Dad being difficult in hospital - they've said they will discharge! Help!

[RentalsDrivingMeMental]

Dad, 87 is currently in a community hospital receiving physio due to his mobility problems. He was in a medical hospital being treated for low blood pressure, complaining of pain in his feet, and feeling generally unwell. He is also under consultants for his bowel (long term constipation/diarrhea) and his bladder (retention). He is (only recently) doubly incontinent. Dementia has been raised but hospital Dr says they won't assess whilst he's in hospital as it won't give an accurate result.

Dad is frustrated at not being able to walk, mentions being in pain with his osteoarthritis (paracetamol, ibuprofen, codeine don't eliminate the pain) and is now becoming quite agitated on the ward. Mum (85 and a recent bowel cancer survivor) has been told that they may discharge him into her sole care if he doesn't listen to staff and do as he's told.

Obviously mum is scared at being left to cope with dad and his increasing needs. Any advice?

Thanks

Who has told you that they’ve said this?

They have to do a care plan before discharging. This is coordinated by a social worker and allows for care and equipment to be set up before discharge. www.nhs.uk/nhs-services/hospitals/going-into-hospital/being-discharged-from-hospital/

Ask to speak to his SW and ask what is in place?

Speak to PALS if you don’t think his care/discharge are being handled appropriately.

No wonder your poor Dad is agitated with the pain he is in, hospitals should be well equipped to cope with this surely? Sorry you are going through this and your Dad.

I wouldn't expect they would completely push him out.

They may move him?

Oh they can and may well discharge. happened to my DF back in January. He was back in hospital within 48hrs mind you.

You can do several things:-

• give your DM permission not to have to care for your DF alone - she needs visiting carers at absolute minimum, and may need to consider care home for your DF

• get on to Social services for both your Mum and your Dad to be assessed, your Mum as a carer, your dad as the caree. They both have needs, some of which will be diametrically opposed

I wont sugar coat this Rentals - You're in for a rough ride

@Soontobe60

Who has told you that they’ve said this?

Apparently the matron told mum!

@SparklingLime

They have to do a care plan before discharging. This is coordinated by a social worker and allows for care and equipment to be set up before discharge. www.nhs.uk/nhs-services/hospitals/going-into-hospital/being-discharged-from-hospital/

Ask to speak to his SW and ask what is in place?

Speak to PALS if you don’t think his care/discharge are being handled appropriately.

Someone is booked already to go into my parents home and assess it for access. I'll have to find out if he actually has a designated SW - I made a referral and then dad ended up in hospital.

We already have a complaint in with PALS from March when he was taken to A&E due to faecal impaction and then discharged, incontinent and with a catheter in place, with no discharge note or any idea how to care for him. Mum was at her wits end. It took us several phone calls to GP/District nurse team to get to the bottom of this as dad couldn't explain why. We're still waiting for a response from PALS over this even though we have chased several times.

@PugMumm

No wonder your poor Dad is agitated with the pain he is in, hospitals should be well equipped to cope with this surely? Sorry you are going through this and your Dad.

I wouldn't expect they would completely push him out.

They may move him?

Yes, I imagined this would be something they would have plans on how to manage. He can't be the first elderly person with possible dementia to have ended up there.

She can refuse to have him back until they actually set up a proper care plan and resources.

Hospitals are in dire straits currently. You don't know he won't manage at home. It's very likely they will discharge home once he's no longer actively unwell or likely to be achieving any further rehab goals.
Don't hold your breath for careers coming in either. Social care is under huge pressure. Caters are simply not available.

@Northernlurker

Hospitals are in dire straits currently. You don't know he won't manage at home. It's very likely they will discharge home once he's no longer actively unwell or likely to be achieving any further rehab goals. Don't hold your breath for careers coming in either. Social care is under huge pressure. Caters are simply not available.

Of course hospital are in dire straits now, but discharge to inadequate and potentially dangerous situation should still not be accepted.

@DPotter

Oh they can and may well discharge. happened to my DF back in January. He was back in hospital within 48hrs mind you.

You can do several things:-

• give your DM permission not to have to care for your DF alone - she needs visiting carers at absolute minimum, and may need to consider care home for your DF

• get on to Social services for both your Mum and your Dad to be assessed, your Mum as a carer, your dad as the caree. They both have needs, some of which will be diametrically opposed

I wont sugar coat this Rentals - You're in for a rough ride

So sorry this happened to your dad.

Dad isn't abusive to staff, he just shouts at himself a lot for being unable to walk and is very unsettled and agitated. Mum is pretty upset over the whole thing. Theres no way she can manage all this by herself as dad's carer.

I had contacted SS before he went in Hospital for an assessment and for mum as a carer too, but it stalled whilst he was receiving medical care. Now he's in the Community Hospital (run by the same outsourced company that provide support in the home) I was hoping for smooth transition over care from hospital to home, but if they're threatening to discharge him, then that looks unlikely.

They have to complete a full care plan before they can discharge a vulnerable adult - this is the crux of the bed-blocking problem. If they could just boot people out regardless with no plan then the whole bed-blocking thing would not exist.

All you have to do is to very firmly say that your mother cannot have him home until proper care is in place. And your mother has to back this up - just say NO!

Contact the local SSD, mention the words vulnerable adult, and they then have a legal duty to assess him; then mention those words again in relation to your mother - they then have a legal duty to assess her. Put these requests in writing and copy to local MP.

The words "if he doesn't listen to staff and do as he's told" are totally unprofessional, and a disgrace.

Sadly this is what the care system is about at the moment; and I am furious that the parliamentary debate today has been simply about money with no mention whatsoever of the need to revamp the whole system so that people receive quality professional care.

