Elderly parent about to be discharged from hospital with a fractured neck. Any questions I should ask the discharge team?

[Yellowbrixlane]

Hi everyone. My Dad is in his mid 90s and is about to be discharged from hospital with a neck fracture.
Apparently he is medically fit but extremely frail, in a lot of pain and has to wear a neck brace for at least another 6 weeks. He also has a bed sore and a catheter.
He will have carers 4 times a day but apparently, isn’t eligible for a hospital bed at home. Due to the pain he’s in with his neck, he sleeps partly upright at hospital and physically can’t lay flat.
I really feel he needs a hospital
bed at home but I was told he doesn’t meet the criteria by the physio. He has no one at home who can look after him either and doesn’t meet the criteria for a stay in a residential home. Does anyone have any experience of this or know how I could get a second opinion regarding the hospital bed? A few other professionals I have spoken too have said that if suitable equipment isn’t put in place, then it will be a failed discharge.

Also, anything obvious I should ask the discharge team?

Thanks

If he has a pressure sore and needs to sleep upright due to neck pain then he should definitely have a hospital bed at home. I would definitely push this with the discharge team and query why he does not meet this criteria. What is his mobility like? Just asking as if it is limited and he will spend a lot of time in bed then this is another point to push as he should have an airflow mattress which pressure relieving and aids in the prevention of pressure sores. Hope you can get things sorted.

I work in a hospital and have done admin for the discharge team.
Before he’s discharged, the occupational therapy team should come to assess your Dad and supply any necessary aids, toilet frames, walkers, hospital beds, commodes etc etc - they’re often delivered from a company who have a contract with your hospital.
Bearing in mind his age and the injury it’s surprising he doesn’t meet the criteria for equipment or respite care.

If you aren’t happy please ask to speak to adult safeguarding team at the hospital and say you want a meeting and for them to assess things.

It is also worth noting that he might be eligible for some respite care (often a period of 4-6 weeks) where he’d get 24/7 care before he went home to the 4 carers a day and that is often a good option for people. You can apply for this through your local authority. Is he in receipt of attendance allowance?

Another useful thing to do is to contact the hospital on-site Social Workers - there will be a HCOP one (Health Care Older People) and they can help co-ordinate things and provide advice.

Mention that you are worried about an unsafe discharge and him being re-admitted without the proper support.

I hope you get sorted.

Has an OT been out to assess what he needs at home? District nurses or a skin viability nurse might advise on the suitability of a hospital bed with profiling mattress. Sorry that you’re dealing with this, it’s hard.

Ask to see the criteria !
I am a district nursing sister in Northern Ireland and out rules are if someone has 2 carers to assist with personal care that requires a hospital bed
For the safety of the carers and the patients
Also if he has a pressure sore... what pressure relief is being offered ?... cushions?
Who is following up the pressure damage ?
District nursing?
Ask..
How many careers will be attending
What will they be doing... will it be meal prep/ medication prep/ personal care/ help with repositioning

Who will be managing catheter changes every 12 weeks... district nursing or continence?
Make sure you, the carers and your dad are provided with their contact number in case catheter blocks etc

Thanks so much for your replies.

I asked about the respite care and was told that he doesn’t meet the criteria for that either as he isn’t willing to put in the progress or something. He can have an airflow mattress but we’ve got to find the bed.
He fainted at home (how he got the neck fracture) and still gets faint every day.

He will have to stay in bed most of the day when home.

Up until his collapse, he also helped care for my bedbound mum. She has her own carers too. I feel no one is listening to my worries and the expectation is that he gets home asap.

@Yellowbrixlane have you tried telling them you think this is an unsafe discharge?

That's the term to use a couple of years ago anyway ... they like to switch up the terminology to annoy everybody. It doesn't sound like a very safe discharge to me.

We may be in territory where they just tell a man in his 90s that he's got to sleep sitting up in a chair though. I'm sorry things are so awful.

i'm guessing there's no family funds available for you to do anything?

No one has mentioned an OT visit to his home but actually, now I think about it, I am sure mum had one when she went home after a long stay.

