Dad is hospital after - will they let him home?

[thethoughtofgettingout]

I'm trying to find out what happens with older people whose homes are unsuitable for their needs after falling.

My dad is in hospital after falling down the stairs. He lost consciousness having had a heart attack. He hit his head hard when he fell. They think he had another heart attack whilst in A&E.

He is in his late 70's and is on a ward. He has a great deal of dizziness (has done for years) & nearly toppled again on the ward.
They are discussing stents & are sending him to a regional cardiac centre.
He has had a series of issues with his heart over many years, including previous heart attacks & aortic aneurysm. He has angina.
He has previously been told he is not fit enough for a heart bypass although needs one.

His lifestyle is terrible - still smokes & very immobile.

He lives alone in a tiny, Victorian terraced house with steep stairs. No downstairs loo or bathroom.
I've been nagging him for years to move to something more suitable but he is very obstinate!

My question is, will they discharge him home given his health?

He can't live with me or my sister as our homes are not suitable for lots of different reasons - I live four hours away.

What will happen now?
Will they discharge him home after treatment & expect him to wash / use commode downstairs indefinitely?
Will he be assessed regarding needing care?
If he can't go home will he stay in hospital or will they send him to a care home?

He is a bit confused but reasonably lucid.

I am hoping he will sell his house & get a supported housing type flat, but I'm trying to navigate this with no experience of these situations?!

I have spoken to him for years about moving & getting a plan in place for care BEFORE he needs it. But my worst fear is now being realised & I don't know what will happen now?!

Any advice or knowledge is gratefully received!

In my limited experience they will send him home with a 'care package' if necessary. There is no space in hospital for those who don't medically need to be there. The system is falling apart unfortunately

Depends if he has suitable space down stairs, if so yes

My friends mum in 90’s went into hospital after a fall . No family nearby . She was moved to a care home .. Dad is still in the home but can financially afford the care home..

I would ask for an assessment before discharge

Social services will get involved and he won't be discharged unless they agree it's safe. There may be a respite facility he can go to.

My sister's dad is in this situation, he can't go home because his wife is a hoarder and it's too dangerous. So he's been in a respite place for over a year.

They will not keep him in hospital pending the sale of his house.

When they think he is medically fit for discharge he'll be assessed as to whether he can go home with or without a care package, if he needs equipment at home, to live on one level or can only manage in a care home.

He needs a full assessment of his needs and referral to a social worker.

Living downstairs with carers supporting might be an option if he can be safe inbetween their visits, if not he may need residential or nursing care.

Could he manage with a stair lift at home or do you not think he can manage at all ?

They will probably be pretty keen to turf him out with a "care package" that will involve someone popping in for 15 - 30 minutes up to 4 times a day.

That's for all your messages - so, so helpful.
I will request a care assessment.
He'll be desperate to go home but I think he doesn't really understand quite how immobile he has become.

Some posters have mentioned a stairlift but his stairway is complicated & he could easily fall again getting in & out of seat + if he loses consciousness again, he wouldn't be able to stop himself from falling.
It might be a possibility - I have lost perspective as I am worried!

I’m sorry to say that in my area, the powers that be try to insist on moving the bed to the living room and placing a commode there.

There should be a social worker within the discharge team who you can share your views with. Often elderly claim relatives can support them with minimal care team input, but you may need to push back on it. They may offer a funded carehome or rehab bed as an interim measure, but such beds are scarce.

Just ensure @thethoughtofgettingout that the staff on the ward have noted that neither you or your sister can take him or provide care for him at his home and that you have concerns about his safety at home and will need an OT assessment , as will his home prior to any discharge .

He can sell and move into a flat with a warden/extracare type set up or full care home. I would arrange to speak with the hospital discharge team to see what they recommend and speak to adult social services where he lives for local options. If his need for supported living is health related then the nhs should pay but getting this agreed isn't always straightforward hence speaking to adult social services

The problem in this situation is if he is deemed to have capacity he can make decisions which you consider to be unreasonable, this includes continuing to live some where unsuitable.

Op tell them it will be an unsafe discharge if they insist on sending him home. Social services and physiotherapy need to do a thorough assessment before he leaves hospital. If he needs 24 hours care they might put him in a nursing home x

That's my worry!
He is not an easy person to discuss things with & very direct about his views...which is a good thing & I don't want him to lose capacity to make decisions.
He is very black & white in his thinking though & he will only concede when it becomes painfully obvious he is wrong!
I just don't think his heart will cope with another incident of blacking out & falling.
I've spoken to him about this situation a thousand times, so I'm feeling frustrated as well as sad...

They will send him home. I fought for months against a discharge into a house which the person could not get in or out of without patient transport or ambulance. They still put him in the house - he was locked in by carers who turned up 4 times a day and it wasn't until he became unwell again that I was able to pursue a care home. The carers were undertaking an assessment and said he was fine to be alone.

Community alarm was in place and smoke detectors despite the fact he could not get out of the house even if he did understand what the alarm meant. Apparently all of this is acceptable treatment of the elderly.

It's a sorry state of affairs isn't it?!

I will do that, thank you

The hospital will want (need) to discharge him when his hospital treatment/tests have finished. There are some possible steps between there and home if it’s deemed he needs/will benefit from it

• rehab hospital/hospital ward - medical oversight and nursing care, the closest there is to an old fashioned convalescent home, may have some rehab element eg physiotherapy
• a residential care home for rehab and reassessment on a temporary basis while he gets a bit of strength back

Both those will be free in the short term at least

Do you have oversight of his finances? As well as owning his home does he have savings over £24k? What happens long term will depend on his £ situation and his mental capacity.

If he says he is happy to have strip washes at the sink or basin, they will probably send him home.

It's pretty normal to want to be at home. The system may be too eager to accept poor discharges but should people really be forced into care they refuse repeatedly?

They will do an assessment including one by an OT, this will establish his level of need

It's likely they will then look for a package of care to meet his needs, this may include equipment and possibly him changing to single level living (living room probably) They will also look at any reablement potential

Do not let him come home without the above, if he is discharged without above it will become your responsibility

They will have to get him off the ward once the medical issue he's in for has sufficiently improved. He may go to a rehab which is like a hospital but they just help you get moving again. Or they do a care package which might be carers or adaptations. He may need a commode etc which the physios can sometimes order.
Obviously they can't command him to sell his home. If a stair lift is not feasible he may need to move his bed downstairs. And use a commode. At least when he first goes back home.

Which means “expect him to wash / use commode downstairs indefinitely?” plus up to 4 care visits a day.

Unless he has lost competence, he can’t be forced to do anything against his wishes.

Even with narrow Victorian stairs, a stairlift may be an option. Reconditioned, no point in going for new, they’re rarely used for long. You can get a swivel seat which rotates at the top of the stairs so it faces the landing and the stairs are blocked off by the arm of the seat.

Moving house would be difficult if he can’t go home - where would he go till the new place was ready?

Anything you tell the staff re discharge, also put it in writing so it gets added to his notes.

All the posts are giving me lots to think about & the advice is so helpful.

I will definitely make sure the hospital is aware of his difficulties & how long things have been deteriorating to avoid an unsafe discharge.
I think they are quite worried about his history of blacking out & falling - the fact they observed him struggling to not fall whilst going to loo on ward means they have seen for themselves how unsteady he is.

I hope they will discharge him into a rehab setting for even a couple of weeks so we can get things sorted for him at home.