Discharge from Hospital - Questions for Social Worker Please

[Watchoka]

Hello

Sorry it's a long one (always is). Hoping for some much needed advice please.

Hoping someone can help me please.

• My Mum is my elderly dad's carer.

• My Mum was rushed to hospital a few weeks ago and remains there.

• My Dad was found wandering outside at same time confused (no dementia diagnosis but he is 88 and can become confused) so he was also taken into hospital as no family live in country and his main carer in hospital.

• Mum now waiting for discharge into rehab. Not sure how long she'll be in there. She will get 6 weeks free and it is an apartment and therapy provided so she could be in 6 weeks (or more) at least.

• Dad ready for discharge home.

• Family have travelled over and stayed over passed few weeks at different times to provide cover and intend to do this going forward where can but trying to juggle this with young kids and full time work is presenting a challenge.

• Dad wants to go home. Mum wants him to go home whilst she is in rehab.

• 3 options presented by SS:

• Carers come in 4 times a day for Dad at home. Not safe for Dad to be on own at home at any time so discounted. SS tried to say that with tech he could perhaps stay on own. This would've been for 6 weeks.

• Live in carer for 2 weeks. Mum wants this as means Dad is in familiar surrounds. Not sure Dad understands this and what entails.

• Respite whilst Mum in hospital which could be for a number of weeks - Dad would pay for this. Mum doesn't want this. Dad - haven't discussed it with him.

So looking at Option 2 (live in carer).

I've read a few threads on here and I'm concerned. I don't feel we've asked enough questions about how this will work (SS only contacted us today mind). I do feel respite may be a better option giving us more certainty. Dad sleeps most of day and I think he wouldn't mind having his own room, tv, meals cooked and help with any incontinence issues. I know he likes the idea of going home but I'm not sure how he will cope without my Mum being there. She's always been there. I think he's going to struggle living with a stranger. I also don't think this is an arrangement we can just try as if it fails quickly for whatever reason we really are stuck. I think SS are keen to move him out (I get that) but once we agree to the discharge arrangement its not really their problem anymore its for us to deal with? Perhaps I'm being really unfair.

Does anyone have any experience of this please?

I want to call the SS tomorrow to discuss this further. I'm putting together a list of questions for them. Please see below. Are there any other questions I need to ask please?

Questions for SS:

1. What cover will there be by the carer? Will they work i.e. 8-4? Hours off during day and week? If yes (which I would expect) is cover provided when they aren't there?
2. Who does the shopping?
3. Will they take Dad in a taxi to see Mum in rehab.
4. Will they wash Dad or is this extra?
5. What if they don't get on?
6. Do we need to arrange to get private carers in place now for when 2 weeks finishes - is this enough time (2 weeks) for this to be arranged?

Apologies again for the long post and thanks in advance.

Bless you I’m in the same boat with my Dad. I live 2 hours away and my mum is my dad’s carer, he’s been in hospital with urine infections for 2 weeks and they want to discharge him. He has deteriorated so quickly and lost so much weight.
the hospital talking about carers 4 times a day but we want him to go into a care home . The hospital basically said that we have to try the carers and when that breaks down and we reach crisis point social services will do something to assess his care for a home.
im so worried about my mum who is not well. This is going to break her..

I would also suggest option 2 from your choices above.

If your dad sleeps most of the day I’d say he’d be pretty comfortable with someone else pottering around keeping on top of things and keeping him safe - certainly better to be at home than in respite.

My dad’s live in carer took care of everything, doesn’t the washing, washes him and dresses him, deals with incontinence stuff, talks to medics/GP etc - it’s what they are trained and paid to do.

You’ll do an assessment with him and the proposed carers, then they’ll assess his home and you’ll have plenty of chance to talk through routines, preferences etc.

Good luck - that sounds really stressful.

Thanks all

@lilyborderterrierso sorry to hear what you’re going through and the lack of options you’ve been given. To have to wait until there is a crisis by before anything else will be considered seems cruel of them.

@DaysofHoneythanks for your advice, it’s much appreciated. I suppose I’m just concerned (not living there) what happens if all breaks down and I’m not round the corner to fix it. If mum finds out it isn’t working then she’ll get stressed and want to leave her rehab early but I agree being back in my own home is something I would want.

