What happens now

[ElderlyPIL]

Name changed for this. After any advice, as this is all new to me. Sorry if this is long, but going to try not to drip feed.

FIL hasn’t left the house in a few years, even refusing to go to his wife’s funeral last year. He has had mobility issues for a while due to arthritis. He lives in a council bungalow, adapted for a wheelchair user as a result of his late wife. It appears he has been having issues even getting about the house, and had arranged a personal alarm himself.

DH is his only child, and has never been close to him. I’ve suggested numerous times, that DH needs to make an effort to visit at least once a week, but DH refuses and keeps FIL at arms length.

Last week, we had a call to say he’d fallen and needed help. This was the first we knew about being a contact point for the personal alarm. DH attended and got him sorted. The next afternoon he fell again, but DH couldnt leave work, so the ambulance came and a referral was made to SS. FIL refused carers that night, and at 11pm we had another call, which DH attended.

The next morning he accepted the carers, who found him immobile, he was admitted to hospital. He’s always been a heavy drinker, but he seems to have increased his drinking significantly.

He’s been having various tests, but not really telling us the results apart from they found an issue with his liver. He is bed bound, they managed to get him in the chair once, but he has refused to have any physio since. He’s on various medications but won’t say what.

We’ve been to his bungalow to pick up bits he’s requested and it’s obvious he’s not been looking after himself. The property is very dirty, and the fridge was full of outdated food. He seems to have been surviving on takeaway deliveries and having alcohol delivered.

We are not in a position to help care for him when he returns home, or be on call to pick him up if he falls, although hopefully DH will agree to visit him once a week.

He’s been in hospital for 8 days now. What’s likely to be the next step in a situation where he doesn’t have family support on hand, is refusing physio, isn’t mobile, can’t really take care of himself, and is highly likely to hit the alcohol hard as soon as he gets home?

Is this in the UK? If so the hospital should hold a Decision Support Tool meeting to identify any needs for care prior to discharge.
They could put a short term support package in at home or use a Discharge to Access pathway involving a care placement.
Providing the patient consents. My advice is to make it very clear to the hospital that the family is not able to care for him and he was self neglecting prior to admission.
It's not easy caring for a frail elderly family member and I imagine substance dependence can make it so much more difficult.

You need to contact SS and say what care you are willing to provide. If it’s not a lot then you need to pull right back and let him fail. The more you do, the more they will expect you to do.

As a PP said let the hospital and others (social care) know that you cannot/will not provide any care and let them know all of his needs/issues in the home that you are aware of. I think this is a better route than trying to persuade your husband to visit more. One visit a week is unlikely to do anything to make him safer. Partly it is his choice how he lives.

Do not offer to do anything. No shopping, no washing, no visiting etc. Make it very clear to the hospital your input will be absolutely zero, as you will be their first port of call. You are the cheap option. Be wary, promised community help is often woeful or does not materialise (ex district nurse).
Let the hospital social worker sort it all out, keep your head down and shrug at them.

OP, this will only go one way. After several hospital admissions and SW attempts to keep him at home, he will eventually be admitted to a hospital and discharged to a care home. The staff there will find it v difficult to deal with his alcohol withdrawal but they will cope better as they are a team, rather than an individual.

Thanks for all the replies.
We are in the UK, FIL is only in his early 70’s. He is still mentally capable. He has an ability to charm people, seems he had various neighbours doing bits of cooking, shopping and gardening for him. Although bit concerning that at least one neighbour was on several occasions given his bank card and pin to get him cash out.

DH spotted him about to get caught by a parcel delivery text scam on Xmas day when he visited in hospital, he also seems to have an online shopping habit, lots of new untouched items and unopened parcels.

I assume the hospital have him on something to control the withdrawal, as when he was first admitted he was shaking lots, but now says he feels fine, despite having had no alcohol for over a week.

We found 8 bin bags of empty larger cans in the spare room, which we removed when we emptied the fridge. I feel like we should remove what alcohol we can find, before they release him, but he will just order more. His property also needs a massive clean, I assume I’m best leaving that so SS can see the true state? He’s already asked us to dispose of a sofa that he’s been spending most of his time on (and looks as if he has had accidents on), again I think we should leave the council to sort this.

Will SS/ hospital talk to us about the care plan before agreeing anything with him? I’m concerned that he assumes we will cover things and persuade SS of this, without them involving us.

