FiL stuck in hospital being rejected by Care Homes. Not sure what to do next.

[Lottsbiffandsmudge]

FIL (lives 5 hours from us with frail older wife (not MIL)) was admitted to hospital after collapsing at home in early Nov. Diagnosed with pneumonia. Admitted to a respiratory ward. Pneumonia sorter after c 2 weeks. Back to being physically OK albeit with chronic controlled heart issues.
During lockdowns his mental health starred to decline. Taken over 2 years (due to covid suspension of services and then waiting times) and he still does not have a formal diagnosis but he clearly had dementia of some sort.
His hospital stay and the infection have made it so much worse. Post infection delirium was a possibility but its now been 6 weeks since the infection cleared up and he is not improving.
He is apparently aggressive, behaves in a sexualized way, is racist and wanders. Although my DH who has spent multiple short stays up there has only witnessed the wandering and some frustration.
He has a Deprivation of Liberty order in place abd the hospital will not release him home.
So far he has been turned down by 3 EMI care homes. They had room but thought he would not be a 'good fit'.
We have MP involved and have contacted behead if social services and the hospital Trust ceo.
He is still in hospital. He has no stimulation or care to speak of except for visits for 2 hours a day on the days his wife can get in or BIL can. His behaviour as a result is getting worse. He does not even have outside space.
It's been 2 months and we seem to have made no progress.
We are at a loss. Has anyone been in this position? The hospital will not allow discharge to home, even if his wife wanted to try which she does.

Sorry for typos...

Is he able to do his own personal hygiene etc?
How were they managing prior to admission?
Does he have Medicine of the Elderly or psychiatric input?
What reasons do his care team give for not allowing him home?
I’m sorry, OP. Intractable delirium is a horrible and frightening thing.

Thanks for replying. Yes he is feeding, toileting etc fine. Physically OK.
Prior to admission his confusion was not causing these issues. He had memory issues and the usual mild dementia issues of forgetting the threads of conversations, names etc. It was worsening but he was totally manageable at home.
The psychiatric team have been involved I think. Getting any clarity on who has seen him and outcomes is v difficult at this distance.
I do not think his wife could cope at home now. He is an escape risk and she is in her 80s and frail. I guess we hoped the delirium might improve. It doesn't seem to be and its worse at night. If he were to fall or escape she physically couldn't cope with it.
A mental health assessment unit has been suggested a whole back which might be where he ends up I guess

Ps what is Medicine of the Elderly? He was finally moved to a geriatric ward 2 weeks ago from the respiratory ward. But they seem to focus on containment and not much else.

Sounds like you need to find a care home for him that specialises in looking after people with dementia. Didn't you or a family member have to agree to his Deprivation of Liberty order?

Private homes can refuse whoever they want with very little reason, often it can be because they have too much going on already in the home and on!y want the 'easy'people. However usually when people are more complex the family haven't been told the whole story about how difficult the persons needs can be, but the homes can read between the lines and tells (if someone's notes say there have been on an perceived or monitored by its an immediate no for the home I work in, if the person has shown any sexualized behaviour again a no, any violence-no, I have to think about my current residents and their families who complain at the drop of a hat). Also I know it means his stay is longer in hospital but hopefully it William a home more suitable is found, if he went to one of the others who had said no you may have been looking for a new home in a few weeks which would be worse for him.

Look at care or nursing homes in different area, they hospital will organise the transportation. My lovely Nan turned violent and no nursing home around where I lived would take her, we found a really great one around 250miles away, ready for patients that week. It was a hard decision to have her taken but it was in her best interest, she was very happy and so much better out of hospital I think in the end it was the best decision as it was me being selfish wanting her close by rather than happy.

He has had a DOLs assessment - this means that in effect he is there under section of the Mental Health Act.

DOLs tend to work the other way - ie a family member cannot insist that a relative is placed under a DOL. He will have had a psychiatric assessment to determine capacity, cognitive function etc then assessed by a DOLs social worker. It’s a lengthy process which is not to be taken lightly.

No one has to consent to a dols.

Hospital delerium isn't unusual in the elderly, would you say he's markedly worse since being there?

@piedbeauty EMI homes are specialists in dementia.

@Lottsbiffandsmudge

in my experience of similar situations in my area, the patients were either accepted at an out of area EMI placement, or a mental health unit. Or their medical picture changed so they required different care.

It sounds like a mental health inpatient assessment may be of benefit, if as it sounds there has been a dramatic change in his behavior. The General hospital will be pushing for that as a way to get him out of their hospital, I’m sure.

Delirium symptoms can linger for months unfortunately but being in a busy hospital ward is not going to help.

I think most hospital wards for the elderly are struggling in the same way, this includes mental health wards. It is incredibly frustrating for all involved and not fair on patients at all.

We have had a fair few patients like this.

I can definitely see it from the care homes perspective, if he needs one to one supervision they have to have staff for that.

One of our patients ended up in a dementia specialist care home and another had funding provided by the nhs to go into a care home. This pays for the one to one staff member.

