How to help DM recuperate after hospital stay

[backatchababy]

My DM 82 has been in hospital for 3 weeks following a fall. She’s due out any day and so weak and frail after her and can barely shuffle to the toilet unaccompanied. My Dad will look after her (he adores her) but is rubbish at things like getting her to exercise, drink water or eat properly particularly when she doesn’t want to - if she’s in pain or tired and refuses they argue and it upsets him so he doesn’t force it so she doesn’t drink or move which of course exacerbate the issue (she was so severely dehydrated when admitted they think this caused her fall and has had recurrent UTIs)

What can we put in place for her to help? I’ve found a brilliant physio to do home visits once a week for exercise - is this sensible? Would twice a week be better? What about the drinking and eating side of things. I’ve tried ordering Hello Fresh type meals in the past but my dad didn’t find it useful so they rely a lot on ready meals. My mum needs nutritious meals, high fat, high water content and someone standing over her making her drinks - siblings and I live miles away so are once weekly visitors at best.

money no object - what would you do or organise to help my mum and support my dad who is struggling emotionally with the sudden decline.

Has the hospital assessed her care needs? She should have a plan in place before discharge. Do they live in a house, is there a bathroom downstairs, can she manage stairs?

Some care agencies will provide temporary full-time carers (or visiting carers) during convalescence following a hospital stay. It would be worth checking out their local agencies. An outside carer may seem more persuasive than your dad (particularly since she knows your dad will just back down).

Is she truly fit for discharge? It doesn't sound like it. She should get some help for up to 6 weeks from the hospital then you may have to pay. Physio is a great idea. Twice weekly if you can. Speak to the discharge team.

Re food. Have you tried Wiltshire farm foods? They are pretty good and come frozen but heat through in under 15 minutes to eat.

Also you could try googling "jelly drops for dementia." They can be good for getting hydration into reluctant drinkers.

I'd get a carer to come and visit - one where it will be the same person every day (rather than an agency where they just send whoever) and who would have time to make sure your mum was up, bathed and dressed, give her a cup of tea and snack, organise their lunch and work with your dad on what they'll have for dinner. The sort of person to gently nag them both.
The lady who looked after my parents for years was like this and it made a massive difference to them. She'd also text me to let me know when they needed something, would check the fridge/cupboards and do a shopping list with dad and was generally the centre of their support system

This is true - the hospital ought to assess her to see whether a care plan would be appropriate.

However, when we were in this situation with DM, it would have significantly delayed her release from hospital (by the time they did the assessment and put everything in place via the NHS providers). Being in hospital was making her so institutionalised and weak that we opted to arrange care privately rather than delay her release.

If you can afford to do this, and if it isn't putting your DM at increased risk, then you may also want to go down that path.

For the foreseeable future get ice pops, yogurt, ice cream, custard and jellies. I would also stock up on the knorr stock capsules. They do chicken, beef and vegetable. You can put it in a bowl with a slice of bread or in a mug. This way she is getting nutrients and fluid.

i have a lot of experience with this and I know that these things are more palatable for elders. People who are like your mum can exist on very little.it is really important not make it a battle. A stock capsule makes 500 ml so I would give it to her in a small tea cup so that she is not overwhelmed.

it may seem that she is not eating and drinking enough but as long as she gets something down it is a win.

My mum has sports bottles of water which she knows she needs to have. They are easier to sip on all day via the straw and are half litre so lots of water

Thanks very much some really helpful suggestions on here.

She is being assessed by OT and assuming she manages the stairs and some basic function tests, she will be discharged. Is she fit & ready? Probably not but they want her out & frankly, the longer she's in there the more she'll deteriorate. If she lived alone it would be different but my dad is there and capable of looking after her albeit not great at cooking or making my mum do anything she isn't comfortable with! All requests and conversations about post-discharge care such as nutritionist, physio, district nurse etc are met with vague respons so not holding out much hope there. I'm sure if we were there and made a noise and didn't budget until we got answers there might be something put in place but we're not and my dad won't make a fuss and my mum can barely remember what day it is at the moment so certainly can't advocate for herself.

I'm arranging a food delivery so will add some of the suggestions - stock, soups, jellies etc. I'll also look at the wiltshire farm foods suggestion as that might be an idea for these early few weeks at least. You're definitely right @Rictasmorticia about not making it a battle but god it's frustrating when you can see it happening, know the solution is something so simple as drink more, but just can't get them to do it. Bottle with a straw is on its way as are first order of Jelly Drops.

We are looking into carers but struggling to find a person rather than agency and I know she'd hate to have a constant stream of strangers (plus my dad is resisting this option at the moment). Really appreciate the responses and any other ideas welcome & I'm sure these sort of thread can be useful for others too.

