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.

I have had similar experience in the recent past.

He was 80, and decorating the house/walking 5+ miles easily, drinking with his friends in the pub, going to football stadiums before he was ill.

Treating the main issue was tough (intensive care for 2 weeks plus weeks on the ward), but then the subsequent infections started. As someone said upthread, he was t able to fight off the minor infections because he was weak from the original illness, plus stuck in bed all day with no fresh air, plus eating minute amounts of rubbish food.

We got him home, but only by ensuring someone was with him for the majority of every day, taking in food, reading the paper with him, taking him for endless walks around the hospital (building up very gradually from a wheelchair trip to the cafe for lunch, and eventually to laps around the floor late over about 2 weeks).

We basically did respite care ourselves. The hospital don't have the staff or the space or the time for intensive respite care, so if you want it doing then IME you have to do it yourself!

Ask to speak to the Occupational Therapist and Physio and ask them to put together a plan that you can work on with him when you're visiting. They will absolutely understand that the hospital don't have the resource for respite and should be glad that you're willing to do things with him. If they won't do that, see if you can get a private OT in to see him to do the plan (OT more important than physio as long as spine healed enough to walk?). We were lucky that we have an OT in the family, so followed their instructions!

Good luck. Don't underestimate how important mental stimulus and regular movement are. It's very easy for the hospital to leave him parked in bed all day, plenty of people are quite happy to spend all day in bed "while they recover", and visitors are often happy to chat to a bed bound patient throughout their two hour visit. An 80 year old isn't going to get better by lying in bed; they're going to get worse and worse. Get him up, get him eating, get him reading/doing puzzles/calling friends.

My Mum had COPD and other co morbidities when she fell and broke a major bone so I have been through a similar experience. Like a PP said I think you need to speak to the consultant and ask for a very honest assessment of the situation. Your father is 82 and the average life expectancy for a man in the UK is mid 70s.

A decent nursing care home is £1700 per week. If he is medically stable they may take him and the nurses on duty will cover most of the needs.
He could have assisted baths and better food. You could pay for private physio to go in etc.
I've worked in care homes so have seen this.
However I agree with those posters that have advised his age and health sadly lead to many of these complications not a fault of the hospital necessarily.
People do forget that 80's is a really good age to reach and especially if someone has pottered along it can be a shock when the frailties catch up to them.
Your DF may be more comfortable in a care home but they won't necessarily manage to get him well enough to be independent again.

Just to add to what @Saintmariesleuth said. A nurse I worked with broke his leg. It was cast but he went on to develop a chest infection.

He was mid 20s in perfect health

I hope you find a solution soon.

I work in private hospitals. It would be prohibitively expensive and the first thing you would have to do is find an a consultant with admitting rights to that private hospital and ask them if they would accept the patient. On top of this, the NHS consultant has to be in agreement (they usually are unless they think the patient is too frail to transfer and their life would be more at risk by the move - the patient would have to self discharge to leave in that case). So, the patient has to be well enough to be safely moved and before that, the private hospital have to have proof the patient does not have current infections such as MRSA (which would be likely to spread through their hospital). They would also need evidence of funding (confirmation of authorised private health cover or a big deposit, depending on estimated length of stay, treatment, investigations, etc). Sometimes a large NHS hospital has better on site facilities, ITU etc and already on site multidisciplinary specialists available than the average smaller private hospital. So, you would need to be careful - not every nearby private hospital is suitable.

Forgot to add, the accepting private consultant would need you to get copies of key tests, etc already done and some sort of medical summary of the patient's case and history to decide if they will take them on (so you will need the treating NHS doctors to help you with providing this info. Sometimes they are prepared to speak to the private consultant sec on the phone to explain the key facts or copy the relevant info (which is good if they do as they are rushed off their feet most of the time with all their other patients too - mostly they are helpful because they just want the best for the patient).

I don't think that looking after frail older people is really a thing that private hospitals do. They tend to be set up mainly for doing operations and procedures and short term recovery after that rather than for acute admissions with fractures or infections. If you can find someone to take him all well and good but not sure you will.

Realistically the likelihood of your dad being up and mobile is very slim . You and your mum need to have a meeting with the physio and OT and perhaps see if it would be possible to move him either home or to a different provision where the care may be better and you could pay a physio to go in . I hate to be doom and gloom but at that age very few people get back on their feet after so many weeks immobile .

Your best bet is probably a care home with private physio going in as much as you can afford.
Unfortunately he is unlikely to get back to baseline, and a frank chat with his consultant may help be realistic about his prospects.
As a nurse of over thirty years I've seen this play out many times. People do muddle along until suddenly.. they don't. A fall is usually the tipping point.

As an HCA I know that your dad's blood pressure has to get stable so he can safely sit out of bed, from the sound of it, that's the key thing.

Speak to the nursing clinical leader/ nurse in charge- His bed should be in the 'cardiac chair' position at all times and he should always be sat in bed upright when he's not asleep. He should only be sleeping at night with a short nap in the afternoon.
Definitely find out the name of his Consultant then contact the hospital switchboard, ask for his/ her secretary and make an appointment to speak to them with your dad.
Ask if you can speak to the physio team and if no joy threaten them with PALS.
Do not let your dad turn down physio because he's tired or feels unwell - I've seen this a lot and it's a slippery slope.
He should force himself to eat and drink as much as possible- to see nutrition as medicine too.

I’d ask for an assessment from physio and social services and see if he can get up to 6 weeks NHS paid for care in a residential nursing home. If he doesn’t need to be in hospital but not well enough to go home this might be the solution. He won’t get physio but they will start to rehabilitate him, take him for short walks and start to build him up.