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Elderly parents

Elderly parent and hospital treatment

15 replies

Notcookingongas · 06/10/2026 12:56

Would appreciate some advice. Elderly father is in hospital with pneumonia. Second time in three months. He has terminal cancer but is too frail, due to other health issues, for treatment.

He was very frail when he went into hospital- it’s now 9 days since he got out of bed independently. He’s now wheeled to the bathroom. He’s on IV and oxygen and has now been told he has heart failure.

He has been in hospital for a week. He’s not had a bed bath and his pressure sores have come back. I don’t know how bad they are but mum is applying cream when she visits. Is this normal? No washing, no treatment or care of pressure sores? We’re not sure how long he will be in - he’s got at least another week and then is likely to be bed bound for a while when he comes home.

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BinturongsSmellOfPopcorn · 06/10/2026 13:04

Not normal at all. He should have had a risk assessment for pressure sores within 6 hours of admission and measures put in place to prevent them.

Now he has them he needs and urgent tissue viability/skin integrity assessment and treatment plan.

https://www.nice.org.uk/guidance/cg179/chapter/Recommendations#management-adults

Recommendations | Pressure ulcers: prevention and management | Guidance | NICE

https://www.nice.org.uk/guidance/cg179/chapter/Recommendations#management-adults

BinturongsSmellOfPopcorn · 06/10/2026 13:09

He needs a proper pressure relieving mattress, and they should be repositioning him at least every 4 hours.

www.nice.org.uk/guidance/qs89/chapter/Quality-statement-6-Help-with-repositioning

LIZS · 06/10/2026 14:25

Not normal at all. He needs special air mattress and wound care for the sores. Either speak to the nurses/doctor on the ward or of no response try PALS.

MissMoneyFairy · 06/10/2026 15:06

What cream is your mum using, has she told the nurse about his bedsores. Call the ward, pals and the doctor to express your concerns, are you able to visit. He needs a full skin, mobility, continence, pressure risk, eating and drinking assessment and a pressure mattress depending on his score. As he is terminally ill I would ask the doctors if he has been referred to the palliative care team and nurse, they can also help with getting things in place before he goes home. I would ask the doctors why he is on iv fluids if he has heart failure, is he still able to eat and drink himself. He may also need home oxygen which the respiratory nurse can arrange. Pressure sores need to be recorded, photographed and monitored, he should be seen by a tissue viability nurse. Sorry you are all going through this, keeping clean and safe is an essential,part of nursing so do follow this up.

Notcookingongas · 07/10/2026 07:02

So after a few visits (two today) and chats with the nurse it seems he has been refusing bed baths. He has also been treated for sores, and has started to have physio (although he refuses to do anything outside of these sessions). I’m not sure how we address these but at least we know the hospital is attempting to providing care for him.

He likely going to be in hospital for another week at least - longer if he doesn’t get himself mobile but presumably he can’t stay in hospital once the pneumonia has cleared.

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DistantEarlyWarning · 07/10/2026 07:07

Is he on a pressure relieving mattress (powered, wheezes like Darth Vader)? He really ought to be especially if he’s non-compliant with parts of his treatment.

LadyLapsang · 07/10/2026 07:16

Do you believe he is refusing personal care including bed baths, or are the nurses / carers proposing them at unsuitable times for someone who is terminally ill, such as very early in the morning? I would contact PALS.

Notcookingongas · 07/10/2026 07:49

Mum gave him a bed bath in the evening but not without some reluctance. She found it very difficult as he can’t move himself well. I’m not sure why he’s refusing help as he knows it will prolong his stay.

At some point they will discharge him and they don’t have any support or suitable equipment at home. He’s refused careers (they have funds so would be expected to pay which he absolutely will not do). Mum will be expected to do it all. I’m not sure if he’s given up which I completely understand given his prognosis. It’s just so cruel on every level.

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beckslovestimmy · 07/10/2026 08:03

A palliative care referral would be a good start. They can plan for discharge whether that ends up being home or a placement if once the pneumonia clears he’s not able to be cared for at home by your mum.

It may be worth considering that the pneumonia won’t clear, as your dad is frail with a terminal diagnosis it may be too much for his body to cope with despite fluids and antibiotics. There may be a time when if he is refusing care that a palliative approach of keeping him comfortable is the kinder option for him, again the palliative care team can be a great support around these conversations.

Does he have a DNAR in place? Something to think about if not considering his cancer diagnosis with an acute condition on top.

His refusal for personal care is a difficult one as staff cannot force him. If he’s more receptive when your mums there maybe they could discuss a time that suits the nurses and your mum and they could help your dad together? Also trying to get to the bottom of why he’s refusing, is it that he’s in pain, or cold or it really wears him out? Does it make him short of breath and that frightens him?

