Transferring from hospital to care home, advice needed!

[41notTrendy]

Have posted on here before about my DGrandad.
He has been in hospital for 2 weeks due to general frailty and a urine infection. As a family we have been struggling to cope with him, he is on his own at home and rings us all hours of the day and night for a variety of, usually non-urgent, things. He has carers, which are not brilliant and tend to miss when he's not well. And if he ups the care package (which happened last time he was in hospital) he cancels it back to just 3 visits a week when he gets the bill!
We seem to have now got him to realise he is not coping at home. My DM has found a good care home, with a place.

He is going to be assessed at some point in the next few days as the hospital say he is ready to be discharged.

We have discovered this morning that if he insists on going home, then social services will up his care package and discharge him to home. He is generally quite frail and forgetful, so does anyone know if we can be present when he is assessed to paint a clearer picture of his needs?

I am so worried as my mum is just not coping with him when he's at home and with her and my Ddad being in their late 60s, their health is also suffering - from the worry, the constant phone calls and also the emotional pain of it all. It seems that we had light at the end of the tunnel, but now? Not so sure.
Any advice?

I work with elderly people, so from a professional POV - you should be more than welcome at various assessments (occupational therapy and social worker) so long as your grandad is happy for you to be there. When it comes to deciding where he is to be discharged to, if the doctors looking after him in hospital feel he is of sound mind and has capacity, he will be the person who decides where he is discharged to, ie. home or care home. You are free to try to co-erce him into what you feel is the safer environment but the decision would ultimately lie with him. If however, they feel he does not have capacity (often due to memory problems) then a decision will be made as to what his best interests are - more paperwork & meetings. Hope that helps.

Thank you for that. We understand if he really wants to go home then we have to respect that. But we know he'll get another infection (permanent catheter) and he'll press his red button and be back in hospital and it all starts again.
But it's good to know we can be there when things are discussed.

Yeah, this is a problem more people need to know about. My Dad was cavalier about pressing the red 'help' button when Mum fell over, to get someone to come round and get her up. All very well - but when this happened, say, three times in maybe half a year, they said, into hospital she goes, she has a urine infection. And we'll keep her there.

Meanwhile, the ward doctor put my mum, who has Parkinson's, back onto Motilium. Now, google motilium and try to figure out why this isn't a good thing to give someone with Parky's. Here's a clue: a side effect is that it inhibits the dopamine receptors. We only figured this out later.

Anyway, soon it became a case of, your dad can't really cope anymore, can he? And look - she's obviously deteriotated. It's time for a home!

So that, it seems to me, is what that red button is for. Push it once too often, and it is used as evidence that you either get full time carers in, or it's a care home. That decision has cost us something like, what £60K that last year. Or rather, it's cost my Dad, or our inheritance (an inglorious comment I know, but still). And all because it was too much to send a couple of burly guys to help pick my Mum up off the floor. Honestly, had we known I'd have paid for a taxi and come round myself, would have been cheap at half the price.

Oh, if you're looking at homes, here are a few things.

1. Do they allow evening visits? Some put the residents to be at 6.30pm! Great! Just when the good telly is getting going. Don't see the point of this, why not just wake them later. Of course, you find this out after you're committed. Which means, it's weekend visits only.

2. Are the residents barking? This seems a bit mean, and if your parent fits the bill, then so be it, fair enough. But it can be distressing to see a quiet, reflective mum who can't talk surrounded by those with dementia, of the noisy, fishwife type. Just ask, how many in the care home have dementia? You could visit, but they might be having a quiet day and you could get the wrong idea. We did, with one. Hardly one person who could talk normally.

3. Get a vibe about the nursing staff. Don't talk to the proprieter, he'll be all jolly. So would you, if you were a millionaire. Hmm, can't say what I'd like to here, but let's put it this way. Sri Lankans, and maybe Chinese care staff seem a bit kinder or more emollient than others. That's as far as I'd go - or is that a kind of 'positive' racism too? You can look on the Care Quality Commission website, but they tend to only have good reviews cos face it, no one is gonna slag off a care home if your mum or dad is there, it's asking for trouble.

