Dad has "told fibs" to be allowed home from hospital

[Doubleknow]

He's been in for 10 days after a hip replacement. He's doing OK, but the recovery isn't happening as quickly as he expected. (He's 85).

I've visited most days, but never spoken to a doctor or OT, both he and Mum have full capacity, so all the important conversations have been with them.

He's desperate to come home, but still very frail and not very mobile.

They live in a big house with no downstairs bathroom or bedroom. (I know, but as I said full capacity).

He has "fibbed", his words, to be allowed to come home. He's told them he has a bed downstairs (he means the sofa) and downstairs bathroom (there is a small downstairs loo) and, I strongly suspect, that he has a wonderful daughter nearby who will be at his beck and call!

Mum is elderly and disabled herself, but very stoic and will get on with doing what needs doing, which would include caring for him and the house with only one working leg. They are both determined not to have outside help. Neither has had a bath or shower in months, although they are very particular about being clean, and they don't seem unwashed, so must be doing a decent job.

I will do bits, but I can't offer "care" and in any case they're not expecting that, they just want the hospital to believe it so that he's "allowed" to come home.

I think I just have to leave it and let them struggle, as is their choice, but it seems all wrong.

Are there other options?

Discharge from hospital with reduced mobility and no care package in place to support a disabled wife is madness. Had he accepted the offer of a care package an OT would have done a home visit while he was in hospital and advised on simple aids and adaptations to help. They would then have arranged for a home visit with OP’s dad to see how he managed before he was discharged. The hospital social worker would have done a referral to the local authority for assessment for longer term care at the same time as arranging the intermediate care so it would all have been in place. As it stands they have to start from scratch which takes longer and places the burden on family.

He can’t be forced, I agree. But that doesn’t mean OP has to enable his selfishness in expecting everyone to look after him. The problem isn’t hot meals, it’s personal care. Very difficult for someone who has reduced mobility and doesn’t sound very cooperative.

It’s standard for state care and it’s nowhere near enough for the current circumstances. State carers will come a max of 4 x a day and will realistically stay only 30 mins.

In any case the OP’s parents seem to have money so the LA will not offer such a package for anything other than up to 6 weeks after hospital discharge (which DF has already rejected).

Right now, 10 days post hip op DF is at serious risk of falls.

District nurse cover is patchy at best due to overstretched services.

As I said OP has 2 main options: retirement village or considerable adaptations + private care package.

I may have missed it but what type of hip operation has your dad had? Total, IM nailing, hemi, DHS? Did his surgeon ask for him to be under ‘hip precautions? I presume he was a ‘trauma’ patient rather than elective? I think a lot of people are giving you well meaning advise without knowing the full picture. If he’s under hip precautions he will have been told not to bed down and do his shoes for example. And the recovery time is totally different for a ‘trauma’ compared with an ‘elective’ so you can’t compare the 2. Sounds to me like your dad has been assessed, the hospital has recommended various things and he has refused. Which if he has capacity is fair enough. Sometimes people have to go home to try before they realise they need a little extra help.

Push for a stair lift. It will solve a lot of problems and save money in the long run. The damage to the walls will only be a minor repair.

Op I doubt they will manage without any outside help, contact Social Services and ask for an assessment of need, or better still ask hospital to do this so it comes from them, make it clear what help if any you are able to offer. Social services can organise adaptations at home, and refer to other services, if your parents refuse any help they will have to try and struggle on until they reach crisis

Our stairlift is bolted to the stairs themselves, through the stair carpeting. There shouldn’t be any damage to the walls.

My mum had six weeks of care after a hospital discharge. Two carers four times a day. They did washing/bathing hair washing, dressing/undressing and made her breakfast. Once the six weeks was up the LA reassessed and she had the same package of care on a permanent basis. It doesn’t matter what income or savings the couple have, the LA will assess care needs and provide whatever is necessary. The couple will have to make a contribution for the care provided, based on their means. Mum also had district nurse visits three times a week because she was severely restricted in mobility and they monitored skin care, and wound care after surgery. This is not a wealthy area, so not over provisioned. OP’s dad is home now so whatever will take the pressure off short term has to be considered while they decide on longer term arrangements. The LA can and will help with that, as will the GP - you don’t appear to understand the care services available if your first thought is a retirement village and private care as standard.

