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.

Op, I haven't RTFT and someone may have already mentioned it, but if you haven't sorted out Power of Attorney then do it quickly.

I know it can feel like the hospital staff just want the bed.

But while there is that from above, it's not just that. The staff have seen the human cost of delayed discharges and don't want that for their medically fit patients: the muscle loss, the confusing exhausting environment taking its toll, the falls, the infections, being the ones who have to move their bed again which in turn makes them worse, the list goes on.

but he looks so poorly to me that I thought he would need hospital care.

If by hospital care you mean more antibiotics or antivirals or IV fluids or adjustments to his usual medications, then yes. I would want to be reassured that the delirium does not require more medical treatment.

If you mean TLC, sadly usually hospital is not the right place, a nursing home or interim/rehab facility is what will give that sort of care if you can find the right one: they are more geared up to building up sitting out in the chair, encouragement with eating and drinking etc.

I suppose part of the problem is what 'medically fit' actually means - I did not expect him to be perfect or even close to that, but I did hope he would be able to hold a plastic drinking cup to have a drink.

It is probably the speed with which this has all happened and the pressure to find a suitable home which has scared me.

I'm an older people's psychiatrist

Delirium can't be treated as such although the causes of delirium eg infections, medications, etc can be.

Sounds like he's had a very bad time with 3 separate infections. The sicker someone is physically the worse the delirium and the longer it takes to clear. Often 6-8 weeks. They may not get all the way back to baseline and sadly (not trying to scaremonger) some people die and for some it does uncover underlying dementia.

What he needs now is time, good nursing care, good nutrition and hydration whilst he recovers rather than more treatment.

Honestly he may well be better in a care home than a hospital. In hospital people pick up all kinds of nasty resistant bugs, everyone is very sick, machines beeping all the time etc. It's a scary environment if you are confused anyway.

If you find a good nursing home with well trained staff he will be well looked after and might recover better. He can have community physio at a care home when he's mentally well enough .

It doesn't have to be forever. You can sign a respite contract for any period of time eg 6 weeks and after that he may be well enough to come back home.

If he is paying privately care homes will be keen to accept him as they can charge higher fees. This may seem unfair but you get what you pay for in the world of care.

I really would look at as many as you can. Meet the manager, look around, check how the place looks and smells, see a menu, see how staff interact with people, ask how they would help him recover. Some care homes specialise in rehab these days.

Don't look on it as writing him off just the next step in him recovering.

Sounds like he was treated for the causes of delirium already

Even if he's been treated for the cause, it doesn't sound like he's being treated for the symptoms. Sometimes hallucinations can be treated with a short course of medication, which is often advisable where the hallucinations are distressing.

I suppose part of the problem is what 'medically fit' actually means - I did not expect him to be perfect or even close to that, but I did hope he would be able to hold a plastic drinking cup to have a drink

Yes that term is a common cause of communication breakdown between staff and relatives

You can be unable to do a single thing for yourself & bedbound and be "medically fit"

medically fit simply means no longer being treated by doctors.
It doesn't mean anything about the level of nursing care.
It's got nothing to do with "fitness"

Medically fit people who linger in acute settings often don't do so well and deteriorate. It's not a good place to be if you don't have to be there for medical reasons.

All nursing/self care needs can be met in other environments which are more conducive to recovering/recouping

The other term is "therapy fit", that's when the physios and occupational therapists have done what they can in the hospital environment.

Again, someone can be bedbound and fit for discharge according to the therapists if they think that things won't improve in the hospital environment.

Well you can give antipsychotic medication for hallucinations but generally its regarded as a bad idea.

These are powerful medications (they have no license for delirium only schizophrenia) and they have bad side effects for frail elderly people eg drooling, stiffness, sedation, worse mobility, worse swallow.

If the hallucinations are due to delirium they will wear off as it gets better anyway so it's best to avoid antipsychotic medication except in severe cases.

