Dad deteriorating in hospital - just want him home

[Bedbouncer]

Dad is 86 and had a fall which broke his arm a week ago. He was putting the lawnmower away after mowing the lawn, which illustrates how well he was. He was also still driving and mentally very sharp. Since being in hospital he has deteriorated shockingly- he struggles to string a sentence together and is hallucinating, which I assume is the effect of the painkillers, but the staff - who appear pleasant enough- assume that's just how he is, and don't take him seriously. He also hasn't managed to walk since being admitted and is complaining that some of the staff are rough with him. He lives about half a mile from me with my 82 year old mum, who is also still very sharp, but wouldn't be able to manage him by herself physically as he is. The hospital suggested discharging him to 'a rehabilitation unit for intensive physio', but the potential places they have in mind look more like care homes to me. I would be happy to move in with my parents for a few weeks to help while he gets back on his feet. I think he just needs to get off the strong pain meds - there's nothing wrong with his legs! I work from home, very flexibly and can work anywhere. But am worried I might be biting off more than I can chew. Due to speak to his occupational therapist at the hospital tomorrow. Do I say we want him home, or go for the rehab/care home??

Haven't read the whole thread OP, your first post was enough. My Dad was exactly the same - hospital admission followed by severe hallucinations, delirium, distress. Ward staff were utterly useless. I don't say that lightly I really don't. I spoke to 8 different doctors, numerous nurses. One day he was settled, the next confused, the next day settled and when I asked about the previous days confusion they thought he had been fine. Then talk about a "rehab bed." Luckily I'm a former care home manager and knew enough to know that was the last thing he needed. Then they challenged his capacity - again, we were so lucky, my friend is the capacity lead at the hospital. It felt like some kind of prison break attempt. He was in and out 8 times in four months, each time the same story, each time getting worse. Eventually, we discussed with his Gp who put him on end of life fast track. The community nursing team were brilliant. Social care were hopeless - offering set time visits when I was begging for help during the overnight periods (crawling round his bedroom screaming that the sea was coming through the window, the diggers were burying him alive in his bed). During the day time when they visited to assess he was deemed not to need additional help as he was settled - of course he was he was exhausted! We spent well over £2k on aids, adaptations as the referral to the OTs came six weeks after he came home. It was utter hell, for a good eight weeks. Imagine an emotionally challenged,
permanently frustrated, scared and anxious toddler who is full size. He's been back home for over a year now. He does have some mild dementia, but has gone from completely doubly incontinent to taking the dog out to do her business. He'd have been dead if he had gone to a care home. If you can, get your Dad home. But be under no illusion it's a hard slog with little support.

I agree with previous posters, trust your instincts, if something goes wrong you'll never get over it. My father had a similar experience after a fall, turns out he wasn't being hydrated properly, he also developed an infection. He went downhill rapidly, by the time we plucked up the courage to question his treatment and take him somewhere else the damage was done. He died. We got a full apology from the NHS who admitted to multiple failings but didn't change the outcome.

I had a similar experience with my lovely mum, the hospital just wanted to sedate her and it was my worst nightmare, she was rapidly declining. She just wanted to come home. In the end I had to force the issue and took no prisoners, she was released at around 9pm after waiting all day for the pharmacy to send the meds up to the ward.
Even now writing this makes me emotional, she was crying her heart out when I walked in and said come on mum were going home.
In the car I said have you eaten anything mum? No they hasn’t even fed her, I stopped on the way home and got a bag of chips and a can of pop.
I can honestly say it was the best most appreciated meal ever!
Don’t get me wrong it’s hard work looking after an elderly parent and nursing them back to health. Get the support that you and your family are comfortable with, it’s a fine balance and always take on board what your dads opinion.
Get your dad home OP, follow your gut instincts, and what’s best for him.

If he’s not walking, how are you going to toilet him ?

"If he’s not walking, how are you going to toilet him ?"

Bedpan? What will they do in the care home? He hasn't walked since the fall, but was perfectly mobile before and his legs weren't damaged. I think if we get him home and of

Sorry, posted too soon & didn't quote properly, was going to say
Need to get him off the opiates and walking again. There's no physical reason why he can't.

