Elderly dad in rehab

Mum broke a hip and has dementia. SW decided she needed to go into a care home, which was what we wanted. As she is self funding it was left to us to find a home. They kept her in hospital while we rang around and visited homes. She went into a very expensive home while we waited for a place to come up in the home we wanted for her.

My mum in law wasn't discharged home 'til everything/equipment was in place, but this was pre covid and 5 years ago. Dad was sent home with the bare minimum this year.
My motto 'aim low and you're never disappointed' ...sad I know.
Things did improve....

The Hospital Discharge Team may try and discharge you dad to a nursing home, to be assessed for paid care (CHC) later. You need to be firm and say you want him assessed now, when in hospital.
Take a notepad or on your phone, jot down the conversations you have, who you speak to - name and designation. Back up with an email to the ward manager...'Further to our conversation of today, can I confirm that you have decided to discharge my dad to a care home without completing the CHC Decision Support Tool.that I requested'.
I found I had to do this and I've been a registered nurse for forty years znd worked in the hospital my rekative was in).
If he is really poorly and you think he may not last months, ask for Fast Track assessment.
If I had trouble speaking to people or no reply or didn't know what to do, I found PALS helpful.

..and insist they've recorded MUST and Waterlow scores (incl. weight, height, BMI) in hospital...my relatives discharge was delayed because they hadn't. Also important when you want to show weight loss over time.

I assume social services are involved? You can never know when they're going to be discharged. I'd say be prepared.The bed status in a home is forever fluctuating (residents dying) so if a place is available Monday, they may want to quickly fill it. This is dependent on transport being arranged of course, which quite often holds things up.Also, if the home has an outbreak of covid or diarrhea they can stop the transfer at short notice (I was on the doorstep with my mum-in-law).
Hospital inpatients no longer requiring hospital care can be moved to a social funded nursing home bed or a 'cottage hospital' (used to get six weeks funded care) until the patient/family sort out whether they're going to stay there and pay or go back home with support.
It sounds like your relative needs to go to a home with nursing beds, rather than a residential home? The staff should know how to cope with the catheter. Check he'll have a pressure-relieving mattress and cushion. Check he takes all his medications with him (they also usually switch to a GP associated with the home, not his usual one) and try and get a printed off Discharge Letter as the electronic ones tend to get lost in the IT cloud.

The reality is he either has to manage a 90 degree step round transfer chair to commode and back again, or wears pads. The OT will be assessing his transfers. Carers will empty his commode / change pads. He has to be able to sit out for 4 hours a day between one of the care calls. If he is struggling with this he may need a different type of chair such as a sorrento which offers more support and can recline. Carers will leave food and drink on a table near his chair / bed which he can access.

Parents both in their eighties.My dad's in a nursing home...end of life and blind. Saying that, he still potters about with his white stick. He tends to have his lunch in the home, then a friend or relative will pick him up and bring him back to his bungalow where mum is and he'll spend the afternoon there. Mum has daily peritoneal dialysis at night and couldn't cope with him then (he was falling out of bed, diarrhoea everywhere). This appears to be the best of a bad situation. Dad wasn't happy going into the home, but the home carers couldn't manage his complex meds , catheter, constipation/diarrhea.He seems resigned to it now and is not so grumpy.

You don't need to be with him any of the time. For this to fail you need to make it clear to staff you will be doing absolutely nothing.
Ask them who is going to do his shopping, cleaning, washing?
See how there are expectations of you already. Quash them. You will not be contributing to his care in any way. Think long term.

I agree with trying to get POA if you haven't already. Many people live in their own homes' immobile with 4 care calls a day. Obviously it's not ideal but your dad has capacity and that needs to be respected. Sometimes places like Age Concern offer a befriending service. You could also look into trying to get him used to an Alexa and a tablet / iPad if he's not already.

@Loopylou38 do you have POA? If not you should get it organised before anyone says he has lost capacity.

@Rocknrollstar the OPs dad is deemed to have capacity and wants to go home. So currently OPs view that a care home would be better is not relevant.

Either dad needs to change his mind and agree to a self funded care home or social services need to decide he doesn't have capacity so his wish can be disregarded and a care home is what he needs.

If there is no bedroom for a carer you can get ‘sit up’ carers at night but they would have to be different from the ones there during the day. If he needs 24/7 care then he can’t be left on his own between carer visits. They won’t keep him in the rehab ward. The usual time limit is two weeks. My DM went home with carers four times a day but I had to be there most of the time between their visits and when I wasn’t there she would phone because she needed help. It sounds as if your father needs to go into a care home. Could you put him into respite care while you find the right one for him?

Was there discussion on how he would go to the toilet, get meals and drinks, etc? Would he be able to summon help if he needed it between carer visits? Was a potential date talked about eg tomorrow, next week?

If these practicalities weren't discussed you need to talk to social services again. Mentioned you want to know he is safe and right now you haven't got enough info to be sure it is a safe discharge. Stress you have a job and cannot do much if anything during the week.

There may be an element of social services not wanting to pick up the tab so you should point out that he has a home he can sell and will be self funding. That might make them more open to suggesting a care home.

Make sure also that your dad fully understands the reality of what going home means - being alone for long periods and expected to toilet himself, make his own drinks and meals (if that is the case). It could be he has to try it to realise it is not really feasible. If so you need to sit on your hands and let the minor issues and problems happen rather than step in - hard I know.

Also try to get the GP to test his memory and check for depression and he will also note his mobility. The decline needs to be recorded in his medical notes and if he is referred for a full Memory Test that will also indicate to social services that capacity may be fading and y they may start listening to you more.

Ah OP It’s so hard when this happens. I would contact your local Age UK & see if they have any visiting schemes where someone will come in & provide some company for him

What does he want? How is his mobility, might he need a commode?
The carers will have a lot of clients like him. If you would feel happier, could you arrange a private carer to go in at lunchtime too?

have a hug if you want one. This is so hard, I know.

Is he self funding or will the council be paying?
Have you considered a live-in carer?
Care home is no longer a euphemism for the workhouse you know - most are fine and some are like being on a lifelong cruise with hot and cold running food, entertainment, drink and excursions.

Mum chose to go into a care home and while she would rather have been at home she really quite liked it - sociable, safe, busy, lots of interesting lovely carers to chat to (she liked them better than the other residents). I visited very regularly and she came home to us several times a week.

His life won't be the same again, but this isn't the same as with your DM, because she had dementia and he doesn't. Honestly, I think just try to be positive OP. He will need to be reassured, but at the same time, he's got capacity and can be part of the discussions and decisions. Talk to him about his care needs and the fact that his home is too small, that new equipment will be needed that won't fit, that he'll be all alone with a revolving door of carers at home and that managing that rota and making sure he's properly cared for will be really difficult if he's at home. The term 'care home' puts dread in the hearts of a lot of people, but there really are some nice places with kind, caring staff. My grandparents were in a really nice one that was warm and comfortable and the staff were efficient and kind. As a PP says - get a list of all the local ones and start ringing round - then visit. You'll get a feel for whether they might suit your DF or not. And talk to him about what you're doing and seeing - let him be part of the decision-making process.