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.

Thanks @PropertyD I’ll do that. It feels heartless but I’ll need to be clear to everyone that no one is available or will step in

Respit care with a view to it being permanent. Think what is sustainable, long term, and mostly fair to the family as a whole.

Yes - that capacity thing always bugged me. They could do whatever they liked.

You have to be pretty bad to be deemed to have no capacity. When I was Executor for my late Father I had to go into the local bank to transfer money around. The manager told me that he refuses to send any money when elderly people come in wanting to send say £20k to a person they have met online who needs money to pay hospital bills and such like. He said he just couldnt do it but knew these scammers would find another way of getting the money. One apparently got the old person to take £500 per day from the cashpoint which they knew how to use, then got 'someone' to go to the old persons house to collect it. A very good friend.. Poor decision making and yet we had to leave them to it.

Its all about the elderly person and giving them dignity I was told once by some twat SW.

Be prepared to tell everyone - all the nurses, the Doctors, the social workers, just everyone you come across that you cannot step in and be available.

Neither is anyone else regardless of what your Dad might tell them when you arent there!

Otherwise it just wont get through and often its never put on the notes.

And my final suggestion is be upbeat with Mum and Dad. Its only for a few weeks, lets see how it goes etc. When Mum comes back etc.

He will know that he is in his closing years. He is also frightened of losing your Mum and vice versa. This makes people do daft things and make daft suggestions.

I honestly know what you are going through but I had big boundaries in the last few years (yes it went on for years with both of them!). Even when in a care home the home calls you ALL the time.

Thanks @PropertyD and @DemonsandMosquitoes.

the SW and OT are both calling me to discuss my dad but if what I say doesn’t really matter then what is the point. I don’t want to be difficult or obstructive but it appears what I think (respite) won’t be taken into account. So by speaking with SW and OT and answering their questions am, I a way, not doing best by my dad? OT wants to know how dad was before he went in hosp but actually I don’t live with him or in same country so I can’t with any accuracy tell you

AIBU howver

OP, I’m afraid you’re going to have to steel yourself, be hard-hearted and insist that he goes into respite care whether he wants to or not. Make sure the SW and OT know you won’t be able to arrange care for him at home and tell him firmly he can’t go home yet so you’re arranging somewhere nice for him to stay temporarily, where they’ll look after him. (He might even find he enjoys the company, activities etc.)

I know it’s heart-wrenching but sometimes we do know what’s best for our elderly parents in the long run and it might not be what they want. Think of it as being like taking away their car keys when they want to carry on driving but you know they aren’t safe to do so.

Retired social worker...Those options are in order of least restrictive for your dad. Working on the evidence that most of us would prefer to remain in our own home, and most people do better at home. But not everyone. So they'd prefer to try least restrictive first. There's a lot of tech now to try and keep people with dementia safe at home, it's down to levels of risk. Live in carers are usually from an agency, and need I think a 2 hour break in the day, which is provided by another agency if no family etc available. I agree be very clear what you are able to provide, or not. It's much more difficult if the carer has to be up at night as well.
Most people get on with the carer and they stop being a stranger very quickly. But not all. Respite varies so much, can be brilliant or not, lot of people with dementia obviously find it confusing. Good luck.

Absolutely speak to the SW and OT. Tell them you are not local, you cannot take him in however temporary they try and make it sound. Dont be woolly.

Ask them to ensure that this is on the notes. I had two siblings and told the SW very firmly they were worse than useless and there was no point speaking to them but if they wanted to here are their phone numbers. Interestingly - they never bothered. I was the name in the frame and I have since found out they often have no way of calling international mobile numbers.

If the SW'S are telling you that you have no input then perhaps ask why they are speaking to you in the first place? I know what they are trying to do - cover themselves as they know not to believe much an elderly person says. They want to be able to quote what you said in case anything goes wrong.

BE FIRM AND CLEAR.

Thanks all! Really appreciate all of this.

one final question sorry - I don’t want to say anything to the SW or the OT that prejudices the future for my mum and dad.

so I know that when my mum returns they will need carers in.

They will decline I know that.

but if I say to SW and OT now that my dad is really bad (to get him into respite or push decision that way) and needs respite and they move him there or a care home - what if he then can’t return home when my mum comes home and I’ve made it all worse for them both?

sorry about all the questions just fearful about doing or saying the wrong thing

A good sw assessment will take your views into account but will also gather info from others involved, and OT will observe/ do a functional assessment. And they're aware that the situation/ physical and cognitive abilities change all the time. So they won't just be taking your word for it, so you can't really 'make it worse'. If he does go to respite they'll check with the care home how able he is to return home etc. But it is harder to return home once you've been in care

Thanks @NecklessMumster

You say this to them. You tell them what you're worried about, what you do know, what you don't know. Don't downplay anything though, or say there will be support that doesn't exist.

