Advice needed for my father in law

SimonHerts

New member
Nov 30, 2017
4
0
Hello, I am asking for advice as my wife is very concerned about the welfare of her 97 year old father. He has had dementia for a number of years when his wife died we tried to look after him initially but his care needs were too much (he was not safe to leave for any time) and he has been in a care home for 6 years. It took him some months to settle, but whilst he has absolutely no short term memory, thankfully, he did get used to his surroundings. It helped that he found a female resident who he believes is his wife on a sub conscious level and she believes he is her husband. or at least that they are both boyfriend or girlfriend - it is hard to explain but it works for them both, Whilst it is very hard for my wife, she understands that this is very important to her dad's welfare. We visit him every week and have learned what to say to him - talking about his football playing and army days which he loves. Even though he forgets we have been the minute we leave and he doesn't really know who we are.

Recently, he developed a bladder infection that requires a catheter. This is quite serious and our understanding is he will require the catheter for the rest of his life. He has been living in his care home with his catheter for a few months without a major issue, but a few weeks ago, he apparently pulled it out, had to go to hospital, was then sent back to the care home and pulled it out again. He has been in hospital for a couple of weeks (he is still there now). When he is in a strange new environment he gets distressed and confused and can hit out which I think it is understandable as he is frightened so this is not great. He is settled in his current home and any change should be avoided in our opinion,

My wife received a call today from his care home. They said the hospital has told them he can no longer stay at the care home and that we need to find him a new one (He is a self funder). She is distressed as nobody has discussed this with her and sought her input. We are both concerned that moving him may be a sound clinical decision but it may not be so sound in relation to his health and wellbeing. He is frail and will be very distressed. We don't know what the best home for him is and we want to ensure he is not too far away from us, the only family that can visit him. We don't really want him separated from the woman he has befriended as their closeness has helped them both. It was good fortune and cannot be prescribed! Doctors don't seem to take any of that into account. We also like his current care home, we trust he is well looked after there. We are flabbergasted that nobody has spoken to us about this from the hospital. If he needs to move home because of his health, can't his health needs be met in the place he is comfortable in? We are concerned that a move will kill him.

If he has to move shouldn't the reason be fully explained. And is it possible we know more than the doctors. My wife did have a strange call a few days ago from the hospital asking questions about him being violent and she was a bit put out as teh person asking them did not seem to have a proper grasp of the dementia and that he is only aggressive when he is frightened and confused. We desperately need advice.
 

Kevinl

Registered User
Aug 24, 2013
6,383
0
Salford
Hi Simon, welcome to TP
If the home he is in can no longer meet his needs then is it that they don't want him back and are blaming it on the NHS or that the NHS has asked the home can and can't cater for and have decided he can't safely be sent back there?
It sounds like his needs would be better met in a nursing home than a care home where there is always a qualified nurse on the premise so medical needs are catered for rather than a care home which may have no medically qualified staff.
You could ask if the NHS will fund his care under Continuing Health Care (CHC) or contribute to it with Funded Nursing Care, the former would pay all his care costs, the latter is a fixed contribution from the NHS of £155pw.
It's in his interest and well as the NHS's that hospital visits are kept to a minimum which should be the case if he moves to a nursing home rather than a care home.
I can see why your wife is upset at not being involved in the decision but if the NHS believe the home can't meet his needs or the care home know that they can't then there's no decision to be made, he has to move to somewhere that can.
K
 

SimonHerts

New member
Nov 30, 2017
4
0
Hi Simon, welcome to TP
If the home he is in can no longer meet his needs then is it that they don't want him back and are blaming it on the NHS or that the NHS has asked the home can and can't cater for and have decided he can't safely be sent back there?
It sounds like his needs would be better met in a nursing home than a care home where there is always a qualified nurse on the premise so medical needs are catered for rather than a care home which may have no medically qualified staff.
You could ask if the NHS will fund his care under Continuing Health Care (CHC) or contribute to it with Funded Nursing Care, the former would pay all his care costs, the latter is a fixed contribution from the NHS of £155pw.
It's in his interest and well as the NHS's that hospital visits are kept to a minimum which should be the case if he moves to a nursing home rather than a care home.
I can see why your wife is upset at not being involved in the decision but if the NHS believe the home can't meet his needs or the care home know that they can't then there's no decision to be made, he has to move to somewhere that can.
K

But what about his mental welfare? - he is settled and as happy as is possible at the home he is in. The home says it is the hospital and they want him. Finding this lady there has been a massive development in his well-being. That is what concerns us. There seems to be no consideration about that at all.

We agree hospital visits should be kept to a minimum and maybe if somebody explained things to us, but it does not instill confidence and we know him much better than any doctor does.
 

