Discharge from hospital to home or care home. Who decides?

[GailM]

No disrespect, and I never would because I don't believe in being disrespectful, but there is going to come to a point that God forbid your uncle is going to need to except
the care especially being the age he is, there is no shame in asking for help, maybe your uncle is just a proud man.
It will get to a point where all relevant parties are going to have to say, enough is enough, your uncle cannot physically and mentally carry on looking after your dad so all professionals will have to step on for your dad's best interest.

I totally agree.

 

[GailM]

Citizens Advice, Age UK and some carer charities can help with form filling. Solicitors can also apply on your behalf - it is expensive that way (about £3,000), but the money would come out of your dads savings and if you dont do it then the CoP will appoint a panel solicitor who would charge for everything they do.

I think your uncle is soon going to have a huge wake-up call.
SS have the authority to over-ride peoples wishes if the person with dementia does not have capacity and is deemed to be at risk. Soon it will become either having carers in at home, or moving to a care home.

We won't use a solicitor. All my Dad's paperwork is at the house. I will either go over and hope my Uncle or Cousin agree to help with the COP forms, or be brave and do it myself with help from one of the above. You're right, My Uncle IS going to have a huge wake-up call. I've known for a long time that the chances of my Dad being cared for at home till he dies, were slim. I am going to point out to my Uncle (as I am sure SS will also do), that they have the authority to over-ride.

 

[GailM]

My Dad will be going from hospital to a care home. At the moment the social worker says he is borderline between a general residential and and EMI home. In the end my Uncle realised he couldn't come home if he couldn't walk (although he believes he can and will walk again...) I mentioned COP, and FINALLY my Cousin has said we need to sit down and discuss it, so I will be going over sooner rather than later. I mentioned it to my Cousin first as if left to my Uncle, I don't think he would be in any rush. Is it possible to have the forms sent in the post rather than online?

 

[GailM]

I rang Age UK for advice re the forms. They told me to contact the OPG who informed me I needed to contact COP. When calling COP you are informed the call will automatically cut off after twenty minutes if the call isn't answered, which is what keeps happening. I don't even know which forms I need....😢 I was hoping COP would be able to send them to me. I will contact CAB and hope they will know which ones I need and also print off. Other than that I'm totally stuck.

 

[Heather 27]

My Dad has been in hospital for nearly three weeks (Hypoactive Delirium). He is medically fit for discharge and has been appointed a hospital social worker. In the lead up to him being admitted he was barely eating, drinking, and unable to stand let alone walk. He should have been admitted to hospital the previous week, but the family didn't listen....My Uncle says he needs to be able to walk. This has now changed to he needs to be able to stand.... My Dad hasn't walked for about a month now. The hospital physios have discharged him from their care as he wouldn't engage with them. Changing my Dad's nappies has always been a battle. My Cousin has hurt his back taking all of my Dad's weight so that my Uncle could change him. My Cousin will not be offering any further help in this way. His back has not recovered as yet. My Dad was admitted to hospital just under two years ago. My Uncle wanted nothing to do with Social Services and was adamant that he could take care of my Dad himself. We are now two years down the line and he is still saying the same thing! He's not going to allow carers in etc and they can all mind their own business! The hospital social worker will be speaking to my Dad on Tuesday. My Uncle was down as NOK, but luckily a nurse I spoke to must have made notes on the system as I will be contacted first. How do the social worker and discharge co-ordinator deal with this type of situation? Is the decision of where my Dad lives down to them or the family? What happens when my opinion is the total opposite of my Uncles, yet he lives with him? Any advice would be much appreciated. Many thanks, Gail.

What a dreadful situation.
My stepmum.was in hospital.untol.last week, medicallyvfit so she's been discharged with 4 care visits daily.
When your uncle is discharged ask for a discharge meeting. This is where all interested parties get together to work in the patients best interest. Its also called a best interest meeting.
Unfortunately, although we asked for it my stepmum was discharged without a meeting. Nobody let us know she was coming out of hospital, so it was a big surprise. My dad, aged 91, is now stressed trying to care for her and she's taken to her bed as she's having trouble walking. I've since learnt there's no hospital Dischrage Policy and the Sister said discharge protocol is by word of mouth. They also refused to hand over the original DNR and said it has to stay in the hospital file.
I guess what I'm trying to say is
1. Don't let anyone rush you into a discharge
2. Have a dischargeseying
3. Document everything...absolutely everything
4. Full care package must be in place

Good luck. X

 

[GailM]

What a dreadful situation.
My stepmum.was in hospital.untol.last week, medicallyvfit so she's been discharged with 4 care visits daily.
When your uncle is discharged ask for a discharge meeting. This is where all interested parties get together to work in the patients best interest. Its also called a best interest meeting.
Unfortunately, although we asked for it my stepmum was discharged without a meeting. Nobody let us know she was coming out of hospital, so it was a big surprise. My dad, aged 91, is now stressed trying to care for her and she's taken to her bed as she's having trouble walking. I've since learnt there's no hospital Dischrage Policy and the Sister said discharge protocol is by word of mouth. They also refused to hand over the original DNR and said it has to stay in the hospital file.
I guess what I'm trying to say is
1. Don't let anyone rush you into a discharge
2. Have a dischargeseying
3. Document everything...absolutely everything
4. Full care package must be in place

Good luck. X

I can't believe she was discharged back home, especially without letting you know!

