What are my options now - if any?

[flossielime]

Hi

Some have you may have seen my thread about my dad being in hospital. I'll just put a bit background if you haven't. Dad has moderate AD. He was forgetful but not really confused except at night. He lived at home and managed ok in the day but going out at night was a problem. Since September ish I have had a night sitter and a homehelp to come for an hour in the day.

Dad has always been in very good physical health and extremely physically fit. On 2nd Feb he was hit by a car and broke lower leg (surgery and metal bar put in) and ribs and hurt his shoulder. He has also fallen whilst in hospital and hurt his back and has a staph infection in surgery wound.

So we are 21 days after the accident and he still has an infection, sore shoulder, ribs and back. But have had a call from the social worker today to tell me that Dad wont to walk unaided again (physio told him this) and he needs EMI nursing 24 hour care. I have to say to tell me this in the middle of my working day was rather thoughtful too. I am going to have to toughen as I find so many people surrounding this situation really insensitive.

I personally think this is a really unfair assessment to make when my dad is in so much pain, has an infection and been in 3 different wards. He also on strong painkillers including orimorph. I asked the social worker if we could wait to see if his mobility improves. But it seems as soon as the infection heals my dad will be medically fit to leave and will have to go to nursing EMI unit. And he wanted to know which places I had in mind.

What choices if any do i have here?

 

[garnuft]

It depends what it is that you want.

If it was my Mam and she wanted to come back home...

I would not allow any decisions to be made until she was recovered fully from the trauma of the accident, the surgery, the added confusion of shuffling her around wards and the infection.
I would want a printed report and a meeting with the physio as well as input from an OT.

I would have expected my mother to be still supported while she recovered from the trauma of...2nd of Feb accident ...it's only Feb.23rd now!!!

Goodness me, my OH broke his wrist in a motor cycle accident (was a jay-walking pedestrian actually but that's another story) anyway he needed my support with washing and eating for six weeks and it was 12 weeks before he was able to return to work.

I would work out what it was my Mam wanted, what it was that I wanted and make it happen.

If they decide to do things against the will of your father and you, they will have to justify it, they will need a DOL order and that means safeguarding.

I would say you want a best interest meeting and that you intend to inform the Adult Safeguarding dept. at your local council.

The outcome of all of this could be that your Dad still goes for EMI nursing care and it may well be the best outcome, it could also be that he goes in temporarily until he recovers from his traumas, whatever the outcome...at least you will know you made sure it was done with sufficient regard to your Dad and HIS needs rather than the easiest route for 'concerned' professionals.

Hope he feels better soon, your poor old Dad...he's been through the mill.

 

[Beate]

Well it was the middle of her working day too - there isn't really a better time to discuss this, is there?
Do you have health and wellbeing LPA? Then you have a say in where he lives but a best interest decision has to be made, and ask yourself honestly if you can cope with someone who might not walk again unaided with the help you have now? I would ask for a meeting to discuss options and make sure your concerns are heard, but please listen to their arguments too. Some people here would be very happy if SS agreed to a nursing home for their loved ones.

 

[garnuft]

You don't need health and welfare LPA for your opinion to be taken into account, 'they' are obliged to take your opinion into account if you are a family member/primary carer.

 

[canary]

Is the nursing home seen as part of rehab?
When my MIL fell and fractured her spine she was discharged to a nursing home for 6 weeks rehab. There was also an EMI unit in that nursing home and if she had had dementia she would have gone there.

 

[Pete R]

My Mom was in a similar situation but very different circumstances.

She had a UTi for 5 weeks in hospital and Physio and OT wrote her off for not cooperating. Physically she was deemed OK. They would not accept the monsters climbing up the wall were actually stopping her getting out of bed. SW and hospital said she must go to 24hr Nursing home as soon as possible.

