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.

The NHS is certainly not perfect, but it’s a system designed to diagnose illness, treat it and send the person on their way. Unfortunately with our aging population many of the ailments they encounter are simply because they are aging, or certainly in DFs case he was in and out a few times with delirium and big blood sugar ranges because even with carers at home, he was simply unable to recognise that he needed to drink fluids and eat regularly and take his daily insulin.
Social services is also overwhelmed and relatives can’t step up to the level needed to keep very elderly people at home when simply they are just past that stage. The only saving grace for this batch of oldies is that quite a few have a lot of savings due to generous pensions and increases in property prices, so some can pay for their own care ( if they agree there is a need). Going forward unless we stop the annual flu and covid jabs and enthusiastic medications for the over 80s we are completely screwed.

@rookiemereThats 100% correct. We do however have legal obligations for SS and they fail to do even the most basic ones. It’s patchy of course.

Also some NHs trusts have cottage hospitals where old folk go to prepare for going home. There’s not one where I am. Then the release team in the NHs talks to you at the last minute about discharge. My DM was in hospital for 6 weeks - never any info about discharge until a few days before she was released. Then I was given a list of homes to check out but SS wanted he care.

The NHS never sorted out pain relief. The pain relief team didn’t show up. Doctors didn’t bother - no doctor spoke to me about what they were doing regarding DM. No Dr’s name above the bed! Nurses never spoke or even looked up - doing their admin at computers. As a result getting old is a nightmare and I’d rather die than go through what my dm did.

The only saving grace for this batch of oldies is that quite a few have a lot of savings due to generous pensions and increases in property prices, so some can pay for their own care ( if they agree there is a need).

True - although if they are anything like the elderly people in my family (now in their 80’s) they seem allergic to spending any money on care or support, and expect their adult children to step in and do it for free, while they hold on to their thousands in the bank.

OP my mum was in hospital in similar situation - had had a fall in which she broke her shoulder, history of low blood pressure.

This is mass-provided care. So there is a bed management process on the ward that is pushing hard to get the space back and hospital keen to get you “off their books” onto the responsibility of community care. Quite right that this tension exists between trying to free up beds for other extremely ill people. Depending on local demand, the beds might be sorely needed so pushing people out a bit early might be necessary. At the patient end - if the patient has no one to advocate for them then they will just go where the NhS tell them whether that is home or care. Where there is an interested family member, nhs will immediately assume and rely on you providing support.

Therefore you have to state “I have a ft job and a baby so I cannot provide care for my dh. His home has no downstairs toilet and he can’t safely use stairs. Before he comes home he needs a hospital bed with rails downstairs (easier to get out), an emergency alarm in case he falls, a commode, a zimmer for stability, a care package with visits 4x a day to help him with self care and food.”

By the way - you can get smart wearable devices that can detect if someone has fallen over. Worth looking into.

TBH it sounds as if he needs 24/7 care, and if he’s refusing a care home, that means live-in carers, which can easily cost more than a care home if they’re needed day and night, so more than one on shifts - since they need their sleep and time off.

But if he has capacity and won’t do the one, and won’t (or can’t) pay for the other, the fact is, he will have to go home with the statutory (and in this case utterly inadequate) 4 carer visits a day - and hope for the best, but….

Sadly this has also been my experience, but at least once they finally agreed to go into a care home - a move that could well have been deferred if they had taken on any of my earlier advice about additional home support- I was able to arrange it quickly for them with huge amount of help from DH ( only DC).

Thats why it’s important for OP to find out if they have PoA and how much savings her DF has. Doesn’t make the elderly person any less intransigent but means once they’ve been through a few crises, changes can be made relatively quickly. Sadly if they hadn’t been self funding, I suspect we would have had to go through the merry go round of hospital admissions a few more times before anything other than home carers would be offered.

If he is self funding then find anice care home and.suggest he goes there for six weeks.til.stabilises
He might like it
Staff on site
3 meas aday and snacks
Entertainment

The op must know if she has POA! If not, get it. However it makes no odds regarding discharge from hospital! Relatives are responsible! Poa doesn’t give you a right to make decisions without the elderly person having input. If the elderly person has full on dementia, that’s different.

@PoppinjayPollythe discharge coordinator just wasn’t listening to either of us!

