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.

This can happen.

In my experience homes with the same 'label' seem to differ quite substantially in what they will accept.

Ultimately the care home are best placed to decide who they can look after.

Dual registered means that a place has residential and nursing wings. If you ask a dual registered place to assess they are more likely to accept.

Hi Fiveshelties, have read part of the thread briefly. I totally understand what you are going through, I had very similar with my own dear Dad. He was fine, perfectly fine, living independently, never visited a doctor, he was taken suddenly ill taken to hospital. He did have a UTI, he had scans twice, reviewed by the MH team. He was found to be suffering from sudden onset Lewy bodies dementia. He now lives in a EMI unit, the care he receives is fantastic. Please have a look at the alzheimers society talking point. They have helped me and there is always somebody who has been through what you are going through. I hope you find the best care for your Dad whether it be at home, hospital or NH. Best wishes to you and your Dad.

Some residential homes are really dimentia/delerium friendly and take it in their stride, others aren't and don't want any more high dependancy residents

It's not about whether they have trained nurses or not, you'ld find the same with nursing homes.

Unless he has specific nursing needs (i.e. wound care/nasogastric tube feeding etc) he might well be best placed in a well-staffed specialist dementia unit with carers who have experience in dealing with residents with confusion (whatever the cause).

You are in a very difficult situation and all the different terms used are confusing.
To reply to your OP: no, don't accept a discharge you are not happy with or you don't fully understand. However, be realistic about a. what powers you have, b. what can realistically be achieved for your dad, and c. what different agencies provide.

Either way, it sounds like your DF will need time and care to make as full a recovery as he can - wishing him all the very best. He is lucky to have you fighting his corner.

What will happen if they all so no? Could this happen - panic panic.

Should I just get him assessed by a few homes and see what happens?

Ultimately the hospital can't really turf him out.

You do have time to find the right place. It will pacify the hospital if you are seen to be looking. When I am on the other side of this trying to discharge someone from my ward I only get cross if the family are not making any effort to look or are wildly unrealistic and will only accept a place with a years waiting list.

If he was local authority funded you'd have less choice and they could place him against your will but as you are paying you hold more cards.

In my area the acute hospital has intermediate care beds in care homes that they pay for and they would have sent him to one of those by now.

It doesn't give me any pleasure at all to feel I'm putting pressure on families but equally I am getting many calls daily for beds for acutely ill people with nowhere to go so it is a matter of what is least worst

Thank you worrall20 - I am so pleased your Dad has settled. It must have been a huge shock for you. I will have a look for the society talking point.

Dual registered is less of an advantage is the main aim here is 6-8weeks recovery then reassess.

Dual registered is good for long term plans where there's going to be degeneration but it's not happened yet.

Just my opinion though. you might feel differently

Right now in your case I wouldn't be prioritising dual registered and would instead by prioritising them dimentia friendly ones whether they are dual or not.

It can take a long time to find a place that will take some people with a lot of different or challenging needs. However your dad's needs aren't that unusual so I think (hope) you'll be okay and it won't take too long to find somewhere who is happy to have him.

If they all say no he'll have to stay in!

They won't though.

Just ask a few more to assess and maybe a dual registered place or one that's good with dementia.

We are not supposed to recommend but of course I do know which local places are good and bad. You could ask his GP or the MH team if they can suggest places

If you turn it back on them then they can't pressure you.

I would ask for

• reassurance that no further medical care is needed and that medical causes of the recent deterioration have been ruled out
• clarification about his care needs: care home or nursing
• perhaps a CHC re-check given the deterioration
• a list of homes to contact so you're not researching from scratch

It must be a difficult see saw mamdoc, - I would love to see him settled, safe and secure in a good environment. I just feel pressurised to get him out yesterday.

A couple of the homes I have visited were particularly grim and I would fight tooth and nail to keep him out of one them.

I guess I was thinking that if a residential place feel he's too high needs then a dual reg place can offer a nursing bed and step down if he gets better.

Fundamentally just visit places you like, tell them honestly how he is when you go and ask them to assess. I'm sure you will find somewhere.

The AD society have a good fact sheet on their website on choosing a care home.

thanks adulting I have saved all that - I m going to be a mine of information eventually.

There are some grim ones , there's no doubt, but keep looking, when you see a really good dimentia specialist home in action it can be bloody amazing! Some just "get" it you know?

Unfortunately sometimes the ones that look most appealing on first inspection are the least dimentia friendly - like I said the matching neutral colours throughout - the hotel-ey look, is not good for memory loss or dementia or disorientation etc.

The ones who are consciously dementia/delerium friendly will want to talk your ear off about the ways that they are consciously dementia friendly, so just ask: what have you put in place to be dimentia friendly? if they tail off after "red cups".. move on.

Since you are paying privately you have to sign a contract and no-one can force you to do that with a place you don't want.

If the LA were paying they would have the contract and they would place anywhere they felt suitable.

Ultimately you hold the cards and the hospital can't really force you unless that have intermediate beds.

Why aren't the hospital helping you find a placement? It doesn't matter if he's going to be funding the care, legally, you have the right to request input in identifying a home. It sounds like he would benefit from a respite stay. Have you seen a copy of his social care assessment?

They are handling this really badly and dumping in on you. Push back at the hospital social worker and start asking questions. These are the main ones off the top of my head. Has my dad had a mental capacity assessment and can I see it? What was the outcome? If he doesn't have capacity, which family member was consulted for the best interest decision? Has he had a continuing healthcare assessment and can I see it? Can I see the social care assessment?

Happy to talk via PM if you need help.

Thank you Doggity - I am going to ask for all that and would love to contact you when I have some answers - thank you for the offer.

specific questions I would ask homes given what you have said about your dad:

• My dad hasn't been eating well, what do you do to encourage appetite? (I would expect a LONG answer from a good dimentia friendly home)
• Do you wheel chairbound residents to the communal areas daily for meals etc or would he be eating alone in his room? (once the shingles is non contagious)
• How will he be kept safe in his room? (thinking falls etc)
• How do you help people like my dad to increase their independence?

I will definitely ask those questions adulting ---- if there is a thread on here tomorrow saying we had a woman round to look at our home and she asked 101 questions you will know it was me

I would also specifically be asking about their understanding of recovery from delirium.

I will definitely be asking that ravioli - I just thought it was something which cleared once an infection cleared. I had no idea it could remain for weeks/months/years.

It can't last for years. If it did that would qualify for a dementia diagnosis.

But it always lasts longer than the underlying cause and commonly for 6-8 weeks longer.

What mamadoc said. Hopefully in a few weeks things will be very different

You need to watch this in case your father s eligible for continuing health care funding

A care home could cost as much as £1000 a week depending where you live.

If your father triggers CHC then the nhs pays

m.youtube.com/watch?v=HrpFLLwGqhs

You definitely need a nursing home ( care home ) not a residential home which are run by carers . They all offer respite , just phone every single one in the area ( may need to go slightly further afield ) , and the care/nursing homes have to have a qualified nurse 24/7 . I would ignore any list the hospital give you & do your own research . There may be some crappy ones out there , but there are also some really excellent ones - worth persevering.