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

[FiveShelties]

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.

We had an elderly next door neighbour in our last property and she was sharp as a tack. One night she turned up at our door at 4am in a state of complete confusion. She had been hallucinating and wandered outside then recognised our door so came to ask for help. We had a doctor check her over and they were convinced it was alzheimers because of her age. I spoke to her community nurse in the morning who said that she had been acting this way following a hospital admission but she didn't know my neighbour prior to her acting this way.

A couple of weeks later I got a letter from my neighbour who had been taken back to hospital. It turned out that she had been put on medications which interacted badly together and caused the delirium. They sorted her medication and observed her for a while before she came home again, and she was fine the next time I saw her.

I would always push for a second opinion in that sort of case.

Apologies in advance as I've not read the full thread. I'm a geriatric doctor so specialise in care of older patients. Confusion is our bread and butter.

This is delirium. It takes time to settle. Weeks sometimes even a month or two. Hospital may not be the best place for this to settle down and sometimes we suggest discharge to a community hospital or temporary care home placements to give them time.

He may not be mentally as sharp as he was before this and certainly ly the longer it goes on the less likely it is to resolve. However he should not be permanently placed in a care home with a diagnosis of delirium.

I don't know where you live. Our area has something called DANA (day and night) and D2A (discharge to assess). These are short term very intensive care packages that allow people time in a familiar environment (their own home) to try and get on an even keel. Only then do they decide if they can stay at he or need placement.

Sorry for the long post but hopefully it has useful advice. Feel free to PM me if you need more details or advice

As others have said, it depends what local services are available - in my locality there are no local community hospitals or rehab facilities and patients in your dad's condition would go to a nursing home in the short term for what is called an 'interim bed'. If at the end of the interim period it was obvious he needed to stay in the care home, a new assessment would be made.

So a lot depends on what is available locally. Advice from one mumsnetter may not apply where your dad lives where the set up may be different.

MrsBB1982's advice is spot on, as it should be from a care of the elderly doctor, people with delirium often never return to quite as good as they were before, and the longer it goes on, the less likely it is to resolve - hospital is generally a bad place for it to resolve if the original cause for it is gone.

It does sound as though your Dad could do with a placement that allows him to recover at his own pace , if it is delerium ( which it sounds like ) his condition will probably be far too much for your Mum to cope with at home at the moment and a acute setting actually is counter productive for the vast majority of patients with this condition . The key is finding the best placement for him , one which understands and has experience of caring for people with delerium. If I were you OP I would be making phonecalls and visiting places to find the best setting for the short term for your Dad . Good luck .

I am so grateful to you all for your help. Am going to write down all suggestions and make a plan. It has all been a dreadful shock as three months ago he was driving, and Mum and he were living without any assistance in their own home, going out and enjoying life.

I know the hospital want the bed, but I also want the very best care for my Dad, and am worried as to just where that may be. I am visiting care homes but just want to make the right decision and not be forced to make an huge decision without the correct information.

Op you do need to remember that he's 86. Admission at that age is often associated with loss of function, loss of muscle mass, general downward spiral. This is what the hospital want you to be thinking about. Tbh it's not that likely that he will 'recover' to how he was before and he should not stay in an acute hospital bed waiting for it. Chances are high he will get another infection. Find a home you like and then see if they will accept him. I do sympathise, it's a very hard position to be in.

An acute hospital bed may well not be the best place for him.
However, the cause of his delirium should have been identified and treated before he gets moved.

I hope he recovers well.
Once he has capacity, please very seriously consider getting PoA put in place, maybe reciprocally between him and your mum, and also for you/your siblings. It makes it much easier should you have to make decisions for him in the future and is much easier (and cheaper) to arrange than a guardianship. And is an awful lot quicker.

This happened to us. No packages available - we paid a private care company to come in to my Dad's home. He got a bit better but overall his pre-existing mild dementia got worse. The carers were great though and he could stay at home.

If you can get a temporary respite as some have suggested that might be the way to go. Time to think

I feel for you OP - not easy for you.

Has anyone suggested or discussed an intermediate care unit? It's a care home aimed at rehab. A person can go there for 6weeks to recuperate and get ot and physiology help and be passed to see if they are able to return home. The majority return home. Or it can help you understand that your dad really does need to be in residential care.

northernlurker - I do appreciate he is not going to be as he was but this change is so very quick and to see him so scared and angry that he is in prison and seeing dead people and animals just makes me want to make sure that he is going to be in the right place.

He is not on an acute ward now, has been moved. It is not that I want him to remain in hospital I just want to have time to find the right place for him.

Junosmum - initially it was stated that he go to a Rehab Facility for 6 weeks and we waited for a bed and then they said that no beds were available and he needed too much care and so they said he needed to be in a care home.

To access an intermediate care unit the social worker would need to refer as they belong to the local authority and the local authority pay the majority of the cost

You need to clarify with them whether hey mean temporary or permanent placement. No way should he be permanently placed on the information you've given. He needs ime to find his new 'baseline' of mobility and mental function. Like I said. He's unlikely to be as good as he was but he's got the potential to improve

It may be they have not explained themselves well. They may mean a temporary placement rather than community hospital so he can go somewhere more settled more quickly

Sorry, hadn't read your update. He needs to be treated for the delirium before a decision can be made!