Even living in the same town doesnt always work. My DM lives a 45 min walk away. If she was to have a fall in the middle of the night its either a 45 min walk there and back or booking a taxi if you can get one in the middle of the night, there are less of them since the lockdowns some were screaming for.

‘Wow!’ to this thread you’ve started @mids2019 - I was going to post pretty much the same thing. You’ve done it for me and for many others with the same predicament, it seems.
I’ve raised my concerns, but the therapists are so robotic and systematic. They just won’t deviate from their mission to get Dad home with a 6 week reablement package that nursing staff say they see fail repeatedly.

@Primrosetulipcrocus It’s a complete lottery and if an elderly person has relatives the help evaporates. Cottage hospitals closed and the elderly are just discharged to home. No one cares if they get out of bed safely or not. There’s no home assessments completed and GP services are non existent if you cannot get your elderly person there. I feel, strongly, that an assessment centre is much better at knowing what someone can and cannot do. It’s so sad we’ve lost these. I’m not sure who actually gets discharge services to meet their needs. It’s a huge worry and maybe being penniless is the trigger. Not sure.

In every single conversation about care you need to state clearly “I am not this person’s carer. I cannot and will not provide care”.

My dm had three unsafe discharges and after each and every one of them I warned them very explicitly that she would end up back in hospital with a week. I was correct every time. The biggest problem I had was the social worker on one of them who was so rude and told so many lies that I had to request via a manger that I would not deal with her again.

On dm’s last stint in hospital which was 6 weeks, I didn’t get to speak to a doctor at all. Not once. The nurses were also failing to document some potentially very important medical information or even pass onto the doctors which could have completely destroyed all plans for her to go to a care home. The ward manager was horrified.

@madnessitellyou That’s even worse than my experience! I did see a Doctor once in 6 weeks and a phone call with a very rude one! The NHs for the elderly is utterly crap.

You really do need an advocate when you get older and frail. In laws are having frequent admissions but haven't given their kids LPA. Fil would say her could care for mil even if he couldn't. Over 200 miles away. Both quite elusive on what's wrong ( don't understand or won't share?) We used AI to write a letter against unsafe discharge after two brain bleeds with two weeks ( both was for discharge after two days still bleeding). But when fil said he was admitted for heartburn five days before a triple spent, it's impossible to advocate.

@SurreySenMum26 You do not need a LPA for hospital staff to speak to you or treat you with respect. They never ask for that when discharge is on the cards. They expect you to jump when they want to discharge and LPA really is only used when the old person has no capacity. In many cases the old person has and wants to go home. Having an LPA does not give any powers to over-ride what the old person or the NHS/social services say.

At some point we have to come the parents to our parents. The phrase is "we don't always get what we want" and tell him to move to a care home.

Vast numbers of the elderly have sudden drops in blood pressure. The NHs doesn’t see that as needing anything other than you monitor yourself.

So an update....

FIL can't still stand up without falling due to blood pressure change. With assistance and a wheelchair someone did manage to take him to a toilet yesterday in the hospital.

apparently he is ready to discharge ??????? The staff are saying it's simply a case of the physios giving him exercises to facilitating standing but I don't see that working when the issue in a complex cardiopulmonary one.

sounds like they do want him out and are looking to get a minimal standard of self support.

There is probably nothing more they can do medically and that’s why he’s now ready for discharge. He cannot stay in hospital if he just has care needs.

Medical problems in the elderly are not always fixable.
He now needs to be realistic about his future which is either go home and learn to transfer from a wheelchair safely or else he accepts a care home.

I expect, from what you’ve said, he will need to go home and fail. But just be prepared that he will probably have to be admitted into a care home directly then. If there’s no treatable medical condition the hospital may well not readmit him

I am going through this at the moment OP, concentrate on dealing with the OT as they seem to be the ones who put everything in place for discharge. My mum has just spent 7 weeks in hospital and was discharged far too early and after 2 weeks at home even with full care package is now back in hospital and in an even worse state. There was a lot of pressure from certain staff to get her home after 3 weeks when she clearly wasn't ready at all and expectation for me to look after her even though I live hours away. Stick to your guns and keep mentioning unsafe discharge.

@mids2019 Where we are, 4 visits a day, 15 mins each. Rural so getting around clients is an issue. They don’t get meals unless you provide freezer to microwave ones. As he cannot make a cup of tea, I don’t think he’s safe. Have you discussed a home with the discharge team? SS won’t like it if they are paying! Can DF pay?