Care on discharge from hospital for immobile relative

[GullyGull]

Wasn't sure where to post this and got directed to here. Would really appreciate advice.

If an elderly relative is in hospital and is immobile long term, what happens on release if no family are able to take care of them?

Does the person have capacity?

diminished but not formally diagnosed as she hasn't left the house for years. Her husband used to do everything for her and he's now had a massive stoke so unlikely to have any kind of capacity.

Family, one lives 6 hours away with no room and small children to look after. Other family overseas.

They should have an assessment before they are discharged and appropriate care package put in place. Generally if there is likely to be an improvement in mobility in the short term they will be transferred to an NHS rehabilitation unit. If they are likely to need a considerable amount of care then a care home option will be discussed. The in between option is carers at home. Who pays depends on the person's assets and income.

They should be offered a max of 4 visits a day to manage care needs
Housework and laundry, shopping would probably not be covered
Residential care would be the other option
Funding depends on financial situation

Think it’s really important that neither patient, nor hospital assume that the family are going to be there when patient is discharged.
Been caught out with that, where patient declared ‘family will care for me’ without discussion, and as the family member doing the pick-up it very much fell to me. Lesson learned.

You need to make it very clear what family support is available or not. Hospital based OT assesses home environment, puts in place any adaptations and equipment and should refer onto intermediate care team to provide ongoing support (carers, physio etc). Ask if there is a Rehab unit bed available if discharge is proposed but no in home support available yet.

The hospital must arrange assessment and appropriate care package. This is why so many elderly people end up staying in hospital for weeks. But it isn't the fault of families who have jobs/ children/ other responsibilities.

My father told hospital staff that he lived in a residential care home (which was true) and they shipped him out of the (cancer) ward quicker than a knife through butter. We had Power of Attorney over his health and financial affairs but no one consulted us.
Whilst it was therefore fabulous that he was beautifully cared for once he returned there, what hadn't been addressed was funding. At that point in his illness he qualified for all his fees to be paid (terminal prognosis/end-of-life care) but we only found this out by accident.
It was a very lengthy process applying for a CHC refund, but we managed it in the end.

My DM was in hospital after contracting gangrene and after surgery was wheelchair bound. My DF said he couldn’t look after her and they arranged for her to go into a local care home. The home took all her pension, but my DF didn’t have to pay the balance. I don’t think they asked if he could pay any more. As people have said a care package has to be sorted out if she is to be sent home.

Ask for reablement care. It's 6 weeks of funded care, not means tested, for people being discharged from hospital to allow them to go back to living independently in their own homes. It's often not publicised but is there for exactly this reason, to help patients be discharged. What this does is buys you time to ask for further assessments to be done about their long term needs. Be very assertive about this.

An ex-colleague of mine is now mid 80s, a widow with no children, nieces or nephews.
She was living alone with a cleaner and gardener/ handyman coming 3 times a week and keeping an eye on her.

She still did her own shopping daily at the corner shop and it was them that went and found her when she didn't appear one day.
She had fallen and went into hospital. After six weeks or so, she was immobile and clearly unable to go home so her goddaughter and a friend from church organised for her to go into a nursing home straight from hospital'for recuperation'.

It is now about a year later, and her house has gone on the market this week.

The goddaughter and friend now have both POAs and have organised this. They removed a few personal pieces then just handed the house over to local house clearance to empty it, then got professional cleaners in.

So I think rhere needs to be someone to make things happen. Someone with the person's best interests at heart, although if they can't care for the person themselves.

What’s your part in this OP? Are you a child of this couple? It’s not completely clear from your posts which of the couple is in hospital and immobile and which is at home (but I may be being slow on the uptake!)?

Is it the husband was ok and caring for his wife, but has had a stroke and is in hospital, and is now immobile? And the wife probably won’t be able to care for him but no one knows her condition / whether she can care for him at home?

Capacity usually means “is able to make rational, informed decisions” not “is able to provide care”.

Who is looking after the wife now if husband is in hospital?

Family need to make it very clear to the discharge planning team/OT/Physio etc that there will be NO family support at home. I've seen it so many times, when the patient will tell staff 'oh yes, by daughter comes daily, or my son will be helping me' when in actual fact, their child lives abroad or in a different part of the country!!!

People obviously want independence and often believe they are able to care for themselves- when they can't. Hopefully your relative gets an appropriate assessment and either help at home, or a care home.

The maximum funded visits per day in their own home will be 4. (Although if they have money they'll pay for that themselves anyway, unless they can get Continuing Health Care, usually for terminally ill patients)

Personally, I don't think that's any way for someone immobile with no other help to live, but ultimately the decision will probably rest on who's paying for it.

If the patient has funds, they can arrange whatever care they want/need.

The family will need to be very clear about what help they can/can't provide. IME hospital OT's only aim is to get the patient out of hospital and they can be downright nasty in the emotional blackmail they use to achieve that.