Will they let him go home?

[NettleTea]

My FIL is currently in hospital.
He has, we suspect, the 3rd UTI since Christmas, 2nd in just over a month.
He also has dementia.
A couple of weeks ago he was strong enough to be walking around outside, which was raised as a concern due to his potential to fall, and we had a meeting with his home care manager and adult social care just last week where things like a GPS tracker and a door monitor were discussed, as well as concerns about him setting clothes on fire due to a habit of putting wet clothes on the aga to dry when his incontinance pads have not coped and many times they have been shrivvelled to a crisp. The fire alarm is set to be linked to my partner's phone and, as he lives very close, he would be able to come if he is alerted, as per GPS and door alert.

the meeting decided that he would continue with his 4 x daily care, put these things in place, and maintian keeping at home. The things that would cause concern would be if he took to wandering and falling, or if he needed care in the night.

On Friday his tea time carer called my partner - his dad was appearing to have a fever - he was hot, incoherant and very drowsy. he also had terrible diahorreah and couldnt seem to stand up. The carer had called an ambulance but they were going to be at least 2 hours, so DP went in to sit with him and wait and I joined later. By which time he seemed to have come around. Was sitting up, drank a cup of tea and although only chatting a little, was aware of discussion around him - ie when I was talking about the cat he looked round at the cat. The carer came back to put him to bed and the ambulance was cancelled because he appeared to be much better and it was considered that maybe he had a stomach bug

Monday morning a friend who comes in very early to let dogs out/feed them and tidy any messes found him on the floor by the bed. It seems likely that he tried to get up from bed and fell. weekend carers say that he hadnt been able to walk all weekend - though Friday was the first time he couldnt, and Id seen him walking on Wednesday. Friend said he often is up before she comes in at 5.30, or at least awake and sitting on edge of bed. He probably forgot that he couldnt walk.

Ambulance came about 8.30 and it took them til 10 before they managed to get him up and on the stretcher - just not mobile one bit.

He is now on a ward - an acute medicine and gastrointestinal ward (although that may just be where they have space) and on antibiotics. It seems that they may want to discharge him home but if he lives alone and is bedbound, and yet walking just so recently, is it likely that they will just send him home like that? He wont do physio without encouragement, and he wont remember he has to, and so without rehab he is likely to stay bed bound it would seem.

His wife was bedbound and still cared for at home, but at that point his dementia was not as advanced and he was there to raise the alarm if she fell. And she was slight, so could be lifted, even if we worried it might huirt her. But he is a big man, and nobody without the right equipment would be able to lift him.

Will they be likely to send him home and continue with him on just 4 visits a day? and leave him alone at night? Is it possible for infections and dementia to cause a sudden and permanent loss of mobility that fast? Im hoping that the current infection is responsible, and him being on a ward may allow some leeway to push for rehab before he comes home, but I dont know how feasable that is.

What would you like to happen? What do you think would be best for him? They will be trying to discharge as soon as he has no medical need to be there. The options I am aware of (there may be others) are a) discharge home on current care package b) discharge home on up to 6 weeks re-ablement c) discharge on a reablement package in a care home or nursing home with a view to eventual return home d) discharge to permanent care or nursing home place

We would like him to at least have the chance to get mobility back, so choice A is out, as if he is still immobile when he leaves I cannot see him regaining mobility without some pretty insistant input

ideally he will come home, but we are not kidding ourselves that, as long as an infection or fall doesnt wipe him out, a care home is going to be on the cards at some point down the road. He has expressed, in the past when more coherant, that he wont leave the farm, so we know that theoretically he wants to stay at home, al;though he actually may benefit more from care. He is probably right at the tipping point of the seesaw of whats best at the moment, all dependant on how things pan out.

For purely headache inducing, absolute nightmare of complexity issues around finances, we are rightly absolutely horrified at the prospect of negotiating around that, however we need to really put that horror to bed in regards deciding how things move forward

I would say that choice C would be our best case scenario - sending him to rehab to get as good as he can, before he returns home if possible

@NettleTea
Bless you it all sounds very stressful;

I'd suggest respite care as this buys you more to assess the situation and also too see what his needs are likely to be.

If he goes home I'd be disconnecting the arga and gas rings or anything else dangerous so it's not a fire risk

It's very sad isn't it but speak to the professionals and get it all in place and don't let them discharge him until you are happy with everything

Does he pay for his care or is it funded by social services?

Who has POA?
As his carers you shou,d be involved in discharge decisions, but if it was my fil with poor mobility/high falls risk who lived alone and was likely to try to move rather than stay seated or in bed then I’d be looking at respite or rehab while a longer term decision was made.

I think you are both saying what we think, because the longer he stays in, the less his mobility is likely to be.

He pays an assessed contribution for his care @Purplewithred - about £150 a week

we cannot disconnect the aga sadly, as it also heats the hot water - it was the first thing we thought of. He is also likely to put the heating on full blast, even when its 30 degrees outside.

It was more wondering whether they would actually consider sending him home, whilst not able to walk and living on his own. He wont want to go into a home, thats something Im sure of, but whether he SHOULD is another question, especially if he falls more often. He would be very vulnerable if they put a side on his bed and he couldnt sit up. I cant see it going well. Hopefully he will be offered rehab and get some independance back

It was more wondering whether they would actually consider sending him home, whilst not able to walk and living on his own. They may do. They were willing to send my father home, largely immobile, confused but no dementia diagnosis, with a bed downstairs and a commode. What they regard as an acceptable life for the very elderly is an astonishingly low standard. So you need to decide what you want for him and push hard. If you don't want him coming home, make clear the arguments against - lack of family support available, unsafe home, likelihood of early readmission to hospital etc. Putting things in wiring and getting it added to his file helps. Also get in writing the rapidity of his decline - write down his activities in the week leading up to it. It wasn't until I did this for my father that it really sank in to the hospital staff that lying in bed unable to walk, being confused with delusions, wasn't my father's normal

so FIL is still in hospital. Is considered discharged by the medical team, but there are questions over sending him home, as he appears to be very confused, even now his UTI has been treated and he now has a permanent catheta, which may help, and he is refusing to try to walk. DP has been asked by the dementia specialist to go into the hospital to assess how he is compared to his 'baseline' and he has been asked many questions by the hospital physio as to how his mobility was, prior to this incident.
Its looking as if they may send him somewhere for further assessment while they make their minds up about what happnes next.