Not sure why you have replied to me like this when I said a short term package of care is put in place and then assessment takes place in the home environment!
I didnt say he should be discharged with no care at all, he was offered it but declined

Its far better to get someone home with STPOC which here includes therapy assessments in the home than keep them in hospital for ages, its far better to see how they cope in their home environment
Ive only ever seen OTs go out to assess from hospital in exceptionally complex cases
They just dont have the capacity, photos and measurements are often sent in by families

All of this is a moot point as he has capacity and hospitals are not prisons, he would have to consent for his details and assessments to be shared with the community teams and he has not
Sadly it will reach crisis point and then he will either be readmitted after a fall or his wife will be admitted and hes home with no care

It doesn’t matter what income or savings the couple have, the LA will assess care needs and provide whatever is necessary.

No, unfortunately not. If you have under £23,250 in savings you qualify for state care. Over that you’re a self-funder and pay full costs.

Equally, when my mum fractured her hip last summer, she had a 4 week care package once a day and the district nurse was supposed to come in and check her dressing, but they didn’t show up for 2 weeks.

@RosaNovella Sadly it will reach crisis point and then he will either be readmitted after a fall or his wife will be admitted and hes home with no care

That’s exactly what’s going to happen.

Thank you so much OP for this thread I am 88 and got spine problems, operation pending, live alone so after reading all the advice I am going to get an assessment before my op. I wish your Dad all the best.

@Comicalblackcat I wish you all the best with your operation. As you have found out on this thread there is a lot offered on discharge after orthopaedic surgery but you have to agree to have it.

It's always a lot easier to accept stuff you don't think you need and then get rid/cancel it, than go home and struggle as you are then waiting for all the assessments while you struggle.

Thank you AnnaMagnani for such a kind response, every little helps. 🙏

You’re the same age as my mummy. Good luck 💕

Oh dear, how difficult. Have organised care for mother with Dementia, and elderly Aunt after hospital stay. Sadly both now passed. (have also had hip replacement myself!)
If they don't already get it, claiming Attendance Allowance could be considered 'money for care'?

As already mentioned, the GP surgery can organise an OT team to assess and provide equipment free, and will take it away afterwards. A trolley that can be used to walk with and carry stuff helpful! Your Dad should do physio exercises regularly to get mobility back.

Agree with others afraid this could end badly. I hope the OP doesn't get dragged into constant visits to help, the LA will happily put you down as the carer if help is needed unless you keep out of it! I don't know why elderly never want care!

My Aunt managed with the 4 daily care visits, plus a cleaner who also helped with shopping, she had to pay though. I organised anything else needed, but she had full mental capacity.

Sorry this rambled on rather, thought some things might be helpful! 😊

I know of two elderly couples, both of whom regularly fell and relied on neighbours for help.

In one case the husband fell on his wife, who died from her injuries. In the other case, the wife died from injuries sustained while trying to assist her fallen husband. Both couples had repeatedly refused practical help, carers, or sensible and helpful changes to their homes and ways of doing things.

10 days is a long time to be in hospital for a hip replacement, so I am assuming there must have been a serious problem. Have they not suggested going somewhere for a rehab stay before going home? Given what you have said about their living conditions, there is a potential for things going badly wrong.

Ah ok sorry. Tbh the hospital wouldn't release him til he can demonstrate ability to navigate stairs with an aid. In my experience.

@BillieWiper he is out, no care package, no evidence of stairs- read OP (see all at bottom right of their posts)

I know. I was just saying what I think should have happened.

I would be worried if there was no chair raiser and raised toilet seat, getting up from sleeping on the couch would also concern me.

We’re talking at cross purposes here. I’m fully aware of the thresholds. You stated that the LA wouldn’t provide anything but the standard six weeks post discharge if the couple have financial resources. Being able to self funding doesn’t mean that the LA won’t provide ongoing care, just that if your savings are above the maximum threshold you will pay the full amount until you drop below the threshold. Once savings drop below £14,250 they are not counted but at all stages income is assessed so unless income is below the thresholds, yes they would have to make a contribution.

Private home care costs significantly more than LA funded care, even if you are self funding because the LA arranges care at negotiated rates at around £24 an hour. Private care can cost upwards of £40 an hour and there is no tapered rate as funding sources drop - you pay the full market rate directly out of pocket.

If he has capacity the hospital can’t stop him from discharging himself against medical advice. Which is what appears to have happened here.

It does mean they won’t provide care. The reality of the threshold is that not only do you pay for your own care, you organise it too.

Unless you were some very vulnerable adult with no family or friends - they might step in.

Absolute nonsense. Local authorities assess for adult social care through a care assessment, using national rules to decide if your needs meet the threshold for support. If you are eligible the LA must create a care plan outlining what services will be provided. If you qualify for care, whether you pay for it depends on a separate financial assessment to assess whether you can contribute toward the cost of that care. Provision of care does not depend on your financial situation, it depends on whether you are assessed as meeting the thresholds for care. At 85 and with ongoing mobility problems OP’s father is vanishingly unlikely not to qualify.