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.

They are not meant to lift people up off the floor. Its against H&S guidance

Care homes should have hoists which lift people up from the floor

I went through this with my Dad but it was a few years ago so hopefully advice/info still relevant.

I would speak to the hospital discharge team and ask if a discharge meeting is being planned as the multidisciplinary team are not in agreement on whether or not this is a safe discharge.

Also ask to be out in touch with the hospital’s social worker to request a care assessment to be carried out. This will inform any package of care going forward - ask if there is a discharge to assess (D2A) process in place - if this was enacted your father would be moved to a care environment for up to 6 weeks to allow for proper assessment and to free up the bed.

When speaking to Social Services make it crystal clear you are not able to provide any care otherwise they will assume family may pick up any shortfall in arrangements.

It’s shit and a horrible situation to be in but ultimately if your father won’t agree to any care home and is deemed to have capacity he may be sent home with 3/4 times daily carers (15 mins each) which may be completely inadequate.

hope this is helpful

Once the patient (of any age) no longer requires treatment from the acute hospital they need to be discharged. The options at this point are home with a care package or a residential care facility - the latter will be whoever has space and accepts the nhs care package. Your father can’t decide he wants to stay in hospital, that’s not an option. I know it’s hard being a distance, been there! But you can either urgently facilitate one of these options or tell the hospital social worker and his local council you are not willing to and adult social services will make the arrangements and assume responsibility for care choices (but not funding, that’s means tested). Alas many of us have been through this, dashes up and down the motorway…. Best wishes op

The visits per day in my LA are 30 mins long. Sometimes 45 in the morning.

Hospitals aren’t care homes and this is 1 of the massive reasons why A+E is in crisis.

I work in an A+E department and we have patients who are lying in corridor’s for 2/3 days before getting a bed in the wards because the wards are full of home care delay patients who are ‘medically fit’ for home but unable to manage. There is barely any movement in the hospital and it’s causing a major problem.

My old Aunt lives alone, doesn’t have a husband or children, she fell at home after a uti + delirium, she should have been home in under a week after antibiotic treatment but instead, was in taking up a hospital bed for 5 weeks in total due to social services sorting out a package of care.

Prob use a hoist if needed

likely that it differs between LAs - all the more reason why a care assessment needs to take place

In similar circumstances the elderly person ended up being confined to their living room and shuffling between bed , chair and commode with four care visits a day. They didn’t have enough money to pay for care and social services said they didn’t meet the threshold so they trundle on.

@Cheese55 Yoy never ever get that in rural areas due to travel time! It’s absolutely horrendous. Plus what @Secretseverywhere says is 100% true. It’s utterly miserable. In my experience SS lie too if they think they are paying. A social worker told me the hospital advised home care. The discharge team and Ots had told me that wasn’t possible. So you have to be aware of lying social workers who haven’t actually spoken to anyone. If you pay you bypass these idiots. In our LA they even refused to do a home assessment. I think legally they must but they avoid responsibility. I’d rather die than have them involved.

Have the doctors found the cause of the BP drops, there is medication for this. And exercises, compression socks. Can he live downstairs, does he have a falls assessment, equipment at home, alarm system. He can't stay in an acute hospital bed forever, gave they suggested rehab if that would benefit him until his bp is sorted.

Stand your ground and ask for discharge to a rehab bed, staff there will do a full assessment of his needs to decide on future care. I would also ask for referral to Social Services for an assessment of needs, full care team review with yourself would be helpful but not always possible due to staffing constraints

We had an awful experience with FIL in Bristol.

He was MIL’s carer so we had to bring her to us and their house was empty.

FIL got delirium and was learning to walk with a frame … and then suddenly he was discharged and dumped in a chair at home in an empty house. An estate agent was there taking photos so she chased after the ambulance men to try to get them back, then phoned DH. We live 3 hours away so he had to frantically phone friends to go round while he drove there.

Without the estate agent he would have been alone in a cold house unable to get out of the chair, with the madness that delirium brings. Just awful.

If he’s not safe to be at home he needs to go into care for his own safety if no one else can look after him. What about asking him to go into care for a period of respite and seeing how he gets on ? If he has capacity he should understand he needs to be safe. The maximum he will get at home is 4 x care visits a day but this isn’t appropriate if he’s at risk of falling as if he had a fall it could be the next carer who discovers him some hours later then he may have to wait hours for an ambulance. He could get a lifeline pendant but if he collapses he might not press it in time. If he lives alone has he been appointed a social worker to oversee his discharge and assess his needs ?

Who has to be “shut up”?
what personal responsibility did your friend take for themselves?

@PoppinjayPolly The discharge team who wanted him in his home because it’s cheaper. Or social services. Again because it’s cheaper if you are at home. Don’t understand about the furniture clearance - why? Where did his furniture go?

@PoppinjayPollythe discharge coordinator. He was not taking no for an answer. He also seemed oblivious to lockdown as well! My friend had not taken any responsibility for himself despite having capacity and had not lifted a finger to help himself in about 8 years. My patience has finally run out.