Bunpoots

Volunteer Host
Apr 1, 2016
7,356
0
Nottinghamshire
If the home want to keep him discuss it with the manager. If they feel they can manage his needs perhaps they could put a plan in place to show to the docs who think he should be moved.

My late mum had a catheter and she kept removing it. I believe the home had a visiting nurse who used to oversee her catheter care. I don't know if she had to go to hospital every time ( I don't think she did) but she didn't stay in overnight if she did. Eventually they took the decision to get rid of the catheter (she pulled it out straightaway every time) and she was ok without it. Not that they had a choice - she wouldn't leave it alone.

She was in a care home with nursing care available to those who needed it.
 

canary

Registered User
Feb 25, 2014
25,083
0
South coast
I think that the problem is that care homes (as apposed to nursing homes) are not generally able to deal with catheters, so every times he removes it they have to take him to hospital to deal with it. The hospital, not surprisingly, dont want him to have to keep going back (especially as it will probably count as a "failed discharge" which will cost them a fine) so are saying that this care home cant meet his needs - which, to be fair, if they cant deal with his catheter, they cant.

I think that you need to speak to his care home manager and see if there is some way of dealing with the catheter in the care home so that he doesnt have to go to hospital every time he removes it, which will satisfy the hospital and allow him to go back there. If something cannot be sorted out then, unfortunately, he will have to move.
 

SimonHerts

New member
Nov 30, 2017
4
0
Yes, that is what we think is sensible. It is not ideal but sometimes the best option is not the ideal one. We have spoken to the hospital who say they have not finally decided, but they have told the home they have. We have asked that they involve us in the decision making process. Our fear from experience is that moving to a new home could be detrimental to him - it might even finish him off - it was a stroke of luck that he and this lady latched on to each other and they are both much happier as a result. We know it may not be an option, but we have a duty to ensure any decision that is made takes into account all factors and options. We only want what is best for him and to be ignored is upsetting!
 

Louise7

Volunteer Host
Mar 25, 2016
4,798
0
Was it a member of the discharge team who contacted the home and said that your FIL can no longer stay there? From personal experience they tend to want to 'do their bit' quickly without bothering to consult anyone else. In my Mum's case a member of the discharge team made a decision that she needed a nursing home without consulting family (with POA) or social services. When challenged she said that the decision was based on information taken from my Mum's notes. Once we had all sat down with a doctor and had a 'best interests' meeting it was agreed that a nursing home was not needed (and had never been needed as Mum had no nursing needs!).

It's frustrating that hospital communication can be very poor at times, and decisions are made without the full facts being known/considered. Hopefully you will now be consulted with regards to decisions but it wouldn't hurt to request a 'best interests' meeting, which maybe someone from the home could attend too to ensure that all options are properly considered.
 

SimonHerts

New member
Nov 30, 2017
4
0
Was it a member of the discharge team who contacted the home and said that your FIL can no longer stay there? From personal experience they tend to want to 'do their bit' quickly without bothering to consult anyone else. In my Mum's case a member of the discharge team made a decision that she needed a nursing home without consulting family (with POA) or social services. When challenged she said that the decision was based on information taken from my Mum's notes. Once we had all sat down with a doctor and had a 'best interests' meeting it was agreed that a nursing home was not needed (and had never been needed as Mum had no nursing needs!).

It's frustrating that hospital communication can be very poor at times, and decisions are made without the full facts being known/considered. Hopefully you will now be consulted with regards to decisions but it wouldn't hurt to request a 'best interests' meeting, which maybe someone from the home could attend too to ensure that all options are properly considered.

Thanks, I have requested this, but the hospital is not being easy to pin down. Ring in 20 minutes, ring in 20 minutes - sorry not free - ring in an hour, can they ring us when they are free - no, ring in 30 mins. Now phone has been engaged since 2:30! If somebody explained to my wife, she might be content, but she wants to ensure any decision takes into account all of the details. It is her dad he she doesn't want to let him down .
 

Shedrech

Registered User
Dec 15, 2012
12,649
0
UK
have you contacted the PALS in the hospital - they will know the systems and may well be able to help you
 

Louise7

Volunteer Host
Mar 25, 2016
4,798
0
Depending on how close you are to the hospital it may be better to go there rather than phone. I had similar problems to you, constantly getting told that someone would ring me back and being unable to get hold of anyone when I managed to get through the switchboard. I found that going to the ward and making a bit of a fuss (saying that I was not leaving until I had seen a doctor, social worker etc) usually had the desired effect! We shouldn't need to do this at a time when we are already stressed due to the ill health of a loved one but sometimes it's the only way to get them to listen to you and involve you in decisions.
 

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