Are you paying for any care for them?

That's really tough for you. I'm just signing paperwork for a family member to go into respite. All of the above is excellent advice!

Yes, told them I think it’s unsafe. They said he can’t stay as he’s medically fit and now in danger of getting bugs etc. I said I understand that but they can just send him home without things in place. Just keep being told he doesn’t meet criteria for this or that. It will be the district nurse who will care for his sore I understand.

Dad’s care will be some 6 week package and then after that I guess he would self fund.

Dad has also said he wants to go home and as he has capacity, they said they have to respect his wishes.

I’m an elderly nurse and if he has a pressure sore he should definitely meet the criteria for hospital bed. In my trust even without pressure damage, if someone has frail skin and reduced mobility, I’ve never known someone to not get one. I’m sure you understand that people can’t just be kept in hospital, but I can sympathise that you also don’t want his skin to breakdown further which would reduce his mobility further and may be a reason for another hospital admission and I would tell them that. The only people that tend to not need them are people that can reposition or mobilise

I understand he has a pressure sore and also sores around where the neck brace is.

I was told he can mobilise but whenever I’ve seen him, he’s needed two people to help him sit up and transfer. He can’t even sit himself up in bed without 2 people helping him. Once supported, he is starting to walk with a frame so I wonder if that is why he can’t get a hospital bed at home. The transferring is agony for him and his bed is at a constant 45 degree angle with 3 pillows.

Ask to see the criteria for a hospital bed
Ask to see the criteria for a safe discharge
Ask for a meeting with the hospital safeguarding team
Ask for a meeting with the hospital social worker
Involve PALS

Contact your local Age UK they’ll have all relevant contacts or be the relevant contact.

Thank you so much, I am rereading every comment and making lists. I did speak to Pals but I have to speak to the ward manager first and try to sort things. Now I feel much more empowered after reading everyone’s suggestions. I am also trying to juggle my job and my little lad too so I am being stretched thin unfortunately.

Try to settle tonight
tomorrow is a new day to tackle this

some great advice on here and hopefully you will get it sorted

it is always hard when someone “has capacity” and their wish it to he at home but in reality a respite placement would be more sensible in the first instance.

I hope you can sort something it must be a huge worry.

We had this with my DM who had full on delerium. Thankfully the discharge co-ordinator listened to us and she was sent to a care home for further assessment. Sadly she was diagnosed with mixed dementia and has been in care since.

Questions - if your DF is discharged how are they going to get him into his house? Are his house keys in his hospital property? If so, take them away. They cannot discharge him home if they cannot take him into his house. We removed my DM's handbag and keys whilst she was in hospital to prevent them doing this.

Ask social care for an urgent care act assessment - he sounds as though he will meet eligibility under that which will get him access to the social care occupational therapy team as well, you could also raise it as a safeguarding concern

Had similar recently with my sibling.
Adult social care will only accept a referral from the hospital while he is a patient, so you can ask the ward to do that, but they possibly won’t.
You need to refuse to collect him and tell them you’ll do a safeguarding alert if they carry on with discharge without everything being in place beforehand. Repeat this in every conversation with OT/physio/discharge team and give them a date to sort this.
Follow through with the safeguarding alert if things not in place by that date. You are not being awkward, selfish, etc - you are advocating for your dad.

What's a safeguarding alert and how do you trigger one?

My mum in her 80s is recovering from a fractured skull and vertebrae and is wearing a neck collar. She has been in hospital for two weeks, is still in terrible pain and has been told she does not qualify for respite/rehab as those places are for people who are not in need of hospital treatment but are still in need of physical care/therapy.

I would encourage anyone to contact adult safeguarding and say you feel it could be an unsafe discharge. Involve adult social care - get it all documented and get a names social worker for your Mum.

It seems to be a bit of a postcode lottery as to what is offered in each area which shouldn’t be the case at all.

it sounds like he needs an urgent care needs assessment to identify his current needs for care and equipment.
https://www.elder.org/articles/arrange-care/unsafe-discharge-from-hospital-uk/