Bed sores and living alone

Discussion in 'I care for a person with dementia' started by charlie10, Feb 18, 2019.

  1. charlie10

    charlie10 Registered User

    Dec 20, 2018
    287
    Elderly person with limited mobility (zimmer frame to move few steps to commode) lives on their own (carers twice a day for a bit of personal care, putting rubbish out etc) and spends just about all their time in a recliner chair, snoozing or watching tv. No diagnosis of dementia, family wonders but then a perfectly normal conversation makes us think we're mistaken.

    In hospital for maybe a couple of weeks with broken hip and medication complications, won't attempt to mobilise despite being told they will become bed bound....he already has a sacrum ulcer....if he goes home and becomes bedbound would he need to be 'turned' to prevent more bed sores....how would that work out with carers? Would he need visits 24/7 and is it doable at home (refuses to even talk about CH....no LPA and probably still has capacity)? He also has lymphedema and arterial ulcers, and has become quite weak since he was in hospital for 3 wks in Oct (I read in the hospital pamphlet that 10 days bed rest can 'age' muscles by 10 yrs, which is another reason for getting patients up and walking, and probably explains why he'd lost so much strength after last time, when he wouldn't walk)

    Don't know when he'll be out, but forewarned is forearmed :confused:
     
  2. garfield3

    garfield3 Registered User

    Jun 30, 2018
    150
    Couldn't the family do more? If he's not fit to live on his own he can't go home. Have the family spoke to Dr's etc probably be sent to rehabilitation before being sent home. Is he very old?

    I think if he's got undiagnosed dementia before major trauma like a hip breakage it can accelerate symptoms.

    My uncle is in a similar situation but in hospital with broken hip and been recently diagnosed with dementia. Lives on his own too.

    Sorry can't really help.
     
  3. Louise7

    Louise7 Registered User

    Mar 25, 2016
    1,065
    #3 Louise7, Feb 18, 2019
    Last edited: Feb 18, 2019
    Prior to discharge he will have been seen by physio, OT etc and if they feel that rehabilitation is needed they will recommend this. If they feel that he is not safe to go home until adequate care is in place they should discuss this with family/social services. Once you know what his care needs are then you will be better placed to decide how best to meet these. At the moment it's all hypothetical until the hospital say he is fit for discharge.

    Is his current care being funded by social services? If so, contact the hospital social worker before he is discharged from hospital to advise that his care needs have changed. They should then undertake a new needs assessment to determine the level of care required. They will usually provide up to 4 carers a day before considering a care home, as that is cheaper. The complication will be if he is deemed to still have mental capacity, in which case if he says he wants to stay at home social services will keep him at home, unless/until it becomes a safeguarding issue. People who are bedbound can be cared for at home but if he is self funding and there is no one living with him to assist with the care then the cost of carers coming in day & night would probably exceed the cost of a care home.

    Edit: Just to add that a pressure sore/ulcer (if not healed on discharge) will need to be treated/monitored at home by a health professional such as a district nurse.
     
  4. witts1973

    witts1973 Registered User

    Jun 20, 2018
    634
    Male
    Leamington Spa
    He could do with a hospital bed at home and an alternating air mattress to help with the pressure sores and to help prevent more occuring
     
  5. charlie10

    charlie10 Registered User

    Dec 20, 2018
    287
    @garfield3 we live overseas and his only family in England is his other son, who lives an hour away....he calls in several times a week after work and at the weekend but is on call for work as well as having a long commute. FiL is 90, and today in hospital apparently 'passed' the memory test (I'm guessing it's just the minicog or the MMSE.....the things that make us wonder about dementia aren't memory but just slightly weird conversations, more multiple slightly strange things rather than a major incident with 'dementia' written on it) so we could still be right....or totally wrong about our amateur diagnosis! BiL is visiting as much as he can while he's in hospital, and I know it's very difficult for him, but he just wants to go with the flow, and thinks everything will magically work out, whereas we (well, Me and with a bit of prodding, my husband!) want to know what might happen so that we can at least think about what might need to be done. Unfortunately we have no chance of doing anything at distance, and BiL can't/won't. I do hope that your uncle heals quickly and goes to somewhere he will be happy

