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Elderly parents

Home First ridiculous-ness!

2 replies

cheesecurdsandgravy · 20/07/2024 22:55

FiL was diagnosed with a mild cognitive impairment in 2019. He’s become increasingly “doddery” since then and, following a fall last month which saw him taken to hospital to check for breaks (none) has been in hospital, he was declared medically fit for discharge the next morning. As he lives rurally, and MiL is physically disabled and cannot be his carer his discharge was delayed significantly. He has now been in hospital for five weeks. During this time he has lost so many skills (using a toilet, eating independently, dressing, washing, personal hygiene) and a significant amount of weight - 10% of his body weight - his BMI on admittance was 18.2 already. He has a DoLs, and needs assistance with all aspects of his day. We have visited daily, assisting him in personal hygiene, encouraging eating/drinking etc. but one hour does little to help really. His notes are abysmal - rarely completed (he’s supposed to be on a food and fluid chart but it’s often been left unchanged for 24hrs or more) and, with no record of oral or bodily hygiene support being offered or given - he has been growing increasingly grubby and his teeth and dentures were foul.

He had a failed “home first” discharge last week. After which we requested a meeting with the ward manager and matron as it was clear that it would never had been successful - he is malnourished, no longer continent and cannot walk (with a zimmer and assistance) from one side of the ward to the other without feeling faint. Plus, his wife cannot possibly support him physically between the 4x daily visits or over night.

On the day of the meeting I arrived to find his sheets covered in dried faeces. The blankets were pulled back, and the sheets on full display - I assumed they were about to be changed, the ward nurse and CSW definitely saw them several times but, after 30 mins I had to request they were done. In addition, his glasses were missing - they were eventually found in a bed bound patients locker - along with SIX other pairs that did not belong to said patient.

I have to say, that following that meeting, things have improved in his care significantly. He is being mobilised, is supported to toilet rather than just using a bottle and a CSW now helps him eat. But, he still can’t do anything independently, cannot walk far even using a zimmer and with support of another person (he arrived in hospital as a single stick user). The dementia nurse has been to see him every other day at least, and his hygiene/food records are now up to date so we can keep a better eye on what’s happening.

There’s talk of another attempt at home first - it’s going to fail. He cannot navigate the house, and the aids he would need would stop MiL being able to navigate the house - at the moment she doesn’t need a carer as whilst she is disabled, it’s a life long condition that she has learnt strategies to work around. Making adaptations to suit FiL would mean she would then need cadet support to move around the home etc.

What is the point?! Gahhhhh!

OP posts:
FiniteSagacity · 23/07/2024 20:14

@cheesecurdsandgravy you’re right. Home first is crazy in these circumstances. There must be a better way.

PermanentTemporary · 31/07/2024 12:24

Omg. The principle of sending everyone home in order to fail horrified us when we encountered it (stroke team). I must admit that it 'works' more often than might be thought. However, the key thing may be night needs. If your F does not need any help at night, the home first thing may be nailed on; if he does, they will look at nursing homes.

The occupational therapist is the one you need to talk to. In my experience 70% are great, 20% are so incredible that they leave you in tears they are so good, and 10% are useless. Scope out which you're dealing with soonest, and if they are in the 10%, start kicking off via PALS.

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