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Upcoming discharge from hospital - but he's not well enough to be home - what do people do?!

25 replies

caredilemma · 10/04/2023 11:33

Hi all.

My 81 year old Dad is in hospital, with a myriad of problems at the moment. Suspected kidney damage, pneumonia, dehydration etc. He isn't getting discharged yet, however, we have been here before and I'm looking for advice please.

The last time he was like this (about a year ago), he was discharged and taken home by ambulance (to his flat in a retirement village), however, he was completely immobile. My sister was with him, but couldn't stay there all the time, as she obviously has her own life, little kids and a full time job. He is 22 stone, and she can't lift or move him!!

We arranged carers to go in 4 times a day, but sister was still having to go in as well, to cover the gaps when carers weren't there.

I live very far away, and work full time, so can't help either.

What do people do here? Is the only option to arrange a live in carer by the week, until he is mobile and recovered? Or are we missing something?

Is there any kind of hospice he could go to, until he was well enough to go home? It seems mad to send an elderly man home, when he is completely immobile and lives alone.

OP posts:
TeenDivided · 10/04/2023 11:37

He can 'bed block' until there is sufficient support in place. Just keep saying he can't ve discharged as insufficient care.

Or he could do respite care in a care home if they have a space. My DMIL in did this, was there 6-8 weeks and then one day said 'right I want to go back home'.

Oodieandacuppatonightplease · 10/04/2023 11:40

Hi. You need to say to those wanting to discharge your father that you have safeguarding concerns, that a care package needs to be agreed before he leaves hospital and all be honest about his needs, day and night. If he is unable to care for himself at home with support a care setting should be found.
good luck, it’s a battle I’m afraid.

AmandaHoldensLips · 10/04/2023 11:43

Your sister can choose not to provide care but she needs to communicate this clearly.

He needs a full assessment of his needs and until these can be met, use the term "unsafe discharge".

caredilemma · 10/04/2023 11:44

I like the sound of respite care for 6 weeks. The last time he couldn't do anything for himself, so it felt negligent for him to be alone between care visits!

OP posts:
PinkDaffodil2 · 10/04/2023 11:44

It sounds to me like he might need to go to a care home for some weeks or months until he is back on his feet. How does he manage normally?
Bear in mind there will be huge pressure to get people discharged home this week due to the strikes so make sure you and your sister are happy with whatever arrangement is in place if he does go home.

Jonei · 10/04/2023 11:47

Ask for a care assessment prior to discharge with a view to him going to a residential home for 6 weeks, to give him a chance to recuperate. Unless they can offer rehab at home.

rattymol · 10/04/2023 11:50

It depends whether he really does need 24 hour care, or you just think he does. For example carerswould be deemed fine if he can just use incontinence pads. Even if he isn't incontinent.

BevMarsh · 10/04/2023 11:53

I think respite care sounds like the best option but be aware that a lot of people who go into homes for respite sadly end up staying there long term as tbh there not a lot of rehabilitation going on and carers do tend to do things for the service users that at home they'd be trying to do themselves (maybe out of getting the job done quicker and staff shortages) and this means a lot do lose their independence and skills they went in with which leaves them needing 24hr çare indefinitely.
( I've seen this happen a lot over the years I've worked in the system).

aholidaynotacarpark · 10/04/2023 12:09

Is it expected that he will regain function / independence? It's really unlikely he will get funding either from the NHS or social services to have 6 weeks "step down" unless there is a dedicated rehab unit which is appropriate for him. Unfortunately it is completely normal for people to be discharged home fully dependent on carers visiting four times a day and being left home overnight. How is he cognitively? If he lack s capacity and insight therefore is likely to be at risk when alone then the discharge team should be recommending placement for him (probably long term).
There are many people living alone who cannot independently get out of their bed or chair and use pads for managing continence. Rehab would usually take place in their own home.
Sorry OP I know it's probably not what you want to hear.

caredilemma · 10/04/2023 14:37

Thanks for replies. I have just found out today that the hospital can release him to a care home (on a temp basis). I have no idea why they didn't do this last time, as he was completely immobile, and alone between care visits! I am so far away, so get all info 3rd hand from my sister.

OP posts:
aholidaynotacarpark · 10/04/2023 16:11

That's good to hear @caredilemma. However as I said it's completely normal to discharge someone home who's immobile and completely alone between care visits. Will your DF be getting rehab in the care home?