4. This is important: is it airy? A lot of care homes just pump the heating up, deyhdrate the residents (easily done as they can't drink much) and age quickly. Only one in the last three care homes had normal air, like at home. One had heat coming out of the floor.

5. Wide corridors? Can be helpful for walking someone around with a wheeled Zimmer frame, to get a bit of excersise.

6. Do they make any kind of activities?

Like having cats around to jolly the place. And do they include everyone in it? The problem with semi-civilised places is I've found they tend to leave the more 'advanced' to their own devices, ie sat in the chair in front of kids' TV. Even the place now, a massive flatscreen - and they'll be sat in front of MTV R&B. Great.

Oh, and is it one of those places with beepings the whole time, someone pressing their alarm or shouting out 'Nurse! Nurse' ad infinitum, whether they need help or not. Unless, sadly, your parent is one of those types, in which case, my apologies. But it's easy to not consider this stuff, as the CQC doesn't quite give the full picture on its website.

Thank you for your reply! Sadly, things have changed. He's still in hospital and carers are being arranged 4 times a day. The hospital discharge team have been appalling and made several errors in passing on (or not!) accurate information. He was due to be discharged on Monday next week, however, today he has been put on oxygen as he's struggling to breathe. We're not quite sure why, they say its because he has COPD, which he was diagnosed with about 4 yrs ago. But, when he was in the same hospital as he's in now, last year, they said he doesn't have COPD! But now he does???! So, his discharge is now presumably in doubt.

Hmm, some typos in my post. Should read 'put the residents to bed at 6.30pm...' Didn't there used to be an edit button here? I remember editing my Checkatrade post, or was that on another site?

Sometimes an edit button can be good to mollify the tone of a post.

Or like, ignoring 41notTrendy's above post.

I think it helps to get hold of the medical notes. Thing is, when we asked for those from the GP, assuming it meant a sort of CV of her medication over the last 10 years, they charged £50 and we got her entire medical history, including what she weighed at birth.

There is a point where you can sort of wing it with this stuff, and other times when you need ALL the facts to hand, such as if a parent can walk and stuff, film it on camera phone and make it date sensitive ie have a newspaper nearby. Try not to pick one that says: Tories Increasingly Unpopular or Arsenal Underperforming or Kelly Brook's New Look as it doesn't tell you much.

TBF not sure anyone will really do that though.

Hello I am a nurse but also went through this with my nan. Unless he has dementia or some other mental health issue that would impact his ability to make an informed decision he can't be forced into a nursing home.

You might be able to talk to the social worker about him going somewhere locally for day care, this might encourage him to consider the benefits of a more permenant placement.

Sorry to hear he is more poorly again, copd is quite difficult to diagnose and is usually a group of symptoms where no other obvious cause has been found.

I would push strongly for a home visit prior to his discharge with an o.t if possible as well.

Hi

Have you considered a respite placement for a couple of weeks ? would he go for that ? That way he could see first hand what a placement was like on a very short term basis. Also is the red button telecare equipment/a life line ? you can pay a small amount extra per week for a response team to attend to him when he presses it rather then you having to respond.

Thank you for all the info. Good idea about getting his notes, we suspect some details on his hospital notes are inaccurate. They have his bmi as 14/15 which we think given his weight would put his height at 5'3". He's 6'!
He won't consider respite. He just keeps saying he wants to go home.
I will find out about the response to the red button, that would be a great idea. Thanks.

agree with you profdent that red button varies from place to place - my mum just wants to alert the carers at 6am that she is wet and wants an early call - rather than wait until 9.30/10am as usual and she presses button and instead of getting a call centre, she gets an ambulance. If she needed an ambulance she would call 999! Some areas run the button as extra help like a warden in a sheltered complex but not my mums area.