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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

To fight hospital trying to discharge my Dad to Care Home?

155 replies

FiveShelties · 24/07/2016 19:11

My Dad is in hospital and has been for a few weeks. He was admitted with an infection and is now desparately confused, cannot walk without assistance and now has shingles. He was forgetful before admission but is now seeing things/people, sometimes does not know who I am etc. Hospital have said he needs to be in a care home and I need to find one and have him assessed. I would like to see him in some sort of stable condition before he is moved - I do not recognise the man he has become and am really scared about what to do.

OP posts:
raviolidreaming · 24/07/2016 19:28

From what you say it sounds like he should have a period of intermediate care or rehabilitation first

Agreed. Dementia does not come on this suddenly. Acute confusion is indicative of a delirium, which is what mental health specialists have assessed him for.

FiveShelties · 24/07/2016 19:30

He did have a urine infection, septic arthritis, picked up a lung infection got over that and now has shingles.

I do not think he would be safe at home, but I also do not think he should be discharged to a care home. I am scared he will just end up back in hospital.

OP posts:
FruitCider · 24/07/2016 19:32

Hi, sorry you are going through this.

You say he has been diagnosed with dementia - has he had MOCA and CT head scan? If not you can def insist on those diagnostic tests before they insist he needs a dementia care home.

Have other causes of delirium been discounted? Eg have they done full blood count/urine dip to rule out infection? If not insist on those too. Have they ruled out malnutrition/dehydration?

It could just literally be a case of hospital delirium - quite common in the elderly. In that case there is no reason why he can't be discharged with home care!

ToadsforJustice · 24/07/2016 19:32

Is he in a position to pay for his care?

AtSea1979 · 24/07/2016 19:32

I would be asking for a second opinion and considering moving him to a different hospital.

raviolidreaming · 24/07/2016 19:33

I am puzzled as what you want to fight against?

OP, you absolutely SHOULD fight against this. Your dad has been assessed as having a delirium, which can take weeks or months to fully resolve, and the hospital should be treating him accordingly. It is massively discriminatory to disregard his presentation prior to admission and seemingly assume that, as he's older, that he's dementing and needs a care home!

WinterIsHereJon · 24/07/2016 19:36

Has he been checked again for UTI?

dottycat123 · 24/07/2016 19:37

I work in meeting health liaison. You are describing a situation which is more and more common with general hospital's saying a person is ready to go when they are nothing like back to baseline, in fact we are told that people are ready to go at the point they no longer require a service only provided by the General hospital such as intravenous antibiotics. Unfortunately your Dad probably had pre-existing cognitive impairment and the delirium has tipped the balance, he does have a delirium which may take weeks to improve. Delirium can rapidly escalate any underlying dementia and sadly some people do not recover. If anything treatable has been ruled out ( ask about UTI and constipation) then he may actually be better out of hospital, ideally at home. Ask about any discharge support team and keep reminding social services that his diagnosis currently is delirium which is a serious medical condition. Unfortunately delirium which prolongs for more than a few weeks is associated with a poor prognosis for full mental recovery.

CocktailQueen · 24/07/2016 19:41

Sounds like it could be a urine infection to me. Has he been checked for infection?

Sounds like hospital just want to get rid of him to clear his bed. But I think he needs more tests before you can say he needs a dementia care home! Has he had a CT scan? Memory tests? Any dementia before hospital admission?

Could a 6-week admission to a home work? That way your mum wouldn't have to look after him but he would be getting good care.

This is an interesting article - www.ncbi.nlm.nih.gov/pmc/articles/PMC3255198/ - it suggests checking things like urine infection, dehydration, malnutrition before diagnosing.

Good luck. Flowers

jacks11 · 24/07/2016 19:43

It's a difficult one, without knowing the full circumstances.

The cause of his current condition is really pivotal, TBH. As is the type of ward he is in now. I assume he's in an acute geriatric/medical ward.

