May 22, 2011

AUSTRALIA: Why old souls are abandoned

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SYDNEY, NSW / The Sydney Morning Herald / National / May 22, 2011

By Eamonn Duff

Elderly patients left at hospital doorsteps are putting a strain on emergency staff, writes Eamonn Duff.

Elderly people are being dumped at hospital emergency departments by relatives - some heading off on holidays, others unable to cope with the pressure of being full-time carers.

Emergency staff are increasingly concerned and frustrated by the added burden of frail aged patients who arrive at their doorstep at Christmas, Easter and long weekends.

St Vincent's, Royal North Shore, Concord and Nepean are among hospitals under additional strain of so-called ''granny dumpers''.

One employee at St Vincent's emergency department said: ''You should hear some of the excuses. When all's said and done, it's no different to dropping your dog off at a boarding kennel.''

Maria Tosti, who is suffering from dementia, with her son Andrew... he has never left her on a hospital's doorstep but says he understands the pressure of care that drives others to do so. Photo: Danielle Smith

Others are more sympathetic, pointing to a massive shortfall in respite care facilities, adding primary carers are often so desperate for breathing space, hospitals end up being their only option.

Concord Hospital emergency department director Richard Paoloni said: ''It's a very real issue which the community would be largely unaware of - and it needs addressing now because these problems are going to be exacerbated in the next 10 years due to an enormous increase in our elderly population.''

Dr Paoloni, NSW faculty chairman of the Australasian College for Emergency Medicine, added: ''I've seen these episodes at my own hospital. People bring elderly relatives into emergency, disappear off and then make themselves uncontactable. This impacts on the hospital because that elderly person has to stay in an acute bed until their family returns, which can be many days. That's a vital bed being used by someone who isn't unwell and who should really be in a nursing home environment.''

The Elder Abuse Prevention Association called for an inquiry into so-called granny dumping, describing it as ''a common phenomenon nationally''. Association spokeswoman Lillian Jeter said: ''Spare a thought for the poor old soul abandoned in such a way. Can you even begin to imagine how that might feel?''

She added: ''There are proper facilities out there but, sadly, some folk are too concerned about heading to the Gold Coast and a dementia sufferer or wheelchair-bound relative is not the accessory many want at the beach. They know a hospital would never turn away old people and they exploit that.''

The term ''granny dumping'' was coined in the US during the mid-1990s. While no detailed research has been conducted here, the Australasian College of Emergency Medicine's Dr David Eddey estimated in 2009 that 76 elderly people were being dumped outside Victoria's 38 public emergency wards each year.

Nick Brennan, St Vincent's Hospital's director of geriatric services, said: ''We could certainly tell some terrible stories about people who have clearly used the hospital system and emergency services to sort out their unwanted problem.''

He recalled the case of a family sending a relative suffering dementia packing on an interstate train that ended up at Sydney's Central Station.

''I think they had simply run out of options. The bottom line is, families know these people eventually end up in public spaces, wander around, become confused, then get picked up. Next port of call is the emergency department.''

But Dr Brennan stressed: ''Nearly always, it's never as black and white as that. Being a carer of the frail and aged is one of the hardest, most stressful, isolating, emotionally challenging things you can ever do in life, but people will keep on going if they are able to get a bit of a break. A week or two to recharge your batteries and off you go again. Trouble is, those co-ordinated respite facilities that enable carers to take that break have virtually all gone. So when they book a holiday, they must hope like hell that when the time comes, they'll be able to find somewhere.''

He added: ''The few respite care services that do exist get pre-booked very quickly. Once they're gone, this issue arises. People front up to emergency departments and say here's my mother-in-law.''

The Northern Sydney Local Health Network, which takes in Royal North Shore Hospital, argued it was ''misleading and emotive'' to describe the practice as granny dumping.

''There is anecdotal evidence that some families, finding it difficult to cope or unable to access other health services over weekends or holiday periods, bring their elderly relatives to emergency departments,'' a spokeswoman said. ''Hospitals and emergency departments are here to help but, obviously, they are not appropriate or healthy environments for elderly people who are not sick or injured. We ask families to consider this.''

An Australian Bureau of Statistics 2009 survey found there were more than 2.6 million carers nationally who provided unpaid support to family members with a disability, mental illness, chronic condition, terminal illness or who were old and frail. More than 770,000 of those were primary carers.

On average carers spent about 40 hours a week providing support. With mental illness, the average increased to 104 hours a week.

Dr Brennan said: ''I view it this way: for the majority of carers, a sudden lack of available care for an elderly patient is an emergency. But I also accept that I see a very different side to life than most emergency department staff. Their role is to fix trauma, broken bones and heart attacks. They're terrific professionals, worked off their feet. When you've got a little, old demented lady sitting there because her carers have disappeared off on holiday, you have to accept that's very likely to get their backs up.''

Carers Australia president Tim Moore said: ''There is a shortage of facilities and some of the respite models that do exist are not flexible enough to provide a right here-right now service.

''Last year we visited carers in metropolitan and rural areas right across the country. As incredibly anxious and guilt-ridden as they might feel, they told us hospitals were sometimes their only choice.''

eduff@sunherald.com.au

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