How to get pre and post op help with hip replacement

[Mascarponeandwine]

My dad had a hip replacement two years ago, and received no help (apart from the actual op and a three day stay in hospital). No pre op assessment, no mobility aids apart from crutches, nothing post op (he was discharged and that was that). Is this normal? He lives completely on his own. He did tell the hospital that he lives on his own and the HCP shrugged and said “you’ll manage”. (I found this out at a later date). I am his only next of kin and never spoke to a single employee at the hospital (there was no one around when I visited, or when I collected him on discharge).

Anyhow, he needs the other hip replacing and is on the waiting list. Is there any way to get him some additional help? Even a call or visit from a district nurse would be more than he got last time! Did he get forgotten somehow? He could easily fall over on the first night home and there would be no one there to know. For various reasons it is not possible for me to stay with him.

I’m sure there will be others on here to offer help but firstly I’d get a lifeline installed - then if he does fall he’s only got to press a button.
There are social services based in hospitals so I’d get in touch with them and see what they can offer post discharge.

Might be worth asking for an ot assessment now as his mobility must be limited.
Chair height, toilet raiser, grab rails etc...... and maybe look at private care package for when he come s out? Contact local social services for contacts- often on their website.

Was an assessment not completed in hospital by an ot or a physio in the hospital? That’s poor. He should have been sent home with any equipment and a print out of exercises from the physio.

Just make sure this time there is...if the OT assessment deems he needs help they will arrange some with the social worker.

You could arrange practical help too. Maybe a private cleaner / someone to do laundry?Batch cook some meals for him for the freezer? I did this for my daddy - made life easier for me and him!

Yes the physio did see him, he was the one that said “you’ll cope!”. I suppose he did at least get crutches , but it seems like the bar is very low for what we are allowed to expect from the nhs.

He has a cleaner and had ready meals etc, so that part was ok. It’s just the first few days/week, where I would’ve thought someone from the nhs should follow up on a nearly 80yo living on his own... He couldn’t even find someone to take the stitches out two weeks later - gp surgery refused, hospital said nothing to do with them. It was only when he got a taxi to the health centre and had a melt down as so frustrated and poorly, that they sorted something out.

God that’s awful. District nurse came to my dad only the once to take out the staples. He was independently mobile with his 2 crutches and able to do stairs so he was sent on too.
I think a lot lays with family. In regards to falling we were told to get the lifeline too.

I agree It’s not the best. I can’t understand why the discharge “left it to family” when they had no idea if he had any family or not! I never met any hospital staff, and no one else visited him (he’s widowed and I’m the only family). Maybe they just don’t bother with anything over and above the barest of minimum, unless someone forces them or says some magic words (safeguarding, duty of care etc)

I’m not sure what you’re expecting. He said in his 70s so not terribly old. A district nurse turn up and do what? Just look at him? There should be advice re removal of staples or stitches etc. Genuinely not sure what you think the NHS should provide to someone who has a cleaner and regular meals. Assumedly he has capacity and would have described his circumstances to the staff. There would be no reason to discuss it with you - in fact very wrong to do so without his express permission.

If you think he cannot cope ask for a social care assessment. Sometimes there is a discharge pack for about six weeks if they need help dressing etc. Otherwise you can pay for a carer to come and check a couple of times a day. Maybe cleaner would pop in more frequently for a few weeks. I need truth the greatest risk is falling and a district nurse or carer isn’t going to prevent that. You don’t want him to become dependent on a rollator, if he doesn’t need one. Confidence is the best way to prevent falls.

I suppose I would’ve expected something more than, well, nothing.

Ward advice regarding removal of stitches was “make an appointment with the nurses at your gp practice”. Not much good when they “don’t do that” (their words).

A couple of his friends of a similar age had things like a pre op ot assessment of their home to see if they needed any equipment (grab rails, raised toilet seat etc). Also a district nurse visit the day after being discharged to check he was getting on ok in the first 24 hours. This was all nhs.

I mean, we are in a crowded county in the SE, but even the sparsely lacking post natal service managed to rustle up a midwife home visit for each baby in the first 24 hours. I’m amazed they can just discharge an elderly gentleman and there’s no follow up.

My dad had the OT visit him at home to suggest chairs, toilet seats, grab handle, shower stool etc etc This was about 3 years ago. I don't remember him having any other home visits he had to go back to hospital for physio.

My dad had two dislocations after and they ended up redoing the op. It was horrendous as the second time we were waiting hours for an ambulance while he was in agony.

A panic button sounds like a very sensible decision (we've had relatives with them). I would also ask for some home care a couple of times a day for the first few weeks.

This seems really odd. When both my MIL and my DF had serious operations, before discharge a care plan was put in place via the discharge team and hospital social worker. My MIl went to respite for a further month, my DF had carers coming in daily. Both had their sutures removed before discharge though. When I had a growth removed, I got a letter for the practice nurse team to remove them a week later, with a dedicated phone number .
Are you sure your DF didn't tell them he didn't need help at home? If you make sure next time that you do speak to the doctor on the ward, discuss support on discharge and tell them your DF has no one at home to help him somcannot be discharged until a care package is provided, then they will have to take action.
I would also advise you to ask your DF to complete both health and financial powers of attourney before he has the op. They are easy to do online.

