Elderly relative joint replacement.

[Danascully2]

An elderly relative is due to have a joint replaced soon (NHS) and has apparently been told she will only be in hospital one night and will have no support or equipment supplied for recovering afterwards as it's a planned op. Does that sound right?? She lives alone with bedroom upstairs and has other challenges as well eg very arthritic wrists so would really struggle to use crutches I think. She's also anxious and easily flustered. I'm really worried about how she's going to manage eg how she would get from bed/chair to kitchen to get a bowl of cereal. Will they really just dump her at home after one night with no conversation about how she's going to manage?? Any advice very welcome.... I am not local, she has one local relative who works full time.

Potentially yes, but she will definitely have a physio review before she goes home and if they don’t agree she can manage they will keep her in. So a lot depends on the quality and bolshieness of said physio. Make a plan with the local relative. Make sure that the team have her home situation in writing, and keep saying it to everyone she meets.

A lot depends on who the key people are in the team. Ring the ward beforehand, during and immediately after, and ask to speak to the physio; if you can, get a contact for the surgical consultants’ team secretary. You never know whether these individuals will be wet lettuces or key voices who get things done, so talk to everybody, often.

Could you take a few days off and camp out at the hospital? Expect the op to be cancelled a couple of times.

They'll get her home as soon as possible.

My 46yo DH had a severed patellar tendon repair done on Friday as a day patient. When he did the other knee 8 years ago he was in for 2 nights. I know a woman in her 60's who had a double-mastectomy last year and was sent home as soon as the drains were removed. If she'd had support at home, she would have gone home the same day.

I'm sure others here be able to help with how a woman in her situation can manage. It sounds scary for her.

Physio will review in hosp before going home.
She can ask about rehab centres
She does not need to be in hosp there are step down centres
Is it hip.or knee?

My experience was that the team that decides whether someone is fit to go home was very keen to offload inpatients in this situation. Hospitals are gummed up with patients who can’t cope at home, and having them in beds just contributes to the massive waiting lists for elective surgery. (Not saying this makes it easier for your relative, just saying the hospital isn’t being mean for the sake of it.)

If your relative will be alone with no live-in care and no means of getting up and downstairs safely, you need to make that really, really clear — I’d put it in writing in an email. The discharge team has a legal responsibility to make sure the home environment is sufficiently safe, and they have to have those things in place before they discharge the patient. That might mean sending in community nurses, meals on wheels etc. But sometimes you have to jump up and down and make a nuisance of yourself to ensure this happens.

I’ve looked after my dad after both a hip replacement and a knee replacement, and there is absolutely no way he could have coped on his own for the first few days (longer for the knee op).

Does she have a downstairs toilet? If not, make that known very clearly to the hospital. Ask to speak to the discharge team yourself and spell out her circumstances clearly. State that they must avoid an unsafe discharge.
What is your aunt likely to say herself? If she’s anything like my fiercely independent elderly dad, she will say everything is fine, she can manage perfectly, etc. My dad would also lie about having a downstairs bedroom/bathroom, anything to get out of hospital asap.

Thank you very much everyone, yes I do understand the overall principle of getting people out of hospital if they don't medically need to be there, I came out after one night when I had my Caesareans. But I had a partner to bring me food/drink and was otherwise fit, well and youngish. None of that applies to this lady unfortunately. A rehab centre would be ideal.
She does have a downstairs toilet. Yes she might tell them she can manage if she's finding the hospital environment difficult (or not hear the question properly as she's quite deaf and just nod as she's embarrassed to ask them to repeat themselves). Thank you for the advice about who to talk to, that's really helpful. The local relative is not very good at dealing with admin/paperwork/officialdom unfortunately.

I can't easily go there especially during the week as am 2 hours drive away and have two very lively school age children with some challenges (for example pick up for the younger one is always a bit of a worry as to whether the teacher will ask to have 'a word'.... )

It's good to hear she will have an assessment of some sort before being discharged but I can see what you're saying about individual variation in staff, especially if they are under a lot of pressure to free up beds.

What are her funds like? If she can afford it, would she be willing to go into respite for at least a couple of weeks? Someone else providing food, drink, medication regularly and generally keeping an eye on her might be worthwhile.

Yes that's exactly what she needs really, someone to bring her meals and keep an eye that she hasn't fallen or similar. Definitely a thought, is that something that would be planned in advance do you know or is it something that can be found at short notice depending how long she does end up staying in hospital/whether local relative can take time off work etc?

A relative lives in a Care Home and they sometimes have people come in on respite when there is an empty room. I think if it was planned and you know when the operation will be, you’d have to talk to the Care Home to see if they have space. There’s is part of the Avery group.

