Elderly dad in hospital - what to do next?

Discussion in 'I care for a person with dementia' started by looviloo, May 3, 2015.

  1. looviloo

    looviloo Registered User

    May 3, 2015
    464
    Female
    Cheshire
    #1 looviloo, May 3, 2015
    Last edited: May 3, 2015
    Hi, I'm new here, it shows you something I spelled my intended username wrongly when I registered (it should be loobiloo)... I can't think straight!

    I'd be very grateful for any help/support/advice.

    My dad, 86 & lives alone, has been mildly confused and disorientated for about the past year, and has had memory problems for years before that. He has difficulty with his speech. No diagnosis has been offered despite visiting (twice) and writing to the GP just before Christmas. The doctor did indicate it might be 'vascular' but no tests done.

    Fast forward to Monday last week and dad had a serious fall on his daily walk into town. He was found face down in the road, and whisked off to the nearest hospital. Broken shoulder, bumps and bruises to face and hands and very nasty bruising to his arm. He was ok though, in terms of his mood, and occupational therapy (and another I don't remember) deemed him fit to be discharged on the Tuesday. Well, we spent that day ringing round and eventually spoke to the social worker in charge of the case who tried to help us. She persuaded the hospital to keep him another night and it's a good job she did.

    Late on Tuesday afternoon he started to hallucinate and was found wandering outside the hospital. He was eventually taken back to the ward but when we saw him on the Wednesday he was extremely distressed and seeing 'things', making up fantastical stories and recalling fragments of memories from long ago. All this while still on the clinical decisions unit, a very busy place that was distressing him more.

    Thankfully he has now been admitted and is on the geriatric ward (has been since Thusday evening). His state of confusion has reduced, but his mobility is still poor and he has been very dehydrated. We've been trying to get more information about his medical well-being but apart from the tests that have been done, no-one's saying very much. CT scan was ok, renal function lowered, low blood pressure etc. But no diagnosis.

    So I guess I'm here looking for advice about what happens next?

    Number one, is to get him medically stable, of course. Then the nurse mentioned a care needs assessment before discharge from hospital. Will that include means testing? And would a continuing care assessment be appropriate? Is that done automatically or do we need to ask? I need to speak to the social worker again as well, but it's bank holiday weekend and I have all these questions...

    We (my dad included) would like him to go directly to a care home, one that he was already planning to visit before this happened. I'm panicking that they'll assess him as safe to go home :eek: because presumably that would complicate matters?

    Also, we have power of attorney, but it seems like the assessments need to be done before we can use the health & welfare one? Does anyone have experience of this?

    Sorry for the long post. I'm living on coffee and adrenaline right now :-(
     
  2. patsy56

    patsy56 Registered User

    Jan 14, 2015
    840
    Fife Scotland
    welcome to TP Loobiloo, <hugs> I may not be able to answer your questions, but I'm sure someone on here will help you. Just know that we are all here for each other.
     
  3. looviloo

    looviloo Registered User

    May 3, 2015
    464
    Female
    Cheshire
    Thank you, it's been a really horrible week. But it feels good to be in a forum where everyone understands x
     
  4. katie1

    katie1 Registered User

    Aug 5, 2014
    122
    Kendal Cumbria
    First of all please look after yourself! eat properly and try and get some sleep. Nothing happens very quickly unless its an emergency, in hospital.
    Ask that a CHC checklist and full assessment is done definitely ! when you ring them to check how he is keep notes and ask what his fluid intake is. When you visit do the same and encourage him to drink--take in a bottle of juice to dilute mark with his name. Put a note over his bed kindly asking staff to make sure he drinks!
    Get the Social Worker on board with the Checklist and full CHC assessment, if you can't get in touch with them try the hospital one.Read his file ask to see the consultant (make an appointment if necessary) to discuss diagnosis and prognosis along with advice.
    You say "we" have PoA who is the "we"? talk to them, get support, get them to ring etc
    Being on the ward will be distressing and confusing for him, offer reassurance that you are trying to sort things out for him......but it will take time and patience and praise him for coping. Its all been a bit of a shock for you, I know what its like, its confusing also. Good Luck
     
  5. looviloo

    looviloo Registered User

    May 3, 2015
    464
    Female
    Cheshire
    #5 looviloo, May 3, 2015
    Last edited: May 4, 2015
    Thank you Katie, you've reassured me that we're on the right track. It just feels overwhelming and there's so much to do. We live 15 miles from his house and further from the hospital, and although I know there are plenty of people in worse situations, I'm struggling to cope. Sleep! What's that?! Actually, I did rest a bit easier last night and I'm taking a bit of a break today :).

    We're a small family, not many to rely on. Just me and my sister, and my husband who has taken time off work to help. We all have power of attorney and I talk regularly with my sister. We are just a bit lost at the moment. I think the shock of his injuries, and then the threat of being discharged sent me into overdrive. His house isn't safe, because of his unsteadiness, and we'd need to move things around. But it would be a heck of a job!!!
     
  6. Essie

    Essie Registered User

    Feb 11, 2015
    566
    #6 Essie, May 3, 2015
    Last edited: May 3, 2015
    Hello Looviloo, I'm sorry to hear about your poor Dad, as you say thank goodness he hadn't already been discharged. Your local council should have details of their particular procedures with regards to a needs assessment but this is a pretty comprehensive generic version that covers the basics :

    An assessment means that you and a social care worker will complete an assessment form to:

    Find out what support you need
    Decide whether you qualify for funded support.

    We use the information from your assessment to decide if you qualify for support under the Care Act 2014.

    There is a national level of care and support needs that all councils will consider when they assess what help they can give you. To qualify for support:

    your needs must arise from or are related to a physical or mental impairment or illness

    as a result of your needs you are unable to achieve two or more outcomes in the areas listed below

    as a result there is, or is likely to be a significant impact on your wellbeing.

