Legal rights of family V 'state' in care of elderly DF/ DM

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Sorry if this sounds more dramatic than it ought to but looking for some advice in case needed.

DF was admitted to hospital following a fall. He's ok but also has dementia so he's not settled very well. He's now been there for over a week while they work on his mobility.

The plan at the moment is to discharge him when he can walk better but in all honesty he's walking less there than at home- he's sitting most of the day.

The drs are talking about a multi-disciplinary approach to his future care including adaptations at home- like lots of hand rails, equipment etc so it's safe for him.

My mum is a bit shocked at this- she's cared for him for 3 years and they manage quite well. She's not delighted at the idea of lots of rails around the house partly because she doesn't think it will help dad anyway, but also- they are on a small budget- she's recently paid for lots of decorating, home improvements etc , which in her eyes would be 'ruined' by mobility aids she doesn't think would help him. I don't want that to sound selfish- mum has devoted herself to his care for 3 years and is in her 90s too.

As a general point, can we as a family ask for his discharge from hospital even if he is not 'ready' in their eyes and also can they force mum to make her home 'suitable' for him against her wishes?

It seems he is now in the system and being processed, without family wishes or input being taken into account.

Does the state 'own' his care rather than family? (my mum, me and my brother had POA.)

The consultant is responsible for his care and will be making the decisions, but those will be based on what the physio and the occupational therapist are saying, and you can certainly influence them.

Go in for the day and talk to them. Good questions to ask - 'what are the barriers to him going home now?' Get them to be specific. I think the point of him doing less exercise in the hospital is a good one. Say that you are prepared to give 24 hour care as a family. I would leave the question of the mobility aids fluid but ask to take him home before they are installed. See how you get on before deciding. You are right that hospital is not good for people in his situation and he will already be weaker.

I don't think it's wrong that the consultant is responsible for his care. But a determined family should show the consultant that you will care for him better than the hospital team.

Woah! Really sorry, missed the POA line! Yes you can make the decisions, bugger me sideways! Sorry, yes you can take him home without an issue though if it is against medical advice you might have to sit there while they explain that.

They will be working on the assumption that most people want the rails/equipment etc.

If you don't want them, tell them.

If you have POA for health and welfare decisions (this is completely separate to finance POA) then you become the decision makers on your father's behalf if he has lost mental capacity. Unless the state has serious concerns they will go with whatever you say.

It doesn't sound from what you have written like anyone is trying to force anything, they are just offering the standard services that are available for people in your dad's situation to go home with.

It's actually quite refreshing to hear that there is a multidisciplinary team at the hospital actually working together and offering the appropriate services to get him home. I'm actually slightly baffled that you think it's an issue?

Thanks so much. I live 300 miles away and as yet have not visited due to my own issues here with a building problem on my own house.

Mum made the point yesterday that he was walking less in hospital than at home. They said 'he's getting some physio' but we suspect it's no more than 15 minutes walking up and down, which is nothing out of 24 hours. At home, mum bullies him to walk around and helps him.

We were all a bit freaked out at the idea of social workers, OTs, physios etc being involved and suddenly felt we were losing control. Mum is on the ball, devoted to him, and they are very independent for their age- in fact everyone thinks she is 10 -15 years younger than she is.

He was supposed to stay in hospital overnight for obs after being taken in after his fall, and now it's going on and on with no real benefit it seems for him.

I was worried because I seem to have picked up here on other posts that the state has control not family.

Really if you think of the consultant having responsibility, rather than the state having control, you might feel better about it. Bear in mind that he did have a fall at home - not surprising and he could easily have more in hospital - but that might easily indicate that a grab rail or similar really would help.

It's actually quite refreshing to hear that there is a multidisciplinary team at the hospital actually working together and offering the appropriate services to get him home. I'm actually slightly baffled that you think it's an issue?

This is the theory. From previous experiences, there has been one cock up after another. (Had he been monitored properly over time for his various conditions he may not have fallen anyway...long story.)

I'm reporting how my mum feels and asking for advice.
She knows him best and knows that all the handrails in the world are not going to be of that much help.
She was under the impression they would not let him home until it had been adapted - some of it against her will. We are thinking they may be holding him there until the home is 'safe' in their view, when in fact he's walking less all the time he is there, getting more confused and being aggressive and downright nasty to mum when she visits.

