Hospital discharge

[Luminousalumnus]

Hi, FIL 90 has been in hospital since before Easter. He was admitted with an infection and whilst delirious from the infection and unsupervised (in hospital) he fell hit his head leading to a massive brain injury. He has had two head surgeries and also a heart attack following. Before the admission he was independent and still driving!
Now he has very little ability at all. Not able to follow any verbal commands, doesn't really respond to gesture, not able to weight bare, incontinent, on a puréed diet, not able to feed himself, no attention span and no focus. But he is stable in this condition and hospital wants to discharge.
What should we expect? We have an initial meeting tomorrow. They have to do a basic assessment to ensure a safe discharge I think? So I'm guessing either home with carers (not safe imo) or a care home. Who decides?
Then at some stage would we expect a follow up detailed assessment? At what point does the financial assessment happen? Might FIL be eligible for continuing health care funding?
Sorry - any insights welcome

There is no one person that decides, there would be input from every member of the multi-disciplinary team and that includes you too. So nurses, physio, OT, social worker. Unfortuntaely funding may come into it. He would not be eligible for continuing health care unless he had regular nursing needs due to his medical condition being unstable, that is if his most regular input was for hygiene and continence that is classed as care needs not nursing. If he would be unsafe left at home then a care home would be better but am not in a position to judge that. He would also need his capacity assessed etc if he is not able to express his preference. There is a lot to be considered!!! Everyone on the team will want to best for FIL but unless he has finances to fund his own care then hopefully you have a sympathetic social worker.

They will not do a CHC assessment in hospital unless he has a prognosis of less than 3 months.

From your description it is unlikely he would get CHC except if they do think he is dying.

The meeting will be to decide home or care home, if you say care home the discharge planning team will tell you what to do next. They will expect you to look quickly and only at homes with current vacancies.

To make discharge planning efficient you need to have an idea of whether he will be self-funding or will be council funded, and a clear view of how much care the family can/will provide. Age UK or his council website will have information on when council funding will kick in.

If council funded then they have more of a say and have a higher threshold for residential care so you will need to be very firm on how much you can do for him if they want to try home and carer visits, but I suspect that's unlikely from what you say.

If he is self-funding then really it's up to you to decide, and personally I'd be looking for a nice nursing home for him close to where his loved ones can visit. Most hospitals can point you in the direction of services who can help you choose somewhere.

CHC funding is effectively for people who would otherwise be in hospital and in need of Nursing care. It's also massively overspent and decisions can be very slow. It's unlikely he will qualify but guidelines are online.

Thank you. So basically the first meeting is to tell us they are about to assess for discharge to home or care home?

Sounds like nursing home needed. Make sure you are up to speed on CHC funding. Go to www.beaconchc.co.uk for free advice.
How sad that his decline was due to hospital negligence.

He DOES sound as tho he qualifies. I got it for my OH on appeal .... the system relies on people being ignorant about it and not pushing for it ... do not be that person.

From what you describe he should be funded by continuing healthcare which will cover nearly everything (they will take all but a portion of his state pension and he won't be eligible for any other state benefits but any private pension and savings are his) the only top up money is for haircuts, clothes and possibly trips out but might not be applicable. If you are told differently seek advice because hospitals can want to discharge but can't until he has an appropriate placement

The first meeting will probably be to discuss his current care needs, what assessments he's had, what the home environment is, is it safer to be in a carehome or at home with a care package which would be carers, equipment, adaptations. They will also ask if there is power of attorney in place, the finances like who owns the home, are there savings and what do your family think he would like to happen. Sorry to hear what happened to him.