LPA only comes into effect if your father loses capacity and has an LPA already registered. Having one in place does not confer any additional rights to involvement or decision making whilst he retains capacity. It’s a good idea for everyone though in case capacity is reduced at any point.

Tell him to ask for a proper assessment prior to discharge. There should be access to raised seats etc. My mother had four weeks of carers twice a day - but she was, in fairness, deaf and blind as well as having a fractured femur.

We set up both the LPA (health and financial) using a solicitor a few years ago. I also completed something at the gp surgery that means I can talk to them about his health / medical matters.

Recently had hip replacement, left hospital with grabbers, and sticks, special chair loaned as can’t bend too much. Also had zimmer, equipment was available to borrow through local council but they need referral from physio. No visits from anyone after surgery. Had to do own dressings. Saw no one till 12 week check up. One of the handiest things I had were little sort of wrist loops for my sticks so I couldn’t drop them.

I believe people are entitled to reablement for free for 6 weeks after hospital discharge, if they are likely to need help:

www.nice.org.uk/guidance/ng74/chapter/Recommendations#core-principles-of-intermediate-care-including-reablement

I suggest somebody asks the hospital before the surgery to refer your relative for a referral for reablement.

I’d also ask about bed based intermediate care. See:

www.ageuk.org.uk/globalassets/age-uk/documents/factsheets/fs76_intermediate_care_and_reablement_fcs.pdf

I’ve asked about the six week reablement, but it won’t be considered in advance here. It’s only set up post operation. I don’t know why the hospital didn’t refer him, as he’s on his own. Do the hospital do nothing about aftercare unless asked? Surely they have some sort of duty of care when discharging patients??

My mum fell and needed a hip replacement recently
She was in nearly three weeks but she has a type of Parkinson's which is why she was in so long. Most on her ward seemed to go home within a week to two weeks. My mum also lives alone
She got physio on the ward and before coming home they arranged a commode from occupational therapy
She was told she gets 6 weeks care, she got 4 calls a day, breakfast, lunch, dinner and bed.
At first they helped her do things now she is doing stuff herself. We have had some issues and I will be complaining after the service ends next week however on the whole it has been good
As my mum fell ill with a chest infection during her 6 weeks she isn't where she should be so we are looking at paying for morning calls for a bit longer. The care providers were trying to say she only got three weeks provided but she did get the 6 weeks in the end
Good luck

On and she got physio at home though he only came twice, each time when she was too ill to really stand.
Occupational therapy also got raiders on her sofa and a raised seat in the toilet as well as a shower chair

She left hospital with a zimmer

Oh and she already has the lifeline at home, it's well worth the money

If he can afford it, buy his own aids for at home, either look on ebay or go to Argos, it is fairly cheap to get zimmer frames, raised toilet seats, shower stool etc, get someone to fit grab rails wherever he needs them. I'm probably having orthopaedic surgery next year & other than a stair lift if I get a new home, I'm not asking social services for anything because you can be waiting forever.

Surely they have some sort of duty of care when discharging patients?? The aftercare isn't their responsibility, but yes they have a duty of care, and in particular a performance indicator around premature re-admittance. So phrases like "unsafe discharge" can be handy. Be prepared to be determined to the point of bloody mindedness.

They won't look at reablement until after the op because it's not till after the op that they know what reablement is required. They can move quickly once they know what they're dealing with - be prepared for major changes with, if you're lucky, a few hours notice. The 6 weeks is a max. If they think you are coping after 3, then it'll stop, And if at any time they think you'll need continuing care, then the responsibility transfers to SS, and help will be means-tested.

I also completed something at the gp surgery that means I can talk to them about his health / medical matters. You'll need to do that separately for the hospital.

Ward advice regarding removal of stitches was “make an appointment with the nurses at your gp practice”. Not much good when they “don’t do that” (their words). It would be the district nurses who do the stitches, and they're accessed through the GP. Not the practice nurses who don't do home visits or stitches removal at the surgery. I can see how confusion can creep in.

He needs to be very clear about the things that may cause him difficulty at home, and to say that he doesn't have family who can help - elders are often reluctant to say this, because it reflects on their ability to maintain a picture-book family life. They tend to overstate the help they get from family and give totally the wrong impression.

SS Occupational therapist can order aids for home. They're on loan, so don't have to be paid for. But sometimes are slow in coming (days rather than hours). If you buy your own, you may be eligible for VAT relief - I think it's if it's a permanent need rather than a transient one, so not temporary crutches after the op, but if the op leaves him with a permanent unsteadiness requiring hand rails, for example. (Really saying this for other people reading the thread who may not know about VAT relief). But not every outlet is set up to give you the VAT relief - it's easier if you go direct to the supplier rather than, say, via Amazon.

You can loan aids from Red Cross like Zimmer, grabs etc

If you haven't already, it's a good idea to get a key pad entry put onto the exterior wall
So if carers need to get in, they can

If your relative needs regular medicine, you can get this delivered free from local pharmacy, if you fill in a form. Then phone for any future

I was a district nurse for many years. Never did we do welfare checks on people post op to check they were ok. That would be hundreds of visits per week just doing that. Impossible. The service is in dire straits as it is.
Make contact with social services, but IME, older people refuse carers etc because regardless of saving all their lives for a rainy day, when it comes down to itmany don't want to pay. It's very common for them to say family will help. They'll take him at his word.