    The areas we look at include:

    Eating, drinking and preparing meals
    Personal care
    Being appropriately clothed
    Being able to make use of the home safely
    Running and maintaining the home
    Developing and maintaining family and other personal relationships
    Accessing and engaging in work, training, education or volunteering
    Making use of necessary facilities or services in the local community including public transport and recreational facilities
    Carrying out any caring responsibilities for a child
    When we do an assessment with you, we will consider your wellbeing and what is important to you and your family. We will take into account whether your situation is likely to get worse in the next few months.

    You may need to pay for some support yourself - we will work out how much you can afford to pay.

    If you have more than £23,250 in savings and capital, you will have to pay the full cost of any support you require. You can still ask for an assessment of your care needs but you will not qualify for any funded support from us.

    What does the assessment involve?

    A social care worker will contact you and talk to you about:

    what's important to you
    what you can do for yourself
    your life and the support required to meet your care needs.
    These will become your 'outcomes'.

    You may also find it useful to ask friends, family or carers who have helped you in the past to be part of your assessment.

    Your unpaid carers may also qualify for support in their own right. For more information see our carers support page.

    What happens if I qualify for funded support?

    If you qualify for funded support, we will tell you how much money we think you will need to pay for your support - your Personal Budget - and ask you to create your own support plan. We will help you with this if you need it.

    This will show how you will use your Personal Budget to meet your care needs.

    If you qualify for support from us, you will have more choice and control over:

    how that support is provided
    who supports you and when.
    What happens if I do not qualify for funded support?

    If you do not qualify for funded support, your care worker will give you information and advice about other organisations that might be able to help you instead.

    If you disagree with the result of your assessment, you can ask us to look at your assessment again.

    ------------------------------------------------------------------------------------------------------------


    From my own experience I would always say talk problems up not down, state and re state what you want, stress the need for care in order for Dad to be safe, 'vulnerable adult' is a good phrase to use. Do keep a record of all meetings, however informal, with names and dates and what was agreed etc. as trying to remember who said what to you and when can be really difficult when you dealing with different departments. I can't advise on the POA as I don't have experience of that but I'm sure someone else will be able to help on that aspect.

    Good luck
     
  7. looviloo

    looviloo Registered User

    May 3, 2015
    464
    Female
    Cheshire
    #7 looviloo, May 3, 2015
    Last edited: May 4, 2015
    Thanks Essie, that's very useful information. I've had to learn pretty quickly about the assessment side of things - this is a needs assessment, right? Which is different from the CHC assessment? Would the CHC assessment come later?

    My sister visited dad today and found there had been a letter left for him, a generic one about having a needs assessment before being discharged from hospital. Dad was confused about it and didn't where it had come from (maybe it was left there while he snoozed). Can they carry out an assessment without informing us? Dad's not capable of understanding something like that...

    When I visit tomorrow I'm taking a copy of the welfare POA and will ask for it to be added to his notes. No-one has asked for our details so far; we had to check whether or not they had our telephone number and they actually had us down as living at dad's GP's address! With the wrong number! I know they are all very busy but if something had happened to him in the first day or two, they wouldn't have been able to contact us :(

    P.S. Thanks also for the advice about talking problems up - I've heard that said before, and I can understand why now that I've had some dealings with the system. We'll make sure the hospital/social care fully understand the situation....
     
  8. Essie

    Essie Registered User

    Feb 11, 2015
    566
    Hi Looviloo Yes a CHC (Continuing Health Care) assessment comes after a needs assessment and separately assesses if someone qualifies for health care to be provided by the NHS as opposed to care being provided by the LA (Local Authority) which is Social Care. As I understand, and apologies if I am wrong, social care is means tested whereas NHS funded care is not but the criteria for CHC are extremely, well extreme!

    This link is a site that will talk you through the CHC assessment and I think gives tips for getting a positive response - http://caretobedifferent.co.uk/paying-care-home-fees/how-to-get-assessed-for-continuing-care/

    Re the bit about letters turning up/contact details being wrong etc etc - oh yes, all so familiar! :mad: A mantra I use for life in general but especially for dealing with anything like this is "never assume anything" - check everything, establish everything and take nothing as 'read'.

    Good luck.
     
  9. Cath59

    Cath59 Registered User

    Jan 23, 2015
    46
    Great information above. One question though is whether or not he would be self funding (assets over £23,750). You did say he had already been looking at care homes. My mother was in a very similar position though we were told she was going to be discharged with an initial four brief visits a day to "see how she got on". She was completely incapable of looking after herself and had enough awareness to be scared of being on her own. Once it was established she was self funding we were pretty well left to our own devices which in some ways was simpler. We were lucky to find a home she liked with a space. They assessed her and she was discharged pretty quickly. Your Dad sounds similar in moving quickly from having very mild problems to being completely confused in hospital. I'm told extra confusion in hospital is usual and my mother certainly improved a lot once she was in the home. Things aren't great now but that's because other health issues came up. If he needs social services to fund him that's an entirely different game of course. Good luck!
     
  10. looviloo

    looviloo Registered User

    May 3, 2015
    464
    Female
    Cheshire
    #10 looviloo, May 4, 2015
    Last edited: May 4, 2015
    Thanks for spelling it out for me - my head's been in whirl! That's a great link and will help a lot :)

    Yes, he'll be self funding but the whole system seems complicated and I don't want to rush into anything without understanding what's going on. Like you, self funding will probably make it easier in the long run, but there has been some talk of LA funded care for rehabilitation and I wasn't sure where this fitted in. One step at a time, I guess. I'm hoping to speak to the social worker and maybe the consultant tomorrow :)
     

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