Elderly Parent - unsafe discharge, any advice?

[havanesehope]

My Dad has been in hospital again, this time for two months. They have found a large heart aneurism this time. He has been in bed virtually the whole time and asleep. The hospital social worker has failed to communicate with us at every step of the way. My Mum is too ill to care for him, she has stage 4 cancer and just manages her own needs with a bit of help with me. I was informed yesterday that they are discharging him home tomorrow! He can barely walk, can’t go to the toilet himself, can’t wash, barely eats. There is no suitable bed downstairs. I talked previously about a respite/ residential place, the discharge team have totally ignored this! Any advice from anyone who has found themselves in a similar situation?

If your dad had been in hospital for 2 months, what have you as a family had planned for discharge? There has been a lot of time to consider this. If going home is not possible what other options have you discussed with him. If he needs a bed downstairs, why had this not been organised in the last 8 weeks. One of the reasons our NHS is failing so badly is that it's hospital beds are full of elderly people who do not need to be in hospital. Every thread I read on MN tells people to put their foot down and say their parent cannot be discharged. Make a safeguarding referral, refuse to offer support. We all need to take some responsibility here. Do NOT wait for a crisis and then insist your parent cannot leave hospital because hospitals are also not safe places for then to be. Hospitals are full of poorly people and staying in hospital longer than you need to as an elderly person is dangerous.
I would suspect that OPs dad will be discharged to all care in bed, wearing pads with carer 3-4 X daily to wash/ change pads/ provide food and meds with maybe a community rehab team visiting to see if he can do more at home in familiar environment and care package be reduced.
It is almost impossible to see a social worker whilst still in hospital in most hospitals as they have moved their services into the community.
OP, I would suggest asking to speak to the ward Occupational Therapist about what the plan is and how he is expected to manage. They may discharge him to upstairs and carers will take meals up to him.

@havanesehope so glad they are keeping him in. Keep refusing to have him home saying it's unsafe discharge. Sending hugs x

Just to add that a bigger number of elderly people are a high falls risk. Being in residential care does not reduce this risk. If someone is happy to await carers/ supervision before mobilising, they can be safe. If they are determined to do things themselves when they feel like it, this risk will be there both at home and in a care home. At home, even if living alone, you can have a falls sensor and other Tele are too at least make sure someone is aware you have fallen. I managed 5 teams off Therapists and one of my favourite quotes, (I think it was from a judge in a case where someone had been put in a care home and went to court to argue to be at home again) was "what point is there in keeping someone safe, if they are miserable'.
Not everyone is miserable in a care home. Some people really thrive in the right one, but for some, it is definitely better to be at home in your own environment, at risk of coming to harm but having your wishes listened to, than being kept safe, somewhere you do not want to be. As an adult, unless I was endangering other people, I would want my wishes respected.

This is also not true. Delirium can last a long time (and sometimes never completely resolve). Once all the underlying causes have been treated, ongoing delirium is just one of the things considered when planning discharge and the risks assessments competed for that task.

We have discussed residential numerous times (self funded). Sometimes he has agreed and other times not, flip flops all the time. Mum had to go into hospital for a bit and back out now, doing ok, we arrived home to mess everywhere and him lying on the floor. This has been going on for years but is so difficult now they are both ill. If she was still fit and healthy it would easier for her to crack on a bit but it is impossible now.

Correct U worded it badly but the Op should seek to have these provisions put in place anyway.

My point is that his homecare provider has a duty of care to their staff. Professional staff will not want the responsibility of taking on someone who cant walk or selfsupport and are a risk to themselves and are a risk to a work place injury waiting to happen.

If he has a long history of falls why would any member of staff opt to risk their job and health by being responsible for him not falling. Most carers I have been in contact with are being discouraged from any kind of manual handling so the OP needs to ask for the provision or physical handling management plan before her DFs care plan is finalised.
The last thing the OP needs is for individual carers coming in and not providing care due to H&S issues.

As for plans for managing his falls

1. the OPs mother and the OP are not going to be able to lift him if he falls so will need to wait untill outside care arrives which is always distressing.
2. the fall plan has to be based on him living alone with 4 care visits a day.

