Dad stuck on an acute ward for three weeks four days no physio please help

[MissTriggs]

Dad (80) had his first fall and broke his hip three weeks and four days ago. he got a hip replacement within a day but reacted badly to the anaesthetic and has had episodes of confusion/depression since then plus he got a urinary tract infection. He has a diagnosis of dementia and because of this staff seem to have low expectations of his prospects for mobility. His mental states are hugely variable - he veers from total withdrawal to chatting lucidly about recent events (he has no short term memory loss which is why I suspect his Alzheimers dx is wrong but till now that hasn't mattered as he and mum got access to support groups they enjoyed, etc). He was fully mobile before he tripped and the hip has healed well.

He is bed-blocking in an acute ward but from our point of view the problem is that he is getting no support to stand. He was walking easily before the trip. He has stood once or twice on a zimmer but this ward is not equipped to spend the necessary time to help him.

Two weeks ago it was decided he should go to rehab. One rehab facility turned him down. They are waiting for a place at another one.

My mum is obviously at breaking point, being frail herself.

She has money but it's like being stuck in an airport for three weeks - you don't leave because you keep thinking "oh, I'd better not walk out now because it's about to end..."

Any advice on what we as a family can do? He can't go home until he's stronger as can't yet walk to the loo and mum is too frail to meet all physical needs.

[ApologiesToInsectLife]

Did they say why he was turned down by the first rehab place? Is there any indication how long till he goes to another one?

[MissTriggs]

Just checked with mum.

It's worse than I thought.

Two community rehab centres have rejected dad because he has a buzzer under his bed to tell them if he falls and the rehab centres don't have these - they don't have beds with rails.

At the moment they are not offering any alternative and the OTs have stopped coming into to see him. He is off the OT list but on the rehab list but the rehab people won't take him. He is in limbo.

[MissTriggs]

Bumpx
:(

[GooseberryJam]

I would focus on getting him back on the OT list and getting better treatment on the ward. Make a nuisance of yourself with management. Say you want to complain and you want him back on the OT list immediately and until he actually goes to rehab. Then there will be more incentive for management to find him a suitable place as they'll want to not have you chivvying them about him all the time. Who on the ward or elsewhere have you spoken to about it all?

[Ginmakesitallok]

Not having bed rails shouldn't be an issue. Bed rails are a falls risk, folk are more likely to fall trying to climb over them. Has a case manager been appointed? Speak to them? The hospital will be wanting him out ASAP as well.

[MissTriggs]

We have only spoken to the nurses on the ward
Who should we ask to speak to about getting back on OT list?
Mum is there all the time

[MissTriggs]

Bump

[duckyneedsaclean]

Ask to speak to the a doctor or the consultant / ask when rounds are and say you want to be present.

Ask them what their plan is. Ask for him to be referred to physio, and for OT to see him again.

[MissTriggs]

Thanks
Mum was told that the medical drs werent really involved any more- but I guess in terms of responsibilities/ acountability it doesn't really work like that?
Appreciate your replies

[duckyneedsaclean]

If he's on an acute ward in hospital be will still be under a consultant & medical team. And they should still be reviewing him and have a plan for his care and how to discharge him - whether to a rehab facility or home.

[MissTriggs]

Thank you

My brother has managed to speak to the physic who says dad is still her patient and she is only able to see him twice a week. he is checking whether dad can be sen by the OT as well

Re the rehab rejection. It is something to do with the corridors being too long to make fall alarms useful therefore no fall alarm therefore they reject patients who need fall alarms:(

[duckyneedsaclean]

I'm guessing he's not in a major city? Only because then there would be more options of higher care rehab facilities.

Could you look into others in the area and request that the OT checks of he is suitable for him?

What is he using for toileting in the hospital? Can be use a commode by the side of the bed or is he using bed pans? If he's able to use a commode they be able to set him up in a 'micro environment' at home.

Sorry for all the questions.

[northender]

If you feel you aren't getting anywhere (as it sounds from your posts), go to PALS (Patient advice & Liaison service). There will be a team in the hospital. Concentrate on getting the message through about his mobility level up to the fall. The "rehab facilities" mentioned sound as if they might be provided by private companies who effectively can "cherry pick" by not having facilities for anything other than straightforward cases. Is there any hospital based rehab?
Above all, don't be fobbed off, but be prepared to have to fight for what your dad needs & deserves

Sorry for my slightly rambling post, hope it helps

[MissTriggs]

Thank you. He is in Poole in Dorset and the major local hospital is Bournemouth.
I wonder how I would find out if there is a higher care rehab facility in Bournemouth.
There is an elderly but quite prosperous population in the area so I know that somewhere near their house the right facility must exist

[Whatdoidohelp]

Does this have any new info you haven't come across?

m.dorsetforyou.com/media/192548/Care-and-Support-Directory-2015/pdf/Bournemouth-Poole-and-Dorset-2015_LR1.pdf

[MissTriggs]

Thank you I am trying to read it but am finding it slightly overwhelming

It is difficult the way that the state provided facilities are combined with all the private facilities nowadays

[duckyneedsaclean]

Not sure if they have considered trying to transfer to any of these?

www.dorsethealthcare.nhs.uk/services/dos/?q=SiteList&service=Rehabilitation%20Care%20Services&filter=

[Fuzz01]

Can he weight bear at all? Alot of elderly patients who suffer hip fractures can struggle to bear wear on that particular joint due to weakness left from the injury therefore requiring a wheelchair/zimmer.if this is the case then it should of been dicussed with yourselves in the mutli discipely team ( which includes doctors nurses ot,physios and social worker)

[MissTriggs]

thank you.