Infections can affect the elderly mentally as well as physically as can certain drugs in particular reaction to anaesthesia. Remember the staff only see your df as he currently presents, not appreciating that he was fit and active previously. Don't write off a rehab unit though. Dh spent a month in one post a hospital stay and it had a care home feel to it, he was the youngest by far but it did a good job of recovering motor and self care skills. The OT visited our hime and recommended adaptations and equipment before he was discharged.

Rehab place was really good for my FIL who was awful in hospital after break .. the change of environment, social company....they were all weller around him ..but mainly the onsite physio/ ot ....everything was geared to getting him moving again... thet got him to do much more than he thought he could and had done at the hospital

I would be worried about not enough physio at home...even after discharge from rehab place he still needed more and was nowhere near as good at doing his exercises...so we paid for more physics...

On our experience if you can get rehab take it ...as a stepping stone to home...

Why haven’t you said you have POA?

how much time do you spend at the hospital? If you are sure you can manage him at home, get him home. So many things make you worse in hospital. Do you know if he gets enough water?

the painkiller thing is weird. On the one hand sometimes you can’t get them. But when I broke vertebrae I was told I ought to take more, even though the amount I had was managing my pain.

you need to spend a whole day there but I reckon home is better for him. Hospital delirium is definitely a thing.

Thanks. I'd be less worried if he was younger. Like you say, the concern is the staff will just see him as a frail confused old man and treat him accordingly. If we can manage it, I would much prefer him home.

The alternative would be a Intermediate Community Care or Reablement team. The contract might be with the council or nhs. They provide carers and services like physio home visits but to a lesser availability than in rehab. Ask to speak to the hospital discharge team which should include SW and OT.

My grandmother went into hospital following falls a couple of times. On both occasions she became very confused - the first time she had a bleed on the brain which explained some of the problems but not the second time. I think outside of her routine she really struggled to cope. She was always well cared for and they kept an eye on her eating/ fluids. It was hard to convince them she normally lived without support and was normally very with it. On both occasions she was discharged to a rehab hospital and recovered fully. If there is a rehab hospital and not a home available it might be worth looking into.

I haven't used the Poa before, have never needed to.
We are only allowed to visit an hour a day. They're quite strict. I'm not confident he's drinking/eating enough - partly why I want him home.

Tell them you have his POA.

Most hospitals have a board somewhere with the lead ward consultant named: put in writing to that person that you have your dad's POA and are looking for a speedy discharge as he is deteriorating under their care. If you don't think he currently has capacity to make decisions for himself then tell them and make sure they know you are the decision maker. Copy anyone you can think of (PALS certainly). Say the same thing to everyone on the ward.

Can he afford private carers for a while? And can he afford private physio? We have a great private rehab place round here, targeted at people post private hip replacement, but it has amazing facilities. Unlikely to be an option but private carers at home while you live in might make things manageable.

When you have the bandwidth tell your local Healthwatch what's happened.

Someone mentioned ReSPECT above - here's a link www.resus.org.uk/respect/respect-patients-and-carers - but not every area/hospital uses these.

Attitude to my father changed when I put down in writing his activities in the days leading up to admission, including date, time, distance walked etc.

Sorry to hear this, has he had blood tests for any infections at all? (I'm juggling an active baby on my lap so sorry if you mentioned this and I missed it)

This sounds very similar to my grandad, he fell broke his leg and very quickly became delirious in hospital, after speaking at length to a few consultants it seems this is a really really common pattern after an elderly person breaks a bone. It was described to me as having a the body really struggles to cope with that shock so it will have a knock on effect on other parts of the body as they have to compensate more than a younger persons would do.

On a practical level I would really try hard to explain how different his behaviour is now, it's easy for medical professionals to overlook this as obviously people's ability in older age varies so much.

I would also really push to get him out of hospital but into a better facility soon, is there an option for a community type hospital? I was with my grandad pretty much 12 hours a day which he was in hospital, he was in ICU as had to have his leg operated on in the end. As much interaction as you can manage and making notes for the patient is also a good way to help them try to comprehend what's happened.