If he is judged to have capacity at the time the he can leave any time he likes.

Thanks @thedevilinablackdress and @NoweverytimeIgoforthemailbox for the practical advice - I’ll do this

Do they have the money to self fund? We had a very similar situation, and the free 6 weeks care that the SW offered was totally inadequate (two visits a day for 15 minutes each, for a man with dementia who was utterly confused and couldn't do much domestic stuff in the house even before he had dementia). There were two adult children within near(ish) reach, but both had already had to take emergency leave from work to deal with the initial crisis, and just couldn't do that for weeks. We (collectively - the wife-carer in hospital and the wider family) decided to reject the SW offer and arrange live-in care instead through a private agency. That continued for a few weeks after the wife was discharged, as she was immobile. It worked very well. We did think about a respite home, but felt that he would have been very confused by the change of scene and might never have come out, which he/family weren't ready for yet.

But all that depended on them having the money to pay.

How did you stop him from wandering at night? Did you have 24 hour staff on duty?

Long term if they both need carers would they consider extra care housing where they have their own flat but with 24 care available or a double room in a carehome, if they are self funding it may cost the same as live in or 24hr care at home.

Regarding them not wanting carers in, nobody wants them in. The knee jerk is back the way things were so we can forget this horrible period in our lives and get back to normal. But it’s unlikely that they will be able to.

Apparently it’s easier to get carers after a hospital stay as it’s all very immediate. If they decline but subsequently need them later (when they realise they’re not fit to change beds, deal with heavy shopping etc) it could take longer during which time family will need to step in. And by then family will have used all their carers leave etc so it will be harder.

Much better to try and make them accept the care “just for a few weeks mum til youre back to full strength. We can’t have you pushing yourself and ending up back in hospital as dad would be in a pickle again so cant we just keep the carers for a few short weeks and then you’ll be back to normal?”

Followed up with “we don’t want dad in a home so having the carers here actually prevents them carting him off to a home, as social work can be reassured youre both managing and the carers can do the heavy stuff like bathing dad, so it’s a good thing to keep you both together at home longer” Just think of them as PA’s.

Thanks all

so my dad has managed to get into a secure rehab for 6 weeks which im delighted about. The SW explained to my dad that my mum wouldn’t be coming home with him and explained what live in care entailed and he has agreed to the rehab place. He will be in a different rehab to my mum so they may not se each-other for a while still but this feels so much better for him.

i agree that now is the time to get care sorted for when they come home and easier to sell it to them now.

good point about a supported type flat costing same as care home as there is one nearby with 2 beds. May cost £6-8k a month but would be good for them. Only thing which may irk them is that they know people living there for free but they’ll need to get over that as they need the care.

thanks for all the practical advice and tips it’s been invaluable.

Next onto what they’ll need when they return but I suppose until my mum has done her rehab and we know exactly how she is I won’t know or really am I looking at 4 visits per day? Do we go private straightaway or let the SWs guide us first? I assume there will need to be an assessment.

I wouldn’t go straight for private care - I’m not sure what part of the uk they’re in but in Wales everyone is entitled to an element of free social care - they may then pay top up fees following a financial assessment. Keeping a social worker involved can also be really beneficial as things inevitably change going forwards.

Make sure that both rehab locations are aware of what going on with the other parent and where they are. In an ideal world both teams will work together to arrange coordinated discharges for both of your parents.

In terms of night time wandering, it is possible to have alarms put in doors to alert other members of the house to what’s happening. These can be set to only activate between certain times so don’t trigger throughout the day. They’re usually arranged as part of a telecare package and ime the council ones are better than private ones.

I'm just coming out the other side of this.
Do respite care. Anything else will go wrong. You will have calls constantly. My mum had fantastic carers but frankly it was not enough
And the mental strain is huge.
Book respite and then take time to think about what should be done.

@Muchtoomuchtodothanks thats a good idea. I was thinking could be change locks to smart locks in house to stop him getting out but probably fire hazard. It has only happened twice so far so over last few years so doesn’t happen often but can’t predict when will happen and could increase.

parents will self fund until money runs out as over threshold in savings

Thanks for all advice everyone we used it yesterday when speaking with sw to voice our concerns and it helped massively