Bobbybobbins · 10/04/2023 16:15

My father in law had 6 weeks 'rehab' care at a place which was between a hospital and a care home in terms if what they provided. It worked really well as when he got home he was able to move independently etc.

I think this is a good time to speak to your dad about his future wishes though. My mum died in the summer and we almost left it too late to have the conversation with her but glad we did manage to.

RettyPriddle · 10/04/2023 16:29

I think they do ‘discharge to assess’ beds in care homes that are NHS funded for 6 or 12 weeks. So they can go from hospital straight to a care home and then be assessed. It’s also a good way of seeing whether a care home is appropriate long term.

Limetreee · 10/04/2023 16:34

Hi. He should have a social worker but they never tell you. Ask to speak with them or the discharge team. My mum had been discharged many times into a rehabilitation centre the last one she was there five months then sent home with carers four times a day . Hope he makes a good recovery . Good luck.

twolilacs · 10/04/2023 16:48

Make sure that your sister tells them that she will not be able to help in any way whatsoever. Even if she can help, she has to tell them that she can't/won't care for him.

It is the only way they will listen, otherwise they will just discharge him and she will have to pick up the pieces.

Mercury2702 · 10/04/2023 21:17

I’m a nurse on an elderly no criteria to reside ward so they come to us before discharge but sometimes are with us months whilst we sort out the social care side.

definitely ask for a social assessment where he would be allocated a social worker. If physios think baseline mobility and independence can be achieved, a rehab bed is an option. Sometimes if that’s not possible we look at respite beds or temporary care packages but a social assessment should look at exactly what he needs

TheHomeEdit · 10/04/2023 21:38

My mum currently on an upto 6 weeks placement at a care home for rehab. Had to insist there was no care in place at home. The care seems good and the community OTs visits. OT also been out to home to assess for her future needs. Hers is called D2H program. I was looking for a private self funded place as didn’t think this would come through, but it wouldn’t have had the same OT link up so this is much better solution.

Lightuptheroom · 10/04/2023 23:26

It's possible that they asked him last time and he said he didn't want to go to the respite placement. If your dad has capacity over his own arrangements then they will only do what he agrees to. My dad was in a very similar position a few months ago, had been in hospital for 6 weeks , lung disease and also has pre existing physical disabilities. He flatly refused to go to a respite placement , told the hospital social worker that he didn't want them speaking to me or my siblings and that my mum cared for him - we told the hospital numerous times that it was an unsafe discharge and they did it anyway, no care package was deemed necessary basically because he said he didn't want one, and he was then assessed as medically fit for discharge and sent home and hour after we were told that he would need to be on a home oxygen system! We rang the duty team and were told that he would have to agree to be readmitted as they didn't have anyone to send.
Don't wish to sound depressing but do be aware that the hospital won't be asking for your opinion unless he has been assessed as lacking capacity

caredilemma · 11/04/2023 11:42

Thanks everyone. Thank you for your individual stories, they are so interesting and eye opening. Its such a horrible situation to be in! I think if they don't send him to respite care, we may have to arrange it privately.

OP posts:
FrenchandSaunders · 11/04/2023 11:45

I think they need your agreement to discharge him. Me and my brother refused to agree to this when our mum was in hospital. They have a duty of care to sort something out.

Jonei · 11/04/2023 11:59

The hospital don't need permission from family to discharge someone back home who has capacity.

Lightuptheroom · 11/04/2023 14:50

@FrenchandSaunders unfortunately the hospital doesn't need permission once someone is deemed medically fit for discharge. The duty of care means that they shouldn't be discharging without appropriate support in place, that doesn't mean that they can't discharge.

AutumnColours9 · 15/04/2023 09:35

Some people do much better rehab wise when back in familiar and own environment. That's why home with carers is generally the first option. D2A beds are often more about assessment than rehab. STP beds also can involve less rehab but more care done for you. Reablement at home can be the best option or home with POC and community therapy follow up.

rattymol · 16/04/2023 10:51

Lightuptheroom that sounds hard for you all. But people are allowed to make dangerous decisions. Anyone can refuse medical treatment for example if they have capacity. Legally the hospital could not do anything differently

Lightuptheroom · 16/04/2023 18:40

@rattymol oh absolutely, he also set up a DNAR and signed a 'respect' form that he didn't want further hospital treatment, which no one told us about until yet another ambulance call...

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