    @Louise7 no he's not with SS but self-funding. He did have 2 carer visits a day, initiated by SS, but as he has just had to refund SS for that just before his latest fall he cut the visits down to one a day, and that's only by persuasion as he doesn't want to pay. Our fear is that if he goes home he may refuse carers, and I can't see him ever agreeing to go into a CH...not because of any possible dementia but just because he's extremely stubborn (and believes in more than his fair share of urban myths about how badly the elderly are treated by officialdom/hospitals/homes etc) If he isn't diagnosed (ie has capacity) and refuses all help but is almost immobilised I don't know if anyone can do anything because of his right to live unsafely....can't work out at what point safeguarding rears its head. Before his fall he was having daily visits from the DN for his leg ulcers, so hopefully, as long as he allows her to come, she will see to his bed sore too

    @witts1973 yes I'd really like him to have a decent pressure mattress, but we have to persuade him to have the electric bed he's got upstairs brought down for a decent mattress to go on.....at present I understand he's got a Heath Robinson affair of old mattress on the settee (I know :eek: like I said, he is VERY stubborn!) but we think he spends most of his time in his recliner.

    We can see what needs to be done but are powerless as the 'intermediary' has his head in the sand and we rely on him to find out anything about FiL. When I read it back, it looks pathetic, but their family dynamics are not like mine, where I can be a control freak with my dad and brother ;):)

    Thank you for your replies....just getting it out there relieves a bit of my frustration :)
     
  6. arielsmelody

    arielsmelody Registered User

    Jul 16, 2015
    512
    District nurses take bed sores very seriously.

    My dad came home from hospital with severe skin problems and the threat of bed sores developing. He had a fantastic district nurse who basically didn't listen to his protests, and organised a hospital bed with a pressure mattress and a pressure cushion for his chair. He ended up in the bed most of the time because sitting long hours in the chair he developed cellulitis in his legs.

    If he has a pressure sore, there is no way that the professionals involved will accept that he can sleep on mattresses on a sofa.

    The district nurse also organised for him to have 'home from hospital' carers twice a day although that was limited to six weeks.

    From what you say, once adult social services get involved and start writing a care plan for him, they won't accept the current arrangements. Even though he is self-funding, he will have a social worker assigned, and that's the person you need to be talking to.
     
  7. canary

    canary Registered User

    Feb 25, 2014
    9,855
    Female
    South coast
    I didnt realise that you were no in UK @charlie10 so I thought I would mention that in UK diagnosis does not automatically mean that you are considered to have lost capacity (I gather that in some places the two are considered pretty synonymous). My MIL was never officially diagnosed, but she was considered to have lost capacity and moved into a care home; other people with a diagnosis can retain capacity for some time.
     
  8. charlie10

    charlie10 Registered User

    Dec 20, 2018
    287
    ah @canary that's interesting, thank you, one of the subtleties I'd overlooked :oops: this thing about capacity seems to get more confusing the more I read....on paper it seems quite clear (and even in the training film I found on Youtube for SWs) but the examples they give are so simplistic and never seem to translate to different scenarios...that's the trouble with looking for a 'one size fits all' answer to something as nebulous as capacity :(

    @arielsmelody he has a fairly feisty DN from what I can gather, but I don't know if she can insist on anything as he has capacity, and is not likely to 'obey' any authority figure (more like the opposite.....imagine 'angry young man' with zimmer). Think we'll just have to bite our tongues for a little and hope he comes round to it.....I'm sure he'd be more comfortable if he just tried it (BiL won't go against dad's wishes so no chance of getting him out for a shopping trip and doing it in his absence :rolleyes:) I do appreciate your input tho.....will keep it in mind in case a chink opens in the future
     

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