I hope you find a solution and your dear dad gets the care and tlc he deserves and you and your mum get some support.

BinturongsSmellOfPopcorn · 07/10/2026 08:11

DNAR only covers defib-type resuscitation. If he wants a more general refusal of treatment then an advance directive can give much more detail on 'this type, not that thie; if X, then Y'.

Once the pneumonia clears he's likely to get a 'discharge to assess' package. Around 6 weeks of funded care at home or in a care setting.

Notcookingongas · 07/10/2026 08:29

BinturongsSmellOfPopcorn · 07/10/2026 08:11

DNAR only covers defib-type resuscitation. If he wants a more general refusal of treatment then an advance directive can give much more detail on 'this type, not that thie; if X, then Y'.

Once the pneumonia clears he's likely to get a 'discharge to assess' package. Around 6 weeks of funded care at home or in a care setting.

Thank you. I’ll look into discharge to access package. I’ve spoken to the palliative care team regarding plans for discharge and they advised we speak to the ward nurse who advised speaking to the district nurse. There doesn’t appear to be a clear point of contact.

What we don’t fully understand is to us his condition seems poor however, the consultants are treating him as though his frailty isn’t really a long term issue. Hes been told he’s got to get up and walk to the loo regularly so they must think him capable. However, he’s telling us he can’t manage it, or he’ll do it tomorrow as he’s out of breath. He’s had many falls recently so he’s probably worried about falling.

No one seems particularly worried; they aren’t coming to us and suggesting we need x,y and z in place at home.

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BinturongsSmellOfPopcorn · 07/10/2026 08:33

Ask for a named discharge coordinator. He should have been assigned one on admission. (NiCE guideline: adults with social care needs).

Is the hospital physio team aware of his needs?

Applesaid · 07/10/2026 08:34

Has he been seen by the fragility or pallative care doctor? Some doctors will just treat and treat and aren’t always good at end of life care. In my experience nurses are always worried about discharge until it’s time to do it. Have you spoken to his OT?

In this situation I would be very worried about your Mum. What does she want?

MissMoneyFairy · 07/10/2026 09:59

Keep pushing for a discharge meeting, they can't force him to do anything but he should be assessed, how do they expect him to get home. He may be entitled to reablement which is free or fast track funding if he's eligible. I'd speak to the nurse, physio, occupational therapists and ask who is his assigned discharge worker or social worker. He can also apply for attendance allowance and free small adaptations at home from the ot and district nurses.

saidwhat · 07/10/2026 10:03

Hi Op,

I'm sorry you are going through this, it really is horrible. My father died a few months ago. I see you've spoken to the Palliatve care nurse, is your father officially under their care now? Have you or your mum, outside of the room actively asked your father's consultant about the realistic prognosis? My father did not have cancer but had heart failure and he was increasingly frail for the last 10 or so months. It was also different because he had dementia and continued to get up, which led to falls. His hospitalisations were increasingly regular, until there were just weeks in between at most. We could see his condition worsening drastically, he lost 2.5 stone in a period of 6 weeks but he was being treated (most times for infection) and sent home again. Yet, the medical professionals seemed to not be too concerned. During one hospitalisation, I spoke to the consultant in the corridor and asked straight out what he felt the prognosis was. He was cagey and said that they could be more precise, timeline wise, if he had cancer because it usually had a pattern and it was harder to predict in the case of frailty related to HF. I then asked the question "where, in your personal opinion, do you see my dad in 12 months?" His eyes widened at the question and then he said that there were indications that we were nearing the end. The infections being so often, lessening time between admissions. He said the speed of the frailty onset was usually an indicator, if you are noticing changes over months, there is likely months left, weeks- weeks left etc. He then said, "as to your question, I think, though it's hard to be completely certain, that it will be much clearer in a month or two"

My dad was discharged that time, had 2 hospitalisations afterwards and died 2 months after my conversation with the consultant. I was so grateful to him because it almost felt like we were being gaslit in a way, we knew it was not good.

So what I'm advising is that you ask the consultant out of earshot of your father and they may speak more freely. Your father has terminal cancer, so according to our doctor, they should have a better idea of how things will progress.

As for trying to keep him moving, they will continue to do that until it is no longer a viable option. Even after my dad was taken off all meds and it was agreed he could stay in hospital until the end, he was being helped to the toilet and the chair. At one stage he was so weak he needed 1-1 supervision due to falls and stubbornness to be independent. I remember thinking he should just be encouraged to stay in bed for his safety but was told that it would be negligent of them not to try.

Once you get an idea of what the prognosis is, then you and your mum and the hospital social workers can come up with a plan for discharge. Perhaps exploring the possibility of continuing healthcare if it looks like he has months or less left.

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