Tips for expediting hospital discharge?

[NotThisWeekSatan]

Hi all, hoping for some collective wisdom 🤞

84 year old DF has been in hospital for 8 weeks. Initially a bowel obstruction, now resolved. But in that time he has become v weak (mobility wasn’t great beforehand) and now needs physio plus building up physically before he’s in a position where DM can look after him at home.

They had paid careers at home before due to his poor mobility but now he’s far worse, and DM now has terrible sciatica so even with lots of care, she couldn’t cope with him how he currently is.

So he’s supposedly having physio which seems hit and miss (I’m sure not all the hospital’s fault; he can be quite stubborn, plus is often asleep when they come. Though I do think they need to be firm here and make him do something!)

But at the mo he’s just getting weaker and weaker. He has next to no appetite - plus is on soft foods so diet is really unappealing which doesn’t help.

I’ve got ideas from other threads re good food to take in - rich chocolate mousse, custard etc, calorific things - but there’s no fridge and DM is reluctant to give them at visiting time as then he won’t eat his dinner.

She can’t stay until after dinner time as the hosp is about 40 mins from home and she doesn’t like driving in the dark.

Meanwhile he just seems to be fading away.

Any suggestions to help? We’re at a bit of a loss.

Can you pay private physios to come into a hospital does anyone know?

It feels that with more intense physio and better nutrition he could start to get better, but the hospital don’t seem bothered that he is just left there plateauing/getting weaker.

Individual staff are lovely and clearly working really hard but nothing seems to hang together and nobody seems to have any real drive to get him better and home.

Sorry it’s long and thanks for any advice or suggestions.

Christmasamtryigtogetexcited

Thank you. He is meant to be having an X-ray to work out what the swallowing issue is but everything seems to take an age to come to fruition. I know DM speaks to the dietician fairly often.

It’s really hard for you OP and the last problem you want is for your Mother to end up off her legs as well Thank you, yes indeed.

In terms of soft and calorific foods, there are shelf stable options you can pick up which don't require a fridge.

Things like Ensure milkshakes, pots of ambrosia custard, rice pudding, tapioca pudding, tinned fruit in syrup, sponge puddings. If he drinks tea/coffee throughout the day, you can get squeeze bottles of condensed milk which would whack up the calorie count and can last a while without a fridge.

EmmaAgain22 don’t worry too much about the wheelchair idea, it was just a passing comment a PP made but we probably wouldn’t end up doing it, I just thought it might be nice.

We have researched care homes, yes, and DM went to visit one (which she wasn’t keen on) but we may need to have a look at some more if we think that’s the best option.

Fatagain some great ideas there, thank you 😊.

I wonder what kind if swallow Xray he's going to have (I'm a speech therapist). I hope it will lead to more clarity about what's going on with his swallow. If what they say about it is difficult to understand do feel free to PM me.

What ward is he on btw?

Mum is the same age as your dad, has had a few hospital admissions but this time they put her on a geriatric ward and admitted the word "frailty". We were all relieved because it felt like in the past, they just refused to admit that age causes problems. They took a holistic view of her issues instead of wanting to see her in separate depts for specific things.

@PermanentTemporary thank you so much. I’m not sure what exactly he’s going to have, will get DM to ask.

@EmmaAgain22 he’s on a general surgical ward. The ward manager is v keen to move him to a rehab ward but there’s no bed yet. An elderly ward also sounds like it might offer more appropriate care/views - sorry you are going through similar.

I went through a lot of this with my mother earlier this year. She went from a hospital ward to a rehab ward to a separate 're-ablement unit', which was a specialist NHS-funded short-term care home where she was given daily physiotherapy and encouraged to do things for herself as much as possible. After four weeks there they basically said she had reached the limit of what they could do for her, but she was not in a fit state to cope alone at home, so she moved to a nursing home on a 'temporary' basis, where her private physiotherapist could visit and work with her.