Good luck

Good luck

If it was me I would get him home. My sons wife had hospital delirium and once home after a few weeks was much better. You can always get carers in if you can’t cope on your own

OK OP, you need to advocate for your father. Hospital is rarely the best place for anyone and you need to get him home with a care package in place (not just you).

Start writing everything down. Email consultants requesting details of tests undertaken, care plan etc, and make it clear that your dad was not confused previously. Then is no response email NHS trust Chair with your concerns and how you have not been given satisfactory answers.

Contact social services and ask for help. If none forthcoming email your local councillor explaining the situation - they will push social services to get something sorted for you.

NHS trusts rarely want people taking up beds when they are medically fit to go home but this means there is a responsibility to put appropriate care in place. If you can afford to pay for some care tell social services this, you may have other options available to you.

This happened to my Nan and she’s never recovered and now permanently in a home costing £6k a month which is privately funded. The rehab bed was in a nursing home and imo it’s a way to get people through the door, couple of weeks on NHS funding then ‘oh they are unfit to go home’ and then easy option is to stay where they are.

so, I would get him home; but you’ll need help. Can you get a local care company to come round each day? What about a live in carer or two for at least a few months.

My nan has dementia and was pretty lucid until 6 weeks in hospital with no visitors. She recovered physically from the fall but mentally and strength wise she was ruined by that time in hospital with no proper rehab support or social interactions. Breaks my heart xx

They have a mimimum of 2 people, training, hoists and a electric hospital beds which can be raised up to a safe work hight, usually with bed guards which the paitent can use to assist. They also have specialist mattresses to prevent bed sores. Hospital rooms and hospital furniture are designed as a work environment, homes are not.

Lie down in the floor and try to roll on your side without using any of your legs. Then roll on your 'good' arm without using the 'bad' one.
You will have an ordinary low bed, no training, and he can't roll safely with the broken arm and he will have to be able to roll and hold to allow wipe time. OT's will be risking their job by giving you a quick training guide and you risk harming yourself and your dad.

Stop focusing on getting him home because if you take him home you run the very real risk of him never getting out of bed again.

How are you going to get him home if you cant even get him into a car?

You need the hospital physio to establish his base line physical capabilities.

The OT will "only" sort out some of the equipment after it has been recommended as needed by the physio. So they should be working as a team.

Can i suggest that you phone his GP explain that he is in hospital and that he has failed and see if they will issue a letter detailing his level of fitness and past medical history and current meds as MereDintofPandiculation points out it gives a baseline pre-hospital capacity with the added advantage this is a professional doctors opinion. Unfortunatly sometimes that is important.

I know my posts appear very negative but safely managing a full grown adult who is bed bound is a massive task. (You are at the start line of a marathon not at the finish line of a sprint.)

You are a serious risk of harm as is you mother.

He did not just stop walking. If you agree to a discharge they will not schedule extra tests. Keep saying "I do not understand why he is not up and walking" and ask what has been done to resolve that.

PS If you have not already visited today spend the first 55 mins organising with the nursing staff to get him up and walking down the hospital corridor.

Very sorry that you only have an hour a day
My neighbour is with her DH all day at the mo as he had brain surgery

They told me I wasn't allowed in when mum was in recently, I just went. Have you told them you want to be there longer?

I guess it's hospital dependent
The delirium thing is such a big issue. I would think he needs to recover from that before you try him walking. He might need a rollator thing, have they supplied that?

have you checked has water that's within reach and have you seen him drink independently?

Get him home with a discharge package they will give you up to 4 visits a day and OT will arrange any rails or equipment he needs .

My dad had a few spells in frailty ward fully staffed and half full and it was border line neglect . He came home filthy with wrong meds and they'd lost his glasses .

I'd get him home.

It's a care home under guise of 'rehab', OP and it's how a lot of older people enter and end up remaining in the care system.

I'd want him home to see how he is in his home environment and you could even get temporary carers in to help if needed.
Physio will also visit him at home.

I know it's not as simple as this OP but I'd not be putting him in a glorified care setting just yet without giving it my best shot.

If you can get him referred to the district nurses, they should be able to direct you to the right place to organise things like the loan of hospital beds, commodes etc