Social worker said it’s not safe to discharge dad from hospital

[K37529]

Dad is currently in hospital after a bad infection in his leg, treatment has went well and he is now medically fit for discharge. Dad has Alzheimer’s and up until 3 weeks ago when this infection began his symptoms were mild, and he managed well at home (he lives alone). He is currently on morphine for pain which I believe is making his Alzheimer symptoms worse, he was on morphine years ago and this happened then too so I’m sure it’s the morphine. He has basically been sectioned as he tried to leave the hospital last week so they did a mental health assessment which he failed. The social worker has suggested a care home but I’m sure that once he is off the morphine his mind will return. He lives in a council house so it won’t be possible for him to return home if he is put in a care home. I’m not sure how to navigate this, I’m his next of kin so the social worker has said it is my decision. It isn’t safe for him to go home right now. Is there any other options? Can I request respite care to a care home with the intention of moving back home? I have asked for him to go to rehab to get him back on his feet but the social worker has said that the OT will decide and I don’t think they have made their decision yet.

I lost my mum to Alzheimer’s. During her illness, she had a few hospital stays for various things. She always declined in hospital and never improved afterwards. I can only speak for her but I wouldn’t bank on significant improvements.

Yes, you can look at respite care. That would be sensible but again, I’m not sure he would be able to go back to living independently after a significant period of being cared for. However it’s worth exploring and respite followed by carers visiting the home may keep him at home longer term.

Thanks for your reply, he already has carers 4 times per day. He has declined so much over the past 3 weeks, I just keep hoping that he will get better but every time I go to see him he just seems more confused and lost. It’s heartbreaking 😢

When my mum had a fall and ended up in hospital. I was told by SS she was not safe to go home. She was discharged straight to a care home. We knew in our hearts that it was the right thing to do as she wouldn't have been safe at home at all. I have no regrets she loves it there has made lots of friends and does lots of activities and is well looked after 24 hours a day. She says it's like being on holiday. As she owns her own home it now has to be sold to pay for her care which is hard going through her things when she is still with us. You could look into respite care if you really think it would help him to go back home.

Generally someone is discharged to a care home for a 6 week trial (often takes longer), HB would still pay rent in council house (as long as stay isn’t made permanent).
but that will give you time to decide and to see how he does.

it’s possible that care home is best place, I have known people to stay temporarily then return home, although most stay and don’t return home.

If he was already having carers four times a day to be able to manage at home, then he was already at the max level of home-based care SS would provide. I'm sorry to say it, but the next step would probably have always been a care home as he'd have deteriorated at some point and hospital stays often mark a decline.

Please don't worry, for my relatives moving to a home was a positive step in terms of their comfort and wellbeing.

My mum had dementia and was cared for by my dad plus carers. She went into hospital for a bladder infection, caught covid, had a heart attack. They wouldn't allow her to go home but she qualified for NHS continuous care. This means being looked after in a NHS facility rather than a care home. It is hard to come by but do ask.

Can I ask what is your concern about him moving into a care home? He will be looked after, have 24 hour support, be well fed, bathed, meet with others, and ultimately be safe. My stepfather had to go into a home from a hospital stay. In hospital, his doctors thought he may have 6 months left, but after a few weeks in his care home he began to thrive. He eventually passed away in his care home 2 1/2 years after moving in.

To be honest they (we) are normally very keen to avoid care homes and send people home. So if they're saying he needs 24 care he probably does.
4 carer visits a day is the maximum at home normally so there's not really anywhere to go.

If you feel he's still affected by his medication/an acute condition then yes I would say he will not be giving up his tenancy and ask for 4 weeks of respite then reassess.

But be prepared that people often don't get back to baseline after a stay in hospital/care home.

Sometimes a hospital will send someone to a care home on a "discharge to assess" basis to free up hospital beds. This allows the person to recuperate in a safe setting to see if they can be discharged home.

Sometimes people do stabilise once they leave the hospital environment enough that they can return home. But even then, it isn't forever.

It’s absolutely the best thing for him to go to a care home. Dementia doesn’t progress in a smooth trajectory. It chunks down. It sounds like it has taken the next step. For him to go to a care home straight from the hospital is going to be so much easier for all involved rather than him going home and then having to go to a care home. There is no way the social worker would say he should do this unless it was the right thing.

He has basically been sectioned as he tried to leave the hospital last week so they did a mental health assessment which he failed

It's more likely they have done a mental capacity assessment and he has been assessed as lacking capacity to make the decision to leave. It's probably a DoL (A deprivation of liberty safeguard) that has been agreed for him which essentially provides the legal framework for the hospital to keep him there. It's very different to a section.

The social worker has suggested a care home but I’m sure that once he is off the morphine his mind will return. He lives in a council house so it won’t be possible for him to return home if he is put in a care home

If he lacks capacity around the decision to move and no one holds Lasting Power of Attorney for Health and Welfare or finances then there needs to be a Best Interests meeting for him to agree a discharge to a care home is appropriate.

If he lacks capacity to make a decison about his tenancy then only a LPOA for finances or a court can terminate that tenancy agreement. There is lots of case law around this and you and the local authority cannot make that decision on his behalf without the proper legal authority to do so. This may mean he has to continue with the tenancy for a while even if he does go into residenta care.