Have you asked PALS to provide you with a clinical point of contact to provide an overview of the clinical picture?

We were in a similar situation a few years ago - DM with dementia and carers visiting 4 x a day were struggling - DM v stubborn and sometimes aggressive. Had a hospital stay and family decided it was the right opportunity to move her into a home. It took ages to find one though. Only one would take her without a sedative prescription (which the doctor refused - looking back, we're very grateful for that though it all felt hopeless at the time). Luckily the home that would take her were the home we liked best - mainly for the lovely staff.
For our search, we got a list of homes with vacancies from the council. Then it was a case of ringing, visiting and asking them to come and assess.
Look for homes that specify dementia and also ask hospital (if you don't know already) if you need nursing or just residential. If possible it would be good to find a place that does both so you don't need to move FIL if nursing needed further down the line.
Good luck

Nhs already offer to pay for one to one care
All homes so far have been EMI so with dementia specialism. Most recent had nursing and residential care. But after a brief visit decided he was too difficult.
I understand he might cause issues but what can we do! He can't stay in hospital forever.
Because he is mainly a problem at night the hospital were trying to avoid a general MH unit because they believe he may get worse surrounded 24/7 by others who are disturbed.
His DoL review is on Fri.

I have seen people fit for discharge on wards be there for months as there is no suitable place to move them to, sadly. All you can do is keep in contact with his SW and keep looking....once upon a time psychiatric hospitals used to be full of elderly people in long stay wards/beds who'd be there for the rest of their lives but care in the community came along in the 90's and now there are far fewer mental health beds..... and those are equally desperately needed for assessment and treatment so its a case of trying to find a fit with a NH. It becomes a catch 22 as his behaviour is less likely to settle on a acute ward and care homes obviously have their choice of patients and are likely to prefer someone with fewer challenges.

p.s. in some areas of the country(NHS postcode lottery is very real!!) there are specific teams that help people return to their own homes after being in a care home, it may be unlikely but your FIL may regain enough function to return home if he becomes more settled . A long stay on a hospital ward is enough to send anyone off the rails .

You have my sympathies, OP. We're having similar problems with MIL, who's been in a specialist MH unit for months after being sectioned. The hospital think she'd be better off in a suitable EMI home, but so far we're getting polite rebuffs even from them about being unable to meet her needs, once they find out what they are. There's absolutely no question of her being able to return home. I don't know what we're meant to do but hope someone will say yes. Eventually. In the meantime, there are other people with severe dementia who desperately need these MH beds.

Its so tough isn't it. If he hadn't got physically so sick, got rhe demntua diagnosis and got gradually into a care package that way it would have been so much easier. The dramatic decline in his mental health has been very traumatic for everyone. Him included. He understands he is 'bring kept against his will', is bored and vv frustrated.

I know, @Soontobe60 - my MIL had a DOL order when she went into a care home with dementia, but the staff asked dh - her son - if he was happy with the DOL.

I had very similar with my dad. He was showing some mild signs of dementia, forgetfulness, anxiety etc but was managing at home with some care. He then caught covid and went into hospital, he developed what was explained as vascular dementia- a very rapid escalation of the dementia symptoms we had seen prior to admission. He then spent almost 4 months in different hospitals, first the main admission hospital, he was then moved to a rehabilitation unit whilst he recovered from covid, then a geriatric unit in a local hospital. By this time his dementia was exacerbated by the constant moving, he became increasingly erratic, angry and violent, he simply didn't understand what was going on. The geriatric unit couldn't cope, he was meant to stay there whilst they found him a care home place- tricky at the time because of covid - but he apparently had an " erratic heart" ( which occurred immediately after a session where he had thrown his lunch at staff) and they shipped him off back to the main admission hospital and refused to have him back when the doctors there said his heart was absolutely fine! He was there for another 3-4 weeks until a care home was found- but only because of the additional funding from covid. He was there for six weeks before the funding ceased and an alternative had to be found! Six hospitals/care homes in less than six months, it's no wonder his dementia became difficult to manage!

@spanieleyes that does sound v similar. The hospital think his (undiagnosed) dementia may be vascular (prob because of his chronic heart problems he has has since middle age) and that vascular dementia tends to get worse in big steps. His brush with pneumonia prob triggered a big step down.

So bit of an update. Looks like the crisis team at the council have been in with a doctor to section FiL so he can be transferred to a secure MH unit- the one proposed is specifically for the elderly. The hospital I think issued an ultimatum saying they would just discharge home which has set stuff in motion.
In the out turn this feels like a good move (the unit has a good set of reviews) but no one in family was involved and no one was there with him for sectioning meeting and my BIL is a bit freaked out at being called out of the blue by another new person and told his dad has been/ is being sectioned.
I have personal family experience of sections but BIL has had the common neg reaction to the news. Will call him later. Just hope FIL can get the help he needs to settle a bit more.
I assume its also under NHS care so funding won't be an issue for now.