Experiences of hospital discharge discussions when an elderly parent is unsafe at home

[mids2019]

I just wanted people's experience of anything like the below.

Elderly parent in hospital with heart failure, collapsed king and large blood pressure crops upon standing. He has been in hospital for around a week now and there are some staff pressuring for a discharge despite it being quite apparent parent would not be safe in their own home and there is a likelihood of readmission.

There are some staff (physios) saying the parent is not able to be discharged safely due to risk of collapse/fall but other staff who feel as there is no longer potential emergency intervention there should be a diacharge.

Has any one else been in involved in conversations like this with hospital staff and how did they go? Especially interested in a nursing/medical perspective.

What do you suggest, package of care at home, residential care?

A patient can't stay in hospital indefinitely, it will be up to your Dad (or you if he's lost capacity and you have LPA) to engage in planning a safe discharge.

Can you consider downstairs living and a lifeline?

It will take time to organise and we are quite distant. Also parent refuses to go into a care home. Ultimately I think the bp drops would it make it unsafe to discharge.

In time I guess the parent will have to review his living arrangments. We don't want a situation of an early discharge with the parent having a call and having to be transmitted through a and e which seems a distinct possibility.

But you need to get sorted.
Hospitals can't be filled with patients who can be taken of with carers at home or in a care home because next of kind is distant or refusal of moving for care.

Well my gran has been living with my parents for over a year because of a situation where she had to be discharged but could no longer live alone and she didn't want to go in a care home so my parents very quickly made a bedroom for her and she moved in with them...she needs 24/7 care now as dementia is very bad on top of other things..but she will happily go to a care home every 4 months for a week so my parents get a break

does Your father have capacity? Everything is dependent on that. If he does then the only thing that matters is what he wants, even if you disagree.

What happens if you don't have children? Is there a separate process?

In time I guess we will have to arrange something but there are staff saying a discharge won't be safe so what can you do in the short term. It's the fact that you seem have to staff at odds with each other about a way forward.

Yes parent has capacity and he doesn't feel he would be safe at home. Every time he stands there is a large blood pressure drop which results in him potentially fainting. This is the reason the physios feel he is unsafe to discharge (quite sensibly) . It takes nurses to escort him to the bathroom.

In my experience long hospital stats are really bad for an elderly person and they tend to deteriorate rather than improve over time (once the immediate danger has passed), because they spend a lot of time stuck in bed. So I would be trying hard to find a solution for them to be able to get discharged, whether that's a care home or retirement accommodation (sounds like they might be past that) or care in their own home (this can probably be arranged the quickest).

Agree with PP, patients are only supposed to be in hospital until their immediate medical needs are met - or while investigations take place to find out what their medical needs are. It doesn’t feel right when it’s happening, but hospitals are not care homes.

He clearly cannot go home on his own and look after himself, so you need to help him organise carers at home. The hospital should be able to give advice, but ultimately this is for him (you) to organise. I know it feels awful, believe me I’ve been there - still there 5 years on - but the sooner you get something organised the better, or else you will be lurching from one crisis to another, which yes will have him end up back in hospital, which presumably is something you want to avoid.

You can send an email to the discharge team expressing your concerns. If your DP has funds and a care home has space then they could told they need to go there if they don’t have capacity to look after themselves. This is what happened with DF. More likely they will be discharged with a care package, which will probably turn out to be inadequate as 4 x visits a day don’t cover the gaps and your DP will shuttle between hospital and home until they finally agree to go into a care home. If they aren’t self funded the cycle could go on longer.

Sorry it is a rubbish situation.

This might help
https://www.ageuk.org.uk/information-advice/health-wellbeing/health-services/leaving-hospital/

If he doesn’t feel safe at home, why doesn’t he want to go to a care home? Does he want to stay in hospital? Is it about the paying for care vs free in hospital?

Thank you for the mesaage. At home care will probably have to be a first step simply because of expedincy . I don't particularly want frequent visits to hospital but maybe it is what it is. As I said before the parent will refuse to go into a care home and maybe that is just a risk to be managed?

But what does he want/expect for discharge? Has it been made clear he is medically fit and can’t remain in hospital?

He just simply doesn't want to into a care home so it probably will be a case of eventually ensuring he is safe as possible at home. The immediate problem is the blood pressure crops which require nursing care i.e. medical intervention.

If he doesn't want to go he (and he is sane) will have to accept carers at home - and hope the best.
He isn't going to be staying in hospital then ready to move on by refusion a care home.

@mids2019 yes unfortunately there will be a period where the EP will refuse to go into a care home and your lives will be collateral damage until they accept the reality of the situation ( ask me how I know this).

If they have funds and you have power of attorney then you can put in place a fair amount. If they still have their mental faculties then it might be doable for a while. Regular hospital readmissions are sadly probably going to be par for the course.

Do they have funds and do you have POA ?

The blood pressure crops mean from one staff group perspective he is unfit to leave. He is in danger of collapse of he stands. However the question is will the bp drops reduce in the short term? There is one staff group really quite concerned and view this as unsafe discharge currently and others that are reaching for reasons to discharge. It's quite disjointed.

Ask to speak to a member of staff with responsibility for his care but start getting sorted. You need to get started on sorting his care needs. He will be discharged. Hospital isn't a long term solution.

If he refuses a care home then you have the option to step back entirely. There's no law compelling you to get involved.

If you say your parent has capacity and does not think he will be safe at home,but will also refuse a care home, what does he think should happen next?
There are lots of people who live at home who are not safe walking independently. Some live alone and are fully hoisted.
If he had 4 carer calls a day they could either supervise his walking or walk behind with a wheeled commode so he can sit any time he needs, it just transfer from chair into commode and wheel to bathroom. He could just use a bottle for a wee and not have to walk anywhere between visits.
Once the doctors have said there is nothing further they can do, people should not remain in hospital. It is very hard for families, but if your parent is the one waiting 2 days in A&E for a bed on a ward, the reason it is not available is because about 40% of people in hospital beds are not needing doctors but saying they cannot go home but don't want carers or care home. If they are happy to accept it, they don't want to pay,so wait a month for a free discharge package and then 2 weeks after that are assessed as having to pay anyway so only got 2 weeks free. It is all a mess.

If one staff group is that concerned, they can ask for a discharge planning meeting to discuss their concerns. Your dad and you if he chooses can also attend and all concerns and solutions can be discussed.

He will go home with carers. He will fall between visits and end up in a&e. On repeat until he accepts he needs a care home. How long will that take? How long is your piece of string?
The staff saying it's unsafe aren't saying he needs to be in hospital. They're saying you need to sort care, whatever he will accept in the short term. Only you can put limits on what you can/ are prepared to do and you just have to hope to God he gets the message quickly.

I suppose the question is whether the bp drops are likely to change, and if so, to change due to treatment that can only be done in hospital.

The arguments about discharge safety are completely normal and take up large chunks of every single day. Typically, the team/system will eventually come up with some form of package of care that allows a discharge with support, likely including a pendant alarm so he can call for help as and when he falls.