And sadly you have to be single-minded and determined - the system that should be there to help you all commonly requires you to go into battle. It is so wrong.

@Northernlurker You don't know he won't manage at home.

He can't walk, is doubly incontinent and complains consistently of pain.

How would you expect him or my 85 yr old mum to manage this?

@DPotter

Oh they can and may well discharge. happened to my DF back in January. He was back in hospital within 48hrs mind you.

You can do several things:-

• give your DM permission not to have to care for your DF alone - she needs visiting carers at absolute minimum, and may need to consider care home for your DF

• get on to Social services for both your Mum and your Dad to be assessed, your Mum as a carer, your dad as the caree. They both have needs, some of which will be diametrically opposed

I wont sugar coat this Rentals - You're in for a rough ride

I wouldn’t designate OP’s DM as a carer. Insist she cannot care for him. Only way to get adequate carers allocated.

Because, as OP says, she can’t. But assumptions are made that family will cope unless it is made very clear that is not possible.

And I send you good wishes and good luck in this task.

Sorry to sound so passionate, but I have recently been through all this for my DH - it was such a stress on top of the distress of his illness. He died. I look back on that time with deep sorrow. The system that was there to help us failed us by making me fight and fight and fight to get the smallest thing. But fight I did. I could do no less for him.

I’m so sorry, Mischance. It’s totally wrong.

The hospital have a duty of care to plan and arrange a safe discharge for your father. If pain is still an issue for him that that should be resolved prior to his discharge.
There ought to be a discharge planning meeting involving all members of the hospital team - physio, occupational therapists, nursing, medics and social workers, and of course a family member. If this can’t be face to face at the moment it should be in Teams, or Attend Anywhere or a similar digital platform.
It sounds as if a significant amount of care and equipment will be needed to ensure a safe and successful discharge is achieved.
If home care isn’t available in your area, then a nursing home place,ent may need to be considered.

Contact the local SSD, mention the words vulnerable adult, and they then have a legal duty to assess him; then mention those words again in relation to your mother - they then have a legal duty to assess her. Put these requests in writing and copy to local MP.

This is poor advice. The ward will have probably already referred to social services. It seems that he is having an assessment from hospital team who will then explain care needs to social services.

Needless letters to an MP when an assessment is underway is a waste of time. It just makes work for social services managers and clogs up the system and causes a delay seeing the next person on the list.

The ward are issuing threats to this man's poor wife (herself elderly and vulnerable) - essentially telling her that if he does not behave they will send him home. This is so fundamentally wrong and the OP needs to come down hard on this, hence my suggestion for copying in to MP. This is not a normal discharge - this is the hospital behaving in a threatening and wholly inappropriate manner.

This is not time to beat about the bush. Such things should never never be said to a vulnerable relative.

This must be very stressful op. My partner was in hospital and because of his condition wasn't himself and was aggressive to staff. Security had to speak with him but he turned a corner and couldn't apologise enough.

Perhaps the staff can give him something to help him relax? As others have said they can't threaten your mum like that, she can refuse to take him home without proper care being in place.

*Oh they can and may well discharge. happened to my DF back in January. He was back in hospital within 48hrs mind you.

You can do several things:-

• give your DM permission not to have to care for your DF alone - she needs visiting carers at absolute minimum, and may need to consider care home for your DF

• get on to Social services for both your Mum and your Dad to be assessed, your Mum as a carer, your dad as the caree. They both have needs, some of which will be diametrically opposed

I wont sugar coat this Rentals - You're in for a rough ride*

I second this. If they think there is someone at home to do care they will try and discharge. My mum was a difficult patient and was discharged far too early and her care needs were downplayed. We were told her incontinence was due to waiting to ask to go and she slept “really well”. She was incontinent, barely mobile and waking 3/4 times throughout the night needing changing. We’re still waiting for her to get adequate care and it’s been 10 months. Stand firm.

@RentalsDrivingMeMental feeling for you. As others have said it’ll be a hard ride.
It should be possible to do a screening assessment for dementia in hospital, it just needs to be the correct one.
Have a search for your local Older Adult Psychology Service, give them a call and ask for advice re assessment.

So they are threatening your mum because your dad won’t ‘behave’.

Pathetic, she is not responsible for his behaviour, he has dementia!!!

I’ll tell them to stop threatening straight away and get care in place for him.

The matron shouldn't have said those things but may have been a misguided attempt to get get family to convince him to listen.

The person coming to the house for access, is probably an Occupational Therapist who will also look for any equipment that may help him. They can often advise on what care they would recommend but usually down to Social Worker or CCO to arrange.However the patient , not just the family, has to agree to this - no-one make the patient accept either equipment or carers if they have capacity.

The Dr is right that they are unliky to formally assess for in depth cognitive problems such as dementia, I hospital. The patient under the mental capacity act has the right to refuse things and make decisions, that you or others feel inappropriate.....if they have capacity. Staff should be obtaining informed consent for anything from meals, medications......amd crucially in this situation, discharge planning. If there is any consideration that they may either be confused, 2 stage assessment of capacity for each particular task should be undertaken by the relevant person. If this is not passed, some things can be effectively done in their best interest. Social worker should then do detailed assessment of discharge needs..which may end up with them putting carers in even if he doesn't want them.

Now if he is found to have capacity, he has the right to refuse everything......in which case if he isn't engaging and actually following advice ...then they are probably left with no choice to discharge him. In this case , make sure you get any contact numbers for your local social services, amd therapy teams, so that you or gp if appropriate can refer your dad to them upon discharge. ....but generally someone in a hospital bed will get priority into provision of care.