Long term options for grandmother

[RedFeathers]

Name change because this has lots of personal details in it.

My DGM, who is 91, had a fall today and has broken her hip. She has a hip replacement op scheduled for tomorrow. At the moment, I'm trying to be positive, although I know how risky the operation itself is. But I can't think about that, instead I'm wanting to think about what comes next.

Assuming the operation goes well, does anyone have any experience of what kind of support/rehabilitation we can expect/push for her to get? Until today, she lived on her own. Her house has a downstairs bathroom and a room that could be converted into a bedroom, so technically she could go home and not need to do stairs. But she was struggling before this, in reality, and I think she needs more support - she broke a shoulder 5 years ago and struggles with that arm too. Mentally, she is still really sharp.

My parents and brother both live close by, I live an hour's drive away. I'm worried she will be sent home really quickly and my parents will be expected to care for her. This would in reality fall mainly with DM, although she is DF's mother. My parents are in their 60s and I don't think either of them could really cope with this, not in the long term.

Can anyone help give me an idea of how long she is likely to be in hospital for, what kind of in patient rehabilitation she might get and just how immobile she could be and still end up going home? Is there anyone we should be contacting now, eg social services, GP, anyone else? Never had to deal with this before and I'm frightened, for her and for my parents.

Thank you.

It can vary with hospital. DM aged 83 was going to be dicharged to an empty flat in an empty building (mainly second homes) on Christmas eve following a hip operation and without either SS or her GP being informed. I later saw reference to the fact that the hospital had noted she was very confused. Given she had not been able to give contact details of relatives and we had only found her by phoning round hospitals, some flag should have been raised.

Short term, buy time. Speak to adult social services in her town, and saw you are concerned about the scope for a safe discharge. Ask them to alert their hospital colleagues. She should not go home until a full care asessment has been carried out and adaptations organised.

Ask the hospital about rehab arrangements. DM was supposed to get a few weeks in a rehab hospital as she had also broken her wrist so could not use a walker. However the hospital sudenly decided this would not be needed. If this happens to you you might see if, as well as SS, you can get the GP on board to lobby. Be careful not to suggest there is an army of relatives reading to take on care.

If not, this might be the time to spend rainy day. I was able to find a private nursing home which could take a discharge on Christmas Eve. It cost a fortune, think £1000 a week, but worth it. It bought time to sort out my mother's accomodation - we moved her to sheltered. The nursing care was great and things like having pins taken out were able to be done there rather than taking her to the GP. She was also very well fed, it was a bit like a 5 star hotel, and there were good activities to draw her out of her room, keep her walking etc. And really small things like they had the adapted showers and we could borrow foldable wheelchairs for hospital visits. In short the six weeks of rehab were needed, its just that we ended up paying for it.

Longer term it seems pretty inevitable that there is a decline following a fall. In particuarly the General Anasthetic meant my mum became very confused. Also the sheer confusion of being in hospital and the shock. Whether she gets rehab or goes home you need to look closely to see what capacity has been lost. I already knew that my mum was struggling so the fall was a one off opportunity to do something.

If she has not signed a Power of Attorney (both types) you should urge her to do so as soon as possible.

Make sure that SS assess her flat and her care needs.

I was able to let my mothers flat, so the sheltered housing was "only till you are better". I would never have been able to get her to agree to make the move, but the company, the cooked lunch and the 24 hour warden really suit her and two years on she is relatively mobile and happy. Albeit with no memory.

You should also push for community physio. My experience was there was quite a waiting list, so ask early that she be put on it. Somehow I managed to wangle a couple of appointments with the hospital physios, who were good and who gave me some idea of how the pin worked, what she needed to be doing and why. Walking in order to build muscles, and ideally (fat chance) climb stairs.

Thank you so much for your reply, its really detailed and exactly what I was looking for. I really appreciate you taking the time to write all that. Glad your DM seems to be doing as well as can be expected. Ageing is just so brutal.

There is a power of attorney in place for my nan, so that's good. I'm waiting to hear how the operation has gone, but if it has gone ok, then I will start working through your suggestions tomorrow. My view is that some kind of rehab is vital, even if it does need to be privately funded.

