Discharge from hospital - 88 year old - options?

[thisoldchestnutyetagain]

Looking for knowledge and experience of discharge process / options.

I don’t think the finer details of his stay are integral, so these are the headlines:

My 88 year old dad has been in hospital for three weeks, but he’s suddenly said he’s been told he can come out tomorrow. He could be mistaken, but it’s made us think.

He has previously lived at home with my brother, who works part-time, and who has acted as cook, taxi etc to date to help him.

We both think he is in no way safe to go home just yet, as there is no consistent care available. The house has stairs, no downstairs loo, dad is extremely frail after this episode.

There is every chance he’s muddled and it’s wishful thinking (and we want him out of hospital soonest, so long as he’s safe). But it made us realise we don’t know our options:

1. Does the hospital need to discuss discharge with us as well as dad? He has capacity, but can be confused
2. Can we refuse him to come straight home (thinking rehab period)? My brother can’t afford to be a full-time carer for him, nor is he trained.

Thank you.

I think you ought to call up/visit tomorrow morning and ask to speak with the ward sister/senior nurse on duty. Check what the plan is actually is, and find out what your dad's needs are. I would also double check that your father has provided the correct information about his hone environment, and the care that your brother has been providing.

If you think your father is confused, has he had a capacity assessment?

If your father is frail, I am assuming mobility issues etc, has he been reviewed by physio and occupational therapy?

It also sounds like you should ask to speak with the senior doctor responsible for your father (depending on the speciality, acuity on the ward etc, this might not be able to happen on the day, but you should be able to be updated on the medical plan before he is discharged).

You need to relay your concerns to the team looking after him (after checking that he hasn’t gotten mixed up).
In acute care in particular sometimes the overall picture can get lost in the minutiae of medicine, if you have concerns you have to let them know and stand firm.
If they’re a good team they’ll be glad you’ve told them, that’s what we’re there for (from an MoE nurse)

Be clear that your brother can’t continue to care for your dad unsupported as well, as quite often the assumption is “someone else is at home, so everything must be fine”.

Yes, that’s the fear re someone at home. Dad said my brother is there and can manage him, and it’s absolutely not the case.

To our knowledge he’s not been assessed again by an OT, just one visit about two weeks ago.

I suspect someone has made a comment that he’s clung to or slightly misheard, but all the same it has made us jump and realise we don’t understand the process!

Can you arrange for him to go to a care home for respite care for a few weeks? It will give you breathing space to organise more support at your brother's house.

We did this for our 90 year old mother - she spent 6 weeks in respite care after quite a long hospital stay. They looked after her and got her back up on her feet and she was able to go home with visiting carers for maybe 10 months.

After that when it was clear she couldn't manage, she went back to the care home (which had been really good) for the last year of her life. The respite care had got her familiar with the care home and she was able to tolerate the idea of living out her days there when she finally needed to.

You need to ask for a meeting.with the discharge coordinator to find out what the plan is and what assessments have been done. You can then correct any missconceptions they may have about the level.of care family is able to offer.

@thisoldchestnutyetagain sorry for your situation. In our experience staff do talk about discharge but the discharge does not happen without a team of clinicians all putting forward their view, occupational health, social worker if appropriate, doctors, physios, nursing staff. It might be there is a ‘rehab/respite halfway house where your father could be monitored but not a hospital. This could buy you some time to make informed decisions about the future. You could ask the ward nurse/doctor for a ‘best interests’ meeting. As a previous poster suggested perhaps if there is no ‘halfway house’ perhaps some respite in a home again to buy some time and see if your father improves in such a setting with staff on hand. He can be told that it is temporary but he may actually feel ok about it.