NHS physio / rehab for elderly parent miles from home and family

[MrsTomHardy13]

Posting here for traffic.

Parent currently in hospital following a fall with a plan to discharge to a rehabilitation hospital to help get back mobile. The hospital they are in is not in the same county as their GP surgery. Seemingly it is the GP surgery location that dictates the rehabilitation location. It would mean parent having to be transferred around 2 hours away and would mean a 4 hour round trip for visitors. The journey alone would be a lot for them right now and we feel not being able to have regular visiting would not be in their best interests from a mental health and interaction point of view.

Has anyone had anything similar, or been able to get parent into a more local / convenient NHS facility at all? Basically been told by the hospital that it's either this or find private care home which is going to be a slower process and would have to pay for. Any advice would be appreciated.

I used to work closely with discharge coordination teams. Discharge placements are few and far between. It is quite likely that this was the only option available so, yes, you can ask but if there was a placement locally they would not have sent your parent out of county.
Technically, you have a third choice - refuse the placement and refuse to take your parent home. That way they will be kept in a hospital until an appropriate option is found. But that's not an option I would recommend and is very likely to end up resulting in them going to the same placement anyway but after a lot of stress and paperwork.
Good luck. I know how hard and distressing it is but, honestly, they would have offered you a better option if there was one.

You could possibly look into whether she can temporarily register with a GP surgery in the same county as the hospital she is currently in. I work in an acute hospital and have supported patients who have had an accident when visiting family and they have done this. We wouldn't be able have a patient admitted to a community hospital for rehab locally if they are registered outside the county.

Private care home is highly unlikely to provide much/if any, rehab.
Does the rehab hospital currently have a bed? - if not, family member could be waiting a while for transfer to happen.
What is likely to happen to parent if they aren't able to get mobile again?
Are there any "rehab hospitals" more local? - they tend to be few and far between these days.
Placement in a dedicated rehab hospital is likely to give best chance of regaining mobility - but, I don't know your parent or their circumstances.
How realistic is rehab? - were they reasonably fit and well before the fall? - or are they 98 years old and could just manage a few steps with a frame before the fall?
All the above would influence what I'd be wanting for my nearest and dearest.
Good luck.

@WhenTheDragonsCame would registering with a GP locally to the current hospital cause any issues with referral to its linked rehab unit? ie hospital know where her current GP is and that family not happy about the current proposal.

@Wingedharpy they were independent before the fall, lived alone, only used a walking stick if going out to the shops. We know a rehab unit will give them the best chance to get going again but concerns from a mental health point of view and having some degree of confusion still from infection / long hospital stay. If they can't get mobile again it will be a case of considering care home options no doubt.

I only know about the trust I work in but it’s never caused any issues as far as I’m aware. Do family live in the county that she is currently in? If so she could temporarily register with their GP.

There are 6 community hospitals where I live where patients can go for rehab following a hospital admission. To meet the criteria they need to either be assistance of two for walking or have sub acute medical needs such as managing a wound. There are no cottage hospitals or places to go for convalescence but there are definitely rehab hospitals.

Most non acute NHS care is linked to where a patients GP is. As an NHS rehab service (non residential though) we refuse referrals for patients who do not have a GP in and live in our borough. It is linked to funding but also discharge planning. When I used to work in a setting like you describe, we used to do short visits with the patient to their home, to assess for home equipment and adaptations, to see how they managed moving around their home etc. This would be really hard to do if the patients home was far from the rehab facility.

Why is the hospital they are in so far from their home?

I agree with your assessment that the proposal is not the ideal option but, sadly, that's a descriptor that can be used for at least 50% of discharges of older people who are off their baseline.

I think it might be worth asking specific questions of the hospital team about how much rehab will actually be provided in this bed (this can be impacted by vacancies, sick leave etc). If your relative will be seen by physio and OT daily, I would suck up the distance because that probably will restore their independence. If "rehab" means physio one day a week, but a care package at home would allow family to visit daily and encourage activity (physical and mental) then that might well be better.

Sadly, due to capacity and funding issues, rehab does not often meet expectations. (NHS Physio)

@Bushmillsbabe the acute hospital they are currently in is the one nearest to home but it takes them out of their county. The rehab hospital is at the far end of the county that they live in /where their GP is.

@dogscatsandbabies thanks for your advice.

I guess part of our concerns as well are that if anything were to happen whilst in rehab they'd end up in a hospital miles away, and if not ready / able to go back home after rehab, which is quite likely, we'd be looking for them to move nearer to us for temporary care, which would be nearer to where the acute hospital is.

Take the rehab asap. It’s so scarce that if it’s offered I’d grab it with both hands at the earliest opportunity. Once there and you can see how / if they’re progressing then next steps can be considered.

If the centre covers the county where your relative lives, they must have experience at planning d/c for those who live at the other end to where they’re located.

If you do go ahead with the further away rehab hospital. Put in request for them to be transferred to a closer one as soon as a bed becomes available. This happens frequently where I work.