I think these are the ones that Poole is trying to send him to ...

My uncle says he went to a fully private rehab half way house.. I guess I could call BUPA/Spire/Priory to see if those are options?

[duckyneedsaclean]

If your parents have the money, it may be the best option, and have the greatest likelihood of getting him on his feet again - the longer be stays in hospital, the harder it will be for him.

Sad that it's so hard to access this provision on the nhs.

[MissTriggs]

shall I start with bupa/spire/priory?

[duckyneedsaclean]

I'm not too hot on private rehab unfortunately.

Have just found this though, which it might be worth pursuing?
www.nhs.uk/Services/hospitals/Overview/DefaultView.aspx?id=2514

"Also at Alderney Hospital are Jersey & Guernsey Wards, a 48 bedded unit that provides in-patient care predominately for elderly people that require rehabilitation (physical services). Patients are usually transferred from either Poole or Bournemouth Hospital following an acute episode; this could be due to a medical or surgical condition."

[MissTriggs]

Thank you
Yes it is alderney that we are trying to get him into

My parents' GP and the PALS service have both telephoned the ward today to express their concern

The lady from PALS is advising me to work on plan B while they pursue plan A. She says if it was her father plan B would be to ask for respite care privately in a facility that was happy to have a physiotherapist visiting regularly/daily

Mum just telephoned me to tell me to stop complaining because the people on the ward couldn't be nicer to her and couldn't be trying harder to get to dad into Alderney. This makes me think I have done the right thing to kick up a bit of a stink today.

[Needmoresleep]

Hi Miss Triggs,

This all sounds familiar. Three years ago, following a fall and a hip operation DM was supposed to go to the Alderney. Then they phoned three days before Christmas telling me that she would be discharged instead. They then helpfully reoperated on her wrist the next day leaving her completely unable to use a walker. The hospital notes later quoted by the memory clinic claimed she was "very confused". In fact she had not been able to give names of relatives and we only found her by phoning round hospitals. She would have been discharged to an empty flat in a block where she was the only permanent resident. I later discovered her heating was not working and there was no real food (Mars Bars and Magnums only) in the fridge.

Unfortunately I knew nothing about the system so did not know about the need to seek Social Services involvement. My guess is that there is a lot of demand, or perhaps a lot of bed blocking, at the Alderney.

By chance I had googled convalenscent care a few days earlier and had spoken to the first people who popped up. They were very helpful, so I mentioned their name to the discharge person who phoned. "ah the Hilton of care homes" she said. By chance they had one spare bed and could take a discharge on Christmas Eve.

Mostly it worked well. It was a bit like a luxury hotel with lovely food (I could join her for lunch which was great as I live some distance away and spent my days racing around), she was encouraged to join in activities, and the nursing care was good. (Even more shocking was the fact that neither my mother's GP nor Social Services were informed of her discharge. The nursing staff spotted a pin in her hip that needed removing, but did not know that there were staples in her wrist below the heavy bandage that also needed to go. Neither were in the discharge notes.) But I would have had to buy in physio.

It was very expensive (£1300 a week) but this was the time to spend rainy day money, plus it bought me time and meant that I was able to sort out suitable longer term accomodation.

You should be aware that if he leaves hospital there may be a wait for community physio to gear up. It was about six weeks in my mums case, so you need to make sure he is put on the wait list as soon as possible. The hospital physio bent the rules and my mum stayed on their books for twice a week appointments until these took over. They also took me through priorities, essentially she just needed to walk as much as she could. DM was able to walk agonisingly slowly before leaving hospital but needed help to move from sitting to standing etc. Her problems with short term memory were not a bad thing as it meant she was always willing to try and walk as she would forget it would be painful.

I don't know what you need to get him on his feet, but once he is mobilised a carer could help. I initially employed someone a couple of hours a day, with the short walks both providing the needed physio and helping orientate her to her new (sheltered) accomodation. It would also be a way of getting your mother used to having outside help, as the carer would then be someone "medical" helping with the recovery rather than because she is not coping.

My feeling was that the General Anesthetic plus the shock and the move had a huge impact on my mother's capacity. Four months after her fall, when she was both mobile and settled, she improved a lot.

It was a bleak time. Do PM me if you want anything further. I am not the only MNetter who visits that bit of the South Coast regularly. If there are others, also feel to PM. In the early days I found it very useful to swap knowledge of bits of the local system. By and large elderly provision is good, but a lot is accessed by askng for it, rather than by it being offered.

[MissTriggs]

thank you.
I'm not ready for this but I guess mum has no choice so it's about her really.

I will pm you to get the name of the HIlton...