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.

Sorry! Didn't see your update.
I must admit that I went straight to private for carers. In theory she should have got a few weeks support from NHS or whoever. The care agency I used was a care at home type one. It was £37 an hour charged, but they would do whatever Mum wanted, take her to shops, out for a coffee, clean, make meals. They were lovely!

Whatever the arrangements are ultimately, regardless of how happy/unhappy they are with them, the priority is that they are both safe and cared for.

@NewsdeskJChow many visits does your mum get a day please and is it the same everyday? Someone said to me to downplay needs at first as (because self funding) they’ll go for top package straightaway when in fact they could start at 2 visits a day and then increasing as needed but I think in reality they’ll need 4 a day. I wonder will it be £37 for both or double that for each visit as there are two

Also sorry another question sorry - we need to ensure access to accounts to help parents pay for things now. They used to be able to do internet banking but they’re not able to now. We do have power of attorneys in place but not triggered as both still have capacity.

whatnot the expert way for us to content banking for them please? They will want this and have asked for help as usually they have to trail 10 miles to the bank. We don’t live near them so wouldn’t be able to sit next to them to log into accounts.

can myself and my sister be added to their accounts easily?

Is there a form or process for this please? We’ll need to help with banking and track payments when carers come in etc and they need help with shopping.

thanks

Thanks @Bonbon21 absolutely right

The financial poa can be started when it's been registered and they have capacity but check the paperwork to see which box they ticked, it will either be when I lose capacity or when registered. Has it been registered with the opg. If it has take a copy to their bank, you can ask for a debit card and can set up any direct debits. They should both have assessments before they go home by the therapists especially your dad if he wanders and falls, they can arrange a keysafe, falls mats, fall detector alarm, pendants or wristbands with a telecare service with emergency responders who can be the emergency services, care agency or family. I'd start looking at care agencies, helping hands get good reviews, they may also need a few adaptations and aids at home which the therapists can arrange which are free.

Luckily he wasn't a wanderer at night. A little bit of sleep disturbance, but manageable. If he had been, I guess it would have needed to be two carers to ensure total coverage without breaks.

@MissMoneyFairythanks I’ll check which box they ticked on PoA. The adaptions mentioned would definitely help

Sorry another question asking for help please

my dad has been discharged into a secure rehab now. He’s wearing his own clothes again and we’re taking his walker to him tomorrow.

he has started having problems with incontinence to a level we hadn’t seen before he just spent 3 weeks in hospital.

so now he’s wearing pads everyday and having some accidents. I’m hoping it’s temporary but they may be wishful thinking.

2 questions please:

1. The rehab today just asked us to provide my dad with male incontinence pads. I leave the country tomorrow night so will try supermarket tomorrow but I’m worried I won’t find right size or amount for him in time tomorrow morning. Does that mean he’ll be left without pads and will wet himself? I’ll do an Amazon order but my only option is to get them delivered to the secure rehab and hope he gets them

1. the rehab apparently has no facilities for washing clothes . I am intending to fly back over asap but I’m very concerned now that he won’t have enough clean underwear if he’s wetting himself and they can’t be washed. I’m looking into private washing company but not sure, without me there, how this will work initially. Should I just get my dad incontinence pants but then I don’t know if he’ll know how to put them on if they need to be fitted like a nappy?!

feeling very sad and guilty about my poor dad. I didn’t think to ask about this stuff before he was discharged to the rehab I just stupidly assumed he’d be cared for as it’s a more secure place.

anyone been in a similar situation and have advice please?

Is this in the UK, it's very strange they don't supply pads, he should have a continence assessment and given the right pads for his needs, is this NHS, what is a secure rehab unit. They can't just leave him wet, that's neglect and abuse. For the time being I'd get him adult pull up inco pants, any idea what size trousers he wears. I'd speak to the unit or nurse manager, I've never heard of anywhere not supplying incontinence items, at home he'll need an assessment by the bladder nurse, pads, possibly a commode and a disposal service, this is all free and pads are on prescription. There are rarely washing machines, only in carehomes, I'd buy cheap pj, tee-shirt, joggers, old clothes from home. Sorry you're going through this. Speak to the therapists as soon as you can, they are always very helpful and understanding.

If you do a bulk amazon order I can pretty much guarantee other patients will be given them.

Has a doctor or nurse looked at why he's become incontinent, has he been checked for a uti, is he on water tablets, he should have had an assessment in hospital. if you do buy him any clothes make sure you label them with his name.

Thanks @MissMoneyFairy it is an NHS secure rehab in grounds of hospital. He used a special bottle next to his bed sometimes at home but never pads. It keys seems to have got worse in hospital maybe with toilet further away.

no one mentioned incontinence to us before he left hospital. I know he takes tablets for adder spasms to help him go but no one mentioned water tablets. He has a bag of tablets mind. Last time we didn’t realise he’d been sent home with senokot and we thought he either had diarrhea or was incontinent.