 

[GailM]

I managed to contact the COP via email, explained the situation, and received all the forms in the post the following day. I was shocked as last time I had dealings with them it took them three weeks to reply! I found out on Friday it has been decided my Dad requires general residential, not EMI. Because of the area my Dad lived/hospital, SS will only search care homes in that area. I need him closer to me, so I need to research care homes and then give the SW specific details. Last Friday I gave her information on a home near me. There were places available but we had to wait till the Manager came back today. There are now no places available there. I have spent all day trawling the carehome.co.uk website. I have a list spanning two A4 pages. I rang one which said they were residential and I needed nursing. I then scribbled out all the ones which said residential. I then looked again at one's which said nursing. I rang a home which mentioned nursing only to be told that what I'd just being told wasn't necessarily true! I've been advised to contact my SW (which I've done) to clarify whether I'm looking for dementia residential or dementia nursing. As yet she hasn't phoned me back. I also contacted my Dad's GP as I know not all GPs will fill part B is it of the COP3. They haven't phoned back, so no doubt I will have to chase it up. I'm going over to fill the forms in on Saturday. If the GP won't fill the form in, I imagine the hospital SW would be able to, but I would then have to arrange it with her. I will be so glad when all this is sorted. I don't drive and I suffer badly with anxiety, so my friend will be taking me to look at care homes as and when she's available. It's such a shame I couldn't get him into the one I wanted near me. It's literally pretty much at the other end of my street. I know quite a few people whose relatives have lived there.

 

[canary]

I think you need to be quite clear about what sort of residential home it is that SS will fund. At one point you said that SS will only fund general residential (which is the cheapest type of home), but you are now thinking of dementia nursing (which is the most expensive). It may be that SS have underestimated his needs, but if SS will only fund general residential and you go for a more expensive home you would be expected to fund the difference.

Not all care/nursing homes are the same and they all have different criteria for accepting residents. Just because one care home says that he needs nursing home, doesnt necessarily mean that another care home wouldnt accept him. If there are are no care homes that would accept him, though, then you would need to go back to SS for them to reconsider.

 

[GailM]

I think you need to be quite clear about what sort of residential home it is that SS will fund. At one point you said that SS will only fund general residential (which is the cheapest type of home), but you are now thinking of dementia nursing (which is the most expensive). It may be that SS have underestimated his needs, but if SS will only fund general residential and you go for a more expensive home you would be expected to fund the difference.

Not all care/nursing homes are the same and they all have different criteria for accepting residents. Just because one care home says that he needs nursing home, doesnt necessarily mean that another care home wouldnt accept him. If there are are no care homes that would accept him, though, then you would need to go back to SS for them to reconsider.

My Dad will be self funding.

 

[GailM]

After the confusion of earlier in the week, I clarified with the SW that my Dad needed residential and not nursing. My first choice of home is one very close to me. They have places but are not taking anyone new on at the moment (I don't know why), so are not accepting his care plan until they open again. On Tuesday I was told it could be a day, a week, or a fortnight. I rang today and was told to phone back Monday when they might know more. I know people who have lived at the home, and relatives of friends. The hospital SW has found a home willing to take my Dad but their care navigator has only searched my Dad's area. I've made an appointment to have a look round the one in his area tomorrow as it's sort of in the direction of the hospital, so my friend is taking me to the care home first. It looks really nice from the photo's, but obviously I know it's not important. If my Dad was to live there it would be difficult for me to get to, but I also have to be aware that if I take too long SS can place my Dad somewhere in his area until I find somewhere nearer. Not ideal, but I fully understand where they're coming from. It's this side of the area rather than the far side. I'm trying to remember what I've read re looking round homes. Maybe have a chat with visitors to get their opinion? Chat to staff if they're aren't too busy? My head's all over the place. Taking the COP3 form to the hospital in the hopes they will fill it in once the strike is over. GP has refused to help as they don't have my Dad's consent. The hospital know I'm taking it in. If they decide not to fill it in I will research Independent Social Workers as they will be my only other option.

 

[Scarlet Lady]

Hello, @GailM . You have said that your father will self-fund his care. In my opinion that gives you quite an advantage over his care options. You do not have to rely on social services or the NHS to find an appropriate facility for him. You also do not have to rely on their ‘opinions’ regarding his needs, his capacity or what may be best for him. You probably already know this.

I understand that when we are trying to negotiate the minefield of dementia, we find ourselves relying on the people we think know best, but it often turns out not to be the case. If you’ve found a home that you think will work, discuss your needs with them. I’m sure that if they think they can meet your dad‘s needs, they will work out a care plan with you. I understand there may be a waiting list for the one you had in mind, but there may be other options. And at least now you know that your dads ‘nursing’ needs may not be as great as you thought they might be, so that gives you more options.

 

[Skylark/2]

Hello,
with regard to asking questions about the suitable of a care home.
Age U.k has info under the heading How to choose the right care home. Look on their website. I found it interesting reading.
Good luck!