I’m not sure how to navigate this, I’m his next of kin so the social worker has said it is my decision

next of kin gives you no legal status to decide anything. Unless you have LPOA it is the local authority that needs to make the decision under best interests. It's easier for them if you agree with them but if you don't then they may refer it to a court to decide.

It isn’t safe for him to go home right now. Is there any other options? Can I request respite care to a care home with the intention of moving back home?

yes that's absolutely fine and normal practice for it to be a temporary arrangement for the first few weeks until a permanent decision is reached. Adult social care will always try and get people home if it's safe and realistic for them to go home.

I have asked for him to go to rehab to get him back on his feet but the social worker has said that the OT will decide and I don’t think they have made their decision yet

You will find that any rehab will most likely be the same provision as the respite option above. Perhaps with a sheet of paper sent with him with some exercises on. Don't get your hopes up that it's a meaningful option even if it's offered.

My mum was discharged to assess at home on Virtual Ward after a broken hip, she got much better once at home and off the morphine patches but took a permanent decline. She had 24 hour care for about 2 weeks then it was either manage with 3 visits per day or go to a care home and she stayed at home. We fought for that for her as she had always been adamant she didn’t want a care home. I would always think what your dad would want and try and get that for him

@K37529 Remember that it's not even the days that are the main problem, but the nights. It is extremely unlikely there are any overnight carers even if he has the maximum of four daily visits in the day. The S/W has to take the least restrictive, but most safe,action which is to be fair usually to go home if it is at all possible. I would be checking that a full 14hr assessment of needs has been completed as will show any problems and therefore, support through the night as well as daytime. It is very unlikely the S/W would have suggested care home placement unless they absolutely, with the input of the wider MDT, think that is best for him. It is also potentially unlikely the therapy staff would feel rehab is suitable if he has no capacity etc

I think it's just that partly people are often on a bit of a gradually declining trajectory, and also that once they are immobilised for a period of time it's hard to get back to previous level of functioning, as sadly hospitals and care homes don't often have the time and resources to be helping people to regain strength and skills, and people can become more dependent,

Not always, but often.

@Sunnyplain
I would also say it's due to the change of environment and routines, especially with dementia. People just about manage in the same setting, same routines, "same" people coming in even if they are different carers. They usually get the food they are used to and have familiar things around them. Suddenly they are medically unwell and end up in an unfamiliar place, don't recall why, don't recognise people or timings and even the nights are noisy. There's far too much demands on their cognitive skills which sadly they often don't bounce back from. The "demand" to get people back home quickly is usually for good reasons rather than oure beds then there is less chance of the deterioration becoming permanent or damaging. However sometimes home is just not an option despite the carers, equipment and telecaster devices etc that can and are arranged. Even a temporary confusion, perhaps after an operation, can last 6 months which is where issues develop. Don't strictly need a hospital but are unsafe to be at home

My DF went into care for a months trial, which he hated, went back home and couldn't remember how to cook. He declined a lot in that month.

Yes they called it a deprivation of liberty. I don’t have power of attorney, just his next of kin and no else has poa. That’s actually good to hear that it isn’t my decision, and it sounds like from your post that this will all take a long time. That’s great because my worry is that his mind will come back to what it was and by then it will be too late because he would have already lost his home.

His carers are only there to give him his tablets because he was forgetting to take them, and make him something to eat. He was managing personal care, showering, toiletting etc himself, so he really was fairly independent. He has had such a sharp decline these past few weeks and I suppose I’m just holding on to hope that he can get back to his normal self.

The only reason I am apprehensive about a care home is because it’s not he wants. If he would go willingly I would be more than happy for him to go but he just wants to go home. I’m also worried that he will decline further with the stress from the move.

He was managing personal care, showering, toiletting etc himself, so he really was fairly independent.

Is he able to do his own personal care and toiletting now? If he isn't then, if he doesn't need to be in hospital now, a care home is the best place for him while you see how much he can improve. His council flat should be kept for him while that assessment takes place.

He may settle well and like the care home. Often elderly people say they want to be at home but having staff around, activities, other residents etc can be good for dementia patients and is less lonely. It is also a huge weight off the family's mind - my mum was occasionally wandering out of her flat and was not mentally stimulated enough before she went to a care home. Now when I see her I am not her carer but her daughter again which is really nice.

Before my dad went in hospital he could walk fine. After being in hospital for a while when he was discharged he couldn't walk as they keep you in bed.

No right now the staff are helping him with personal care, he can use the toilet himself but he needs help walking to the bathroom. That’s really good to hear that your mum has settled well. That would be my hope that he will go in for respite and love it, because even if he does improve and is able to go home, chances are he will need a care home at some point.

Honestly whilst the drugs dont help, it's very unlikely he will get back to his baseline. I'm not sure exactly why this happens, I think being out of their routines and normal surroundings the brain seems to forget everything so much more quickly and they dont get it back. Suppose if they arent regularly making themselves toast etc for 3weeks they will forget how quite quickly. My experience of working in these wards is if they're saying he isnt able to do these things then he really isnt and you should consider a CH.
Rehab isnt always an option especially if that person doesn't engage regularly and its unlikely he will be able to relearn skills hes lost since being in hospital. A x4 per day care package is all they can provide at home and they dont deem that safe so I'd definitely consider a NH, he well be safer and better cared for there than at home.