Alzheimer's, broken hip and delirium

[loopylou459]

DM is 85 - has quite advanced Alzheimer's and lives in a care home. She could walk a little way unaided and quite well with a zimmer. She could eat and drink independently. Was incontinent though.

She had a fall on Sunday evening. Paramedics called and said just bruising. Was in a lot of pain the following day and eventually taken to hospital on the Tuesday afternoon, where it was found that she had, in fact, broken her hip. She eventually had a repair operation on Wednesday.

I've come to visit her today (I live a long way away) and am feeling pretty despondent about the future. She is looking extremely frail, not eating or drinking, refusing medication. Mainly sleeping but when awake not making any sense at all. They say it's delirium. She's refused to get out of bed for physio due to the pain.

Looking at her, I just can't see how she's ever going to recover even enough to go back to the care home.

Not really sure why I'm posting.

She is medically fit, in that the type of care she needs doesn't require her to be in hospital. And it is in her best interests to get out of hospital asap as they cannot meet her other needs and she is likely to deteriorate.

I assume they will remove the catheter before she leaves? The care home should have the staff and equipment to use a hoist. Several residents in my mother's care (including my mother, in the end) were routinely hoisted from bed to wheelchair to lounge chair and back again.

Have you spoken to the care home manager? If not, do so straight away.

If this care home will not take her back, you will need to find her another care home placement. If she is self funding it's up to you to find the placement. If she is funded by the local authority, Social Services will find the placement.

If she’s self funding now might be the time to look into NHS continuous health care taking over payments.

Does your DM have a named social worker to help guide her discharge into a more suitable care facility?
It might be worth trying to get her reviewed by the hospitals falls clinic whilst in there, very good in my experience.

She's self funding at the moment but about to go below the local authority threshold - in about a month's time.

You say I'd be the one needing to find the new home if the old one refuses to have her back. What if I don't agree to take that task on? Who does it then? (Not saying I wouldn't do it but just interested in what happens if the children don't agree to fulfil this role - obviously my DM can't do it so who would?)

She doesn't have a social worker afaik.

Re the NHS funding - I'll ask but nothing about this or any ongoing support has been volunteered by the hospital. Quite the contrary, they seem to want her off their hands as fast as possible.

I agree it would be unsafe for her to go back to her care home. She's not eating or drinking for a start (aside from everything else). They are not set up to provide fluids /nutrition by drip as far as I know. I'll go as far to say that if she goes back there I think she'll be dead within a couple of weeks. I'm just so shocked it's even being contemplated. She is in a terrible state and needs medical attention not just day to day care of the type offered by the care home.

In answer to your question, if you don't want to find a placement, Social Services will. As she is going below the funding threshhold next month, they should do it anyway because they will be the ones paying and therefore choosing the care home.

It is unlikely your mother will improve while she is in hospital. Hospital staff do not properly understand dementia and do not have time or interest in prompting and helping her to drink, eat or mobilise. A good care home will be able to do these things.

There should be a social worker attached to the hospital ward, so you need to get in touch with them and they will help with discharging her to an appropriate setting.