How is a live-in carer going to stop him wandering?
Care homes usually have better security and more people around.
(Thinking of this as a beloved elderly relative back in the day died after "going wandering" in cold weather and ending up in hospital.)

Also, "what if they don't get on?" is a biggie.
My elderly relative started off with a live in carer but there was something of a culture and personality clash, and crucially the carer was Not A Cat Person ....

As long as finance is not a problem, I would go for respite care. Live-in carers can be great or awful, in my family's experience. I wouldn't want a complete stranger living in my home with me, and your DF might find it harder to understand than just going somewhere else for a short break.

At short notice I’d opt for respite care because it can time to set up live in care teams, one person can’t work continuously

We luckily had excellent care from live-in carers over a few years. The carer had 2 hours break during the day. So.etimes they went out, sometimes they stayed at home in their room. They also went out to do the shopping so they could have been out for more than 2 hours in a day. But we didn't have to worry about our folks wandering. They did all personal care during that time. They did take dfil out to meet his friends at the golf club for lunch.

We only once or twice had a situation where they didn't get on. Our care was theough an agency so they just swapped in another carer.

If your dad is already a bit confused though would he understand why someone who is not your mum is living there? Or would he better understand that he's having a rest/break/holiday somewhere completely different?

And what happens at the end of the 2 weeks? He still can't live on his own.

What happens when the 2 weeks of live in carer ends?

What has happened to your Mum? If she needs 6 weeks of rehab then she won’t be able to come home and care for Dad, it maybe that she needs care herself.

Thanks all

my concern is also (apart from how will this work and will it work well) is what happens after the 2 weeks

Either my mum will make herself come home early and not finish getting the rehab she needs or she’ll try to get distant relatives to provide some cover for dad when they’re not carers and not responsible for him.

I have no idea about getting anything in place after the 2 weeks

social worker is coming this morning to see if house habitable but I suspect after the 2 weeks of my dad is self funding they won’t be involved or care.

my concern is also that these decisions are being made when they’ve already both been in different hospitals for 3 weeks. They haven’t seen each other for about 3 weeks. My dad has been in a noisy ward with lots of comings and goings and although he seems okay and has been very patient he wants home. Things are starting to irritate him now. My mum wants to move on to the next place.

so they’re at the point of desperation and they just want things to go back to how they were as much possible (which they won’t) so they’re not interested in the pros and cons of the choices or how it will all work out. They just want him home.

What happens at night if your dad has carers in during the day? You don’t want him out wandering or unlocking doors for burglars to find, so someone needs to stay overnight? Elderly men tend to get up through the night multiple times to go to the loo so unless he’s medicated with sleeping pills I’d be worried for his safety. When he notices his wife is ‘gone’ he will be out looking for her and forget why he’s outside or where he is… And that couod be at 6 or 7am before the day team come in. So it doesn't feel safe.

I think a live in facility would be safer. 24hrs a day care and no unlocking the door to wander. Yes he will be confused. No he won’t want to go as the knee jerk is to return home for the fear of “once youre in a home you won’t get out” but if he keeps getting told it’s temporary til your mum gets out? And I’d suggest he needs a four times a day care package once he gets home now anyway so get that out in place prior to his leaving.

PS While he is still “with it” most of the time you might want to get a power of attorney sorted. That will be a massive help for the future. If he’s already too far gone then some kind of diagnoses surely needs made by his GP?

I will with my sister of course being coming over regularly but we can’t plug that regular care gap. I did think about bringing him to live with me for a while but he may not want that - I have noisy kids and it’s not his home. Also - part of the week I’ll be in the office so no one to be in home watching him. We wouldn’t be far (6 miles away) but still if he falls I’d be calling on neighbours and rushing back. Not sure I could get care arranged here for him at short notice.

im thinking perhaps we saw a respite and if it was a nice room he’d go for it. Who knows.

Sorry very long posts! Thanks again all

Thanks @RentalWoesNotFungood points. The carer would live in during the first two weeks but I agree whilst carer is asleep he could wander out. Not sure what happens after 2 weeks

thanks fully we got powers of attorney sorted for both parents (finance and health) last year but need to look into how trigger them

Rental is spot on. Respite care with a discussion around it being temporary until your Mum comes home. That is all you know now. If things change then that can be addressed at the time.

I was POA for both parents who divorced many many years ago. I am going to be harsh here but there will be a senisble decision based on the circumstances here. Its not 100% but its almost the best of a bad job type decision.

