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Dad due to be discharged from hospital - really doesn't want to return to nursing home(5 Posts)
Not sure what I'm looking for by posting here - maybe just an outlet...
My dad was diagnosed 2 years ago with metastasised prostate cancer, at which point he became bed bound. A year ago, his hormone treatment stopped working, and he has been receiving palliative care since, in a nursing home funded by the NHS Continuing Healthcare Funding.
Last week he was admitted to hospital with Grade IV (I think) pressure sores, as he was bleeding from an artery. He has lost so much weight, I don't see how his body can keep him going much longer. The hospital are very unhappy with the standard of care he has received at the nursing home, and said they will be reporting this to social services.
Since being in hospital, he has seemed much happier - he is eating the food, being turned with care so he is not in pain every time he is moved. The hospital told him they expect to discharge him next week - he cried He really does not want to go back to that nursing home. However, being under the Continuing Healthcare Funding, we only have a choice of 3 nursing homes in the area, one of which I thought was far worse than the one he is in, and the other I haven't seen (only my mum has).
I don't know what to do. I can't bear to see him sent back to his current nursing home when he is so unhappy there. I honestly think he doesn't have long left - months at most - and so I'd almost rather pay for him to be in a private home, even though I know the cost is huge. I'm not sure my mum would be happy with that though - after all, it is their money.
He is receiving support from a local hospice, and he made the decision some time ago that he would like to die there, but I am not sure at what point they would take him as an in-patient. He would be very happy to be there, but I know they are a charity and as such, have limited space available.
Has anyone been in a similar situation and can share their thoughts and experiences with me?
I don't have any direct experience but I really feel for you. Why don't you speak to the hospice staff and go visit the 3rd care home before you go any further? I know our local hospital has a discharge ward for patients who no longer belong on the ward they were being treated in but still need full time care. Does your local trust have anything like this?
I can see why you don't want him to go back to a care home that seems to have neglected him so speak to the hospital and hospice staff about your concerns.
I hope your dad gets to spend his remaining time as comfortably as possible.
Firstly I am so sorry to hear your DDad and family are going through this.
I am a nurse and I am sorry to say that such severe pressure sores are very unlikely to have developed without at least an element of neglect. What are the nursing home saying about the sores? Have they given any indication as to how long your Father had them before they 'took action' either getting the h in or requesting a referral to a tissues viability nurse? Was he on a pressure relieving equipment? Were they keeping a record of the positional changes they should have been providing? Sorry about all the questions but knowing the answers to these questions might help you work out if their care was lacking or if there is some other factor. The last time I discovered a person had developed this level of pressure damage In a nursing home I made a safeguarding referral .
Anyhow, what to do now. If he does not want to go back then he should not be made to.
Do you have a case manager for the CHC? Or if not a Social worker? If yes then I think you should flag you concerns, and your Fathers decision not to return to the home to them in the first instance. Be firm but make it clear that going back there is simply not an option, your Father has made his decision and you as family feel it would be unsafe/inappropriate for him to return there.
Explore the third home and the hospice too, if neither are these are viable you need to go back to the person managing his case again and ask them! how do they suggest the situation be managed. Can they give you other options / take it back to funding panel to see if some additional monies can be found? Or if your DF/ DM would not be able to fund a placement in it's entirety then how about them 'topping up' which again might give them more options funding wise.
It's important to remember that if your DDad ( and yourselves) do not agree to his going back then the hospital cannot just send him back so 'worst case scenario' he may need to spend longer in hospital til this situation is resolved, or the hospice can take him. You need to communicate this to the ward staff and make sure it is documented in his notes too.
Thank you friend and Mrshumpty - I really appreciate your replies.
That's quite telling re your experience of sores this bad, Mrshumpty. Thing is, my dad was resisting being turned as often as the nursing staff were suggesting, because it gave him such immense pain to be turned, and the turned position was so painful for him, he didn't want to be left like that for long periods of time, as the staff would usually take a very long time to respond to his call button.
However, since going back into hospital, he has not resisted any turning, and he doesn't cry out in pain when he has turned - which just goes to show that, with proper care and attention, his needs can be met.
Social Services have said this morning that we will have a choice of three homes, so just waiting to hear what they are, then my mum and I will go and visit. Still trying to track down the hospice keyworker for her input...
You mentioned "topping up" to give more options - is this something you've come across before? I did ask my mum if that was a possibility, but she didn't seem to think so. It is probably something to ask the hospice, anyway - I'm sure they will no. Thankfully at the weekend my mum did volunteer that if we considered none of the choices offered to be suitable, she would pay for private care, if that was what it took to get him the right level of care.
Thank you again both so much for your replies
Hope your dad gets the care he deserves and you get the support you need.
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