Discharge

[Scoobydo87]

Hi , I’ve just had such a shock my dad is currently in hospital after a stroke , I’ve just phoned to see how he is and he’s being discharged to rehab tomorrow
Nobody has phoned me to notify me the rehab is quite far , I spoke to the physio this morning and she mentioned this particular rehab , I told her if was too far but it seems they are moving him tomorrow

I’ve had no family meeting with the hospital or anything can they just do this ?

What happened today op? Lots of men are like that, they say nothing! Then they wonder why wives, daughters and sisters get cross with them

I work on a discharge ward and in reality the only person who needs to agree to it is the patient. It is good practice to inform nok obviously but if the patient has capacity it falls to their decision. As said rehab beds are like gold dust and prevent people ending up in 24 hour care, enable them to progress back to their baseline and keep some independence and they won’t hold them for long as there’s so many waiting for them. If rehab beds continuously get turned down due to distance, often they will end up in respite care in care homes etc until fit to go home and that can make them deteriorate and never reach home sadly.

rehab beds mean they think the patient has potential to regain to baseline and they’re only temporary, even if distance is far from ideal

Would you know if the rehab have occupational therapists to determine if my dad can go home safely ? I honestly don’t have a clue about what happens once he’s discharged from rehab

Yes. That’s the point of rehab beds for OT and physio. Determine future care needs and reduce where possibly to increase independence.

Honestly sometimes we get 1 hours notice and often it's down to the nurse to photocopy notes/organise transport/sort discharge drugs. I hate it when we don't get much notice. Did nobody mention the possibility of rehab at all? What did you and your sister think was going to happen?
As nurses we do try to update relatives if we are able to (it is good practice to) but, if your dad has capacity (which I assume he does) perhaps he could have asked for you to be informed.

Rehab is the best thing for your dad now, he will be reassessed before discharge to see what he needs next, could be care package, short stay placement and/or community therapy.

I would consider taking his house key to stop them discharging him home without a pre-discharge visit, care agreed and in place. An ex colleague did this after his mum was dumped into a cold home with no food the first time. The next time, they called him with no notice saying she was being discharged home. He was working hundreds of miles away for a few days. He said how can you discharge her as she doesn’t have her house keys, I will bring them for the OT visit so we can plan her discharge and care.

Thankyou all so much for your help and advice I think as one post said we have to get my dad to rehab asap regardless of where it is .
The particular rehab that was offered is a fair distance but my dads been in hospital 2 weeks now , I’ve tried my best to find somewhere closer and there’s no way they are going to discharge him home as he wouldn’t cope atm
He would prefer to go home providing we get the go ahead that it’s save , I would think that he’d need a carer a couple of times a day but I’ve heard that the NHS ones aren’t always reliable ?? Are they expensive
He would also need someone to do his shopping

I'm a bit confused by your last post. Did they change their minds about moving him to the rehab? I thought he was due to be there by now. It could be really crucial in helping him to regain as much mobility and independence as possible.

My MIL was in her 80s when she had a stroke. After languishing in hospital waiting for a place she spent about 6 weeks in rehab and she worked very hard on her exercises etc. The staff were amazed at the progress that she made. They ensured that everything that she needed at home was in place before she was discharged.

It was only about 20 miles away from her home so she still got some visitors and initially we had to talk her round from just giving up hope but once she was motivated she didn't care if anyone came or not.

She went on t have a few more years of reasonable quality of life before COVID got her. I dread to think how she would have suffered if she hadn't spent that crucial time in rehab.

Hi msbevvy, I’m so sorry to hear of the passing of your MIL , I too lost my mum through Covid 😢
My dad is still in hospital I’m going to see him this morning and hopefully he’ll be going to rehab next week
Your post is very reassuring Thankyou

I would take the rehab option even if it causes you some difficulties in visiting, hopefully he will improve more quickly with in house physio, OT etc. Often people get 6 weeks fully paid non-means tested care when they are first discharged, with a review. You need to be on the front foot to make sure ongoing care is organised and funding agreed.

Does your dad have more than the upper capital limit (UCL) of £23, 250, if he does he will have to pay for any care deemed social care. You can always install a ring doorbell if you don’t think he is getting the care agreed, I.e. carers not spending sufficient time with him, we haven’t done this as we employed a good private company and, to be fair, the immediate NHS package, the first time was good, but I did have to be quite pushy to get the level of care needed while the relative was still in hospital, a time when I would say you have where you have more negotiating power ( they want the person discharged), it is all a lot more difficult if the come home with an inadequate care package.

On shopping, perhaps you could arrange home delivery and either you or the carers could help him put it away. If he would struggle to cook, think about some nutritious ready meals in the mix. Depending on where he lives, he may get the same delivery driver and they can be very helpful. Once, my relatives carer forgot to unlock the gate to the door my relative could access, she couldn’t use her walking frame to get to the front door, and the driver climbed over the gate to unlock it to deliver her food.

Thankyou for all the info , is there anything else that I need to check with the hospital before he’s sent to rehab ?
I know that a few of his meds have changed since the stroke ie aspirin, blood thinners and another med for his copd

All your advice is greatly appreciated as I’m finding it all so stressful

No the hospital will sort the medication side, we have to supply them with so much weeks worth of medications and if they require dressings it’s normally 28 days supply.

We also sort transport there. The only thing I would say is most rehabs won’t supply continence pads unless the patient has been seen by a continence nurse which can be a lengthy wait if the patient has continence issues. We try to send with a few days worth of our hospital pads and then family usually need to supply. Toiletries will also probably need to supplied and ensuring he has adequate clothing etc sent with him. If patients have any injectables like insulin not all rehabs have nurses 24/7 so if they don’t we sort district nurses to go in

This exactly what happened when my mum had her stroke too, we knew nothing about it, weren't notified so we could explain to Mum. She was just transferred.

Thankyou for the information Mercury2702, I’m so nervous for his future after rehab , I’m sure that the OT’s will have a good idea
I don’t think that we can afford private carers but are the nhs carers reliable ? I’m worried that there could be times that they don’t show up
Sadly I’m really not sure if my dad will return to his base line the stroke could be life changing , I guess we have to be positive .

On carers, I think there are good and poor carers in both the NHS and private sector. I think the NHS carers have less time allocated and there can be a lack of continuity. One late 90s relative (widow / children dead) was getting short pop ins on the NHS when he was supposed to be getting longer visits. Family had to complain and that was when we installed a ring doorbell to check on them. Service then improved.

Another relative has Superb carers from a small private company, one or two are ex nurses and particularly good. When she came home from hospital they will schedule a longer visit, one popped in with flowers from her own garden, they use their initiative and would drive her to a GP appointment or contact us if they think something is wrong etc. However this is now 1,400 - 1,600 a month for two visits a day ( Home Counties) and she pays full fees while in hospital and not using the service. Because she is the client, they will meet us to discuss care needs. The ultimate accolade is that she thinks of them as friends rather than carers.

If your dad is not already getting any benefits, you could perhaps investigate attendance allowance and any other help. Age UK has helpful information on their website.

Remember to look after yourself as even if you employ good carers there is still a lot to do and it can take a good chunk of your time, especially if you work full time.