Hospital discharge help

[Frenchdressing]

My 82 yo dad fell in the garden and fractured his hip. He’s in hospital now. They aren’t operating but looking at rehab. He’s in lots of pain and on lots of medication and having short physio sessions to get him moving.

The hospital are talking about moving him to a care home for intermediate care until he can move more and use the toilet independently . He really doesn’t want this. My mum, who has some health challenges herself, is at home and can drive and cook. They live in a bungalow. I think with help he could get home but obviously this would need daily care visits, OT assessment and home based physio. I feel this would be a better option as mentally he will struggle in residential care. He’s scared he may never come out!

i appreciate the can’t force him into a care home but wondered what options were, how to approach this etc. the hospital aren’t great at communicating and unfortunately I live aboard. So can’t advocate easily.

Any advice welcome.

He needs rehab! Trust me, they won’t keep him in rehab for any longer than he needs as the NHS will be paying for it. The concern about him going straight home is that the services he needs - carers, adaptations etc can take a long time to put in place. If he gets home without them being in place and your DM can’t manage, he’s screwed basically. If he’s fit for medical discharge but can’t go home, he’s bed blocking.

Are there any community hospitals with rehab beds in his area?

Doesn’t look like it. Just a couple of residential homes that take over 65s and include options for people in my Dad’s situation. Neither have a great reputation and poor CQC ratings,

How long do NHS pay for continuing health care?

I would ring the ward and ask to speak to the physios- get the lowdown on what the options really are, and ask if they will start applying for CHC funding.

I don't think there is an official timescale for CHC funding but once agreed it is regularly reviewed.

I have to say that his needs don't sound complex enough for CHC funding but you don't have to take my word for it, my only experience is doing the application once for my mum.

He won't get CHC until he has been fully assessed and that shouldn't happen till he has had some rehab. He may get 28 days intermediate care paid for by NHS but this may vary by location.

Previous pp is probably right and needs will not be complex enough for long term CHC so he should be assessed for social care needs. This is means tested so he may have to pay towards it.

The intermediate care will be to get him moving again and assess his long term rather than short term needs and yes it can take some time to put services equipment in place for him.

So intermediate care is NHS funded?

Sorry about your dad. He would be far better going to intermediate care and having daily physio until improved than going home with community physio input which would not be every day and may not be immediate. Care packages can take weeks and even months to start if not already in place, by which point he could really have improved.

Intermediate care ordered by the NHS will be funded by them. If you take him home, while the physio and ‘treatment’ part will be funded , you may have to fund any personal care, and as pp said, that may take some time to arrange.

In my area they call this an assessment bed. They are usually for 6 weeks max and will be funded by the local authority at their rate. In my area this is roughly £671 per week, anything over this amount they will expect the family to pay. So if you chose you can ask for a better care home in your area, depending on if they have availability.

I know he doesn't want to go but it really will be the best option for him to get back on his feet. They will not want him in there for any longer than he has to be. The majority of service users that go into In assessment beds go home.

Yes the intermediate care will be funded (until it's decided that he doesn't need it any more - after that he would have to pay if he wanted to stay there). There will be a regular funding review (say once every 6 weeks).

I agree he should accept the intermediate care. It is his best chance of getting back to a good quality of life. Your only option would be to pay but even then unless you have live in care it will be a huge burden on your DM. He should look at it as convalescence. They won't keep him in unless he is not progressing.

Different situations in Scotland and England. In Scotland we have a system called discharge to assess (think that's what it is) where someone who was previously fit and well are encouraged to go home and are treated with the hospital at home team alongside care support workers from your local council. It's a great system and basically does what it says on the tin. If this is the case then try to get him on that. Worked for my 89yo mum. I'm a CSW and I can assure you it works for our clients as well, therefore freeing up a need for someone who needs it.

@Happygranny59 I am also in Scotland, and while Hospital at Home is NHS first choice, it’s cheaper, it is not always suitable, and funded intermediate care is offered instead.

My MIL had this last year, hospital wanted to send her home, luckily the social services manager at the hospital disagreed. In her case she had physical issues coupled with dementia.

Thanks all

Agreed that it's not always suitable for everyone, but it is great for getting those that were fit and active before, back on their feet again. Often much quicker than they would sitting in a hospital. Hope your MIL is managing well now

He needs the intermediate care. Honestly. Your mum may be able to cook - but how is she going to manouvere him to sit up so he can eat? She can drive - but how is he getting to the car? What about when he needs the toilet and he can't get up? What if he calls for your mum but she's away cooking and doesn't hear him? He tries to get up himself and falls again. If he falls in general - my aunt put out her shoulder trying to lift a fallen grandparent. Call an ambulance? Enjoy leaving him on the floor for several hours waiting.

He needs care until he's well enough and strong enough that he's no longer a danger to himself and your mum if god forbid he pulled her down with him.

Thanks @Happygranny59 She is actually ‘in a better place’ as she liked to say . But her ending was as good as it could be - well cared for, pain free, in her bed. As we would all wish.

We have Discharge to Assess (D2A) in England as well it's been around for at least 5-6years in my local hospital trusts.