I don't think someone standing over her making her drink is necessarily the right thing to do. There is encouragement and then there is turning life into one big battle, where everyone ( mum included) is miserable.
@Rictasmorticias ideas are good ones.

Request a reablement package via hospital discharge team . Carers comng in once or twice a day to help her get up, wash, prepare breakfast etc and take some of the pressure off him. OT can provide grab rails, perching stool, shower/bath seat.

Don’t get the farm fresh meals. You will be wasting your money. The size of the meals alone will make her panic and overwhelm her.

Put her food on small plates or even saucers. If her memory is bad she can have several small meals a day as she won’t be aware of having already eaten.

As well as my other suggestions, I suggest you get some ritz crackers spread with triangle cheese. Just two will probably be enough. Also hot chocolate or coffee made with full fat milk. Again this is something that can be offered several times a day, if you add a chocolate covered digestive that will up her calories.

Is your dad dehydrated too? Can they remind each other to drink a bit more. Less nagging more working together.

One word of caution, you are sometimes advised to drink less with certain conditions (heart failure etc). Have they taken this advice too literally?

Here is the jelly drops link
https://www.jellydrops.com/

my dad is in pretty decent health it’s my mum who is under weight and letting herself get dangerously dehydrated so monitoring her fluid intake is really important when she comes out. It’s not intentional of course but she zero appetite and I suspect the number of UTIs she’s had make her reluctant to drink (Which of course in turn gives her UTIs).

Jelly drops have an excellent marketing campaign. Before deciding they’re the solution, look at how much water they actually have and how much sugar.

Nutrition, fluids and mobility wise. I’ve taken you at your word on money no object. Also a selection that can mix together.

Meals - M&S ready meals, Charlie Bingham or Cook. Higher budget and higher nutritional context ingredients than many others. Tastier than Wiltshire farm foods. Then add smoked salmon / hot smoked salmon, cheese and biscuits, and proper puddings. Custard, rice pudding, ice cream (mini Hagen daz tubs, mini magnums).

Then outings for meals. Book a taxi twice a week to pick them both up and take them somewhere they like for coffee and cake / lunch. Pick a friend up on the way if helps. There will be a local taxi driver whos happy doing frail and doddery. By booking it, it’s a commitment rather than a casual thing that relies on your dad nagging to do. Even if means first few weeks getting an agency carer to go with them as a helper. Generally you won’t get a person, but talk to agencies and get a feel. Some will have a small pool they will work from for each client.

Physio - great idea. Ideally home visit so can also eyeball the set up, make tweaks and leave them both with their homework. Second visit of chair based exercise person, or a PT (there are one who specialise in elderly). Then add a regular massage therapist. Get moving and aches fawned over.

Drinking wise - get clear on what the mobility and urinary continence situation is. You’ll know is theres no toilet around that’s easy to use, you won’t drink lots yourself. But you make it up later. If toileting is always hard for her, or struggles with leakage the logical solution is drink less.

Mobility - hair appointment once a week? On a day with nothing else on. Drink at the hair dressers. Preferably with biscuits. Get hair dresser on side. Also, going out forces the getting up and moving a little bit to get there.

Does she happily eat sweet things?

If so try Jelly Drops Water Sweets. They were designed to get fluids into elderly people and contain 95% water plus added electrolytes and vitamins. Each pack is 50ml water.

Is there any real difference between Jelly Drops and just a pot of jelly? Or is it just marketing?
I think I'd rather have a pot of slightly fancy jelly from Waitrose with the fruit in it.

Jelly drops have added vitamins and electrolytes and are sugar free (but don't have a laxative effect like you get with some artificial sweeteners). So I would rate them, personally. They are also very 'snacky,' and easy to leave the pot open on a side table and have one or two of them here and there, like sweets - it all adds up without you really noticing.

However, they are not cheap, and I absolutely agree that if you fancy a nice jelly from Waitrose instead then that's what you should be having. Basically it's about getting the hydration in by whatever method is most acceptable. If it works, it's good.

The 50ml in a pack of jelly drops is a trivial amount. You'll get more liquid, as well as more nutritional value, from 'wet' foods - soup, custard, rice pudding, actual jellies, stewed or tinned fruit, ice cream, etc.

If money's no object, a daily carer¹ who's there long enough to go through the physio exercises and supervise at least 1 meal and a couple of drinks. I know a few people who've found good individual carers through care.com.

Physio twice a week, working up to 3 if they think your mum can manage it.

¹ If there's a personal care package from the hospital, the private carer could be more of a befriender/housekeeper than an actual trained carer.

I mean it’s much easier to get an older person to eat a few sweets rather than sit and eat a pot of jelly…

Absolutely there are better ways, but if she says money is no object and her mum will eat them in addition to meals because they’re like sweets… then that’s added hydration.