to make it plain to df that if chooses to go back to his house we can help but can't run round after him constantly

Another one who has looked after elderly dad and then elderly mum who both had this approach to ageing. Dad was dementia, eventually sectioned, mum was stroke. I’ve also been bedbound myself and remain disabled. We were all self funders.

I’ll be frank, once you’ve been in the position of needing carers or a care home, you quickly realise how unrealistic and selfish parents can be. It’s rarely health issues that can’t be overcome, it’s attitude and the belief adult children should do it all. Even parents who say when younger they will do xyz suddenly find themselves acting like this when the time comes. Yes they can absolutely decide to stay in their own home, the majority of us will want to and it’s possible. Equally you can decided to do none or minimal care as the relative. Both these things can happen just fine. It’s often not the best solution for family to be relied on for home care because they have jobs, their own kids, live far away etc. OP is right to be concerned, family care no matter how well meaning is often unreliable or not enough in the long term and results in another hospital stay sooner than anyone wants. You need a proper safety net able toadapt as things change.

Absolutely the hospital is responsible for sorting out a discharge is safe, equally the council is responsible for carers and social care. If they are self funding, the parent can and should pay for carers. Be clear on who is responsible for what. It might vary a bit on the situation but honestly most of the time it’s just the hospital and council trying to wiggle out of it till they absolutely have to. Obviously if parents is responsible for paying they can’t be forced and can give another layer of difficulty in accepting how things are.

I don’t think the OP is asking for more than what would be considered at discharge for someone of any age. The hospital shouldn’t need to be reminded that prior to discharge they need to arrange what needs to be to make home a safe place but it sounds like they do.

All in all it’s very sad.
Nobody wants to be in this position, whether the elderly person or the family.

Very reasonable but you do have to realise that your dad is a grown man who is within his rights to stay in his own home, difficult though that may be for everyone else. There will come a time when we are all in your dad’s position and may also not want to leave our home and memories, despite currently believing we’d be ok with it.

Yes, going through exactly this now with MIL.

I have found that even perfectly reasonable people like my DM can be nigh on impossible to have a constructive conversation with after a certain age. When she was my age she was looking after her demanding elderly mother who refused to have 'strangers' in her house to care for her. And so Mum had thoughts about her own old age with quite rational options about how she could live with loss of independence. None of this thinking has made it into her actual old age which is filled with denial, grumpiness and being demanding towards her DC. Although she does have people (not 'carers') who come in, keep her company and drive her around since her eyesight got too bad to drive herself.

I'm not really sure how to approach things for myself tbh. I don't think I will turn into my DM, but then I didn't think that she would turn into her DM. My DD lives abroad and my DS has multiple issues and needs support in adulting so isn't likely to be able to anticipate my needs when I can't be independent.

Her response: well work will have to sort themselves out, you’ll be needed so you can’t be at work.

Wow, that's a pretty selfish response. I would go down the 'I need my job and can't afford to lose it as we will lose our home' line.

Indeed. It's nigh on impossible to have any sort of difficult conversation with my DM, always has been.
If changing the subject was an Olympic sport...

Trouble is, a lot of us HAVE had the conversation, multiple times, and the elderly parent ignores it, or agrees at the time and then refuses to do anything different.

I had it again over Christmas. Reminded “D”M that if she had a fall/stroke/crisis I can’t just drop everything and come
and deal with it. Because of my dc, and job (FT, demanding, involves travel and overnights). Her response: well work will have to sort themselves out, you’ll be needed so you can’t be at work.

When the next crisis happens, she’ll be yet another one stuck in hospital whilst SS try to get hold of me.

I suspect, OP, that he will be changeable about what he is willing to accept.

To the PP who says that families should have 'the conversation' with their elderly relatives, let me say that I have had MANY conversations with my DM and while she has been somewhat agreeable to accessing various types of help when she is in an occasional crisis, she usually backs out or denies that she ever agreed to anything. She will say things like "yes, one day I will need more help but I'm not there yet" which means that she gets herself into another crisis situation that could have been avoided. I don't think that my mother is unusual, it think there are a LOT of serious conversations being had by the children of parents who simply will not give it consideration.