He could be presenting in this way because he has an infection or other illness- but it could also be delirium. One of the (many) frustrating things about delirium is that it can persist for quite some time after the initial trigger (e.g. an infection) has been treated and has resolved. It can also be intermittent, or re-triggered by really minor things (constipation, really mild viral infection and so on) after the initial episode has resolved. If your dad does have delirium triggered by the infection that has resolved, and is otherwise not acutely unwell, then it could be that a nursing home (or rehab bed either in a rehab ward or in the local community hospital if you have either locally) may be the better option when compared to a bed in an acute hospital ward. This is because the acute ward is likely to be busy, noisy, with coming and going all night etc and this kind of thing can worsen/sustain delirium. The things that help, settled environment, low lighting, lots of reassurance and explanation, are far more difficult to do in the busy acute ward with lots of new patients coming in/patients being very unwell and so on. For patients who have persistent delirium, it can be more appropriate to look into a quieter setting. Whilst in an acute bed the risk of hospital acquired infection is also present, so this needs to be considered too.

Shingles can be treated with antivirals if caught early enough but not much else can be done (assuming he has not developed any complications such as neuralgia) so again this in itself should not prevent discharge to appropriate care setting in an otherwise physically well patient.

I can understand why not being able to mobilise independently would cause concern- but again a rehab bed would be more appropriate for this problem than an acute bed. In a rehab bed he could have physio/OT assessment as well as nursing care and community rehab teams can go into nursing homes to provide physio etc there.

I think you should ask for a meeting with your fathers team and find out why they have come to this conclusion. For example, I'd want to understand why they are suggesting a care home- is it because they think this is delirium which is going to take time to settle but there is nothing acute (in medical terms) which requires in-patient treatment? If that is the case, what are the plans regarding rehab? What rehab resources are available in the community? Or do they not feel that he has rehab potential? If not, why have they come to that decision? It would have been better if they had explained this already, of course.

It is, of course, possible that he is being discharged prematurely due to bed pressures or something of that ilk, but I wouldn't jump to that conclusion immediately. Speak to his team and go from there.

hobnobsaremyfavourite · 24/07/2016 19:44

Do you have an advocacy service local to you provided by someone like AgeUk or Age Concern who can support you with speaking on behalf of your dad.
It might be worth googling older people advocacy services.

catseverywhere · 24/07/2016 19:45

Hi
I am using my partners account as I feel so desperately for you.
I am a local authority Social Worker and have work in Hospital discharge.
It sounds to me as if your dad has what we call a UTI (urinary tract infection) that in elderly people can have a devastating effect upon older people that were otherwise fit and healthy.In no way should your father be moved into a care home without proper assessment and treatment.
It sounds s if his infection is still on going. Please insist upon a referral to a Social Worker who will appropriately assess your dad and provide you and your Mum with information advice and support

raviolidreaming · 24/07/2016 19:48

cocktailqueen the OP has already said that her dad had a urine infection, septic arthritis, a lung infection, and now has shingles.

Memory tests would not be appropriate when someone is presenting with delirium - acute confusion will produce a much lower score than would have been achieved at baseline.

A care home is not a medical environment. OP's dad needs treatment and follow up for delirium, which he was assessed for and diagnosed as having.

raviolidreaming · 24/07/2016 19:51

Yes to jacks11 and particularly the suggestion of a rehab bed.

YeOldMa · 24/07/2016 19:51

My grandad went into hospital with a urinary infection, became completely bonkers threatening the staff with the sack because he owned the hospital, etc and they said that the infection often affects older people that way. He had a brain scan which didn't show anything untoward He'd been living on his own so they discharged him to my care and I was happy for them to do so because his odd behaviour was going to be temporary. Sadly, it wasn't and his descent into full blown dementia was rapid. Sometimes, I was told, this just happens. He lived with us for a couple of years because I couldn't bear to put him in a home but to be honest, he probably wouldn't have known any different.

