How to get my dad out of hospital? Is there anything else I can do?

[wakinguptomusic]

3.5 weeks ago my dad had a hip replacement. After a week (and some great physio) he was ready to go home. He has carers (state funded) at home 3 times a day and because he’d been in hospital for 7 days, he needed to be reassessed so the care package could be reinstated. 2.5 weeks later he’s still in hospital, stuck and effectively ‘bed blocking’. He’s desperate to get home!

I’ve tried everything I can think of to get him home but so far, not really been able to get any answers.

He was reassessed (over the phone) by Adult Social Services The funding was approved and my dad’s case went to the ‘care arrangers’ team. Social Services said he’d be released most likely last week but it didn’t happen. I’ve left several messages but no one got back to me. Since then I’ve spoken to hospital discharge team, to the hospital social worker, to the ward manager and although all very nice, they don’t have an update. Spoke also to the care agency (it’ll be the same people who were helping him before he went into hospital) and they’ve not yet received a referral. I spoke to PALS yesterday too and everyone just says it’s the ‘care arrangers’ but I’m not able to speak to them directly.

I’m really aware of the crisis in social care but in this instance, it would seem the hold up is with the hospital (I could be wrong but that’s what it seems) and meanwhile my poor dad is climbing the walls wanting to go home. I think if we had a timeline, we’d be better but we don’t have any information and facing another long weekend in, is really upsetting my dad.

Is there anything else I can do? I don’t want to be a nuisance but it’ll soon be a month and it just seems like a waste of a bed. We’ve been advised against self discharge (I did ask) because he’d then have to re-join the queue and start from scratch.

Trying to work out if there’s anything else I can do or do I just need to be patient?

Can you speak to someone senior at the hospital? Contact the ceo or a senior director? They should be able to make it happen or get you answers.

Sounds like you have a useless discharge coordinator. Some of them are terrifying Rottweilers and stuff happens. Occasionally they are just nice, effective people. Some of them are wet lettuces.

I would go and take up residence on the ward from about 7.30 one day (a weekday) and buttonhole everyone. Write it all down. Somewhere there is a mismatch of something and nobody but you and your dad cares enough to sort it out.

If you can’t do that, ring the ward and ask to speak to the sister, and if they’re not available, to the matron for geratology/acute medicine. Emphasise that he is ready to go home, you want him home, something seems to be holding it up.

How bizarre OP, most people have the opposite problem of hospital chucking them out when it's not safe for them to go home! PPs have good advice here. Good luck!

That’s what I was thinking - a useless discharge coordinator.

Last time my dad was in hospital (a different hospital) the discharge coordinator was ruthlessly brilliant. She wanted healthy people out of her hospital beds and she was straight on to the care agency to get them organised for dad.

This hospital, although the staff are lovely, just seem to be passing the buck. One lady I spoke to yesterday seemed offended when I asked if she’d ’give the right people a nudge’. She was implying I was trying to ‘jump the queue’. I said I was simply trying to advocate for my dad’s needs and I wanted to make sure he’d not fallen through the cracks. If that’s ’jumping the queue’ then so be it.

DH is a hospital director and is pretty ruthless about discharges! If this was happening in his hospital he would absolutely want to know!!

Yep, it’s so strange. It’s a small ‘cottage’ hospital. He had his surgery in a bigger hospital and was then transferred to the smaller one for physio. They don’t seem to be in any hurry. I was told by one person that as it’s still the summer, there’s less pressure on elderly/geri beds because there’s fewer chest infections/pneumonia/Covid etc. I just wonder if the delays are being caused by people being on holiday.

I like the CEO suggestion. If there’s no joy today, I’ll try that tomorrow. Someone also suggested my dad’s MP who has a reputation over being really active in local/community issues.

The frustrating thing here is that everyone will want him out of hospital. You’re just trying to work out what is preventing that.

I can’t help noticing it’s still August so the resident doctors are still quite new. That won’t be helping. Is his discharge summary done yet? Are the TTOs ready? (Medication to take out. They probably won’t be until the care situation is sorted but there’s no harm in asking).

Without wanting to be culturally prejudiced about this, in my Trust the role of discharge coordinator is heavily the specialism of women from Central Europe and frankly you don’t mess with them. But there will be someone like that in the system even if it’s not them.

It’s a discharge coordination issue but crazy as clearly hospitals are not good places to be if you do not need to be in them. Can’t do a discharge summary at this point, no date of discharge for one and what if further info needs to be added. TTOs could be sat in a ward cupboard I agree but again what if meds are tweaked?
Discharge coordinator, ward sister, MP and CEO/medical director all good shouts to highlight how bonkers this is. My hospital running a big campaign at the moment on preventing deconditioning ie preventing older frail folk losing muscle mass and strength, balance etc by lying or sitting too long. But in most modern hospitals what else is there to do no day room to go socialise in.

I got my aunt out in a similar situation but it was a bit risky.

It started with me shouting (as she's deaf) "I've no idea why you are still here at all. No one is telling us why" and a lovely OT overheard and went to find out what the hold up was. We agreed to take my Aunt home and care for her ourselves whilst waiting for the care package, as she was deteriorating in front of our eyes in hospital and we were fortunate enough to be able to do that.

We were pleasantly shocked when the carers arrived the next morning, so it worked out well for us.