It's tricky because for some, delirium can be made much much worse by being in an acute hospital setting.

If it was brought on by infections and shingles then it does sound plausable that it's delirium not dementia, unfortunately shingles knocks you for six for a long time and it can take ages to get over it, if he was to stay in hospital for that lengh of time chances are he'ld catch some other bugs and also there's other real risks of actute hospital stays for elderly patients such as muscle mass loss.

but I am not sure how the MH team can say it isn't dementia. Have they done brain scans etc? there isn't one conclusive medical test for all kinds of dimentia unfortunately.

If it was my I'ld be asking how sure they were that he didn't need any more antibiotics. If I was satisfied with the answer, then I think I'ld chose the home over acute hospital personally.

What is it you think they can do for him in hospital rather than nursing home if he's no longer needing antibiotics?

Firstly, sorry to hear that you and your dad are going through this. Secondly, do not be bullied into things you don't want to do by SS. When my DF was terminally ill last year, SS were very keen to push anything they could back to family. Now, that's fine to an extent but if I hadn't been extremely assertive, they'd have been more than happy for me and my siblings to do their job for them. Obvs the reasons for this are complex and multiple, lack of funding and so on, but nonetheless. My DB was at a meeting with dad's social worker, physio, consultant etc one day (multi disciplinary something or other) and had to stop it partway through and ask who was going to carry out the various action points they were working on as both he and I live overseas (though obvs spent much time back and forth after dad's diagnosis). Arm yourself with as much info as you can and make sure you know your rights, those of your DF and make no secret of the fact when it comes to the crunch. CHC assessments can be incorrect, deadlines missed and so on, benefits not claimed, all through lack of knowledge and you can't rely on the NHS/SS to give this to you. After my own dad's fast track discharge deadline was missed twice, I threatened legal action. It was amazing just how quickly things moved then...

To add, this was an absolute last resort! But the lack of coordination and anyone taking responsibility was appalling. God help anyone who can't advocate for themselves when the chips are down. Stay strong, OP.

He needs to be treated for the delirium before a decision can be made!
Sounds like he was treated for the causes of delirium already
With a virus thrown in the mix as well as the infection then it's possible he's "post viral" so the delirium won't clear up dramatically and could drag on, being made worse by the hospital environment

The key here I think is whether the infections were effectively treated, or if another infection has occurred. Asking about that should guide the way forward.

If the infections are sorted and it's just the lingering effects of the virus then I would want him out of there.

People sometimes deteriorate in hospital because it's a hospital. Sleep deprivation, terrifying stuff going on, bugs flying about…

adulting I think he would be better cared for in hospital, but I could be wrong. He looks dreadful, really poorly, not eating and hardly drinking, is in bed all the time and chatting to dead bodies under the bed - I just thought that he would need hospital care. But I also feel I need time to find somewhere suitable - there appears to be a huge difference in the standards of care homes

CHC assessments can be incorrect

They are subjective and can change
If your father's condition has changed it might be worth asking them to re-do the runding checklist (even if you are not keen on nursing home at the moment) because if his needs are different now to when it was previously done he might get a funded place.

adulting I think he would be better cared for in hospital

In what way?

In a nursing home he might get more help to start sitting out in a chair, which in turn might make him more keen to eat and drink (likewise being wheeled to a sociable eating area), more exposure to daylight and fresh air and a more homely environment might help with the delirium. In an acute setting it's much harder to meet those needs.

He might be talking to dead bodies because of the amount of dead bodies he's seeing wheeled past his hospital bed (yes they cover them but still..) some times there's elements of truth in deliriums.

Dad had Lewis Dobie ( sp ) dementia , he had hallucinations ,
The nursing home was best for him , and may well be for your father too
The care staff there have more time , and visiting is much easier than a hospital
Don't dismiss a nursing home , but choose one carefully and don't be rushed into a quick decision, , Dad was looked after so well at his

Another exhaserbating factor in delirium which occurs in acute settings is all the bed moving/reshuffling

This is dreadfully disorienting.

It can be like human tetris, Gov fines hospitals if they have mixed sex bays, so a male bay has to be turned into a female bay one day, and back to a male bay a couple of days later, your in a side room., out of a side room, in an observation bay then someone needs the observation bay more….

They can TRY to minimise moving someone with delirium too much, but sometimes there's no way around it.

It can make people's delirium or dimentia much worse. A nursing home is one move then the bed would be his and that would be that.

adulting - he was sitting out in a chair, but has deteriorated badly since he got shingles. I not trying to criticise care homes but he looks so poorly to me that I thought he would need hospital care. He has had one assessment by a Care Home who have said he needs too much care - it was a lovely home.

No one has died on any of the wards he has been on so he certainly has not seen any actual dead bodies there, he is also seeing dead dogs, sheep. It is really sad.