But by that point she was getting frailer and less interested in engaging in physiotherapy, and she basically stopped getting out of bed. She knew on an intellectual level that if she ever wanted to get out of the nursing home she had to put a lot of effort into physio, but it was all too much for her, and you can't force someone to do the exercises if they don't want to. She died in the nursing home about three months later.

exexpat I am sorry to hear that.

i'm not sure what I expect from mum's physio either. Her two brothers spent the last years of their lives just going from bed to chair. Of course I don't want that for her. I just can't see how physio can really help. There's a lack of acceptance in the medical world atm, IMHO, that our bodies do just wear out. She is following her mum's medical history too. Her father was spared by a massive heart attack in his 50s.

on a cheerier note, she forgot her zimmer while going to the loo, she realised as she got there. But I see that as a very good sign.

I echo @exexpat's mention if reablement. It's a short term facility which gives intensive support to establish the patient's likelihood of being able to live independently.
I think that this would be perfect for your Dad, as it would help him while not putting your mum at risk of being responsible for 24/7 care of someone who is poorly while frail herself.
Added to which, care workers in the community are like hens teeth.
Ask your council about re-ablement provision. But be prepared to have a fight on your hands while nhs and social services battle between themselves about who will fund.

The other option might be "respite" from a care home, which can then be extended if needs be - a lot of care homes have temporary beds for this.

We looked in to this for my dad & some would take for 2-4 weeks then review.,

It does sound like he has high needs (hoisting etc) so home is perhaps not realistic.

I used to work in a rehabilitation unit and tbh, your DF general condition doesn't sound conducive to effective rehab. Motivation to engage is massive. Even then, it's rarely a magic wand.
Unfortunately, those that insisted on going home like this often ended up on the floor with a broken hip or the like soon after and back in hospital before the inevitable care home. Hospitals are full of cases like this up and down the country.
Not to be negative but realistic. Good luck.

I'm no expert but I think he sounds like he would be best in a care home. They can meet his needs and help with rehab, physio and social activities. Your mum can visit regularly and enjoy his company without having to worry about toileting, feeding etc. I would definitely explore that option.

Agree with pp even if it's not what you want to hear.

Thank you all, really appreciate your replies.

@exexpat, very sorry about your mum.

The reablement sounds interesting - will look into that. And we will explore other care homes, not the one we looked at and didn’t like, re respite care and see where that leads.

Thank you all again. It’s so hard isn’t it? In an ideal world we’d all be like the Queen, pretty much ok until we’re suddenly not at 96. Sadly doesn’t always work like that. Hugs to you all in similar situations xx

It is really hard OP
I'm sorry to ask a delicate question but how is toileting managed in his situation?

I merely wonder because I know mum dreads that happening.

No problem Emma - he uses a bedpan (if they’re still called that - the disposable cardboard ones they have in hospital).

Not much fun but he seems resigned to it. He had carers helping him with this before at home so I think he has got over any embarrassment already.

Oh I see
Mum is so worried about this. But she walked up and down her room unaided a couple of times today which is good.

Oh that sounds very good - she is in a different league to my DF, mobility wise. I hope she carries on getting stronger.

Thank you

tbh most of my experience is from my late father

but mum is very clearly in decline so I'm wondering how some of the practicalities work.

Oh gosh that sounds so diffiult. The best thing you can do is be proactive. He's effectively bed blocking at this point (through no fault of his own or yours) and they will definitely want him off a surgical ward at this point.

Speak with the ward manager and ask what they suggest in terms of either a move to another hospital on an elderly ward if they have no alternative bed there for him, or if they feel he should be moved to a (or respite at the least.) Be firm - this isn't the best place for him and they equally need the bed as it's a surgical ward. Ask them what needs to happen to get him somewhere more suitable.

Long-term unnecessary stays in hospital are awful for elderly people. My DGM ended up with hospital acquired delirium which resolved itself (to a point, she has dementia) once she was moved to a home she is happy in.

In a home you can get phsyio organised (especially if you're funding it) and it might perk him up with it being a change of scenery and having more/different staff and other residents about.

or if they feel he should be moved to a *home (or respite at the least.)

If he is declining therapy input/physio then there isn't much more therapists can do, they cant force him. It is common for families to complain that no physio was carried out but if you look at the notes the person declined to participate or was unable to.