Getting Father in Law out of hospital

[MrsMoose]

He got admitted there after a fall - broken ribs. Something weird also happened to his blood flow afterwards because he has a pacemaker. And then the hospital discovered an aortic aneurysm.

This all happened about 6 days ago. The rib is healing as ribs do. The hospital however is holding onto him - - at least till early next week - because they want to
a) build up his 'baseline strength'
and
b) teach him to use a walking/Zimmer frame

My father in law's confusion seems to be made worse by being in a busy urban hospital where there are shift changes and he's been moved from one ward to another.

His 'baseline strength' isn't great because he isn't eating/getting fed. He doesn't fill in the sheets where you have to tick the various options. Instead he just writes stuff - eg 'Soup' on the sheets. So he doesn't get brought anything. Rather than flagging this up, he believes that he must have eaten already.

And I also don't know whether he can retain the info that physio/OT staff give him about using the frame. His dementia means that it's almost impossible for him to learn new skills.

We want to get him back in to his care home where they will a) feed him properly so that he will get stronger and b) give him plenty of encouragement and reminders re using his walking frame.

I can see that the care home don't want to take back somebody who is fragile and falling all over the place. But we also don't want him getting weaker and more disorientated in hospital. Any advice?

 

[malengwa]

I can't advise I'm sorry, but it's the complete opposite for us when mum was in hospital. ..They wanted her out asap. But then she was previously at home, and is now in an assessment bed in a care home. However very little 'assessing' seems to be happening.
not that this helps you, sorry, surely the care home can meet his needs or are you doubtful that they can?

 

[Amy in the US]

Hi, Mrs Moose. I'm very sorry to hear of your FIL's fall and rib fracture(s) and hospital stay.

I went through something similar with my mother earlier this year (fall, broken kneecap, surgery, hospital stay, rehabilitation facility stay, finally returned to care home) and I know this is not easy in general, and ten times more so with a PWD (person with dementia).

First of all, I would talk to whomever you have a good relationship with and trust at his regular care home (manager, nursing supervisor, whomever!) and see if they can take him back now and meet his needs. They may have an OT/PT person on staff, or may be able to bring someone in, or not. They may or may not be able to manage his medical issues. But you won't know until you ask.

If they can't meet his needs, explain you want him out of hospital--they are sure to understand that. See if they can recommend an in between facility, a rehab unit, a stepdown unit, something like that. I don't know what is in your area and of course it depends on availability of beds, but that might be a way to get your FIL out of hospital and into better care, even if he can't immediately go back to his regular care home.

Or perhaps there is a care home equipped to deal with his current needs (higher level of nursing care?) that you could use temporarily.

As far as the hospital stay goes, I am not suggesting this to be critical or to cause you more of a burden, please believe me, and I'm sure you know this already, but it's the only advice I can give: don't leave FIL alone for one minute in hospital. Insist he be given one-to-one staffing, or a sitter, or whatever they call it, for the times when the family can't be there with him. If necessary, privately hire and pay someone. Order his meals for him, sit with him, and feed him if necessary. Insist on supplements (Ensure, Complan) if he isn't eating well. You could also ask for a consult from the dietician. You can also take him whatever food you think he will eat.

Be prepared to explain to everyone who walks in the room, every single time, that he has dementia and can't accurately self-report and they need to speak to you privately in the hall for information--I had notes written out to this effect that I could hand to staff people in hospital, as I couldn't speak freely in front of my mother. I kept a notebook and wrote down the name of every person I had any interaction with, the date and time, kept track of my mother's meds, the names of all the doctors/consultants she saw, you name it.

Hospital induced delirium is very possible with PWDs. About the only thing you can do is 24/7 company and get him out of there as soon as humanly possible.

There may be a social worker or similar person on staff at the hospital to whom you can speak about some of your concerns.

Regarding the Zimmer/walking frame, all I can say is that it depends. My mother's dementia is advanced enough that she could not understand, let alone remember, that she had broken her kneecap, had surgery, and couldn't walk for a while. Even the pain in her knee, the brace and dressing on it, and being in a wheelchair, were not a deterrent and she would get out of the wheelchair and walk. The therapists were fantastic with her and she would use the Zimmer frame if they gave it to her and prompted her continually, but there was only so much they could do. She also had a lot of trouble doing the physical therapy as it required constant prompting (again, memory and comprehension issues). The Zimmer frame that she is supposed to use, now sits untouched in her room most of the time, although her care home staff are good about reminding and prompting her.

So definitely try, but don't be surprised if the dementia presents barriers.

Mrs Moose, I am genuinely sorry and again, I don't mean any of this to be critical or overwhelming at a time when you have so much to worry about. I hope you and the family are able to work something out for your FIL and that he gets the care he needs. Very best wishes to you and your family.