Old People - Being discharged from hospital

[Cheesecake2018]

Sorry, I didn't know how to title it....
My neighbours are elderly, he is in his 80s and she, her 70s. A few weeks ago he fell down the stairs and being typically proud people she tried to pick himself up on her own. Long story short their daughter arrived assessed the situation and called and ambulance. Turns out they were both suffering from a strong strain of a bacterial infection plus pneumonia. The last few weeks they have both been in ICU, at one stage they said it was more beneficial if she didn't breathe for herself and that 'a machine' do it for her. She is a fighter, younger (female :-)) and she's turned her situation around in one week. He meanwhile has taken a turn for the worst. Bottom line is that just yesterday after about say a week of having 'a machine' breathe for her they've now said she's fit to return home but with daily care of four visits a day, whilst her husband remains in hospital. Her house is not fit for purpose, her bathroom is downstairs and I fear she will fall going up or down her stairs. Her son has just been round, he's at the end of his tether, the hospital are following a pathway with no consideration of the whole situation. My question is...... is there anyone/anything they can do - they feel she needs to properly get her strength back whilst in hospital whilst they try to make their home fit for purpose..... they are such a nice, proud couple I worry about what would happen to her once home a. in a home that she can't navigate securely and a b. without him (will be for the first time in 50 years....)
any advice would be appreciated :-)

In medical terms she isn't requiring support to stay alive, I know it seems harsh but being convalescent doesn't require hospital care which is why they have arranged a support at home team. This is -usually- free for 6 weeks if they think she will be able to care for herself independently after that. Otherwise, it's very expensive (think over £1000 a month) but considerably cheaper than residential care.
Her options could be:

• short term convalescent care in a residential home, perhaps until her husband is able to return home
• altering the living arrangements at home - make a downstairs bedroom

which could be down quite quickly, as could installing a stairlift, and in the very short-term making do with commode/stripwash.

Yes the date company will do an assessment if she can't manage the stairs then it's a chairlift or the bed downstairs and if they can't access the bathroom then it's a strip wash at the sink

This is standard procedure for someone having care 4x a day

It's a tough one. Assuming your neighbour has capacity, these may be her wishes and they are accommodating them.

My mum had these 4x day visits post discharge and they worked very well actually. It was hospital nurses and physios who came rather than a care agency. However my dad was there (and he did the cooking) I'm only up the road and do their housework and so it's a bit different to how this sounds. Her children might need to keep an eye on things, but it could be OK. I think they need to express their concerns to the ward manager at the hospital and see what the response is.

The hospital should've contacted social services to arrange a discharge assessment before letting her go home.

However, as sad as this sounds, the hospital can not afford to have any "bed-blockers". If they can free up beds and her life is not in immediate danger, they can easily discharge them regardless of whether they have adaptions or not. I work in a home where they take on elderly patients from hospital for temporary stay while waiting for a care package due to them urgently needing the beds.

It is disgraceful but that's the way NHS is. I would contact Age UK for more advice and hopefully they'll point you in the right direction.

Why don’t the family look at a nursing home for a few weeks instead, that may be more appropriate for her.

There is an awful lot of evidence to show that older people being in hospital when they do not have an acute medical need deteriorate much quicker than they would at home. They are also at more risk of hospital acquired infections. The days of “convalesce” are not there any more.
As long as they have the support they need to meet their needs they are much better off at home.

as pp have said if she's no medical need the best place for her to be is at home.
If she's unable to use the stairs safely then a micro environment downstairs where the bathroom is would be needed. The hospital will arrange any equipment.
I work for social services. In my area where there is a need for care on discharge my team provide the care while working with the patient to regain their skills. We aim to get them as independent as possible, and regain lost confidence and review after each week.
Everyone is entitled to two weeks for free, although we will stay with people for up to six if we can see there is scope for skills regain.
If she's still in need of a package of care after social services have made the final assessment then it's all down to her finances as to who pays and the threshold is different in different areas.
Tell her son not to panic, the team that deliver the initial care will be professionals with a focus on his mums safety. If they feel that his mum has been discharged too early they'll send her back to hospital as a failed discharge.
She really will be better in her own home, building confidence and avoiding the risk of hospital born infection.

Elderly people do not recover well in hospital, sadly.

They frequently get new infections, usually pneumonia, and lose their ability to live independently very quickly. I would not want any elderly relative of mine go spend longer in hospital than absolutely necessary.

It does sound like modifications need to be made to the house though.

As others have said the support package should help her to manage at home. If her care needs prove to be more than this she will either be returned to hospital (if there is a medical need) or assessed as needing either extra care visits or potentially residential nursing care (just been through the whole process with my mum who is terminally ill with cancer - initially she had 3 visits a day on discharge from hospital but couldn’t manage her stairs and couldn’t get on and off the commode they provided next to her bed so she needed extra help in a nursing home- she’s now been moved to nursing home; obviously that’s just my mums situation).

If she can’t manage the stairs they will set her bed up and everything else up downstairs for her where the bathroom is. (If her bathroom was upstairs they would provide a commode and empty this for her).

If she doesn't need medical treatment then the hospital can discharge - it's up to family (or adult social services if there are none) to either bring a bed downstairs (ideal if bathroom is downstairs) or find respite care. If she's not medically fit then nhs continuing care will pay for care visits or nursing care. Ask for an assessment of needs from nhs continuing care and see what they offer. Acute hospitals aren't for long term nursing care, it causes bed blocking.

Hi all,

thank you for your responses - all very interesting and I can understand their reasoning behind their decision.

:-)

Also, you don't mention what your neighbour actually wants.

It may well be that she wishes to be in her own home. There is nothing to stop that from happening.

Is she getting domiciliary physio? There are huge systems in place to prevent falls because they are so dangerous and expensive.

There may be private physios who can come to her house if her family can fund that.