CocktailQueen · 24/07/2016 19:53

I'm not sure why you're picking on me, Ravioli, as several others have said the same. Just because op's dad a urine infection and it was treated does not mean it cannot return.

CocktailQueen · 24/07/2016 19:54

Dad had a urine...

PacificDogwod · 24/07/2016 19:54

Delirium is by definition treatable and reversible; dementia obviously not but can often only be diagnosed after a period of time. It IS possible that his recent illness has affected his cognitive function longterm.

Absolutely fight your DFather's corner.

And intermediate care bed for further rehab and/or assessment would be idea.
Thanks

FiveShelties · 24/07/2016 19:55

Thank you so much - sorry for delay am cooking dinner.

He is 86 and yes, would be paying for his care - not bothered about paying just scared of him going into a dementia unit and being written off so to speak.

OP posts:
ChoudeBruxelles · 24/07/2016 19:58

You need to ask for a continuing health care assessment as well as an assessment from social services. Also ask for a carers assessment for you.

Care should be person centred so focused on his needs not because the hospital needs to free up the bed

Wolpertinger · 24/07/2016 20:02

You need to ask the hospital why they think he is ready to be moved now - is this as stable as they think they can get him?

It sounds as if the diagnosis is delirium - this can take a very very long time to settle, if at all. It is reasonable for the hospital not to want to keep him in hospital while it does, in fact it's more likely to settle outside of the chaotic hospital enviroment as long as they have made sure they have treated everything they possibly can treat - have they done that? Have they explained this properly to you?

I would ask for a meeting with his consultant (NOT the social worker) to explain his medical condition, what they think the plan is from now, why they think he is ready for discharge and what you and your mum should expect. Is there a possibility for rehab? Not all older people are able to rehab after a serious illness although after a rest outside of hospital people can always surprise you.

I suspect them wanting your Dad out of hospital is reasonable and to go to a care home is also reasonable given how severe his care needs are - what isn't reasonable AT ALL is how little they have communicated to you about how seriously ill he has been and how it has impacted on his health or what you should expect now.

raviolidreaming · 24/07/2016 20:02

Sorry cocktailqueen - wasn't meaning to pick on you, just saying that the OP had said her dad does have a current infection. You're right though, I missed other people asking the same.

Unicorntrainer · 24/07/2016 20:03

My mum became totally confused when in hospital for a while. Then they called one night to say they couldn't wake her. Turned out she was dehydrated.

jacks11 · 24/07/2016 20:04

Cocktail

Diagnosing dementia after a recent series of infections when he already has a diagnosis of delirium would be completely inappropriate- in all likelihood he would not be able to complete the cognitive assessments (memory tests) due to the delirium thus rendering any diagnosis of dementia unsound. This is why dementia assessment is not done in the initial stages of delirium, although may be assessed for this if delirium is persistant. CT scan may be appropriate, but may already have been done to exclude organic cause of confusion.

In addition, it is fairly common for a degree of cognitive impairment/mild dementia to be exacerbated by delirium (itself triggered by infection, constipation, pain, dehydration and so on) and in some cases, the patient never fully recovers to their pre-illness state.

Another thing to bear in mind, as I said in a previous post, is that delirium can persist long after the initial trigger has resolved and rear it's head intermittently thereafter with minimal trigger. It does not, therefore, follow that OP's father has a current infection or any other illness sustaining the delirium- although agree it is worthwhile asking what they have done to exclude this. If that is the case, then an acute ward could actually be the worst possible setting for him- not only will the environment not help the delirium, he is also at risk of hospital acquired infections.

Intermediate care/rehab/community hospital may actually be a better option for OPs father. If not available then a period of care in a nursing home with psychiatry of old age liaison/GP/community medicine for the elderly input (in our area this is possible) may be suitable.

PacificDogwod · 24/07/2016 20:06

Do you have Power of Attorney for your father?

Did he used to live on his own or with you?

You may have very little legal rights here to make decisions for him Sad.

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