatening to kill me and everyone else around because he thought in his delusional state that everyone wanted to kill him. A porter wheeled him off to a cubicle, however during this short trip he had managed to get off the trolley so I had to then keep him within the cubicle but no one had been back to give him an extra sedative as promised. I was left in charge of keeping him within the cubicle as in his paranoid delusional state he surely would have harmed either himself or others. Even at 83 he is strong and very physically fit. After an hour or so a nurse appeared and tried to take his blood pressure and temp etc but he would not allow them to and he was becoming more agitated and aggressive so they left. Again I was left in charge to make sure he and others were safe. About an hour later a doctor tried also to get his blood test /pressure etc again he was aggressive and resisted, they openly admitted they did not know what to do because they could not admit him if they could not tell what was wrong with him! Really, I am not a doctor but it was plain to see he had mental health problems, even if they could not find a physical cause. I asked that they call the on call psychiatrist or mental health team but no response from them. The doctor said they would refer him to their medical team and left, no explanation, no offer of help, no timescales. Again I was left alone to keep my father and others safe. In the small hours I asked a male nurse what was happening and he said, “he had been referred to the medical team and it was just a waiting game.“ Again, I said that they should call the on duty psychiatrist/mental health team. He said he would see what they could do. My reply was they could section him so that they could then get the tests that they need and a full mental health evaluation and also that he was a danger to himself and others. Another doctor came to see him and this time the nurse was more forceful but polite and managed to take his blood pressure, oxygen and temperature. The doctor again took a short history and I again showed him the tablets that dad is on he also conducted a quick memory test prime ministers, kings/queens date of birth etc none of which dad could answer and indeed dismissed the questions quite aggressively. The nurse was worried that dads temp was down to 34. 5 and asked him to get on the trolley bed and use a blanket. He refused and she was very worried and said he needed admitting so that he can be in a bed and warm up. They left and again I was left in charge of his care, he finally napped in the chair so I covered him up with a blanket, when he woke up about an hour later he threw the blanket off. By the morning no one had come to see us and no one had rechecked his temperature. The concern over his temperature seemed to evaporate the minute they booked a bed but as no bed available nothing changed. I left the hospital some 10 hours after I arrived the night before. Before I left I spoke to the nurses at the desk and asked if they wanted my father’s medications they said no as they had all his needs on a chart and would do the rounds in due course that am. In the afternoon they called my mother asking what medication he should be having and he was still in a cubicle not on a ward some 18 hours after admission. At least 3 medical staff had taken note of his meds and I had offered them to the team so why did they not know and, more worrying, obviously had not given him any that he should have had. On the Monday the hospital called my mother to explain he was in the MAU and would remain in hospital for a couple of days as a social service visit had been organised to sort out long term care/needs etc. Later that Monday afternoon someone called from the MAU to my mother to tell her that dad was being discharged in an ambulance to her home with antibiotics for a Urinary infection. Can you just imagine the fear and panic suffered by my mum who is 80 as he had previously threatened to kill her and all the neighbours and police had said she had been lucky to escape the house and may not be so lucky again. I called and spoke to the sister who categorically stated that no discharge plan was in place for dad and that nothing will happen till after the social services assessment. I again asked if any mental health assessment will be done she said yes it is on his chart and again no discharge plan will be made until that is also carried out. How can someone from the MAU make this decision and scare my mother? They had not done a risk assessment, a mental health assessment. I understand hospitals are under pressure to discharge patients especially the elderly but had this happened with the worst possible consequences that person could be responsible for the death or serious injury of my mother. Also if I had not attended when he was admitted at least one but probably two members of staff would have been tied up by caring for him etc It seemed to me that it was assumed that because I was there they did not have to bother with their duty of care. He was finally admitted to a ward but due to the failure of the doctor on that ward to get a mental capacity test done by the mental health team and also the slow reaction of social services he stayed on ward for two weeks whilst we tried to get him into residential care he then had a fall in the middle of the night and had broken his hip. We made a complaint but heard very little and will be writing to the chief exec next.