MIL went through all this over 2 years until she passed away at Xmas
First 3 falls... discharge home.
Next fall DH stepped in with the words "unsafe discharge"... reenablement and discharge team brought in to assess house and make sure she had a hospital bed, steps, handrails, bath seat etc. Provided 4 weeks of care visits.
Same for next fall.
Next fall - broke her pelvis. Sent to a cottage hospital for rehab for 6 weeks. Then home with carers, adult social services heavily involved.
Fell again. Rehab, physio, all agreed it was time for nursing home
.. she didn't... so cottage hospital for 3 days, then transfer to 12 weeks of respite care with physio, she stayed after respite as she then realised she would never be alone and was simply not going to "get better".

We dreaded the call from the fall-pendant company or paramedic.

@ChubbyPuffling My dm got confused when she fell and never used the pendant. Just found cold but alive in the morning. A cottage hospital? What is that? All gone here. You come out of a general hospital and go home! No assessment in terms of managing. Dm didn’t get rails put up as they said they were stud walls! They were but we all have those. It’s a shit show.

We had this with my FIL in 2023. Blue lit into his local hospital 50 miles away from us after a heart attack (not his first). He had many health issues including some that required a colostomy bag to be fitted during his hospital stay. He was there for about a month with the drs regularly telling us he might not make it, he became homeless whilst there, and then they called us on a Friday morning to
tell us they were discharging him to a local Travelodge at 5pm that afternoon. Shout out to Neath Port Talbot hospital for that awful treatment 🤦‍♀️. We dropped everything to bring him back to our massively unsuitable home that night - and working with some brilliant ppl got him an assisted living flat within 5 miles of his previous home within 24hrs of discharge. So, whilst I agree that the NHS can’t afford bed blockers in hospitals my limited experience is that the system is really shit at linking the hospital discharge department with social workers and any form of real practical assistance outside of hospital.

Good luck OP. My FIL passed away from another heart attack within the year and tbh he was pining for my MIL who died the year before so he would have been happy to go but my blood still boils when I think of that casual “we’re discharging him to a Travelodge at 5pm tonight” call.

So why didn’t his son use his wonderful communication skills to sort things out?
using bullying or “strongly worded emails” to force a hospital to keep a medically for person in hospital and bed block, isn’t an achievement.
although can imagine the son would be the first on to PALs to complain if his dad was left on a trolley because no ward beds!

@PoppinjayPollyit wasn’t bullying, it was just firm in saying that he would not be his fathers carer. I don’t blame his don for not wanting to be involved. He lives 3 hours away and feels that his dad abandoned him as a child. He was discharged to a nursing home in the end as the flat was not habitable. (Friend had refused all offers of help.) He is still there and loving not having to lift a finger.

@IAmTooOldFor Our nhs is a shit show isn’t it? Them and social no services! None of them keep relatives informed. There’s a huge expectation and imposition at the very last minute. No planning, no communication and in our case, a rude doctor, when after 5 weeks I dared to ask for an update on DMs health!

My DH and I are currently living through his recent almost complete lack of mobility following a seemingly minor fall (not his first) that shot his confidence in walking. The paramedics who came to rescue him contacted Adult Care and they were swift in arranging the necessary equipment to deck out our living room with a hospital-style bed, commode and the wonderful sitting/standing aid called a Rotunda. Our lives have been totally changed by all this, in rapid time. I am 74 and fortunately pretty fit (though have my own health issues too) and I can honestly say after 4 weeks I am completely shattered. The care package (free for 3 weeks) has been a godsend but four half-hourly visits just doesn't cut it. He ALWAYS needs the toilet ten minutes after they have gone, and often a complete wash afterwards if he has used the "nappy", they don't think about teeth-brushing or washing feet or hair, they focus on things that are not really "care" such as making a cup of tea (just for him - none for me!) and we have seen almost all 30 people on the staff so no continuity of carers. Of course, all household tasks are now left to me - lawn mowing, car MOT, shopping, excessive washing and drying, the usual chores as well. We have (very welcome) visits from the physio 2-3 days a week (with some success thankfully) and several (unannounced) visits from GPs and nurses to conduct tests of various kinds. I daren't go out without making sure he is suitably seated somewhere safe and has all his toileting needs at hand, plus drinks and whatever else, the phone, the pendant alarm and so on. His new bedtime is now 7 p.m. when we don't normally eat till 7.30 and they come to get him up at any time at all. It all consumes about 17 hours a day of my time and I am truly KNACKERED already!

As someone above said, we should have moved to a more manageable bungalow ten years ago but DH would not hear of it. We have few facilities in our rural village and most of our friends are similarly housebound or dead, so I am now grossly isolated. I believe he is also depressed, and I don't blame him, but it means he is pretty miserable and not the man he was.

Beware anyone thinking they can commit to someone like my DH and still have any life of their own, cos it can't be done. If my DH gets any worse, it would have to be a care home - and he could live a very long timee as his problems are not life-threatening in themselves.

Time the government gave some thought to the care of the elderly but the required budget would be enormous.

That wasn’t how I inferred your original post with the It took a strongly worded email from his son to shut them up.. As that comes across as the “you’ll do what we tell you” to staff, when families have high levels of demands and expectations on others, but no sense of personal responsibility for themselves or EP.