Dad in hospital & need to discuss options for the future

[EchoElephant]

My dad (90) was admitted to hospital after a fall at the weekend. He has been in quite good health up to now with no health problems of concern.
His only issue was that his strength was very poor and he kept falling or just collapsing.

However, this latest fall seems to have caused more problems. The hospital say he is becoming more and more confused. Arguing that someone has stolen his lunch. Not understanding where he is etc.

They've asked my mum to go in and visit to see if that will help. They also want to discuss what happens next. He's medically fit to be discharged but not safe to be sent home.

My mum can't look after him. And he's refused point blank, in the past, any help she's offered. Their relationship has gone downhill in the past few years.

Neither of us knows what to do for the best, what help is available and how we find it.
I don't live close by so I can't easily help but can make phone calls.

Has anyone been in a similar situation? Any advice?

Ring adult social services in their area, they should be able to help you.

Do they know why he collapsed or why this fall has made him more confused, has he had a brain scan. The doctors need to find the cause before they can plan for the future. Your mum needs to tell them that he is unsafe at home and she can not look after him safely, the staff will need to assess his care needs, his mental capacity, his physical state. They may not be able to do this if he is very confused, just because he is medically fit it doesnt mean he is ready to leave hospital. I would question if he really is medically fit if he is getting more confused, there must be a reason, does anyone have power of attorney for him, maybe a carehome would be a safer option but if he is unable to make a decision himself at the moment then mum needs to say she cannot cope.

Did he fall due to tripping or was it a medical problem? Confusion is very common in the elderly, perhaps due to an infection like a uti , shock or just being out of usual routine and familiar surroundings. Hopefully a visit will help orientate him.

Hospital OT should assess him and refer to discharge team who can organise support from carers and the reablement/community therapist and assess for any home equipment. Your dm and you may need to be quite assertive that you cannot take on his full time care.

He’s not fit to go home. It’s not normal to be falling and collapsing. Even though seniors of that age become confused easily it’s a health crisis which needs sorting first before discharge.

My own Mum has just been in hospital for a fall, similar age, and she had a UTI. They have treated the infection, but she has not managed to recover back to the same health as before sadly.

It's a distressing time but don't panic, don't waste your weekend trying to guess what might need to be done. The discussion about what happens next is where it all happens. You don't have to work out what services your dad needs, that's going to be done by professionals prior to discharge. He's not going to be packed off home in a hurry. In England there will be an assessment as part of discharge planning, they will be asking about support at home, bathroom arrangements, steps and such like.

Can your mum say "no" or does she think "no" but say yes? If she's not going to be able to advocate for herself then you might want to be a part of the discussion.

Blunt question no need to answer on here, does your mother want to take care of him or would she prefer he goes to a care home?

You, your mother and other siblings need to have a family meeting and work out what level of care you can provide to support your mother in looking after your father.

Unless he has a diagnosis of a mental deterioration the confusion is a likely symptom of some underlying condition = he is not medical fit to be discharged. (UTI Stroke etc)

Presuming that your mother is willing to make the changes needed, get your mother to say:
That she is refusing to take him home.
That she is no longer able to look after him safely at home.

That she needs help at home or he needs to be assessed for residential care. This is vital as it will force the discharge team to mobilise all of the services and supports which come with community care.

Then if he is assessed and home care is agreed, no matter what is agreed do not allow your mum to take him home untill all the required provisions are funded and start dates are the day he leaves hospital.
If they need the bed they need to provide step down care.
I known that the idea of a care home (even pre-Covid) sounds horrible but if there is no medical condition it's cheaper to manage an OAP at home.

People don't just fall.
Why it's happening needs to be established is it mechanical (trip etc) or medical (dizzy etc).
At 90 how is his heart, as blood pressure drops due to movement can account for sudden intermittent weakness.

At home has he access to a downstairs bedroom and toilet and wash area
Can the home be accessed without climbing steps

He may likely be recommended a Zimmer frame etc as a tool to minimise the fall risk. These tools need extra space to work.

One of the things the OT will not do is be ruthless in how they currently live.
Your mother (you) needs to look at all the rooms and furniture placements mats etc and ask is it really needed or can it go and if it stays can it be arrange better. This will be as hard on your mother as your father.

If he is refusing your mother's help I would 100% push for a care worker calling in at least once a day.
It would eliminate some of the conflict between them and give your mother some day to day support.
It can be sold as a "help for her" or "as a condition of his release from hospital". You are better positioned to know which approach will work.