Hopefully you can get an occupational therapist round to the house as part of the discharge process. They're the experts in knowing what's needed - handrails, toilet risers, shower seats, grabbers - things you wouldn't know about or think of yourself.

This is a safe guarding issue and you are quite within your rights to get social services involved.. Is their power of attorney in place ?

Of course they will expect family to provide any care they can, why wouldn't they. If family can't no one can force them just like they can't force anyone with capacity to accept help.
Hospitals are full of patients medically fit because family decide on day of discharge that it will be unsafe for them to go home, or they are going on holiday so nobody at home to provide care, or some other excuse that they must have known about for the weeks their relative has been in hospital.
People play the system all the time.

There doesn’t appear to be any reason for them to doubt his capacity. He doesn’t have dementia. There is a presumption of capacity in the Mental
Capacity Act principles unless there is evidence of a disorder of his mind or brain.

From my experience, if they deem him to have capacity (and the bar is very very low when they deem they don’t) there is very little you can do ☹️

Having been a discharge facilitator I have to say if he has full capacity you a) can’t keep him in hospital against his will b) his choice is his choice and yes that could end in a crisis but make sure he is aware of the risks/consequences and fully understands them c) you HAVE to stand by what your saying and don’t give in as hard as it may be.
Sadly for individuals that have full capacity to make a a decision even if it’s what we/you class as unwise they have the right to do this and often people do infact have to reach crisis or it be a failed discharge for them to understand what care and support they really need.

Wishing you and your DF all the best xxx

he has been refusing all help

Do you mean he refuses help from you?

Or he refuses to pay for help?

I wouldn’t even ‘help’. It’s too ambiguous a term to say you’ll ‘help’. Theyll take your hand off. Step right back, say you will be staying right away, doing nothing at all and force a crisis. As long as you are propping up the situation little will change.

Please no one think that forcing the hospital to keep him for an extra 4 days is a win. Those over 75 years of age lose 10% of their muscle mass and mobility PER DAY in hospital.

Not having the conversation with our elderly parents about their plans as they enter frailty and old age with dignity is absolutely screwing the NHS. In its busiest week of the year there have been all between 10-20% of beds occupied by people with no medical need to be there. This poor SF was one of them.

It’s no one’s fault and this is not a flame but I can’t walk past this post without asking all those with elderly parents not to leave it to social services or the hospital ward team to have the conversation. They can’t do anything without the family.

good luck OP.

Cross posted with ThePure
Yep, your df is a capable adult. Once he is medically fit he will be discharged. It isn’t up to family to decide this. Staff will speak to him and go with whatever decision he makes. This was my experience despite my relative being unable to do things such as bath themselves, go to the toilet unaided etc.
Again, maybe those who get things for free have a different experience.

This is a very difficult position op.
I do sympathise.
At the end of the day it will be your df decision. The hospital staff will not override this.
Make it very clear to him that you will not be going round to help him every day. That he will be alone, and have to sort himself out several times a week.
He might agree to pay for carers once he realises the reality of the situation.
Having been through this, it is a nightmare op.
Maybe it depends upon the NHS trust, but I also found that anyone who is self funding is let down. You are charged an extortionate amount of money for very little.
Might be different if you get everything for free.
What you need to remember is that, like another poster said, some people prefer to he at home, whatever the circumstances.

You can use whatever form of words you wish but he appears to have capacity to make his own decisions and as such the hospital cannot prevent him choosing to return to his own home. They can offer him a care package (dream on if you think there will be an OT home assessment) but if he declines it that is at his own risk. They certainly will not keep him in an acute hospital bed whilst renovations are made to his property on an open ended time scale. If that’s what needs to happen he would need to go to a care placement in the interim.

Shit situation, repeated up and down the country x1000.

i would ask hospital to add to his records that he lives alone and does not have access to a working toilet or stair free access to washing facilities. And that despite him saying that family will help, family have jobs and responsibilities that make this not a good solution.

On the other hand, he may not have long to live - this coupled with entering a care home could literally kill him (ie he gives up).

Ask the hospital in front of df what care package to expect.. Tell df in their presence you absolutely won't be able to provide him with any sort of care...
They need to make provisions or keep him.