Discharge from Hospital - Questions for Social Worker Please

If he is judged to have capacity at the time the he can leave any time he likes.

You say this to them. You tell them what you're worried about, what you do know, what you don't know. Don't downplay anything though, or say there will be support that doesn't exist.

A good sw assessment will take your views into account but will also gather info from others involved, and OT will observe/ do a functional assessment. And they're aware that the situation/ physical and cognitive abilities change all the time. So they won't just be taking your word for it, so you can't really 'make it worse'. If he does go to respite they'll check with the care home how able he is to return home etc. But it is harder to return home once you've been in care

Absolutely speak to the SW and OT. Tell them you are not local, you cannot take him in however temporary they try and make it sound. Dont be woolly.

Ask them to ensure that this is on the notes. I had two siblings and told the SW very firmly they were worse than useless and there was no point speaking to them but if they wanted to here are their phone numbers. Interestingly - they never bothered. I was the name in the frame and I have since found out they often have no way of calling international mobile numbers.

If the SW'S are telling you that you have no input then perhaps ask why they are speaking to you in the first place? I know what they are trying to do - cover themselves as they know not to believe much an elderly person says. They want to be able to quote what you said in case anything goes wrong.

BE FIRM AND CLEAR.

Retired social worker...Those options are in order of least restrictive for your dad. Working on the evidence that most of us would prefer to remain in our own home, and most people do better at home. But not everyone. So they'd prefer to try least restrictive first. There's a lot of tech now to try and keep people with dementia safe at home, it's down to levels of risk. Live in carers are usually from an agency, and need I think a 2 hour break in the day, which is provided by another agency if no family etc available. I agree be very clear what you are able to provide, or not. It's much more difficult if the carer has to be up at night as well.
Most people get on with the carer and they stop being a stranger very quickly. But not all. Respite varies so much, can be brilliant or not, lot of people with dementia obviously find it confusing. Good luck.

OP, I’m afraid you’re going to have to steel yourself, be hard-hearted and insist that he goes into respite care whether he wants to or not. Make sure the SW and OT know you won’t be able to arrange care for him at home and tell him firmly he can’t go home yet so you’re arranging somewhere nice for him to stay temporarily, where they’ll look after him. (He might even find he enjoys the company, activities etc.)

I know it’s heart-wrenching but sometimes we do know what’s best for our elderly parents in the long run and it might not be what they want. Think of it as being like taking away their car keys when they want to carry on driving but you know they aren’t safe to do so.

And my final suggestion is be upbeat with Mum and Dad. Its only for a few weeks, lets see how it goes etc. When Mum comes back etc.

He will know that he is in his closing years. He is also frightened of losing your Mum and vice versa. This makes people do daft things and make daft suggestions.

I honestly know what you are going through but I had big boundaries in the last few years (yes it went on for years with both of them!). Even when in a care home the home calls you ALL the time.

Be prepared to tell everyone - all the nurses, the Doctors, the social workers, just everyone you come across that you cannot step in and be available.

Neither is anyone else regardless of what your Dad might tell them when you arent there!

Otherwise it just wont get through and often its never put on the notes.

Yes - that capacity thing always bugged me. They could do whatever they liked.

You have to be pretty bad to be deemed to have no capacity. When I was Executor for my late Father I had to go into the local bank to transfer money around. The manager told me that he refuses to send any money when elderly people come in wanting to send say £20k to a person they have met online who needs money to pay hospital bills and such like. He said he just couldnt do it but knew these scammers would find another way of getting the money. One apparently got the old person to take £500 per day from the cashpoint which they knew how to use, then got 'someone' to go to the old persons house to collect it. A very good friend.. Poor decision making and yet we had to leave them to it.

Its all about the elderly person and giving them dignity I was told once by some twat SW.

Respit care with a view to it being permanent. Think what is sustainable, long term, and mostly fair to the family as a whole.

So, what I would do now is emphasis this is all temporary, fib if you have to.

Once he is in respite care it would be extremely diffficult for your Dad to get himself out of there.

Tell the SW;s and nurses you are not available to care for him.

It is very common for elderly parents out of your earshot to offer your services whilst not of course mentioning anything to you. My daughter does all of this etc etc.

I always found it interesting that despite Mum in particularly becoming confused etc that she ALWAYS had the capacity to sneakily do something without me seeing.

Quite honestly - save yourself. Dont try and persuade them you are right and they arent. They wont listen. They will say 'Aunt Joan said once she would help', 'all you need to do is..,' 'it wont take long' or the best my late Mum used to say..

'I dont want to be a burden but...'

Forget about the communication. Short firm statements saying its the best decision for now and can be addressed when things change. They wont get better, things will get worse I suspect.

You can visit at the respite care home as much as you like and I promise you there will be lots of people like your Dad there. He might even find he has found his tribe!

Yes, Mum rarely knew what she wanted. I would tell her do something sensible and then literally when I was leaving she was planning to do the complete opposite. No one was egging her on. It was just her which is fine in one way as its her decision but its not fine when what I have told her not to do gets done anyway and the consequences are then mine.

When she moved into her sheltered flat on the first night I told her to go to bed early and I would be back first thing in the morning but she started wandering around, fell, gave herself a black eye and then pulled the cord. The warden then called me - at 2230. I had only just left her tucked up in bed!!

My father in law did not want to go into care or hospital but once there he loved it ( small hospital) . Once he went home he missed it - the seeing of people, the cups of tea etc - and he went into decline with UTIs following on from lack of attention by carers ( to be fair of patient says no to a wash what can they do) and a family member . He got sepsis and died.

When your Mum comes home after (hopefully) full 6 weeks of rehab she is not going to be as fully fit as she was beforehand! She will be fragile and to an extent institutionalised. Dad needs to go for respite meantime and IF he goes home they will need ongoing support.. both of them. Be aware that this may well be a downward slope from now on.
Hard facts. Hard decisions. What they each want may not be the best or safest solution for either of them.
Sorry to be brutal... hard won experience here.