Elderly dad in rehab

[Loopylou38]

Hi , my dad had a stroke in May and was in hospital for quite a while then caught Covid/pneumonia which has set him back with his recovery . I’m out of the country at the moment but he was eventually sent to rehab and I’ve been told by a relative that there isn’t much progress due to other health issues
He also has copd so his breathing is pretty much walking is very difficult .
Im returning home next week as the physio would like to discharge him on the 21st aug which doesn’t give us much time

i understand that they will need to put a plan in place but sadly he needs 24 hour care now prior to the stroke he was living independently.

I honestly don’t know where to start with all this it’s going to kill him being told he can’t go home his property is very small so doubt a carer could be there over night

secondly going home would be lonely as carers come and go, I’d love for him to go home but it’s impossible

how do I find a good care home ? The cqc and carehome.com are so confusing I just want the best for him
any advice please ? Can rehab discharge him if we haven’t found a place that we’re happy with ? Thankyou

You don't need to be with him any of the time. For this to fail you need to make it clear to staff you will be doing absolutely nothing.
Ask them who is going to do his shopping, cleaning, washing?
See how there are expectations of you already. Quash them. You will not be contributing to his care in any way. Think long term.

Thankyou all so much for your advice my head is all over the place. My dad does have capacity every now & again slight confusion but that’s mild . He can’t walk and can only sit out in the chair 2 hours max at the moment due to being tired and insisting he wants to go to bed , we was told by the rehab team that he needs to be sitting out at least 4 hours a day if he is to go home .
How on earth can he go home, if he needed the loo in between the carers , needed a drink or food , or was uncomfortable in the chair the worry for me would be constant .
The occupational therapists are coming to assess his home today , I honestly don’t think he can go home and it’s very sad he would also be very lonely as I can’t be there all the time .

He owns a small place which isn’t worth much but he would be self funding to a certain degree
finances haven’t really been discussed I just feel that it’s all being rushed to get him out .

Parents both in their eighties.My dad's in a nursing home...end of life and blind. Saying that, he still potters about with his white stick. He tends to have his lunch in the home, then a friend or relative will pick him up and bring him back to his bungalow where mum is and he'll spend the afternoon there. Mum has daily peritoneal dialysis at night and couldn't cope with him then (he was falling out of bed, diarrhoea everywhere). This appears to be the best of a bad situation. Dad wasn't happy going into the home, but the home carers couldn't manage his complex meds , catheter, constipation/diarrhea.He seems resigned to it now and is not so grumpy.

The reality is he either has to manage a 90 degree step round transfer chair to commode and back again, or wears pads. The OT will be assessing his transfers. Carers will empty his commode / change pads. He has to be able to sit out for 4 hours a day between one of the care calls. If he is struggling with this he may need a different type of chair such as a sorrento which offers more support and can recline. Carers will leave food and drink on a table near his chair / bed which he can access.

Hi Tomisanotherday, my dad also has a catheter
I’ve been informed this morning by the occupational therapist that my dad has been assessed & can only stay out of bed max and hour & he’s eating very little now
she feels that he would be nursed via his bed and given that he has copd he’s high risk with breathing problems she has advised a care home now .
The decision has been made for me as I was weighing everything up on going home ,
Surely they can’t discharge him on Monday as planned as I haven’t found a care home

Im going to be meeting the OT are there any questions that I should be asking I’m finding it all so hard

I assume social services are involved? You can never know when they're going to be discharged. I'd say be prepared.The bed status in a home is forever fluctuating (residents dying) so if a place is available Monday, they may want to quickly fill it. This is dependent on transport being arranged of course, which quite often holds things up.Also, if the home has an outbreak of covid or diarrhea they can stop the transfer at short notice (I was on the doorstep with my mum-in-law).
Hospital inpatients no longer requiring hospital care can be moved to a social funded nursing home bed or a 'cottage hospital' (used to get six weeks funded care) until the patient/family sort out whether they're going to stay there and pay or go back home with support.
It sounds like your relative needs to go to a home with nursing beds, rather than a residential home? The staff should know how to cope with the catheter. Check he'll have a pressure-relieving mattress and cushion. Check he takes all his medications with him (they also usually switch to a GP associated with the home, not his usual one) and try and get a printed off Discharge Letter as the electronic ones tend to get lost in the IT cloud.

Thankyou for your advice , surely they can’t just discharge him to a random respite until I sort out something permanent ?
I know that rehab beds are scarce as we had to wait a while but I’m worried sick
social services have to be involved to sort out his property & finances as we don’t have the cash for the fees so there will be a charge put on his property

..and insist they've recorded MUST and Waterlow scores (incl. weight, height, BMI) in hospital...my relatives discharge was delayed because they hadn't. Also important when you want to show weight loss over time.

