Can we discharge dad from hospital and pay privately? Been in 6 weeks and declining because of constant infections caught on wards

[LindsayLaing]

82 year old Dad fell at home 8 weeks ago and fractured his spine. Up until that point he was fairly mobile. Paramedics who came out missed this and he wasn’t admitted to hospital until 6 weeks ago when he couldn’t get out of bed one morning. They decided to treat it conservatively - physio, back brace etc. since he’s been in hospital he’s caught flu, pneumonia and two chest infections - doctors said this is unfortunately common. He’s also had a blood clot on his lung from being immobile and is now in adult nappies and has a catheter as he cannot get to the toilet. He has COPD and low blood pressure which caused his fall - his blood pressure plummets when he stands. They’ve just started him on a new medication for the low BP (started last night 6 weeks after being admitted). Mum and I are now feeling that they’ve given up with him and she’s worried he won’t come out. He went in with a fractured spine (which docs think has now healed itself) but now has loads of other problems caused by being in hospital. They keep saying he’ll be discharged soon but then something else happens. He’s been moved 3 times and each time he goes to a new ward they seem to start all over again. They apparently only have a few physios for the whole hospital and he’s lucky if he seems them for 3 minutes a day. The longer he lays in bed the less chance he’ll walk again. Every visit we try to talk to a doctor and they tell us different things and we never see the same doctor twice. Mum has complained to PALS. Would a private hospital take him on in the middle of treatment or would a respite place be better for him? They will have funds soon from their house sale so could pay for some private care for a while. Thanks for any advice.

Do you or anyone have a health POA for him?

I don’t really know the answer to your question but I would caution that you look VERY carefully at the possible costs involved in this.
There is no guarantee that there will be a quick fix or recovery. What is the plan if the money runs out?

Yes, a private hospital would take him and you'd get better and quicker treatment too.

Without any health insurance I’d suspect the costs involved could be eye watering.
Those of us used to the nhs have no real clue as at how much health care costs.

Why not ask if his current consultant, or another working in the speciality, works privately as well. Often they can admit an NHS patient under their care in the private hospital they're attached to.

I had similar and I took my relative out of hospital. Paid privately for a physio . But can you .manage catheter, etc at home. My uncle already had a carer and she came to my house.

Take him home with a care package? (Free)this gives help with bed time washing(he was given a bed bath today, got nothing like that in the hospital) and help to get out of bed. Perhaps pay for part time carers if you're able ? We brought my dad home when we discovered noro virus was rife in the next ward. He has a care package and mum but has improved (for now)since coming home. Also 82 yrs old. Good luck. I feel for you x

Does the hospital have a private ward, he will still have copd and low blood pressure if he moves to a different hospital. What does he want to do. Is it more that he needs rehab now to help him get back walking. It sounds like he's had a very difficult time and has suffered through being immobile but if he's wearing a brace and his spine is healed is he getting out of bed now.

I took my uncle out as the care package would have taken nearly 3 weeks they said. I knew we could manage at home knowing that help was coming

This is not the sort of thing private hospitals in the UK really deal with.

UK private sector is about elective surgeries and cancer treatment, not managing the complex needs of the frail elderly. The costs would also be astronomical.

I would focus on getting a meeting with a senior doctor for a realistic discussion about what the future looks like.

I'm sorry that your Dad has been so poorly. The doctors are right that these things are unfortunately common after a fall, but it sounds like there are other issues too. I am sure the ward moves are frustrating- do you know what kind of speciality his current ward is?
It sounds like you may need a bit more information before best deciding how to proceed (I apologise if you have done this already):

• have you spoken with his consultant (rather than the junior doctors)? If not, this would be a good place to start to understand the problems now, and what the treatment options are going forward

-What exactly has your mum said to PALs and what has been their response so far?

• have you spoken with the physiotherapy team to understand what the physio plan is, and address your concerns about the lack of physiotherapy input?
• does your father have capacity, and if so, what does he want to happen next?

He might be eligible for a rehab unit or reablement ward but probably not unless he is medically stable and not requiring 24 hour monitoring.

Very similar happened to my grandad, he went in for a very minor ailment and unfortunately passed away to sepsis, that the hospital missed. It should not have happened, we are all so very angry. Please get your dad out.

His complications are not from being in hospital. They are the result of a major injury and the reduced capacity the body has to deal with such things as we age.

Respiratory infections and a loss of muscle mass and strength affect anyone who is immobile, more so when the person is elderly.

Moving him may not improve his health.

Does your dad have capacity? If not then medical decisions will be made in his best interests….but might not be what you think is best for him

You are within your rights to take him home yes and/or move to private but as pp pointed out private sector don’t really cater for this sort of scenario.

Two thoughts
One: look for a private care home where he can recuperate but also get cared for until he’s well enough to go home.
Two: kick up a fuss. The sad truth is that those who shout loudest get listened to more in hospital. I say this from bitter experience.

I'm sorry to hear about your Dad. It sounds really tough, but unfortunately he seems to be on a natural progression of his general ill health exacerbated by his recent fall. Excuse the rubbish picture but this is from the Rcgp gold standards framework, if you look at the middle chart you can see what happens to someone who has general gradual I'll health. Each time they get ill they fail to regain what they had before being ill. Your Dad is very sadly moving down that chart as is natural. A good nursing home may be able to help but expect him not to get back anywhere near where he was previously. And expect to pay up to £8k a month in care.

You could ask for an assessment for continuing health care paid for by the NHS but it's difficult to obtain.

Big hugs.

Relatives do not have the right to remove a patient if they have capacity and ask or agree to go home or to another hospital or carehome. If they lack capacity and there is poa in place they can arrange a move if appropriate and in their best interests. I would ask to speak to the discharge Co ordinator and senior doctor and ask about what the realistic plan is for the future. A private carehome might help for a few weeks and he can pay for a private physio to visit. Rehab might be appropriate which can br nhs or private.

@IIdentifyAsInnocent thank you for the chart. I have taken a screenshot as I am sure it will be useful in coming years.

As long as they have £600-£1000 to oat for said care home. Xxx

£600 - you aren't finding a care home with nursing care for that money.

You need to double that and prob more on top.

I agree speak to the Consultant. Can you speak a private physio in? On the pretext it's a family friend? To assess and advise?

The majority of private hospitals won't take him as they tend to focus on non-critical cases likes hip and knee replacements and usually don't have consultants in the building overnight, proper critical care facilities etc.

I've tried and failed before to get my elderly parent transferred, their needs are just too complex.

If you did somehow manage to find a hospital that said yes, you'd be looking at £350-500 a night, plus every scan (from a couple of hundred for an xray to £1,200+ for a pet scan), other procedures, non-standard drugs and daily consultant visit (at £120+ a time) on top. For potentially weeks on end.

Elderly care in the UK is broken. But it might be worth a frank discussion with his consultant about his prognosis and whether discharge to a nursing home is a possibility to work towards?