In the next few days ask the stupidest, simplest questions. If you think you understand, say whatever is said back in your own words to confirm it.
Get a hardback notebook, which is easy to carry, and a pen. Take notes of discussions and what actions will be needed and who is responsible for the doing.

Best of luck

Look at Attendance Allowance if he needs any sort of help. It is not means tested and will help with anything he needs. You can fill in the form but put down every little detail .
A relative of mine could have claimed for ages but didn't know about it.

Thanks for everyone's comments. They are very helpful.

To answer a few questions. My dad has been falling over for some time now. It goes back as far as pre Covid. But he refused to go to the falls clinic or to use a walker.

However he was hospitalised at the beginning of the year after a fall. They couldn't find any reason it was happening other than the fact he is quite frail and has no strength in his legs to hold him up.

He was sent home with a care package. And told he had to use a walker. Which he does round the house but refuses to use it outside. The carers lasted 2 weeks then he said he didn't need them any more. Various adaptations have been put in around the house to help both of them.

The confusion seems to have come on rapidly over the last few days. I've told my mum to ask about the possibility he has a UTI.

From comments above, I understand that the hospital will look at all the options - home with carers or care home - and discuss with my mum.

I've told her to be honest about what she can cope with. She has her own health and mobility issues to deal with. Plus the fact my dad refuses to accept any help from her. They have completely seperate finances and he locks everything away so mum can't see it as he doesn't trust her!

Unfortunately, I live at the other end of the country and they have no other family nearby.

I'll wait to hear the outcome of the visit today and see what is being suggested.

OP I was in your shoes about a year ago

Like your dad, mine binned off the Carers, had another fall and ended up in a nursing home which is a weight off all our minds - but also he is much happier as he doesn’t worry about falling now and is eating properly etc. I also think he is getting far more social input than he has done for years - his cognitive skills declined during lockdown.

We are in Scotland but basically the discharge team orchestrated his needs, the social worker kept us informed as to what he required, we picked the home and then once we could prove we have the funds to pay, he was accepted. Now that he has passed assessments and an adjustment period, we are allowed to sell his home for the fees. Nursing homes I think wait for the home to be sold and there is slight pressure to sell but they are happy to wait.

The situation would be different for you guys as your mum won’t have to sell up. But you’re supported through it

There are care allowances that you can apply for irrespective of income too. Social worker will know these. Good luck.

Also
My dads UTI presented as very sudden dementia - definitely worth considering /!: flagging up to the docs

Can you get your mother to video call you or just phone you and put you on speaker when in meetings?
That way you are hearing what is being said first hand rather than a summary from your mother.

You need to speak with your mother and find out what happens day to day to highlight what she is finding difficult. Is food, cooking, cleaning and general household duties all falling on her.

Sometimes mild cognitive impairments can appear as the person being more of an asshole than usual.

If your father has locked his finances how are the household bills being managed.
Has your mother authority to access the light and heat providers?
Plus any other important services.

I do hope I'm wrong OP, and quite obviously I am not a HCP and have not seen your Dad! But. A friend's Dad was 89, previously in good health. The short decline (a couple of months) before he died was marked by sudden onset dementia-type symptoms.
Based solely on that, if you were my friend I'd be suggesting you clear out your calendar a bit and do your best to go and see your Dad when that's possible. Not for care reasons, just to see him. Just in case.

Hopefully he's got cast iron genes and has a few years yet though.

You need to make it very clear to the hospital that there is no one to care for your father at home and that plans need to be made for him to either have carers set up to care for him at home or arrange for a care home.

Don't let them fob you off or assume that the family can look after him 24/7. I know it is hard but the best thing is for his needs to be assessed by professionals.

The hospital are running some tests but they suspect my dad's decline is caused by a UTI.
Mum went to see him yesterday and he was very aggressive towards her. Fortunately the doctor she spoke to had seen my dad when he was admitted and agreed that this change is very sudden and out of character. He'd already ordered the tests before my mum was there.

Fingers crossed OP.
I saw a miraculous overnight return to coherence in my mum (who was delirious and making No Sense At All) once they gave her the right antibiotics and they kicked in.

Has your dad been tested for a Urinary Tract Infection (UTI) or been checked to see if he's dehydrated? Both can cause unsteadiness, hence falls, and also confusion. Both very common in elderly people, and easily treated.