Well, hospital is not prison so you can just take him home. Call crisis response and they will arrange immediate care. If it’s all been approved there won’t be an issue going forward, they just need a kick up the bum and you need to advocate for your Dad, whose mobility will be declining by the day in hospital. Not to mention the risk of hospital acquired pneumonia, norovirus etc….

Unless the CEO or your MP are HCPs and can attend to your Df 3x a day, there’s not much else they can do. I can bet that the delay is down to lack of carers. Until they gave found carers, he won’t be discharged,

8 weeks and counting here. Now has medically complex needs which require NHS continuing care. Hospital MDT have done assessment, discharge co-ordinator is great. Sticking point is that care is to be provided by a different county to the hospital care. Funding has been agreed but package is still not sorted and he’s too unwell to come home without. Time is very much not on his side. We’re now being told maybe Monday. In the meantime he’s in a specialist high dependency ward as no other ward is suitable. There are only 12 beds on this type of ward in the entire county.

You need to find out exactly what the process is, and what part it's stopped at. We had this and it was stopped with Social Care organising a proper assessment. But the hospital is probably not passing the buck - it's probably already with social care. It's very annoying but you need to get the right name of whoever this is sitting with, and then pester them.

Don't worry about being a (polite) PITA - make the ward manager sit down with you and write a flowchart of the process, and find out exactly where you are, what's been done, and what's stopping it. If they aren't helpful, ask for their manager.

Might be worth asking for a senior director responsible for 'carers' (you) if you are totally stuck. Keep pestering.

The stats for elderly people who remain in hospital that long are really bad. Hopefully your dad is up and walking around, but a person of 80+ who stays a week in hospital will lose 10% of muscle mass. And that’s one of the less scary ones that DH quotes.

i hope you get some joy OP.

I have explored the idea of taking him home but was told if I did they would drop his case and I’d then have to go back to square one with a new assessment with social services and that could take months. I could afford to help him at home for a week but I couldn’t take the risk of it being months.

Yes thankfully he’s getting up and around every day. He’s doing laps of the ward (on his zimmer). I also take him out in a wheelchair and we go and sit in the hospital gardens.

I’ve not heard anything today so I’ll go in person tomorrow and start insisting on answers. Dad’s care agency have said they’ve got capacity to take him on but obviously need the referral.

I think we have some progress! I rang the care coordinator at my dad’s care agency mostly just to ask her to explain the process at the NHS end. The agency staff like my dad as he’s quite a ‘character’ so she was happy to help.

The good news is, the referral was received today so it looks as though it’s been sitting with the hospital for nearly 10 days. They are now actively working on a plan to get him back on the rota. If they can give me a date for say early next week, we’ll ask for dad to be discharged to my care and I can cover things until the care package kicks in. She’s going to call me and let me know the date they can start.

Fantastic - fingers crossed!

We’ve finally got a discharge date of next Tuesday. By then he’ll have been in hospital for a month after a surgery which should have seen him home after a week.

I’m still not sure where the blockage was. It wasn’t with the care agency because as soon as they got the referral, they’d organised a care package to start within 3 days. I feel sorry for anyone who doesn’t have someone to advocate for them!

This is really bad advice. In my area there is no such thing as 'crisis care response'

Anyone discharging themselves from hospital without the proper care in place would be joining the same adult social care community waiting list as everyone else and in my area that's still around 3 weeks for anything fairly urgent. 3- 6 weeks for routine and 3 months for anything low priority.

Every area is different so unless you have detailed knowledge of the various discharge processes for the ICC involved, it's difficult to give advice.

The hold up seems to have been with the hospital care arrangers/ brokerage teams. They are often quite small teams with only two or three people in them - sickness and leave probably has significant impacts on them and as OP has found can cause delays across the hospital.

Just shocking isn’t it that it all falls down so badly. I think you could chuck all the money in the world at the NHS but it wouldn’t solve this issue of what seems a total lack of joined up services and inefficiency.

I have my fingers crossed that he gets out on Tuesday and finally goes home!

The hold up seems to have been with the hospital care arrangers/ brokerage teams. They are often quite small teams with only two or three people in them - sickness and leave probably has significant impacts on them and as OP has found can cause delays across the hospital.

I can’t believe that something as simple as this would be so overlooked when it comes to resolving this problem.. Bed blocking is constantly in the news and I’m sure if it was this simple, money would have been thrown at it and it would have been resolved long ago, or you would like to believe that was the case.

He should be going home with a reablement package? This should be able to start same day and then he can get his long term care package a couple of weeks later ?

Behind the scenes there will be escalation meetings where the managers of the care arrangers will be being grilled by hospital managers about when the care will be back in place and emails will be flying about. I think public bodies who commission services from private companies have to follow tortuous processes to evidence fair processes and I suspect this is where the glitch is. I’m so sorry for your Dad as this delay will be reducing his chances of a successful transition home and increasing his chances of getting a hospital acquired infection. In the meantime anything he can do to combat institutionalisation will help. Does he have clothes and outdoor shoes so he can get dressed every day? Is he mobile enough to go for a short walk regularly eg to the hospital shop or outdoors? Is there a visitors kitchenette where he could make a drink? In terms of influence, the Manager of the Discharge Team would be a key figure. Ask the discharge coordinator/tracker who their manager is.