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!

@thethoughtofgettingout be the relative who makes some noise about this. Be assertive. Keep on. The reality is that those who have relatives fighting their corner tend to get more of the very limited provision.

Unfortunately this has also been my experience. MIL lived in a terrace house, ended up in a wheel chair, could only get out with 2 carers or me and DH lifting her into a hospital bed in her front room, next to a commode. 2 steps to get into the house and at the back door, couldn't put a ramp in due to lack of space. If there had been a fire she would have died in it.

MIL wanted to go home, and had capacity, but couldn’t use stairs anymore. They sent her a hospital bed and commode to use in the dining room. She had a strip wash at the kitchen, but couldn’t stand to cook. She had four carer’s visits a day to empty her commode, and get her meals - using a microwave. She was housebound and wouldn’t have been able to get out the house, in a fire.

They will push to get the bed back whether he can manage or not, we have been told someone only needs one visit a day, we get them home and they need 7x4x2.

Keep pushing them. It's such a difficult situation OP, I hope everything works out for your dad

People who are at home with very limited mobility can have community alarms linked to smoke detectors, falls detectors, carbon monoxide detectors etc. If the alarms are triggered the call centre call the emergency services. It’s not ideal but far better than nothing being in place.

I may have missed this from pp, but be absolutely clear that you are not able to stay over with your dad - hospitals are very good at making assumptions. Ditto Homecare.

Not quite the same situation, but when my late husband had his stroke he had 4 months in rehab. We were promised 3 visits a day as an interim measure. (Initially, they assumed that I would give up my job.)

DH was brought home in an ambulance and taken upstairs. The extra bannister he needed had not been fitted. I was told it would be done the day he got home.

Chap from the council arrived, expecting to measure for a new bannister, not fit one.

God bless him, he managed with the materials in his van.

Then someone from Homecare arrived. They took one look at me and cut the visits from 3 to 1.

@WearyAuldWumman It's bloody awful

It really is.

One of the other patients in the ward was in a much worse condition than DH. Dh was alert and though paralysed down one side, had learned to walk again.

The other chap had lost his cognitive function and couldn't walk. His wife was promised a through lift which would be installed after she got him home. He'd have his bed moved to the living room as a 'temporary' measure.

Once he was home, the OT and Social Services reneged on their promise. In the end, the wife looked into paying for a lift herself...but her husband died before she could install it.

The chap in the bed opposite my husband was also mentally alert but - again - was left with hemiparesis. To add to his difficulties, he had thalidomide and his "good" hand was the hand affected by thalidomide.

He and his wife were promised that he'd get a stairlift installed, but he'd have to have a bed in the living room first...

Knowing what had happened to the other couple, this wife played hardball: "I'm not having him home unless you have the proper equipment installed."

They got the stairlift.

Similar happened to us some years later, after DH was admitted again with an acute kidney injury. We were promised a bed raiser, to make it possible for me to get him in and out of bed without injuring myself. (I'd already damaged my shoulder from moving and handling. I've since had to have a shoulder decompression.)

Remembering what had happened to the other patients, I gritted my teeth and told the hospital that I was refusing to have DH home without the equipment. I went as far as pointing out that the house was in my name...

Miraculously, until the "correct" equipment became available, an interim device was delivered to the house.

I later found out that the OT had quizzed my darling about the state of our marriage...I have no doubt that she had the impression that I was a complete b*tch.

We were promised additional grab rails which didn't materialise. I paid a tradesman to do the one in the wetroom for us.

The man from the council installed the exterior grab rail the morning of the day my husband died.

Sorry - this is a bit of a ramble, but I don't want the OP to be caught out.

@WearyAuldWumman I totally agree with you, it's a shit show and it's the people who are most vulnerable that suffer the most

Carers breakdown because they are left with it all and it's just too much

I hope things got a bit easier for you and DH

It really is a shit show. Unfortunately, DH only survived another 3 months after getting home, but at least we had that time together.

I am so sorry x

Thank you.

Have you spoken to him since this latest incident? It might have made him realise it's not the right place anymore?

My son is 9 so I’m not sure how similar it is but after cancer and septic shock, my son is now in a wheelchair for the foreseeable future.

