Medically optimised!

[anotherboy1]

My lovely dad who is 93 has been in hospital for the last month. The drs are saying there is nothing medical wrong with him and he needs to be discharged to somewhere. He has hardly eaten for the last ten days and will not drink. He is on a drip to get fluids into him. He is asleep most of the time and I don’t think he is aware I’m even there. Could someone advise me what to say to the hospital please x

Where did he live before he went into hospital? Can he go back there? What do you want to happen?

Being in hospital is horrible. It makes you feel ill to be there. It might well be that once he is home in his own bed his health massively improves. However there will need to be plans in place to make sure he is kept fed and clean and safe.

If the amount of care he needs is greater than what can be provided by visiting carers then he will need to be discharged to a care home.

Ask for a needs assessment, and some dietician input on nutrition and hydration.

(But realistically, it sounds like he no longer needs hospital care and will need discharge to somewhere suitable. There’s probably social services link for ward).

Thank you for your replies. He lived independently by himself

The hospital will have a social worker whose job it is to assess your dad and decide what level of care he needs in order to be discharged. The physio, occupational therapist, ward dr and others should also be involved. And you / family of course.

you will need to start asking for names, asking about discharge plans etc.

why did he get taken into hospital? what have they been treating him for?

He originally hot taken into hospital with a UTI. He has got worse why being there. He is refusing to eat and drinking very little. I wonder how much longer he can go on for

Bump

Have the drs given you a prognosis? As in what they expect to happen next?

Has the infection cleared up now @anotherboy1?

I’m given different opinions by drs. Some say he can have rehabilitation but I’m finding that hard to believe when he won’t wake up

The infection has cleared

If he is literally sleeping all the time, unable to eat drink, I can’t imagine they mean to send him home. Maybe they expect him to go to a rehabilitation place?

you may have to pester them to find out the next step.

I don't often comment on posts in elderly care because as a nurse it can be frustrating to read about poor care but I find these posts difficult to ignore. I would suggest that your Dad may have a hypoactive delirium, in very elderly people this is common and poorly recognised. Hypoactive delirium can persist for weeks after an infection is treated and is a serious concern, unfortunately prognosis is often poor. If he requires I/V fluids to maintain hydration ask what the plan is for managing hydration in the future, because out of a hospital setting this won't be given. It might be that it is the right decision that no more fluids are given by drip and your Dad may start to drink or take small amounts. If he was independent before this episode ask how do they account for the rapid decline. Medically optimized tends to be a term used for people who still have a high care need but at a level not requiring them to be in an acute hospital. Ask the medical team to be honest about his prognosis. I hope this is helpful in some way and not distressing but there is still a reluctance for some medical/ nursing staff not to be transparent about people's conditions. I hope he has seen or is under the care of a care of the elderly Consultant.

You need to speak to the discharge coordinator. The hospital must assign one when a patient with social care needs is admitted. They will act as liason between the various departments that need to assess him and formulate a discharge plan.

Discharge directly home sounds unlikely. A better option would be intermediate care/discharge to assess into a care home. This gives a month or 2 of funded care (regardless of the usual self-funding savings rules), which should come with a rehab package of physio etc. During this period they can see whether he improves once out of hospital (many people do once getting proper sleep and in a calmer environment than a ward) and make a long term plan.

And I agree with dotty that you need to be quite forceful about making them understand his pre-hospital baseline. There is a tendency to assume old = dementia and existing high care needs, and therefore to not recognise what is a new symptom that needs investigating.

This is often not the case anymore - the OP would need to check what the local arrangements are in the hospital as many now operate a Discharge to Assess process where Social Care only get involved after discharge.

Gently OP - the hospital are saying it's time to start looking for 24 hour care homes as there isn't anything else they can do medically at this point (although I'd challenge this if he is still on a drip).

Agree with above, also a nurse, not in this field though. You need to be very direct with the Drs and ask what they think his prognosis is. He needs a need assessmemt as obviously is not at the baseline he was in pre infection. Sadly very common.
i experienced very similar with my own mum.

Thank you for your replies I am going to try to see a doctor either tomorrow or monday and them to be honest with me about what happens going forward

Delirium (if it is this) can take a while to resolve and cognition doesn't always go back to prior baseline sadly. It is likely he will need carers or IC/d2a/reablement at home/bed based.

At 93 he has greatly reduced resilience to stress so the combination of UTI and being in an unfamiliar environment, being practically bed bound for a month and not using his body/ mind to do all the things he was doing previously will have had a huge cumulative effect on his physical and mental state.

it sounds like the Dr's are saying that medically there's nothing wrong but the stresses of his illness and hospital stay have fast forwarded the aging process and he's now a lot less fit / more frail than he was before. Any recovery will be slow and he'll be vulnerable to set backs.

Even very proactive rehabilitation will take weeks / months to make a difference and is unlikely to get him back to his base line of full mobility and independence. It's clear he will need to be discharged with a completely different living arrangements / care plan compared to how things were before he went into hospital.

You need to explain that he's far from his baseline level of fitness/ function and that he will need a significant care package before he can be discharged. Don't be pressured into saying you can manage/ support him at home, the hospital will be pushing for a speedy discharge now he's medically well and, while you do want to get him out of there, hospital is not a good place to be stuck as an older person, it's important he get the right level of support / rehab once he's out.

Well, at the very least there will be some process in place within the hospital to look at the next steps, whether it's direct to social care or something else.

Actually you are right - when FIL ended up in hospital over Christmas there was a 'Hospital to Home' team who got carers in place so that he could go home asap. This arrangement lasted for 2 weeks or so until the social services took over. The Hospital to Home team were able to provide a lot of feedback to social services, so the transition to social services carers was fairly seamless. Then a third set of carers was brought in after a further two weeks, when social services handed over to a private company 🙄It was a bit much for FIL with the constant changes, but he seems settled-ish now.

Do you think he’s just given up? Hospitals are horrible depressing places. You definitely need to get him home. You would need to make sure a care plan is in place before though.

OP

Just be on your guard for any on-going care arrangements that might involve you. Were you involved in visiting your dad or doing anything for him previously? Are you willing / able to provide any form of care or support if he does go home?

I did visit my dad every day but due to my mental health I would not be able
to do personal care x

Ok you have to make that very clear to whoever is organising what happens next.

is your dad awake enough to express a preference for what happens next? Do you have any siblings?