What I would suggest you sincerely think about (with kindness and please forgive the words) is what is also manageable for YOU. Elderly parents are not best placed to make these decisions. They will run you ragged and you will drive yourself barmy with trying to please all sides. Your mum is assuming distant relatives will help. Where has she got that idea from? Have they said so or is it just her solution. YOU will be sorting all this out. Not your Mum and Dad

Hopefully your Mum will come back raring to go back to her old role but I think you know that isnt going to happen.

We did consider live in carers for one parent but the house was a hoarders paradise and flithy. They ended up in a self funded care home for nearly 4 years in the end. He was 'towards the end' for years but he was a tough old bugger and refused to go quietly. Other parent was likely to chuck out any carer that came in when she was in one of her moods. I wouldnt have put it past her to put the key chain on to stop entry.

So I would go for respite care.

With regard to trigering the POA. Just show the code to the relevant party. POA's now come with codes rather than you having to go into each financial institution and get the whole document copied.

First I woud do is his main bank account and GP surgery.

@PropertyDthanks for your advice - really useful. You’re spot on - my mum has made unfair assumptions about distant relatives coming forward. It’s really not their responsibility and they’ve never offered. We will end up running into around trying to keep the wheels on. My dad has actually thrived in hospital in some ways. Regular meals and being around people. He’s stronger mentally and physically than he was at home which makes me think respite could work for him well if he had his own room.

Thanks @PropertyD I’ll look into this today re triggering PoA

When your Mum comes home after (hopefully) full 6 weeks of rehab she is not going to be as fully fit as she was beforehand! She will be fragile and to an extent institutionalised. Dad needs to go for respite meantime and IF he goes home they will need ongoing support.. both of them. Be aware that this may well be a downward slope from now on.
Hard facts. Hard decisions. What they each want may not be the best or safest solution for either of them.
Sorry to be brutal... hard won experience here.

Thanks @Bonbon21honest brutal advice is what I need to hear

My father in law did not want to go into care or hospital but once there he loved it ( small hospital) . Once he went home he missed it - the seeing of people, the cups of tea etc - and he went into decline with UTIs following on from lack of attention by carers ( to be fair of patient says no to a wash what can they do) and a family member . He got sepsis and died.

@octopustheslapper sorry to hear about your father in law. It’s so difficult - not just getting the right arrangements in place but also communicating to them that this is the best arrangement for them and managing expectations.

I expect my dad will say no to everything the carer offers too at home. In hospital it was bad enough - he wouldn’t fill in his menu or just say he wanted custard for every meal as he wasn’t hungry when in fact if a meal was put in front of him he’d eat it.

he says no to everything

Quite honestly - save yourself. Dont try and persuade them you are right and they arent. They wont listen. They will say 'Aunt Joan said once she would help', 'all you need to do is..,' 'it wont take long' or the best my late Mum used to say..

'I dont want to be a burden but...'

Forget about the communication. Short firm statements saying its the best decision for now and can be addressed when things change. They wont get better, things will get worse I suspect.

You can visit at the respite care home as much as you like and I promise you there will be lots of people like your Dad there. He might even find he has found his tribe!

Yes, Mum rarely knew what she wanted. I would tell her do something sensible and then literally when I was leaving she was planning to do the complete opposite. No one was egging her on. It was just her which is fine in one way as its her decision but its not fine when what I have told her not to do gets done anyway and the consequences are then mine.

When she moved into her sheltered flat on the first night I told her to go to bed early and I would be back first thing in the morning but she started wandering around, fell, gave herself a black eye and then pulled the cord. The warden then called me - at 2230. I had only just left her tucked up in bed!!

So I’ve just been informed that as my dad has capacity this is purely his decision to make so no input fr me permitted but then expected to deal with any fall out

@PropertyD your mum sounds exactly like my mum. It’s exhausting when all you want is the best for them

So, what I would do now is emphasis this is all temporary, fib if you have to.

Once he is in respite care it would be extremely diffficult for your Dad to get himself out of there.

Tell the SW;s and nurses you are not available to care for him.

It is very common for elderly parents out of your earshot to offer your services whilst not of course mentioning anything to you. My daughter does all of this etc etc.

I always found it interesting that despite Mum in particularly becoming confused etc that she ALWAYS had the capacity to sneakily do something without me seeing.