 

[sisterlouise]

Citizens Advice, Age UK and some carer charities can help with form filling. Solicitors can also apply on your behalf - it is expensive that way (about £3,000), but the money would come out of your dads savings and if you dont do it then the CoP will appoint a panel solicitor who would charge for everything they do.

I think your uncle is soon going to have a huge wake-up call.
SS have the authority to over-ride peoples wishes if the person with dementia does not have capacity and is deemed to be at risk. Soon it will become either having carers in at home, or moving to a care home.

 

[GailM]

Hello, @GailM . You have said that your father will self-fund his care. In my opinion that gives you quite an advantage over his care options. You do not have to rely on social services or the NHS to find an appropriate facility for him. You also do not have to rely on their ‘opinions’ regarding his needs, his capacity or what may be best for him. You probably already know this.

I understand that when we are trying to negotiate the minefield of dementia, we find ourselves relying on the people we think know best, but it often turns out not to be the case. If you’ve found a home that you think will work, discuss your needs with them. I’m sure that if they think they can meet your dad‘s needs, they will work out a care plan with you. I understand there may be a waiting list for the one you had in mind, but there may be other options. And at least now you know that your dads ‘nursing’ needs may not be as great as you thought they might be, so that gives you more options.

I have my fingers well and truly crossed that the home nearest to me are open again on Monday, or at least may have a better idea of when they will be. I am worried SS will intervene if I don't find him somewhere within a reasonable amount of time as he is medically fit for discharge. Having said the the hospital SW is lovely and has also commented on how quickly I am trying to sort everything out. Hopefully that means she won't put pressure on me anytime soon. Hospitals aren't the best places for people with Dementia. I just hope I can sort it sooner rather than later.

 

[GailM]

Hello,
with regard to asking questions about the suitable of a care home.
Age U.k has info under the heading How to choose the right care home. Look on their website. I found it interesting reading.
Good luck!

Thank you. I will take a look (and make notes).

 

[GailM]

I should really start a new thread but too stressed to figure it out. My Dad moved into a care home at the end of June and has settled well. A few weeks ago he broke his right hip and had to have an operation, He is now immobile (he walked a lot before). He is being hoisted. He was seen by a physio at the hospital but cannot engage with them. On Sunday the home contacted me to say my Dad was ill and the paramedics were with him. Seemingly, he had gone grey, wasn't eating or drinking etc etc. The paramedic said he observations were ok and would pass things to the out of hours doctor. I KNEW I was going to get another call. Three hours later paramedics had been called again. This time he had a temperature, fast shallow breathing and his oxygen levels were low. They had been recorded earlier at late seventies/early eighties. I had a care plan in place which stated he shouldn't go to hospital unless it was for broken bones. However I decided as my Dad wasn't EOL, he should be treated. He was given intravenous antibiotics, and was eating and drinking the following day and yesterday. I had a call from the care home late this afternoon to say he wasn't eating and drinking and they were struggling to get the oral antibiotics down him as they are large. I spoke to the paramedic who said all his observations were fine and he didn't need to go to hospital, but if I wanted him to go they would take him. I commented that it was Sunday all over again. She said it wasn't because he's being treated for the problem. She said the probe the care home used was probably faulty. I've found out since that it was showing as 70%, and they tried two different ones! So it was decided no hospital. Then the out of hours doctor phoned and said she disagreed with the paramedic. She said who is to say that the care home monitor was wrong? Nobody knows. She said he could have a pulmonary embolism which can present with fluctuating oxygen levels. She said she didn't want to leave him in the home and then him deteriorate when it could have been treated if he did have a clot. She said there was nothing on his discharge sheet to suggest he'd been checked for one, and she felt it needed to be checked. Therefore I agreed he could go back to the hospital. I was told my Dad had an infection but they didn't know where. Today I was told he has Pneumonia. I keep having to make the decisions. I hope I am making the right ones.

 

[canary]

Im sorry to hear about your dad. It sounds like the fall, fracture and surgery have really shaken him up so that hes finding it hard to fight infections.

These decisions are hard even in better circumstances, but all you can do is what seems to be best at the time.
xx

 

[Sarasa]

Sorry to hear about your dad, @GailM, as @canary says you just have to do what you think is best. At the moment being kept comfortable in hospital sounds like the best option.

 

[GailM]

I had a call a few hours ago to say they were unable to do a blood test as my Dad was distressed and being aggressive. They must have managed to do it as I've just had a call from the hospital to say his D-dimer levels are raised and he needs a CTPA scan. Thank you both for your replies.

 

[Sarasa]

@GailM , last new year my mum ended up in hospital with sepsis. As part of the treatment she had a scan which revealed a possible indication of cancer. The consultant phoned me up and we had a long chat as to whether further tests were advisable. Mum was 94 and her dementia was very advanced so I said no, as any intervention would be distressing and I didn’t think she’d survive an operation anyway. She returned to her care home and is still with us, pretty much the same she was then.
I think that you might need to discuss with the host if a lot of tests are advisable if they are distressing your dad. This might limit his life do a tricky decision to make.