Struggling with my Dad

[welliesarefuntowear]

I feel like I've been dropped into a new world here. My mum died on January 4th. My Dad was initially coping well but has got terrible sciatic pain due to degneration of the spine. I'm at the end of my rope trying to care for him. We've had an ambulance out to him twice this week, he was retaining urine on Wednesday and released fromA and E with a catheter and today he was in such pain I thought he was going to pass out. I've got him home, I'm staying with him tonight and I've just got him into bed. We don't seem to be controlling his pain adequately, the pain relief he has is codeine based and causing him constipation. I think he needs nursing care, perhaps in a home, even if it's just for the short term. How do I get him assessed for this? Could anyone advise me, thanks.

Wellies that sounds awful. Not an expert, but would gp be first point of call to try and get pain relief sorted- then adult social services? Google your county council social work team- ours have 24 hour number. Was there a discharge team at hospital? Sounds like rehab could help short term.
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In theory, via the GP, or via Adult Social Services. You can ask Social Services to do an assessment of his needs, and of your needs as a carer. I have no experience of this.

Does he have District Nurses coming out to him? They got the ball rolling in my father's case.

I have just been through this for weeks on end on behalf of my grandmother. I tried the local impact team, adult social services, GP for referral to rehab centre and then the hospitals care package. The GP had to refer for impact team and rehab centre. Adult social services had a 3-4 day wait for a call back. Eventually we got some help hrough the care package put in place by the hospital before she was discharged. It was a physio doing an assessment of her needs. Unfortunately, they discharged her 5 times in 7 days without adequate care in place and she died following this on 1st March. I had asked them to not to discharge each time. I have never experienced anything as awful, made hundreds of phone calls and was passed here there and everywhere. Eventually I contacted PALS complaints who sent matron down to talk to me within minutes of my call and who agreed she needed rehabilitation and not discharging, but by then it was too late. I hope you get the help you and your dad need.

Are district nurses coming out to see him, does he still have a catheter in. I would call for either his g.p. or out of hours doctor to come and see him, if he has urine retention, constipation and uncontrolled pain he needs a proper assessment and push for him to either be in hospital while they sort this out and refuse to take him home until he has it all sorted. Longterm he should have a care needs assessment, a home visit by therapists to see if he would benefit from any adaptations to the house, assess for carers coming in, who do they think will care for his catheter and bowels?

I'm sorry for your loss OP

and I'm sorry you've barely had time to take a breath before this appalling treatment of your Dad.

What's the start of the chain - constipation can cause urinary retention - so could the whole thing be that he can't take that painkiller, or possibly he needs to take something alongside it to stop other problems?

It's terrible that you might have to point this out to the GP but you might. I couldn't tolerate any strong painkillers after spinal injury and found out - after discharge - that I should have been given something to protect my stomach alongside them! Two different doctors and hospital never mentioned this, even though they knew I had to stop taking the pills. So you might have to really push.

in terms of nursing care, it's adult social services I'm afraid. what is the funding situation for you? If you are self funding you might be able to get him a place very quickly.

Thanks for your responses. No discharge team, no advice about how to care for Dad, I have got number for adult social care team through social services. I need to ring them and get him assessed . He has his own house, and some pension due from my mum which we've taken as a lump sum. My biggest concern is his risk of falling over.

Also in response, the codeine caused constipation which meant it oressed on his bladder. The macrogol was given to him but he had been constipated for four days at this point.

I'd have a think about what you want to happen

there was a point with my dad's adventures in hospital, where he was discharged and I thought he needed more care than mum and I could do. But when we spoke to the discharge team they said "why? He is mobile, he has medication".

It's a pretty low bar I think in terms of getting any state care. If he can pay for private care, it's different.

if you don't mind me asking, what was the reason for calling the ambulance? I'm wondering if the GP could get him admitted to hospital.

Call the council, and ask for a visit from social services, to assess him for some help at home. Tell them that you can't cope as a carer on your own. He is entitled to some free help for a period (I think a couple of weeks, I can't remember) before he has to start paying for the care, and if he has money below a certain threshold (cash) they won't charge him anyway, although they may put a charge on the house to be recovered at a later date. They will never put him out of his house, so don't worry about that. But number one is getting help at home, and perhaps think about installing a carelink type alarm so that he can wear a pendant and press it if he needs urgent help.

The first time for calling the ambulance was on Wednesday evening due to urinary retention. He had seen the GP that morning. The second time was yesterday afternoon because we couldn't manage his pain. He has an appointment with the fracture clinic on Tuesday afternoon at the hospital he was sent to. I think this is the point I will bring up about his care needs, pain management and physiotherapy. He has already seen a spinal specialist at a different hospital, still nhs, which he was referred to by his GP. He is supposed to be having an injection in his spine. However, despite an urgent referral being sent by his GP on Monday to expedite this appointment there is still no date set.. The secretary has been on annual leave and is back on Tuesday. It seems as though I can't close the loop on any of this.

Can you take him back in to A&E with impacted constipation? It'snot safe if it's pressing on his bladder and his degenrated spine. Poor you and him.

As my gorgeous F-i-L says, growing old has nothing to recommend it.

how is his pain now?

If the main issue is pain relief, could the GP do a home visit tomorrow?

be aware, the macrogel might not seem to be working and then might suddenly work very well!

How old is he if you don't mind me asking?

Hi, he's 79, 80 in May. He's presenting unusually as he's been very fit and capable of cycling 20 to 30 miles as recently as three weeks ago. Dads, constipation has gone now, as you said the macrogol worked very suddenly. I've rung him tonight after being with him the whole weekend and he seems happier and more settled. He's got the number of a lovely neighbor who will come round to him in the middle of the night if he rings. She was a good friend of my mum. She made us a chicken dinner today with veg and gravy. I think there has also been a massive grief reaction here. The A and E we have been too is where mum died very suddenly after a brain haemorrhage. So, although he's clearly been struggling with this for a little while, was diagnosed in December with it after an mri, it's been an emotionally very tough time. We did have quite a nice day today. My mum liked to collect wade ornaments and she had them on display in a unit. It was all dusty, so I photographed them, cleaned them all and put them back in exactly the same place whilst Dad did the crossword and listened to Rado 4. I suggested going for a run out in the car. Whilst getting ready he had another pain flare up which we managed with ibuprofen and diazepam. These sudden pain flare ups have caused him anxiety and struggling to sleep. He doesn't know when they're going to hit and he's not used to this. We managed to go out in the car for a run in the country and he said the car chair was really comfortable. My brother has ordered a new orthopaedic chair for him, which should arrive this week. I've just got to get a clear plan going forward. I'm going to ring his go tomorrow and ask him to prescribe naproxen as ibuprofen has helped. I think he needs anti inflammatory medication. Wow, I've written a massive post!