Who is it at the hospital that we should speak to about rehab/physio initially? I've had lots of hospital experience with my DS who was ill as a baby and always found it really difficult to track down anyone with the power to do anything.

They will try to "mobilise" your nan in the ward first. However in our, poor, example they took a painfully slow, two inches at a time shuffle, as walking. At the point of discharge my mother could not move from lying to sitting, or sitting to standing on her own.

If she gets rehab in some sort of community hospital it should all be easier. You wont need to deal with the discharge and the rehab hospital should have easy access to community physios.

It was useful for us to have discharge straight to a nursing home as they were more experienced. It did not stop the hospital leaving my mum waiting for hours before she was finally signed out.

There will be some follow up hospital appointments, with the hip people. I pressed them and somehow pursuaded someone to phone the physio people in hospital and ask if they would see my mum as an out patient. I think by then they may have felt a bit sorry for me. I lived well over two hours drive away, and for whatever reason the hospital seemed unable to send any appointment letter to either the home she had been discharged to or to me, but instead everything went to her empty flat. (Additional tip - at discharge make sure you know what appointments will be needed, and ideally the contact, and if you dont hear, chase.)

To some extent the physio is not so important - my mother was too confused to remember the exercises anyway. That first appointment was really useful though. The message essentially was walking is the best exercise. It is very painful at first and will be for months. Essentially you need to build muscles that counterbalance some spring they put in the hip. Too many people give up. When she finally moved into her sheltered housing, I hired a carer for a couple of hours each day to take her out to the shops, with a twofold aim. First to her with her orientation (and she was far more confused then than she is now, it really took months for her to know where she was) and then to keep her moving.

I only had a couple of hours to find a suitable home. By chance, sort of at the stage you are now, I had googled and phoned the first on the list to ask about whether they provided convalescence, cost etc. They were very helpful and with it, so when the hospital phoned me to say they were discharging DM in couple of days I first checked with the discharge people that they knew the Home ("the Hilton of Care Homes in the area" apparently - though this probably reflected the price more than anything) phoned them first and they had one bed. I would really recommend visiting a couple when you next visit your nan. Even if you don't use them this time, there is obviously the chance you will need them in the future.

Sorry another essay. It was a huge learning curve.

Also don't forget applying for attendance allowancve once you can work out what help your nan will need with day to day living. Not means tested and you can spend it on anything, so you can pay for things that might ohtherwidse fall on your mum.

Again, thank you so much.

First good news is that the operation went well. My parents said she was "surprisingly well" when they saw her and she had it done by epidural so they avoided the GA problems, which is great news.

Your advice was very helpful too, in that I've now got in touch with the relevant social services team. They are based in the same hospital, but have not been notified about my nan and don't have her down on their records. It may be that it was just too early days, but either way my parents are speaking to the ward sister now and know what questions to ask and to make sure the referral goes through. It's all early days, but I feel cautiously more positive than I did on Wednesday.

My Nan is such a strong person, I hugely admire her. It took her an hour and a half to manage to get to a phone when she fell but she did manage it, and she did make it through the op. I want to make sure I do everything I can to support and help her.

Glad the op went well avoiding a ga. Do check that on occupational therapist comes to do a home assessment- they provide all sorts of things like raised loo seats with handles/ grabbers/ walkers etc which make a massive difference. Good luck

Great!

The key message to SS is that you are concerned she is not "safe" to return home, at least without:

1. a suitable care package
2. suitable adaptations

They should assess both once they have an idea of how she is. Hopefully the need to do this causes them to discourage the hospital from too early a discharge home.

Also you might want to think why she fell in the first place. Is this a symptom of an emerging health issue, too much clutter or bad luck?

Then think about what you want to happen next. For me, this was the crisis I needed to get my mother out of her home. She was not coping but would never have agreed to move. If though remaining at home is very important to your nans quality of life, eg good neighbours, shops within walking sidtance etc, and a move would mean she may give up in some way, then you could look at short term 24 hour care. Saga is one provider. The issue is that it is a not an attractive job and so carers can be great or pretty awful. FWIW we ruled it out because DM would not have tolerated anyone in her home.