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

It’s a more immediate way to get adult social care involved. You still ring your local adult social care number to do this.
When I rang my local adult social care, it was one of the options I could choose.
As it happens, the threat of it was enough to get the hospital OT and discharge team to get things in place that we’d been requesting., so I didn’t end up making the alert. It really shouldn’t be such a fight though.

This is really useful information for anyone going through this. Wish I’d had this 2 months ago.

Just read the above article, it really was useful. Thank you.
So I managed to speak to someone on the discharge team today who was very helpful. Didn’t have much luck when I phoned the ward. I did mention that at the moment I feel it’s an unsafe discharge. I need to email my concerns too. Tomorrow I will make more phone calls (and continue to follow the advice from this thread).

My DH (79) had a fall at home. Not badly injured but lost the nerve to go upstairs. Within 24 hrs he had a hospital bed, commode and Rotunda machine to get him out of bed - all on load till he does not need them. No financial assessment made. We have been told he can have the equipment for as long as he needs it. Competely free of charge. This is Derbyshire County Council - not normally known for their generosity! He also has a visiting physiotherapist twice a week - arrranged automatically. He's doing well but slow progress, it will take weeks if not months.

Fight as hard as you can, using the good advice given on here. Good luck - the elderly deserve it all.

Oh OP you are really going through it
You are doing so well
It's so frustrating all these obstacles
Thinking of you and sending you a big 🫂

That sounds horrendous, OP. I really can’t see how they will even be able to get him home, and as others have said, if he has no key and you refuse to help, what are they going to do? I’ve heard tales of people ‘abandoning’ relatives, forcing SS to do more than they would otherwise. Safeguarding is definitely the way to go if no one else is listening. They both sound so incredibly vulnerable - can they not move into sheltered/warden controlled accommodation?

You say your mum is bedbound, does she have a hospital bed or were they sleeping in the same bed together? I only ask as I wonder what your dad wants? Has he said he wants to continue to sleep in the same bed?
from what you say he should qualify for a short term loan of a hospital bed with a pressure relieving mattress. You could ask to speak to a senior therapist about this.
A district nurse referral will be sent from the hospital, district nurses can also request hospital beds from the community if needed - just in case you still get nowhere with the hospital.
Each ward should have a discharge coordinator who can help you arrange meetings and speak to the correct people.
PALS are usually good in these situations- they can help to liaise between you and the ward.
Dad can have hospital transport to get him home.
is there a keysafe at the property? So the carers can let themselves in? And does dad have a lifeline to press if he falls again? These should both be discharge dependent.
Good luck, it’s hard.

I must admit, I naively assumed that dad would go into some kind of accommodation that would support him as his neck healed but he doesn’t meet the criteria and even if he did, we were told it could be a 4 week wait for a place.

Trying to juggle helping mum, my work and also my own primary school child, I don’t usually get to see dad until the evening at hospital (when the physios, Drs etc are no longer about). As a result, I have to try to mange through phone calls and keep being told I need to be there during the day to speak to someone.

I have family who are also helping so not alone in this and we are all trying. I keep updating them with advice from here too.
The hospital’s argument is that he’s medically fit so hospital is no longer the place for him. His bed is at angle as he can’t lay flat. We were told he’ll have to manage with pillows when at home. He’s dizzy when he stands (we were told that is to be expected) they tried removing the catheter but due to the neck brace, he couldn’t look down to manage the bottle thing.

Let’s see what today brings. Xx

The other thing I would ask about
Are the carers trained in collar care?
How many sets of pads will they send them home with?
Who will change the collar pads?
Who will check the neck for pressure sores- orthotics teams will normally recommend pads being changed everyday/every other day?
How are the carers going to clean the neck- there should be one to hold the head and the other to sort the brace?
What will happen if there is an occipital pressure sore- will the carers be able to check for one
I am an orthotist and this is what I would ask- I have shared the aspen collar pad change video below
share.google/QLgpgOCmFn1AvAqu0

Hi - one thought. When my dad was discharged he had a number of mobility problems and we got a turning bed. It was v expensive but it enabled him to stay living independently. The bed turns and sits the person up. If affordable it might be an option? I agree with others - keep saying unsafe discharge and push for hospital bed.

A few years ago now but my 85 year old stepfather was going to be discharged home with a suspected broken neck to be cared for by my Mum who had advanced Alzheimer’s. I arrived at the hospital to find someone showing my Mum the neck brace and explaining how to change it / clean him etc several times a day. I had to take them outside and explain that there was no way on this earth that would be happening! Didn’t seem to make a difference. Luckily it turned out his neck wasn’t broken so the neck brace wasn’t needed in the end.

My mum fractured her neck and was in a hard neck brace from June to October. She needed regular appointments with the spinal team and X-rays to assess the healing.

I was with her every day for months. She couldn’t walk safely on her own because she couldn’t move her head to see the floor. I got her up in the morning and helped her to bed, helped her dress and shower.

She had the community rehab team OT and physio once a week along with the district nurses to change the padding on her collar.

The OTs gave her a wheeled trolley with two trays on it so she could take a drink and meal from the kitchen to the living room. This was after many weeks though when she was able to do a microwave meal herself.

It was a hellish time.

Since then we’ve had a few unsafe discharges.

