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

@Mischance

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.

You said to contact the social services dept and copy to the MP.

The OP may well have a complaint about the staff member in the community hospital but the complaint needs to be made to the NHS trust not social services.

Have they done any cognitive assessment? You could ask for an assessment of his mental state now, separately from diagnosing dementia. In my hospital they usually do the MOCA but there are other assessments.

We had this in my family.
Your mum will have to be strong and refuse to have him home without a proper care package. She needs to be very clear and unbudging on that.

I'm sorry this is happening.

So sorry to hear this OP. We had a similar experience with my grandfather who the hospital attempted to discharge when he was incontinent, unable to walk to the toilet and with really unstable oxygen saturation because of his COPD. He lived alone at the time. They were very pushy, but did back down when I absolutely insisted that it would be dangerous for him to be at home without a plan in place. Hopefully, if you and your mum are absolutely adamant that you are unable to care for him without time to plan for carers etc, they will listen.

I think PP may be right about them trying to shock your dad into being compliant by threatening discharge, but what a cruel thing to do to a person who is distressed and confused and to your poor mum too. I do hope it gets resolved for you.

Complaint indeed needs to go to the NHS for the appalling unprofessional behaviour of the staff - although in this case is not clear whether this interim facility is run by NHS or SSD or jointly.

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.

I think the concept of capacity is a fine and good one. However in day to day operations, the bar is set very low for judging if someone has it. My DP's father has dementia and was judged to have capacity at a point where he was a danger to himself and others - peeing on to the electric fire springs to mind. Basically as he was able to string a few words together, refusing all help, all help was withdrawn as he was deemed to have capacity. Eventually resolved but it was a fight at 200 miles distance too.

Oh dear your poor mum.

She needs to speak up very clearly And very consistently if she can’t care for him or keep him safe at home. We had to coach DFIL to say this, when the hospital were contemplating sending MIL - unable to walk, stand, toilet, etc, Parkinson and dementia, doubly incontinent - back home. We got him to emphasise the safety and well being aspect. To release a patient home, social services depends on the cooperation of the carer - if that is withdrawn then they should not proceed. But silence is taken as assent - so your mum (and you if you can) must speak out, loudly and frequently.

...so the hospital needs to be told that your mother is not well herself and therefore is staying with you meantime so if they discharge your father it will be to an empty house. Your house is not suitable for your father. They have a duty of care and have to put an agreed care plan in place before discharge. He is a vulnerable adult and it is their responsibility and their problem.

“Someone is booked already to go into my parents home and assess it for access”

The hospital OT did this to my FIL too and it didn’t occur to him to say no. In fact a whole bunch of mobility equipment was delivered before it was even discussed whether MIL could come home safely!

I think that medical staff rely on older people and their families just accepting what they are told because it’s coming from “the hospital”.

It's the occupational therapist you need. That's the profession that assesses the patients care needs they complete a functional assessment to determine what level of assistance they need,how many times per day and if any equipment is needed.
They let the social worker know all that then the social worker fills out the paperwork.
Speak to the OT they Will know your father the best

@Newchances

It's the occupational therapist you need. That's the profession that assesses the patients care needs they complete a functional assessment to determine what level of assistance they need,how many times per day and if any equipment is needed. They let the social worker know all that then the social worker fills out the paperwork. Speak to the OT they Will know your father the best

It’s a multidisciplinary meeting that agrees to assess needs and set everything up. An OT cannot do that alone.

We found that the physio and the OT had the most say. When DH finally managed to talk to an actual Dr about his mum, he was told that the hospital is not allowed to make any kind of recommendation about where the patient should go - only to make the decision that they are “cured” and are ready for discharge. So it’s the OT, Physio and the SW that seem to have the most say.

Probably different in every situation but here the ot does all the recommendations. The physio isn't involved in care provision and the social worker doesn't complete a functional assessment. So the main profession is occupational therapy

My dm is currently in hospital for the fifth time this year due to infections which they cannot pinpoint. They tried to send dm home, but she’s still unwell and now has a temperature. Db is her carer and knows her meds.
Dm is aggressive, angry, confused and not what I call herself. A complete 180° in personality. Rude too. This is not my mother and she won’t be coming home until she’s well. No dementia or Alzheimer’s present as she’s had every test going.

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.

Is that Social Services Department? Sorry if that's bleedingly obvious to everyone else.

Mischance so sorry that you have to fight at such an awful tome and so sorry for your loss

The elderly are thrown out of hospital all the time into dangerous situations. My fil and mil both were, now they are dead. It was absolutely appalling.

There is a severe lack of caters right now.
My mum was in hospital for a week and got her 6 week enablement package, she's down to 1 cater a day, she's decided to pay for a cater each day but SS cant get anyone. Some of the ladies that come to my mum say they have loads waiting to move on but the care companies are stretched and struggling to recruit

If your dad comes out they won't leave him with a package, he will get the 6 weeks and the option to pay for care after that
Good luck

@Newchances

It's the occupational therapist you need. That's the profession that assesses the patients care needs they complete a functional assessment to determine what level of assistance they need,how many times per day and if any equipment is needed. They let the social worker know all that then the social worker fills out the paperwork. Speak to the OT they Will know your father the best

OTs assess someone's interaction with environment, transfers, walking, risk of falls, how they access bathroom facilities and kitchen and sometimes how they manage in kitchen, with a view to equipment to maximise independence. They can make recommendations.

To assess needs under care act 2014, for discharge home from hospital usually it is a hospital social worker that does this as part of a multi disciplinary team. Some hospital discharge teams have delegated responsibilities and have OTs leading this process or reablement teams which sometimes provide short term right sizing care support at home fit first 2-6 weeks , who advise community teams if ongoing care is needed after they review in community.

Definitely ask the ward to refer Dad to social services (adults health and care / adult social services) for a needs assessment.

It really depends on the local discharge planning arrangements that hospital has for people who may be in need of equipment or care support at home on discharge.

Adults with dementia can be less stressed and more co-operative in familiar surroundings. The matron therefore may be thinking that he would be better off at home.

Your mother will need to say quite firmly that she is not well either and can not manage his needs at home without support in place. Therefore she cannot have him home without that support actually in place.

It sounds as though he really needs to be discharged to a care home- but your parents may find it difficult to accept this.