How do you tell them they aren’t coming home?

[bridgetreilly]

My dad has been in hospital for over a week following a heart attack. He is now medically fit for discharge but needs assessment by the physio and occupational therapists. His mobility is extremely limited, his memory is very poor, and he has numerous minor needs. My elderly mother and I have reached the difficult decision that it is no longer safe for him or her to have him cared for at home. We have been to look at a care home and the plan is that he will be discharged from hospital directly into the home, probably next week.

He will hate the idea. He doesn’t see why he isn’t at home now. Partly that’s because he doesn’t remember the heart attack, and partly because while he is in hospital with people to help him with everything, he feels quite well. He has no idea how hard life has been for Mum over the last year. They have had carers coming in, but she has also done a lot and she is exhausted. We’ve discussed 24/7 care at home but there are a lot of reasons why this won’t work.

I actually think he will settle quite quickly and contentedly into life at the home, but the prospect of telling him - and it will have to be done repeatedly because of his memory problems - is daunting.

Does anyone have experience of this and suggestions of what to say/not say?

If I’m honest I just kicked the can down the road. I said to my mum that she needed to convalesce. I never said ‘you’ll go home when you can do x’ but I did say vague statements like ‘you do need more help at the moment mum’. Then I changed the subject. And said it again every time it came up (several times a visit).

I have a relative that runs a care home and she said they usually say to just come in for a few days.. it's very hard and very sad and I sure you and your mum haven't made this decision lightly. Wishing you all the best.

Can you actually do that against his will?

@Imtoooldforallthis yes, if he doesn’t have the mental capacity to make the decision himself.

The op doesn't mention lack of mental capacity only a poor memory. Wouldn't he have to either give his agreement or be assessed as lacking mental capacity?

I’d just tell him it’s a clinic to help him get stronger/ better as a pp said, you don’t need to tell the truth just avoid it

So he has been assessed as not having capacity to make this decision op?

Capacity isn't a general assessment, it's a time specific thing, and based on different decisions. Poor memory can simply be age related, and lack of mobility and numerous minor needs does not supercede his legal right to make his own decisions about where he wants to live.

If it's home, then has a care package been looked at prior? He may qualify for up to 4 visits a day.

Does Mum need respite? A holiday? And then all personal care needs be dealt with by professionals? There are lots and lots of organisations, and community care packages that can be looked at before the need for this. The support is out there. Happy to signpost if you haven't been already. :)

It's usually something like... you're just going here "until you get better", "until the doctor says you can go home", "until your walking is better". Something that is a bit vague on the details.

What doesn't work... saying a set time frame, for eg for 2 weeks. Somehow they always know lol. It also doesn’t work telling them it's not a nursing home, it's a hospital... someone always slips up and tells them it's a nursing home!

What most definitely doesn't work... not telling them at all! Oh yes we've had that many times believe it or not... when they expected the ambulance to be driving them home, but instead they're at a nursing home. All hell generally breaks loose.

Make sure you tell the staff all his likes and dislikes, especially activities, routine, personality traits... that way he will start off on the right foot and have a positive experience from the start.

Good luck OP. Sounds like you're making the right decision, for both of your parents' health and well-being.

Geez that sounds really hard OP. no advice, just a hug xx

There's a nursing home near us that does offer convalescent facilities and people do go home so it's not a reach to say that.

Don't lie but bend the truth a wee bit. He isnt well enough to manage at home just now so needs to go somewhere safe. Also remind him that it would be too much for your Mum to care for him 24/7.

We told my Grandad it was, "until you get better". It took him about a month and then he was settled and everytime we visited he pointed out the things he liked in the room. It was brighter than his home and he liked the decor. I think the regular food and drinks and friendly faces really helped.
He died recently and they were so supportive and treated him as an individual so he was able to die in his home there. I'm glad he had support and we could all visit and be his family rather than be his carers and struggle with him in his own house.
We got to know the carers and some of the residents too. The rule was to go along with what the residents said and to try to stop them squabbling over TV channels and walking aids (it was a bit like a nursery at times).

Tell him he's at a convalescent home?

I have an aunt who believes she's staying in a hotel while her home has some much needed repair work done...

Thanks, everyone. I’m really not comfortable lying to him. And I definitely don’t think it would be good for him to spend all day every day asking when he can come home, which is really what I think it would be.

He is capable of making the decision, so we will need him to agree. For mum’s sake, I think he will. If he absolutely puts his foot down, I’m not sure what will happen. I understand all the options about care at home. That’s what we have been doing. Even if that were to extend to 24 hour live-in care it’s going to put so much strain on Mum. She can’t cope with it any more.