I’m glad to hear this, OP. You need to be really clear about what support would be needed if he is discharged home - care, environmental adaptations such as a hospital bed, and what has happened previously. If your dad is saying certain things can be done once he’s home and you know that is incorrect, tell them. If he’s got delirium then a capacity assessment is tricky.
If he’s is a self funder and agrees to step down care in a residential home, then that should be possible. Could 24hr care at home be self funded too? If he goes home he should get 6 weeks of funded reablement care which would be a max of 4 visits a day. You can add to that as needed if you pay the additional costs.
If he goes home he should also get an OT/PT assessment on discharge as part of the Discharge to Assess pathway. But as I said earlier, he must have had a physio assessment on the ward. Even if it was just to say “unsafe to mobilise/ unable to transfer”.

If a person falls at home and cannot support themselves back off the floor, then no carer is going to assist them up. You are correct. In this instance the family or carers would need to call 999 or the local pick up service if there is one. Even with a hoist there are manual handling risks of getting someone up from they floor, which is why hoists are not used for this purpose in the community.

I sympathise and have been in a similar situation. Out of interest, if your Father has assets/ money, do they expect you to set up carers, or is everyone entitled to a degree of home care?

Sorry 🙈
@dreamingofanotherworld that opening paragraph should read

"Correct U I 👀 worded it badly but the Op should seek to have these provisions put in place anyway."

I have lost count of the number of times paramedics have been out for falls and then the local falls service who sometimes referred onto the paramedics. Then sometimes paramedics would take him to hospital, sometimes not. He has been referred to hospital so many times but this is the first time they have done a full body scan and found a major aneurism which has been developing over time. Loads of visits to the GP never any referrals for scans. And so it goes on and on and on.

@cotswoldsgal1234think there is some care initially set up but then transfers to self funding.

Good that he is being kept in.

Can you encourage him to do a "trial run" in stepdown care?

Has he been added to the geriatric service i find that having a whole team who look at the whole person (medical and domestic and wider community / family) can prompt a better outcome rather the siloed team managing whatever landed him in hospital.

6 weeks care is funded by the NHS, if it then needs to continue it either switches to self funding or the local authority assess and agree what they are prepared to fund. There's a financial assessment done to determine contribution.
Delirium can also change the person's 'baseline' so just as an example, my dad fell and broke his hip, after the surgery he developed post operative delirium, the medical teams thought this may be short lived, in which case they could have discharged him home with a care package. However, the post operative delirium didn't improve so became his new baseline for assessment of what his care needs were going forwards, in his case his new baseline was so low that he couldn't return home and was discharged to a nursing home. There was a multi disciplinary team meeting during that time as he moved to through the thresholds for home care, residential care, nursing care. When they discharged him to nursing care, the local authority moved him 6 weeks later as it was too expensive for the local authority funding.

Sorry you are experiencing this. I had to totally step back from dad as the social work team expected so much from me. I work away 50-70% of the week and also have bipolar and GAD. The whole family hate me for it, but I had to think about myself and my dc.

Please check out the Care Act 2014, it’s there to protect families in situations like this. We were given legal advice and told to quote ‘A care plan that assumes a level of family input or seeks to impose an unreasonable demand on an unwilling family carer is prima facie unlawful’
10.26 of the care act
I know it feels cold, but he is the state’s responsibility, it is their duty to find suitable care not yours and make sure they know you know this. Obviously you’re going to want to oversee all of this to make sure he’s looked after, but it’s important to use the right language as sadly that’s all that seems to work

@sockheadthank you, that’s useful to know.

@alifeonourplanet75bless you, burn out and exhaustion is real. Feel mentally nackered at the moment.

I arranged a care home for my mum, they couldn’t get the room ready until the day after. I asked them to delay discharge for one day so I could book the day off, arrange childcare, collect her and take her to her care home. One measly day. She was well into dementia and suffering from extreme pain due to repeat falls. I did not live local. They didn’t give a fuck, they took her in a private ambulance, used the key safe to get in, dumped her in her chair and left her there. She had no downstairs bed or toilet and couldn’t get up the stairs. I work and I didn’t live nearby. When I got there, she was soiled, upset and in pain. To be honest that was just one incident of a multitude of how the NHS let her down and it’s not just funding, some of it is absolute callous individuals who should not be involved in the care of vulnerable people.

I am sorry that was your experience. Where I work, they would be delighted anyone had been proactive enough to arrange a care home( providing the patient was in agreement or lacked capacity and relative had POA) and would not have quibbled over a day. I think one of the issues to is that the hospital trusts are not the ones providing the care on discharge so sometimes patients are discharged with a care package that fails to materialise and the hospital are blamed. However I also know that it's not much consolation when things go wrong. It all needs to be more joined up.