Your DH needs to ask the ward who his SW is, or for a contact number for the team.
Honestly, we went through hell with a relative and had to let them fail for the SW to jump in. Before that they left us to it when we weren’t wanting to do it, had our own lives to contend with.

Here’s what I suspect will happen.

He is not going to change his lifestyle once he’s out of hospital. He will carry on drinking and (by our standards) neglecting himself. No amount of state intervention or care or visits by you will change this. So he’s not going to be transformed into a model elderly parent through the simple application of a weekly duty visit from DH.

He will continue to fall at home, because of the combination of drink, poor nutrition and unwillingness to do any physio/exercise. DH will continue to get calls, and ambulances will arrive. Sometimes they will be able to leave him at home, sometimes not. His liver will get worse. You’ll be surprised every time he survives to hospital discharge, and continue to get drawn into discharge decision/social care assessments, and this may go on for quite some time. However, eventually there will be a crisis of some sort (sepsis, liver failure, gastric bleed, whatever) and he will die.

And because he is DH’s father you will feel connected, as if you - or particularly DH - “should” be doing something to prevent all this. And you will crack every so often and go round and clear up his flat and change his sofa and help him apply for attendance allowance. And none of it will make the slightest difference.

I know this is a horrible situation for you but seriously? Protect DH, protect yourself. I doubt you can make the slightest difference for FIL.

Will SS/ hospital talk to us about the care plan before agreeing anything with him? I’m concerned that he assumes we will cover things and persuade SS of this, without them involving us. He is mentally capable. They will believe what he says and will not check with you. You cannot quietly stand back, you have to loudly distance yourself.

Your DH isn’t required to look after him or even visit so don’t pester him to do so.

Absolutely agree with PPs OP. Do not agree to anything. Make it VERY clear to hospital staff that he needs a comprehensive care plan in place before he is discharged and do not agree to anything. You have FT jobs etc etc and cannot commit. SS will get involved and will meet with your Fil to assess his financial situation. If he has enough money he will have to pay for carers or if not SS will arrange for council funded care. There will be absolutely no expectation for you to fund any care for him from SS - they will only take his finances into account. You are not financially responsible for him. Difficult situation OP but do stay firm about it.

• Edit after reading through again OP! From my experience, physio have to sign off a patient before they are sent home. They need to check that they have some mobility and can care for themselves. If he is refusing this and is actually not mobile enough to get out of bed then I doubt if they will allow him to be sent home. Might send him to a rehab place (depending on what you have in your area) but if he's not engaging with physio this may be a waste of time? My guess is, they'll send him to a council run care home.

Thanks to everyone who commented, I found it all very useful.

As an update, FIL is still in hospital, although arguably not being treated for anything for over 3 weeks. Seems they have been shuffling him in and out of different wards and corridors, until they can sort a care package out. At one point early on they moved him to the discharge ward, and he was under the impression he was being taken home the next day. At that point he had refused all physio and was unable to get himself out of bed. So I called the hospital and made clear it would be an unsafe discharge and he had no family to assist in caring for him. I was assured he wouldn’t be discharged without a care package, and shortly after he was moved back up onto the main ward.

The council have since visited his property and decided to set him up with carers 4 times a day. They are also dropping off some furniture for him in the next few days, so he can be set up in one room, things like a commode on wheels, and possibly a bed hoist thing.

DH and I have been to his bungalow and realised he has been using his spare room as an extended bin, there’s visible mould everywhere in there. So with his agreement, we have taken steps to empty that room of everything for him. At least with the spare room empty, the rest of the contents in his way, can be moved from the rooms he will be using, into there if needed.

The whole property needs a massive deep clean, no idea if the council will arrange this, not sure carers will be keen to work in the place as it is, filthy and reeking of damp, or maybe they are used to this?

I said before he has an alcohol problem. We worked out before his admittance to hospital he drank a litre of whisky in 4 days, along with numerous beers. He had 2 more litres of spirits delivered while the ambulance was with him! We are going to remove all the alcohol when we remove all the out of date food. Hopefully if he is not very mobile and with carers coming in 4 times a day, he will have less ability to get to alcohol for a while.

DH has been corresponding with the care package team, to ensure they put care in place, but has decided once FIL is back home, he will step right back, so council can see exactly what care FIL needs long term. I suspect the 4 times a day package is temporary, and we need the council to see that FIL needs an ongoing care package (he has no assets and no savings) as we cannot fill that gap and provide the level of care he needs.