It's very different recovering from something like this when you are already not in great health eg arthritic in many other joints. Rather than otherwise generally functioning well with one specific issue (like me with the Caesarean, not that that was at all easy).

Thank you Tiny mouse, that's useful to know. I wonder what happens if respite care is planned/booked in advance and the operation is cancelled? Would she still be charged??

I think you would have to ask them, sorry.

A friend in her early 70s who lives alone had a knee replacement and paid for two weeks in a prívate rehab place. Does she have any savings that could fund that? I guess the alternative might be the standard 4 visits a day through the local council but that would be tough on someone in pain after an operation.

I work for a team that supports people coming out of hospital so I do in general believe that people are infinitely better off in their own homes if at all possible. I would say that the ‘no equipment’ line is not likely to be right, if she does need a walker or crutches those will probably be issued. My mum had a commode at home after a hip operation - a toilet frame which raises the seat could also be a good idea. At the time we borrowed these from the Red Cross but I don’t think they do this any more. Amazon is always an option but get advice from the ward team on what would help.

Im extremely concerned that she doesn’t hear well and is apt to agree for a quiet life. That’s a recipe for disaster- make sure they know this, by phone call.

Could she afford to pay someone from a care agency to live in for two weeks? It can take a bit of time to organise so I’d get on it asap. I just think she will rehab better at home if at all possible. It’s very expensive but not that much more expensive than respite, it may even be about the same. This is definitely the time to spend rainy day money, if she has any.

I’ve just reread your posts OP. Is she willing to talk to the GP about her anxiety? Medication these days is very far from when they just handed out Valium and it might help her cope better than she is now.

Ive also spotted that she is Deaf. Is she willing to have a hearing test and try hearing aids? Is she aware of the link between hearing loss and Dementia?

in my experience elderly people want to either get home as soon as possible not thinking about being unable to cope and just wanting their familiar surroundings not thinking of the reality.
or
they pretend they are ill or cannot cope so they can stay in longer because they enjoy the break/rest/ beimg cared for/company.

im sure there are some that dont do the above things but that’s my experience.

what they say to hospital staff is critical. she may say that she has “family coming round daily” and her “grandson moving in for a month” and it’s all lies to get home but she gets discharged based on this. so you need to make sure they have the full picture.

DH is due to have a knee replacement in a weeks time. He has an occupational health appointment , via phone , on Thursday to assess his needs. I have to go around taking measurements to see if the home layout is suitable and whether he needs any adaptations.

I wonder if your relative has had an assessment done but been economical with the truth. If they are normally very independent they may not want some of the services offered or have ignored the advice given.

I have had to reorganise DHs appointment because I know he will want as little interference as possible and is likely to play down his specific needs, he had a stroke a few years ago. However since I’m going to be his carer for the next few months and have back problems I don’t want to be struggling.

Thank you, all the best to your DH, hope it all goes well. Yes I have known of other people where the hospital have checked their living arrangements. I have been telling her to tell everyone at pre op appts that she has no help afterwards but I don't know whether she has as I haven't been at the appts.
I have also been helping another older relative this weekend (at a distance in a different direction) and had to call an ambulance for an elderly neighbour earlier in the week so feeling a bit drained!!

Ps to answer a few of the other questions, I believe she has hearing aids sitting in a drawer somewhere.... 'anxiety' is a bit of a shortcut for a much longer discussion which would be a whole thread on its own but yes she's been to the doctor about that.
I am thinking of writing some key points on a sheet she can take with her and posting it to her (eg 'I am deaf, please talk slowly and clearly'). I don't know whether that sounds a bit childish though...

Is she not hard of hearing rather than deaf. If she's embarrassed about not being able to hear that well, there is no way she is going to describe herself as deaf.

Thank you for all your thoughts, I really appreciate them all.

I have heard her say 'sorry I'm quite deaf can you say that again' or similar so that is how she has described it (I don't know whether there's an official definition of being deaf so apologies if that's not strictly correct but that has been her wording). She would be willing to accept help but seems to think she has been told she won't be getting any....

It would be unusual to not have OT and physio input pre-op to help planning equipment and support. Is she sure that's what they said, rather than she just didn't hear what they said. If she has capacity and doesn't tell them what her concerns are/that she doesn't have the support at home then she's really setting herself up for a hard time. One night in hospital is routine after a straightforward hip (same day discharge is increasingly routine) - she needs to tell them what she thinks she might need or perhaps spend some cash on private placement/carers for a while.