After an OT and physio assessment, our house was deemed unacceptable for him and we were put at the top of the housing list for an accessible place to live. This was also after a housing assessment from the council.

We were told that he wouldn’t be discharged if there wasn’t anywhere suitable for him to go.

We got an accessible place after just a month of waiting.

If the medical and discharge team believe he is unsafe and cannot yet return home, but he disagrees, they can still refuse to send him home as they will deem that he does not have capacity to make that decision. This happened to my MIL. She was moved from hospital to a rehab place, then to a short term care home. Sadly she deteriorated there and passed away after a few months.
You also need to tell the doctor to arrange a falls assessment. Your DF has had some major surgery particularly with his AA, it’s unlikely that they will do anymore heart surgery with him as he would be unlikely to survive the procedure.

Sorry if I’ve missed it - does your dad have capacity and if so what does he want? Anything that happens after that will entirely depend on those answers.

if he has capacity and is adamant he wants to go home, there’s nothing anyone can do to stop even if everyone knows it’s a terrible idea. If he’s amenable however to respite/permanent care home, then that can be worked on.

As terrible as the consequences may be, no medical professional should ride rough shod over a persons decisions, irrespective if we think it is not the right thing. Patients are discharged back to unsafe environments - if they have capacity, understand the risks involved and still want to do it.

The trick seems to be that you (as his relative) needs to be involved in the decision making process to point out any unsafe plans that are being proposed, while at the same time clearly refusing to provide hands on care and insisting that carers need to be in place.

If the social workers think you can / will do it, if you are to eager to get him home, then it will be left to you to do the caring. If you don’t get involved at all, there is no one to advocate for your father when unsafe or unworkable proposals are made. So you need to find the sweet spot of being involved - but without getting roped into the actual caring (unless you want to of course).

My dad has been living at home on his own for years. 91, no carers. Then at the beginning of Dec he had to go to A&E and it turned out he was seriously ill. He couldn't come home even with a care package. But the hospital wanted to discharge him.

Then you discover what a scramble it is to find provision.

In the end dad actually qualified for nhs continuous care. He is in the same place my mum was in years ago.

The thing about continuous care is that there is no charge for it. My mum was there for over a year.

But when we were looking for care homes, they were all full, with waiting lists.

So do start making enquiries soonest x

Fall alarms are all very well, but some people take them off at bedtime and forget to put them back on!

This. Take a notepad with you and when talking to the medical professionals make notes on what they tell you. This shows you're serious about it all and discourages anyone over promising support that they later back track on.

There should still be available something like 'rehabilitation care' but it has different names in different areas. This is for 6 weeks of after care following a hospital admission to help the person get back to the point of living independently again. It's not charged for or means tested. My mum got this and was transferred to a convalescent home while she recovered. Ask about this as a first step.

It's very common for older patients to deny needing any help or lifestyle changes and rejecting any offer of them. Remember that your dad can't just say 'I want this' and expect everyone to make that happen. He'll have to compromise which may involve carers or residential care. Don't then feel you've let him down by not doing what he asks for. And do not agree to do the care yourself or you'll never get any help.

There are bed occupancy and floor pressure sensors that don’t rely on people wearing a pendant or watch style button. My personal feeling though is that the level of risk is this big, someone might be better off not being alone at home.

Our thoughts exactly, but MIL was determined to stay at home until DH told her, she had to go to hospital (UTI with delirium) and she never got home after that! Nobody took any notice of her wanting to go home - because DH and his sister refused to look after her, even with carers 4x a day!

I really feel for you. There will be an assumption that you can step in.

Realistically we have a big issue with people living longer. Both my parents lived into their 90’s. It sounds wonderful but truly isn’t. DH was OK in a care home. DM definitely wasn’t. She didnt want to move from her old house even though she was struggling to live on her own and called me often. She had capacity but would listen to me (sometimes!).

There are many threads on MN with people saying that you have to respect the older person’s decision but you KNOW what the consequences are likely to be.

It will involve you dropping what you are doing now to go and help. Whether that be as you are going out for a well earned holiday, about to present to an important meeting or in the middle of the night.

That is what really messed me up. You never knew when you were going to get the ‘phone call’.