What can you do when they refuse to get out of bed and mobilise?

Realistically, if he wants to go home, he needs to engage with mobilising and toileting progress.

If he doesn’t, and he wants to go to a care home hes going the right way in not.

@BB49 are you resistant to the idea of him going into a care home? What's his financial situation? It sounds like you could suggest anything and he will agree without too much argument.

FIL talked a lot about wanting to be 'looked after' when he came out of hospital. He meant a care home - either that or SIL visiting every day, at least 2-3 times a day. Or taking him to live with her. He basically didn't want to have to do everything for himself any more. He saw MIL being cared for 24/7 in her care home and that's what he wanted - being lifted and laid and brought a cup of tea and cake three times a day.

But he was mobile, didn't have any fractures to recover from and was only in the very early stages of dementia. He went home with carers 3X per day. It's been bumpy, but he no longer wants to go to a care home with quite the same conviction.

District nurses have criteria to meet for hospital bed - in this situation it would be social services that would provide the bed

Pads and changed in bed.

catheters increase the risk if CAUTI and are not recommended for convenience

Hospital should use HOUDINI to decide

I do know of someone who in a similar situation (after a fall without major injury) at a similar age just decided she was done with walking and opted for a care home (self funding). She was quite sure in her mind that was what she wanted and her family facilitated it - it's her money after all. No question about capacity , everyone agreed she had it. It was her active decision.

I do think sometimes people can eventuallly get to a point where they just can't be bothered any more

You say he has short term memory problems, he's 88, it's likely he has some form of dementia. That means that he will tend to say 'yes' to whoever is asking. So if the nurse suggested a care home he'd say yes; if you suggest going back home, he'd say yes. He probably wouldn't remember either of these conversations afterwards. He has no concept of the practicalities, and it sounds impractical for him to go home with carer visits.

So the person with POA has to make the decision as to what is best for him. One option is to arrange for a few weeks' respite in a care home. Most care homes offer this. They will have all the kit he needs - wheelchair, hoists, hospital bed. And carers on tap to help him 24/7.

He may recover enough to return home after a few weeks. But more likely he'll end up staying. Is there a social worker involved? Or will he be self funding his own care?

I get the impression that you are resistant to the idea of a care home. Why is that? Have you asked him how he would feel about living in a care home? There are some wonderful care homes, he'd have 24/7 support with everything, the company of others, you'd have peace of mind. It could be a good option.

From what you describe I think a carer home could be the best place for him. What you asked if what he thinks about going into a care home?

How much does he understand? What does he mean when he says he wants to be looked after?

To be blunt if he isn’t able or willing to get by himself to have a poo and he is at home with 3 carers visits a day then he is going to be left sitting in his poo.

I think you need to be realistic about what is going to happen next.

Often after a fall older people will need more support. As he already had 3 carers coming in day the next step up would be a care home. If he is sleeping a lot and not wanting to get up then it sounds like he is heading towards the end of his life.

Whatever conversation the staff member had with him, it doesn’t sound either like a capacitous decision made by thinking about all the options, or a best interests decision made by the team - apart from anything else, you should be involved in that! Sounds more like the sort of thing the care home receptionist says to me when I’m leaving my mum’s room looking glum - ‘tell your husband to look after you’ kind of thing. So I’d ignore that.

Id usually say the person you need is the ward occupational therapist.

Yes a hospital bed can be arranged, either through the therapists or district nurses. You have poa so you need to speak with his doctor, staff nurse, therapists for a discharge meeting. Don't order anything yourself, if he were to go home the ward will arrange everything. Nothing can be done until he's had a capacity assessment and care needs assessment, do you know which department the assistant was from.

Rib fractures are very painful, not so much at rest, but when moving, especially getting in and out of bed. I would be very surprised if he wasn’t on anything in pain, and if he’s not perhaps he needs to be?

being forgetful is not the same as not having capacity. As it stands, your dad has capacity to make he own choices regarding rehab and his discharge.

Many people go home with 4 care calls a day. Ideally if he could transfer himself to a commode next to his bed that would be something.

Has he been seen by an occupational therapist on the ward? They should be looking at his home environment and considering what could be done to be as independent as possible.

Wanting to be looked after is not the same as wanting to be waited on, he's had a serious fall and he's very old. Bedbound people can stay at home but 4 care visits a day with perhaps a quick night visit is the most you get, would he be paying for his own care. To go home he'd need special equipment and his home assessed, have you discussed a carehome instead with him. Even if he does start getting in and out of bed in hospital it doesn't mean he will at home and he could fall again.

multiple broken ribs aged nearly 90 are a life-threatening injury - it's a huge injury to recovery from and takes a lot of energy. What caused the fall? (falling is often a symptom of something else going on). PP makes a good suggestion re hypoactive delirium. UTIs don't always come with the usual symptoms in this age group either so sometimes that's worth thinking about. Presumably they're happy he's not had a proper bang to the head too? If all the medical stuff is as well managed as it can be and he just wants to be 'looked after' then perhaps the kindest thing would be to listen to that.

At 88 if he wants to ‘give up’ then isn’t that his choice? I think it’s fair enough if everything becomes too hard to just say that’s it I’m done with it now I’ll lie here and be waited on?!

obviously yes that then means conversations about care / care homes but if he won’t do it I can’t see how you can make him.

Ultimately, he gets a fair amount of choice in what he does.

If he wants to go home, then he’ll need to get moving. If he doesn’t, then not cooperating is a good tactic in his part.

It might help to point out its care home if he continues this (if you think he won’t be keen on that).

Could he have hypoactibe delirium? It sounds as if he’s too responsive for that but maybe check with the team.

How are they assessing his pain? Is he definitely not in pain when he moves? They’re not only asking him about pain when he’s NOT moving, are they?

How sure are you he is in no pain?

pain can be experienced as fatigue and nausea as well as the more obvious signs.

What does he want to do next?