My advice would be to kick up one hell of a fuss. Tell them he isn’t safe to be left on his own between carers. How will he get to the toilet to open his bowels if he’s on his own? How will he shower? How will he mobilise around the home with limited ability to see due to the restrictions of the collar? Are they expecting him to stay in bed 24/7? Insist that he is assessed properly on his mobility with collar in place as he is at risk of falls due to the injury, brace, frailty, painkillers, lack of full visual field. It sounds like he needs better pain relief too so that should be sorted before he’s discharged. I’d be asking the tissue viability to get involved because a pressure sore is going to get worse under these conditions.

I’m amazed that he doesn’t qualify for respite care or residential care. Make sure to tell the hospital in no uncertain terms that there is nobody to care for him at home and that he is not safe to be discharged. Medically fit is one thing but that doesn’t mean safe. Mum has since needed carers and we are on our 5th company now and they’ve all been varying degrees of useless.

I’ve had to be that daughter many times now. The hospital mum was treated at for the fracture was in London and we live up north. The doctor who saw her on the ward expected me to take her home in the same way as we got there: on the train with my 3 young children. I said no and had to fight to get her hospital transport home. Sadly, a lot of doctors just see medically fit and off you go and don’t look at the bigger picture.

All the best to you and your dad.

Mum has a hospital bed but she sleeps in the lounge. Dad did sleep upstairs could not manage the stair lift atm. Yes, carers are able to let themselves in.
Dad will need hospital transport to get home.

Where will he sleep? Thats something to ask the hospital. I got my mum a hospital bed after a broken hip, honestly it sounds like that’s what he needs

It's a lot to hold, and you're right to be uneasy — "medically fit" just means the hospital has done its part. It doesn't mean home is set up and safe, and you can ask for that to be sorted before he's back.
I'd start by asking the ward OT what he'll need at home. Given the bed sore, a pressure-relieving cushion and a profiling bed really matter, alongside a commode and some rails. Most of that comes free and fairly quickly through the community equipment loan store.
Make sure there's a named district nurse owning the catheter and the pressure sore from the start — that shouldn't land on you to manage alone. He should also be eligible for up to six weeks of free reablement care to help him settle and rebuild a little confidence.
If anything feels rushed, you're allowed to say so — discharge should happen with support in place, not despite the lack of it. And as his carer, you're entitled to your own assessment too.
Has an OT actually been out to see the home yet — and who's taking ownership of that sore?

OP you mention work and juggling everything. Is your employer / type of work something where you could take emergency carer leave (or even sick leave as I am sure this is stressing you to the max) to focus just on getting your dad the support he needs for this discharge?

Today is Friday - getting discharged from hospital over the weekend is never easy as the consultants are often not around to sign the paperwork. Assuming they are now talking about discharge early next week, can you take Mon off to get all your issues and concerns raised with the doctors in person?

From the link I posted yesterday a safe discharge should include:

• A medical assessment confirming the person is fit to leave
• A care needs assessment covering mobility, personal care, and safety
• A clear written discharge plan
• Medication review and explanation
• Appropriate equipment (e.g. walking aids, grab rails)
• Arranged support, such as reablement, community nursing, or home care.

It sounds like so far only the medical assessment has been done so the discharge is unlikely to be safe.

Wow, that is awful. My mum is now incontinent as a result of being in bed so long and they are saying, oh well, we’ll put a catheter in. She was fine before her fall!

I am saying unsafe discharge over and over but clearly there are very few beds and the hospital just want to move the responsibility onto adult social care at home if they can.

I’m disabled.

ongoing care and healing at home if he needs day to day support is an adult social care issue and hospital will be trying to get him home if there are no further interventions needed.

if he has enough money to self fund then he’s expected to pay for care as needed - so that would include carer visits etc. if he doesn’t have any money then it would need to go via social services and they would do an assessment.

most hospitals are now doing discharge to assess where the person is discharged with a temporary care package and SS then assess within that temporary time frame what level of care is required.

has he been offered six week reablement care at home?

oh, and additional info:

adult social care do not see taking a shower and being able to get to the loo as requirements.

a bed bath with wipes/a bowl of water and flannels is considered appropriate for cleanliness if the person cannot access a shower (presumably your parents do not have a wheelchair accessible bathroom with shower)

overnight and if unable to access a toilet catheter plus nappies are considered ok.

I’m not saying this to have a go, just be aware that their minimum standards of care are quite low.

I think you need to take someone with you as I dont think you are understanding what they are saying. Its a confusing system for sure. Physio can only assess for rehab not respite and they are saying they don't think he's suitable for that.

He’s been offered a 6 week reablement package. My mum is disabled and went through something similar. Then self funded afterwards etc.
My main issue atm is trying to get a loan of a hospital bed while his neck heals and he’s in a neck brace as he physically can’t lay flat.

Yeah, he doesn’t meet the criteria for respite and it’s certainly confusing. I do think he needs the temporary loan of a hospital bed however.

You can rent hospital beds.

plenty of places do it eg this one.

https://medbedhealthcare.co.uk/?gad_source=1&gad_campaignid=23612623342&gbraid=0AAAABCo0GRFmmqQEWaAUxl3lRYDGL97qV&gclid=EAIaIQobChMIgs2r2IfwlAMV85RQBh3IzxK8EAAYAyAAEgI6tfD_BwE

Oh amazing! I had no idea. Thank you. I’ll look into this.