That's not just my opinion it's also NICE guidance

Even if he's been treated for the cause, it doesn't sound like he's being treated for the symptoms. Sometimes hallucinations can be treated with a short course of medication, which is often advisable where the hallucinations are distressing

Yes, that's why I'ld ask for reassurance that no more medical treatment is needed.

After that, getting him out of an acute hospital ASAP = a type of "treatment" in itself

I agree with mamadoc , I think respite in a good care home is your best option at the moment . He will continue to be seen by Drs & there are trained nurses at all times . In fact you might find that they have more experience in treating him compared to a hospital ward . Hospitals are not always the best place ,& just because he's in a care home doesn't mean he'll stop getting treatment - his treatment will continue .

Op did say up thread that he'd seen liaison psych who would be best placed to advise on this

an acute hospital bed probably isnt right for him now, busy, noisy, lots of coming and going (staff and patients) day AND night wont help his delirium...he needs rest and time to recover....a busy ward isnt the place....short term care may be helpful and then a reassessment of his situation

sparkle - the care homes I been told have vacancies by the Field Bed Person have no trained nurses - they are staffed with care workers.

Tatty

There is no point trying to arrange power of attorney in this situation as OPs father does not sound like he has the capacity to consent to Power of Attorney (PoA). He may well recover enough to be able to grant OP power of attorney and sign the paperwork, but as it stands this would not be possible.

If he does not improve, OP would need to apply for a guardianship order- a similar thing to PoA but is done via the court of protection (in Scotland) in patients who lack capacity.

Mamadoc, of course. I was thinking of the guidelines for if there is considerable distress which isn't being relieved non-pharmaceutically.

It is probably the speed with which this has all happened and the pressure to find a suitable home which has scared me

That's understandable. Ask the ward to save you as much leg work as possible by giving you lists and contacts so you're not starting from scratch.

My tip would be that for dimentia and delirium, looking like hotel isn't always a good thing: all matching neutral decor throughout isn't very easy to navigate/orient to with dimentia/delerium. Signs that somewhere is dementia/delerium friendly are things like contrasting colours, themed rooms (not the same indistinct watercolour picutes and colour scheme in every room) , no loud telly on all day, things like that. Coloured placemats or plates/cups. Chairs facing each other not in a semicircle around the telly. Hope that helps a little x

A nursing home has trained nurses 24-7
A residential home does not
A dementia residential home doesn't have nurses but does have staff trained in dementia care
District nurses will still visit residents in care homes

The hospital should give you clarification as to whether he has 'nursing needs' eg peg feed, pressure sores, insulin injections

He might not need a qualified nurse if his needs are for care eg help to eat, drink, mobilise, wash, dress

lemon he was in a ward with three other men, really calm and quiet, no IVs or machines beeping etc. They moved him into a side ward when he got shingles so he is alone now.

sparkle - the care homes I been told have vacancies by the Field Bed Person have no trained nurses - they are staffed with care workers

does he have specific nursing needs?

Some care homes (as opposed to nursing homes) are fantastically dementia/delirium friendly and really well thought out and run, likewise some nursing homes aren't.

Nursing homes aren't "better" than care homes, they just provide different things such as tube feeding etc.

Also, in some homes which are a bit of both, the nurses only look after the side with the patients with nursing needs.

The hospital staff should be clear with you about which type of care your father would be having

It's something they need to clarify for you because if you end up paying for a nursing home when his needs are care you might end up paying more and not getting anything extra for the extra money. (and he'll still be cared for by care staff)

adulting - the hospital said to find home which has a residential side with a dementia unit so that he coud move between the two if necessary. So I found a really lovely home and they said he needs too much care for them to take him as he needs nursing/dementia - the hospital say he does not. And then he got shingles!

Just to reiterate - I am really grateful for all your time - I have learnt a lot and don't feel quite as scared as I did. I am more than happy to find a home but I need to find the right one.

sometimes it comes down to their individual ratios.

If it's residential care not nursing he needs some may take him some won't, that's why they come and assess individually. They may for a simplistic example only take say 3 bed bound at a time so might turn him down saying he needs more care than they can provide IYKWIM, another care home on the other hand may be fine to take him.