I had assumed he’d get more personal care here he is. He went there yesterday afternoon and wet through 4 pairs of trousers . He could use the toilet apparently due to how it is positioned.they said they check him every 24 hours. He didn’t sleep last night due to wet trousers. They said we have to provide the pads. Good point about if I order them direct to place anyone could use them. Just not sure now no one there at moment with him how we handle this. We spoke to a sw in the hospital who arranged this rehab but I don’t know if she is the one I need to speak to about this issue.

my mum used to get boxes of pads sent to her house so I’m surprised this isn’t covered

Sorry @MissMoneyFairyjust seen your recommendation to speak with the unit. Thanks - breaks my heart to think of him in wet trousers not knowing how to handle it and not being able to sleep

That sounds awful, I've never heard of it, I've been a nurse 30 years and would never just let someone wet themselves intentionally, the very least the ward should have sent him to rehab with pads and pants. They need to check him every few hours and help him use a bottle or walk to the loo. If the pads were for dad that were sent to the house he may be known to the community continence nurse already, I would speak to the nurse in charge and pals. How do they manage with patients who don't have family. Which hospital is this in, there must be a senior nurse in charge or a matron.

If he's there for rehabilitation do tell the physio and occupational therapists that he is incontinent and it's not being managed, beingvincontinent leads to all sorts of issues, infection, bed sores, falls, embarrassment.

Thanks @MissMoneyFairy I’ll do that tomorrow - thanks for your advice

There are also condoms called conveens which can be used attached to a bag

Thanks @MissMoneyFairy not something id ever considered (or knew existed for incontinence) but I’ll take a look! Thanks again

Hi All

i hope it’s okay to resurrect this thread.

my parents are both still in different reablement centres

they are on week 1 out of 6

my mum is more independent than my dad. My dad has just been placed under a DOL. he is somewhere where you can’t come and go as you please.

they’ve both been appointed social workers who haven’t yet spoken to each other.

When they leave - my dad will need care but my mam won’t kind term

they will self fund as they have over £23500

i spoke to my dads sw for the first time today and they said dad will be assessed for care and council will commission it and we’ll pay for it.

I feel very unequivocal for all this.

any tips on what I need to watch out for during this time please?

Did they sort out dads continence issues. Now he's on a dols they have decided he lacks capacity, he should have a capacity assessment and someone to represent him, usually family, a carer or they can appoint him a IMCA rep. Does anyone have health and welfare power of attorney for your dad , if not then they or family need to consider applying for deputyship through the opg and court of protection, any decisions about his current and future placement and care will be made in his best interests and a best interest meeting should take place with a doctor, nurse, social worker, therapists, representative and your dad if he's able. It may be that he will be safer long term in a carehome, his care needs will be assessed in the rehab unit, they will need a financial assessment to see how much they need to pay and what financial help they may get. If he's self funding and has nursing needs he may get funded nursing care which is paid to the carehome. If your mum goes home, or if they both go home, they need a home visit from the therapists, any adaptations or equipment made to the house which the therapists can recommend and supply small items. As you have a registered financial power of attorney and if your dad has an official capacity assessment which says he lacks capacity you take all that to his bank to take over his finances, if you have registered health poa you can use it now. Take a copy for the social worker.

Thanks @MissMoneyFairy

they've given him a catheter for now as he was retaining fluid. The waterworks actually seemed to be sorted out largely but as care home giving him lots of laxatives he has to now wear a pad for facetious.

i have health and finance PoA for him.

his confusion has massively increased in a short time since he has been in hospital/rehab and im hoping this isn’t a long term thing

i just get the feeling the social worker wants him out of the rehab and off their books especially as he is a self finder. She was questioning him about his finances the other day which I thought was a bit odd as he is under a DOL and no one else was present but I assume she can do this.

is there a guidebook or set of rules which so isl workers have to work by? At the moment I just feel lost at sea and I don’t really trust the sw

Ps I think his issue with water retention is linked with the home not ensuring he takes his tablets for his bladder. They also lost his teeth (again)

My Dad's in hospital and will be leaving for a care home of some sort.

Live in carers were mentioned but whilst there were lots of different considerations the one thing that made us discount this was...

Wandering. A live in carer couldn't stop him doing this and in his home town he would head for the high street. In addition to being a falls risk and wandering across roads, he would, sadly, be extremely vulnerable at that location from mugging as it is notorious.

For this reason above all of the others live in care at his home wouldn't be appropriate.

4 carers a day would also not be appropriate for my Dad as he needs, for a specific reason, someone around to help.him overnight.

So, our only choice now is a care home. We are awaiting him being recovered sufficiently in hospital to make this transition.

I've found sometimes it's one particular constant issue that rules some of the more preferred options out.

@Navigatinglife100I'm sorry you’re dealing with this. It’s so difficult and worrying especially when they lose capacity. Worry for my dad and I also worry about how people are treating him when I’m not there (I live in a different country). I hope finding the right care hole for you dad will be an easy task for you