What can you do when they refuse to get out of bed and mobilise?

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FIL is currently in a rehab hospital after a fall a few weeks ago when he fractured a few ribs. He is in no pain from that now and the hospital is trying to encourage him to do physiotherapy and move around using a walker and support, as well as sit in a chair for short periods, but he is pretty much refusing to do anything. He is meant to be discharged soon to go back home with carer support, but as he is barely walking and cannot get out of bed or a chair unaided I am not sure how this is going to go? He is more than likely going to fall again when back home.

He keeps saying he is most comfortable in bed. He sleeps a huge amount and we can't really reason with him very well to try and move around to strengthen his body as there is some short term memory loss.

Is he on any pain medication, HD must be frightened to fall again, they can't make him get out of bed but they will explain the risks to him, can he have a hospital bed at home that moves into a chair position. He needs to be fully assessed before he goes home, including if he is going to be bedbound, and care and equipment supplied before he's discharged. Does he have capacity, is there any poa in place. What's his home and financial situation.

@MissMoneyFairy thank you for your response, he's not on any pain medication. A hospital bed hasn't been suggested yet. He doesn't really have capacity at the minute (hospital stay has made him forgetful), and we have POA. He has had a catheter put in by the hospital - if bedbound when home would this stay in? How does toileting work otherwise?

Sometimes the body starts preparing for the inevitable. How old is he?

My stepdad took seriously ill a few years ago he refused this that and the next thing, it was bloody frustrating.he had a commode for .peeing in, there was nothing we could do, my mum took on a carer role, it was up to her really you can't force him to move sadly, step father is better a few years on but not great sadly,

If they let your fil home with a catheter his bag will need emptied and a district nurse would need to change the catheter if it falls out or needs replaced. So he would need a care package.

A longterm catheter can be put in while he's in hospital, I think they get changed every 3 months but you can look this up online. As you have poa you can speak with his doctor nurse, therapists, social worker, discharge team. If he wants to go home and everyone is in agreement he needs a full care needs assessment, a care package, equipment, carers, district nurses, if he lacks capacity after a formal capacity assessment then a mdt meeting should take place, if he's not going to be safe at home in-between carer calls then would he be safer in a carehome. I would ask the doctor and therapists what they think he would be able to realistically manage, is he likely to deteriorate or stay as he is, it's a difficult conversation but it's no benefit to him to be in rehab if he's not benefitting from it,

He's 88 years old.

MIL (91) has had poor mobility for a long time. But v recently something has happened like a stroke (but it’s not) and it’s almost as if she’s paralyzed. She’s not but can only make minimal movement unaided. It’s also affected her speech. I am not sure what can be done. She’s in a brilliant care home, but I suspect she may not have long. Such a difficult time. We’ve been encouraging her to move more for years - but it’s not what she wants to do.

Good luck OP.

What does he want to do next?

How sure are you he is in no pain?

pain can be experienced as fatigue and nausea as well as the more obvious signs.

He’s not complaining of pain and has been asked lots of times. He’s saying he wants to be “looked after”. Before he had the fall he was at home with carers coming in three times a day.

Could he have hypoactibe delirium? It sounds as if he’s too responsive for that but maybe check with the team.

How are they assessing his pain? Is he definitely not in pain when he moves? They’re not only asking him about pain when he’s NOT moving, are they?

Ultimately, he gets a fair amount of choice in what he does.

If he wants to go home, then he’ll need to get moving. If he doesn’t, then not cooperating is a good tactic in his part.

It might help to point out its care home if he continues this (if you think he won’t be keen on that).

At 88 if he wants to ‘give up’ then isn’t that his choice? I think it’s fair enough if everything becomes too hard to just say that’s it I’m done with it now I’ll lie here and be waited on?!

obviously yes that then means conversations about care / care homes but if he won’t do it I can’t see how you can make him.

multiple broken ribs aged nearly 90 are a life-threatening injury - it's a huge injury to recovery from and takes a lot of energy. What caused the fall? (falling is often a symptom of something else going on). PP makes a good suggestion re hypoactive delirium. UTIs don't always come with the usual symptoms in this age group either so sometimes that's worth thinking about. Presumably they're happy he's not had a proper bang to the head too? If all the medical stuff is as well managed as it can be and he just wants to be 'looked after' then perhaps the kindest thing would be to listen to that.

Wanting to be looked after is not the same as wanting to be waited on, he's had a serious fall and he's very old. Bedbound people can stay at home but 4 care visits a day with perhaps a quick night visit is the most you get, would he be paying for his own care. To go home he'd need special equipment and his home assessed, have you discussed a carehome instead with him. Even if he does start getting in and out of bed in hospital it doesn't mean he will at home and he could fall again.

Rib fractures are very painful, not so much at rest, but when moving, especially getting in and out of bed. I would be very surprised if he wasn’t on anything in pain, and if he’s not perhaps he needs to be?

being forgetful is not the same as not having capacity. As it stands, your dad has capacity to make he own choices regarding rehab and his discharge.

Many people go home with 4 care calls a day. Ideally if he could transfer himself to a commode next to his bed that would be something.

Has he been seen by an occupational therapist on the ward? They should be looking at his home environment and considering what could be done to be as independent as possible.

I went to see him today and the hospital assistant was very forceful in trying to tell me that he had told them that he wanted to be looked after when he left the hospital. She was implying a care home I think. However FIL had no recollection of the conversation and it almost seemed like she wanted to put the words in his mouth?!
I asked if it was possible to get him a hospital style bed for home that can help him sit upright and change position. She wasn’t very forthcoming, does anyone know if a bed can be supplied?

Yes a hospital bed can be arranged, either through the therapists or district nurses. You have poa so you need to speak with his doctor, staff nurse, therapists for a discharge meeting. Don't order anything yourself, if he were to go home the ward will arrange everything. Nothing can be done until he's had a capacity assessment and care needs assessment, do you know which department the assistant was from.

Whatever conversation the staff member had with him, it doesn’t sound either like a capacitous decision made by thinking about all the options, or a best interests decision made by the team - apart from anything else, you should be involved in that! Sounds more like the sort of thing the care home receptionist says to me when I’m leaving my mum’s room looking glum - ‘tell your husband to look after you’ kind of thing. So I’d ignore that.

Id usually say the person you need is the ward occupational therapist.

I think you need to be realistic about what is going to happen next.

Often after a fall older people will need more support. As he already had 3 carers coming in day the next step up would be a care home. If he is sleeping a lot and not wanting to get up then it sounds like he is heading towards the end of his life.

Yes she was definitely wanting him to tell me that he wanted to go to a care home. She was a member of the discharge team at the hospital. They'd obviously had the conversation with him a few days ago, and I think with a bit of persuasion from them he may have been slightly pressured to say he wanted a care home. Although today he had no recollection of it and when I was speaking to him about going home, with support, he seemed perfectly happy.

We have a discharge meeting with the hospital next week.

How much does he understand? What does he mean when he says he wants to be looked after?

To be blunt if he isn’t able or willing to get by himself to have a poo and he is at home with 3 carers visits a day then he is going to be left sitting in his poo.

@JinglingtoChristmas good point, we definitely need to cover toileting. He does seem to understand but as I say, short term memory has taken a nosedive! Thank you for all the very helpful replies.

From what you describe I think a carer home could be the best place for him. What you asked if what he thinks about going into a care home?

I get the impression that you are resistant to the idea of a care home. Why is that? Have you asked him how he would feel about living in a care home? There are some wonderful care homes, he'd have 24/7 support with everything, the company of others, you'd have peace of mind. It could be a good option.