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.

@Watchoka

Thank you. It's really difficult.

We are hoping Dad will be able to go to a home where he has had successful respite before but it will depend on his progress and ultimate needs and if they can meet them when his new baseline is known (he recovering from sepsis).

One advantage if your Dad has care home respite is that you start a relationship with them and, if successful, that may be a useful contact in the future.

If a SW was questioning your Dad about finances this was likely a Mental Capacity Assessment to see if he can make decisions around his finances.

If he's suddenly become confused and incontinent he may have a UTI.

I'm afraid my response won't be as civilised sounding as some of the others on this thread.
It is a problem that once you get the elderly in hospital, whatever gets cured will be compensated by some new problem. Certainly incontinence, simply because the staff will not get them to a commode or the loo, so they piss themselves, because you would. That then becomes the norm.

Another problem I recall was swelling around the arms and feet, that afflicted my mother in the hospital but went within days of leaving for a nursing home.

They never let them out of bed into a wheelchair so over a couple of weeks they lose upper body strength and deteriorate.

My advice is to give your Dad a drink when you visit, aim for 600ml which is easy enough if he can use a straw, otherwise if you can get him to hold a cup of tea then that is a way forward. Dehydration imo is their way of finishing off the elderly - it's a variation on the Liverpool Care Pathway which may be illegal but hasn't gone away, I'm afraid. We used Lipton's Peach Tea which is nice but not too acidic.

I never met a social worker we could trust, but we live in Surrey, it may be different where you are.
You will not get Deputyship re Health and Welfare for your parent, it virtually never happens If you didn't know to get LPA in Health and Welfare beforehand, you are stuffed. Dodgy social workers may suggest it however, but it is a ruse to win your trust and reel you in. It is different for finances as I recall, simply because they do realise you need access to their cash to pay for care homes etc

Some sort of regular home help would be my advice but - and I haven't read the entire thread - it depends on how close you are living to them and how much time you can give up also.

Thanks @Pelvicpaininthebumthat brings some reassurance to me

@NewspaperTaxisthanks - I was saying just a few minutes ago to my husband that my mam and dad seem to have come out of hospital with different conditions to what they went in with.

i don’t live in the same country so I do worry about how he is being looked after.

last Tuesday evening he called me from the home (I think a carer had dialed for him) and he was begging me to pick him up. He had so much desperation in his voice. I said I couldn’t as I wasn’t in the country but broke it my heart. I got the next flight home at 6.15 the next morning and turned up at the home and he was fine. No memory of calling me. I stayed for the week but had to get back to my kids and work.

Agree or constipation if they're giving him laxatives. As you have health poa and he lacks capacity you must be involved in his future care, where he lives, how he pays, where does your sister live. Don't worry about the sw, they are not solely in charge, if the rehab unit is attached to a hospital there will be doctors, nurses and therapists, all of them get involved in discharge planning, he will need a care needs assessment and if he is to move into a carehome the manager needs to come and assess him to make sure they can meet his needs.

If he is under a DOLs then what is the SW discussing his finances with him? The only reason she should be doing this is to show that she has attempted to explain to him and has recorded the conversation. I had to do this with my stepfather when I was applying for Deputyship and then selling his house.
Rehab isn’t the best place for him - he needs to be in a long term residential setting. He likely will settle there after a while and see it as his permanent home.
Regarding their finances, it’s important to separate out their finances if they’re currently in a joint bank account / savings account. That way, once his savings have reduced to the threshold he would become a partial funder. If all their savings are in one pit it’s much harder to keep a check. Also, do they each have Attendance Allowance? This should certainly be applied for for your DF to pay towards his care home.

Rehab is for getting someone back to either how they were before or assessing any new needs to help with future care and planning, like if someone had s fall and needs extra time to start walking and managing. You said your dad is in a secure rehab unit, is this a specialist unit for mental health issues, dementia etc, secure usually imp,it's that or is he there for physical rehabilitation, only.

Hi @MissMoneyFairymy mum got rushed to hospital unconscious about a month again. She has one kidney and had an abscess on it. This caused sepsis. Because she is my dads carer and there isn’t any family living in country they had to take my dad into hospital also as he was in a confused state.

my mum was released into a reablement centre last week where she is learning to adjust post hospital

my dad has gone to a different reablement centre as he has greater needs than my mam. He isn’t able to return home until she does and there is a care package in place for him.

my parents had always resisted having any care and then this crisis hit which has forced the issue. I’ve been arguing for years that they needed carers in and social services have been involved for a few years.

@Soontobe60 thanks - I think they’re getting all benefits entitled to including attendance allowance and DLA but will check this out again

This is the problem with resisting getting carers in. Because, tbf, it is often a waste of money as it's not like they stay long or do much necessarily. But without weekly carers, parents are more vulnerable to outside State influence when things like this happen, as you have to go from a standing start.

Yet the money is also open to misinterpretation. A hundred quid or so a week to have carers in (not idea how much it now costs) can seem a waste but that might be false economy given it is knocking on £2000 a week in the South East to have a parent in a nursing home. So which would you rather?

That all said, to have a parent in a home for respite for a week may seem inconceivable - over a grand for a few days' off, what a con! - and especially as you may be worried how they are getting on all that time anyway. But mostly because it's quite likely they will emerge from it significantly worse than when they went in, either from a fall, or now being incontinent, or some such thing, to the point that Social Services can now say, well, you can't let them back home now, 'and old people can suddenly deteriorate very quickly.'

Will point out the OP's dad is probably better off in a care home than in hospital where the likelihood of getting Covid is higher.

We have this situation No to any help -

we are at risk of alienating both of them - its nearly stop interfering and just go away ......
we cant Dad it's dangerous for you both
and they both lie lie lie to authority Heads in hands for family

Option 2 might be difficult - funding would be a challenge (unless you can afford to pay). It would be very expensive and 2 weeks doesn’t give a lot of time.

could there be an option 4 that your dad goes to the rehab with your mum?

I think you also need to consider the longer term - can you mum go back to offering the same support as she did before and is this sustainable? 6 weeks isn’t a long time and I can’t imagine she will be back to baseline in that time.

Would you/they consider them both going somewhere where they both receive support?

Sorry this is happening it's stressful and sadly very common :(

I wanted to reassure you that despite what discharge teams and social workers say you have say in the care providers - they just will have pre-approved contracts they'd prefer to use. So I strongly recommend looking at options yourself - this will also help with a continuation of care when the 2 weeks of funded care is over.

you can use websites like https://lottie.org/home-care/ to see what options there are for live in or visiting care in the area. I believe that website also offers care home comparison if you did want to look at respite in a care home for either of your paretns.

I really hope things become more settled for you all soon.

If your dad sleeps during the day and is more “with it”, but wanders at night, (or has behavioural changes) perhaps he has Sundowners. I would query looking into reassessing his capacity.

Hi All thanks again for all your advice on this thread it’s been invaluable