Yes he did have a fall at home and he had another one in hospital 2 days later due to not being supervised when he used the loo at night, despite mum telling them he had not to go to the loo at night, but use a bottle which he does at home. They also lose his hearing aids daily - between bed and breakfast- so all in all it's not good.
I 'm not being arsey over this, but as I'm far away I am trying to see both sides and help my mum.

In lots of people's opinion (backed up with statistics) hospital is the absolute worst place for very elderly people, unless they actually need surgery or something.

When my mum was taken in after a fall she immediately got very confused (it has a name - hospital induced delirium I think ) and also hardly walked at all when she was there.
The consultants wanted her out of there ASAP as well, due to above reasons.

She had a social care assessment at home which was actually quite helpful and they provided a couple of things we hadn't thought of.

She also had daily carers for a few weeks after the fall (provided by local borough), as she lives alone.
I think as your mum at home caring for your dad, they can 'release' your dad into her care, without waiting for a social care assessment. I'd try get him home ASAP.

You/she just need to talk to them.

As far as they are concerned their role is to provide their duty of care in making his return home as safe as possible. So yes they will be delaying discharge until rails etc are in because that is the organisationally correct thing to do.

Unless you as a family tell them that you are happy to support discharge home without the equipment in place then they will continue down that road.

They can't force private home owners to accept equipment and adaptations, but they can express concerns about your dad going home without them, but ultimately they would have to have an exceptionally good reason to go against family wishes if family hold health and welfare POA.

To be honest most hospitals if approached and told that the family wanted discharge without equipment etc and were happy to support the risks at home themselves would bite your hands off and the family member would be on the next spare seat on ambulance transport out of there.

If you genuinely think that your dad is going to be okay going home without the suggested support in place then just get your mum to tell them that she has decided to have the rails etc done privately.

We had a slightly similar situation in that my granny was discharged from hospital into a horror of a nursing home.

After a few days the family took her out of there. She lives in an assisted living flat and the problem we had wasn't the taking her out, but getting the assisted living home to accept her back without the official discharge. Taking her out with assurances that the family could and would cope and be there daily (and one of us will be there daily anyway) did the trick.

Great he can come home. I'd note that in these cash strapped days they don't tend to put a multidisciplinary team on the case for no reason, and from 300 miles a way you are placing a lot of trust in your mother's view that he will be fine without any further assistance at home. Many older people feel very defensive about their ability to care for their partner and lose a bit of perspective - they are both in their 90s and he has already fallen once, so a grab rail or ten might be a necessary pain in this situation. Can you visit before he gets discharged?

Thank you all. I really appreciate this. I feel quite helpless being so far away (it's a very long way for me to go to see them and I've had issues with my own home lately so am supervising building / repair work here.)

Mum is not being silly over it- she knows there need to be some rails at home - but she felt she was losing control of her home.

On balance, dad would be better off at home. He has developed fantasies about why he is in hospital and accuses my mum and my sister of 'putting him there to get r id of him'..so it's very upsetting for her. She's having to pay for taxis to get to visit him and when she does get there, he's abusive to her.

I'm as worried about her as well as him, to be honest. It's exhausting her and she is 91!

I have a sibling who lives 5 mins away from my parents. Between us we have found a private care provider who can help mum with dad and getting him up, helping him around the house etc. The issue is more about how MUCH care he will need and which rails would go where. I think that will be sorted, but being in hospital is not helping.

It might be worth asking the hospital if they have any kind of 'discharge to assess' or reablement pathway that could get him home quicker.

With discharge to assess the idea is that rather than sitting around in hospital waiting for OTs/physio/social workers to come and do their bits on the ward that the person goes home and those assessments happen within a few days at home.

It does sound like he would really benefit from a full social care assessment and the quickest way for him to get that is via the hospital discharge team but I understand your concern about him being in hospital too long.

Is there any chance of putting in some short term care at home to improve the chances of his recovery and to reduce the risk of a readmission. I got my mother discharged very early following a fall and UTI because I promised 24 hour care. She only needed it for three days - the point at which she was demanding the carer pay her rent was when we know she was back on form.

Or book a private physio to come in for a few sessions to help get him back on his feet. It takes ages to NHS commiunity physio to gear up., by which time any lost mobility might be lost forever. Instead someone working out an exercise programme based on his situation at home, and which your mother might be part of, could prove money well spent. We have used these people