So we are going to have to try.

I can only say that, fortunately, my Dad thought he was in a hotel and that the food was good.
He settled in very quickly and only asked once when he was going home.

@bridgetreilly just a solidarity virtual hug. It is very hard and it sounds like you (and your mum) have been in the trenches of caring for some time. You know your dad (and your mum) best and what is sustainable. I wish you luck with convincing him and please forgive yourself if white lies are needed. We said it was a holiday and did indeed have a respite contract initially. We involved our Dad in the review to decide to stay ‘for longer’ but still have to avoid and deflect in conversations about independent living.

That’s really what I’m hoping for.

OP My grandmother went in to a care home when the council were refurbishing her kitchen.

She ended up staying there.

Before the home she had what on paper was a great care package. Carers came in, someone came to cook her dinner and she had 2 daughters and 2 grandchildren who lived locally and visited often.

Social care is very much 'person centred' so the person who's job was to cook would ask her what she wanted to eat, she would not want to bother the nice man who cooked so she would ask for a sandwich.

That doesn't sound bad, that's what she asked for but she was getting more and more frail. She had dementia as well.

Once she was in the care home she would be asked to sit at the table and asked if she wanted 'chicken or fish' or whatever was on offer that day. And she would eat it and a pudding nd ask for bread and butter afterwards.

She gained weight, seemed happy when I visited, she remembered my name but not that we were related.

Sometimes a care home really is for the best.

OP I really feel for you. This is a particularly difficult situation, I think, when a person still has a degree of mental capacity, but their wishes (and their understanding of their level of need) don't align with their partner's. We've had a similar situation. To those saying there are lots of alternatives, with increasing care at home - yes there are, but they still have to be facilitated and enabled (and often supplemented) by the partner. At the most basic level, for example - the person needing care might feel that they don't want to be in a home, but they otherwise need 24h hour live in care at home - but the other partner might feel that they are unwilling to have a carer living in their home - and they have rights and needs too. Whose preferences and needs trump whose? And if it's not live in care but frequent care visits, then the partner still needs to do the filling in and ebabling in between the visits. What if they're not willing or able to do that? And if this is private care (because they're self funding or because social services doesn't assess them as needing full 24 hour care), then someone needs to make all the arrangements, not just initially but on an ongoing basis.

It's really hard. In our case, basically, the partner needing care wanted to be at home, but the other partner found live in care incredibly stressful and intrusive and effectively refused to have it, but was in the end just not able to cope with providing the care needed herself. In the end, a series of respite stays in a care home became more frequent until they were eventually permanent, and the partner in the care home died shortly afterwards. The respite and then permanent move wasn't exactly against the will of the partner needing care, but if I'm honest they were a little bit railroaded into agreeing to it. It was a horrible, sad situation all round, but there was never a 'good' solution.

And her mother has a right to not damage her own health further looking after him. It's clearly in everyone's interests that he goes into a home, it's not all about the patient.

@Imtoooldforallthis , no they can’t! Suggestions of saying that it’s only for a few days are disgraceful.

Hi. This is one of the hardest most heartbreaking things to get through. My mum was in hospital adamant that she wouldn’t go into a home she actually laughed when it was first suggested.
She was 92 and ended up in hospital because of a high bp and confusion. We had many bedside meetings with her social worker and me, there is only me so just horrible.
The social worker wasn’t very helpful and kept asking if I could take her home. It was only because I stood my ground and insisted, that the social worker eventually agreed. I told mum we’d see how she was, if she became stronger she may still be able to go home.
Unfortunately mum deteriorated in the home and became more confused and weak she died 6 month later. Be wary of SW some aren’t helpful and only think about their budgets. If your dad has capacity he will need to agree. I wish you all the luck in the world. I hope your dad gets the very best care and settled beautifully 🤞

The OP is just trying to make the best decision for all.

I think the people who are saying that you cannot force them, dont lie (even a white lie!) or 24 hour care clearly have NO idea how difficult this is to manage.

The person needing care wont be managing it. The Mum wont organise. It will be a daughter, hour after hour, day after day. They wont go on holiday. They wouldnt dare. Issues will come up which THEY will need to resolve.

And all because the elderly person's wants and needs even if they are plain daft or unrealistic are taken as gospel.

And yes, I was asked by a SW if I could take my Mum in. As soon as I said Mum was a self funder she completely changed.

It actually is all about the patient if they have capacity though. He cannot be forced into a care home if he doesn’t want that.