Oh Thankyou I’ll make a note of that is there anything else that I should ask before discharge please.
Im asking for a wheel chair as I had a job getting my mum one once she was discharged

The Hospital Discharge Team may try and discharge you dad to a nursing home, to be assessed for paid care (CHC) later. You need to be firm and say you want him assessed now, when in hospital.
Take a notepad or on your phone, jot down the conversations you have, who you speak to - name and designation. Back up with an email to the ward manager...'Further to our conversation of today, can I confirm that you have decided to discharge my dad to a care home without completing the CHC Decision Support Tool.that I requested'.
I found I had to do this and I've been a registered nurse for forty years znd worked in the hospital my rekative was in).
If he is really poorly and you think he may not last months, ask for Fast Track assessment.
If I had trouble speaking to people or no reply or didn't know what to do, I found PALS helpful.

My mum in law wasn't discharged home 'til everything/equipment was in place, but this was pre covid and 5 years ago. Dad was sent home with the bare minimum this year.
My motto 'aim low and you're never disappointed' ...sad I know.
Things did improve....

Thankyou so much Tomisanotherday, your advice is greatly appreciated, I don’t think there is pals on this particular rehab I now realise that his needs are great but I don’t want him dumped in any random care home .

What does an assessment in hospital involve as I was told over the phone this morning that they gave been assessing him this week and have decided that he can’t sit out of bed long his good tray is red as he’s at risk of choking due to his copd & coughing
what else would they assess please as his walking is no longer he refuses

My dad will be self funding his care I don’t think he’s entitled to chc as he was living on his own

Mum broke a hip and has dementia. SW decided she needed to go into a care home, which was what we wanted. As she is self funding it was left to us to find a home. They kept her in hospital while we rang around and visited homes. She went into a very expensive home while we waited for a place to come up in the home we wanted for her.

CHC funding has nothing to do with if you live on your own....its about whether you have a health need rather than a social need.For example, if you need wound dressing changes, medication titration, mental heath input.....rather than social need such as washing/dressing, meal.prep. It doesn't matter if you're well off and own your own home (like my mum in law) or you have no savings....anyone can be assessed.

I think.its worth confirming with the ward staff what kind of assessment they have done...was it for Fast Track? Was it for CHC funding (the Decision Support Tool)?

Even though I've been a nurse for 40 years, (ICU and community)I knew nothing about care funding 'til it happened to my folks and meant I did a lot of Internet searches.

If the rehab unit is NHS, there should still be an associated PALS.

I’ve just spoken to the discharge team and they’ve mentioned a placement asap
This worries me can anyone tell me how it works to me it’s short term respite

Did they not explain to you how it worked? They must know this is stressful for you and you have never done it before so should be holding your hand through getting him a place.

I am assuming they are not able to place a self funding senior into a care home of their choice because they want him out of rehab / hospital and then expect that person to pay for it so I imagine they are going to fund a few weeks at least.

In every conversation try to ask as many open questions as you can like 'so how does that work?' 'Who are that team?' What do they do? How long will that take? Who funds this initially? How do I get a financial assessment? Who can help me with that? What is the next thing I should do? Etc. Before you end the conversation ask for contact details for that person in case you have questions later.

Also try to read back through this thread and make notes of suggestions people have made such as getting a social worker for him or how to find a care home of your choice rather than where this initial placement will be.

www.ageuk.org.uk/information-advice/care/arranging-care/

Age UK have advice here.

Thankyou , I phoned age uk but they can’t say if social services can force my dad into a placement that isn’t our choice

Surely as a self funder he can go wherever he chooses?. First time mum was in respite care from hospital, I got my chosen place to assess her, they agreed to take her and we told the hospital we were going.

is the urgency about freeing up the bed? In that case, he might only need a couple of nights in their chosen place?

Hi EmmaEmerald, tbh I think that they want the bed , I don’t want to keep moving my dad he’s been through enough it could be upsetting for him . I just need to find a care home of my choice . We don’t have the cash for care but he owns his own place so I’m thinking that the council will put a charge on it .It’s all so complicated

I know it's scary but it might be better for him to go to a place of their choosing and be out of the hospital. That buys you time to find somewhere and he'll be somewhere nicer than hospital.

is there any cash available up front for a respite stay somewhere you choose? I'm going to flag this up on the main thread in case anyone can advise re charge on home etc.