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persons recovering from an acute illness or operation can be admitted
to a convalescent home, so shortening the average length of stay of
patients in hospitals and so leading to a greater turnover of hospital beds.
Many were admitted to hospital not because it would be only in a hospital
that such a person could obtain the necessary medical or nursing attention!
but because that patient could not in his own home receive the
attention he needed. In these days it is less likely than previously to
be because he cannot receive the services of a doctor or of a nurse, but
might well be because of the unsatisfactoriness of the home conditions.
The extent to which hospitals can be relieved of demands on their beds,
occasioned by difficulties which would follow from the patient being
nursed at home, depends partly on the efficiency of some of the Part III
services provided by the County Council. Unfortunately, in this district
it is proving impossible to recruit up to full establishment Home Nurses
or Home Helps. Even were the recognised numbers of these staffs
engaged, there would still be difficulties arising from the fact that the
patient needs attention at times the Home Nurse is not available, while
many of those at home need the help of someone less skilled than a
nurse but help which would be outside the range of activities of a Home
Help. There is room for an extension of these services which can be
provided in the sufferer's home which would avoid the necessity of
admission of the patient to hospital where, if admitted, he would be
occupying a bed which would then not be available for the admission
of those suffering from acute conditions needing only short-term attention.
The chronic patient occupying a bed for twelve months might, by blocking
that bed, have caused difficulties in the reception at hospital of twenty
other persons, persons too who could be helped only by the services
available in hospital as contrasted with the needs of the one
chronic patient whose needs so often could be met by help elsewhere
than in a general hospital. It is this question of the chronic patient,
especially the chronic elderly patient, which is causing such concern to
the hospital administrator. They cannot be admitted to hospital on
such a scale as would result in the virtual withdrawal of the general
hospital's facilities for those in the district suffering from acute conditions.
On the other hand, they all cannot be ruled out of consideration, partly
because ultimately many will progress to reach the stage that they
should not be nursed at home, partly because of the severity of the
burden imposed on those running the home in which they are. It might
be that a working arrangement will be the allocation of a number of beds
for the short-term admission of this type of sufferer which would both
enable the condition of the patient to be improved and also give the
attendants at home a much-needed rest. If, as seems to be inevitable,
many of these persons have to spend their days at home, there is much
room for voluntary effort, especially as " sitters-in," to free for some time
those running the home. But in many households because those at home
cannot attend to the patient either because of their own infirmity, or
because they have to leave home to earn their living, it would seem that it
will be necessary to recruit someone, a paid worker, not a volunteer who
is less trained than the nurse, who could be a " sitter-in " and who could
attend to the needs of the patient. Until someone of this sort can be