I refused and what seemed to abate their insistence, it took a while, was this paragraph from.......
Age UK FS76
"Section 2 of the 2009 intermediate care guidance stresses that anyone facing permanent admission to residential care should have the opportunity to benefit from rehabilitation and recuperation once their acute treatment is finished and to have their needs assessed in a location other than a busy acute hospital ward.
The term ‘acute hospital ward’ means a medical or surgical ward in a general hospital.

Even if you agreed with their assessment I cannot see any home taking your father whilst he has an infection. When they finally agreed to send Mom to a community hospital they even refused to take her till the UTi was clear (They took out the catheter and 3 days later she was free of torment, amazing no one thought of that earlier) and was no longer constipated.

The day after she was transferred she was a totally different person and later, again another battle, went onto a reablement programme with a view to going home.

If you believe you are doing things in the best interests of your Dad and is what he would want then keep going and don't let them grind you down.

I wish you well.

Not sure if you have PoA but I did NOT at this time.

 

[canary]

I see what you are saying Pete - but the question is: Do the hospital see this a permanent thing or temporary for eg rehab? Flossielime doesnt say in her original post and when my MIL broke her spine she went from hospital to a nursing home for rehab - she too had been told she wouldnt be able to walk unaided again, but they were aiming to improve her to a level that she could go home.

 

[susy]

Flossieme, can you ask to find out more about a placement in an emi place. Go and have a good look round and see what you think first. An acute setting such as a ward is no good for him but the emi place may well rehabilitate him enough to come home. "They" are not going to lock him up and throw away they key.

If things do improve like how you hope then fabulous. I would look at that point if he is happy as he can be or not. Would it actually benefit HIM to come home and would HE and YOU actually fully cope especially as his home may no longer be familiar to him.

Bottom line is, he isn't ready yet, he may be in the future. Cross the bridges that you have right in front of you to the best of your ability and make plans that are changeable for the future.

I hope he comes out soon and recovers from his injuries fully. Best wishes x

 

[flossielime]

Thanks everyone for your kind replies.

The idea to get things in writing is good idea and I think that section of the guidelines will be useful.

I realise that EMI nursing might turn out to be the best thing for him but I just think it is a premature decision. And I think all the moving about is really unsettling for him. I think he would be better staying put in hospital or going home.

My biggest issue I think is I feel he is being written off too soon.

He is not suitable to go into a rehab place as he needs close monitoring and keeps trying to stand up and falling. But if he goes to an home even temporarily he will not get physio. I know they say care staff will do them with him but as my mum is already in a nursing home so I know the reality of the situation. Plus he keep falling in hospital - he fell again today - he needs watching one to one at the moment. They would not have the staff ratio in a nursing home to give him that input.

I wondered about bringing him home (home is fully disabled accessible) while we see if he recovers. BUT he would need 24 hour care and Physio . He does have a private pension and I have some money I could use to fund this short term (a month or two). I asked the SW about NHS continuing care to support some of this. He scoffed at that 'Oh he wont qualify for that'. I cant to even begin to understand how he can say he needs 24 nursing home care and then go on to say oh he dosen't need nursing care. But I know hardly anyone gets it.

As the care accident was due the driving driving with due care I have contacted a solicitor and they have said my dad has a good chance of compensation but that will take a long time, so my dad will not get the money now when it would be most useful to give him choices'.

I have POA.











Beate- I am a teacher and got this call on my lunchtime and had to teach in the afternoon. Never has anyone up to this point even slightly suggested my dad wont walk again. In fact the surgeon and nurses at the first hospital all assured me he would recover physically. So this was a very upsetting shock to have to deal with at work.

 

[flossielime]

What now?

I have spoken to the physio who has informed me that my dad cognition is too poor to understand. He is unable to retain guidance on how to walk with the new nail in his leg from one second to the next.

I have asked the physio to document her findings on my dad's prospect of rehabilitation in a written report. She seems very nice but very reluctant to do this. She is checking with her line manager.

Anyway shocked and upset at further professional opinion that dad wont walk much again I went to visit again after work. I got my dad up to walk (with the zimmer) he walked the full length of the ward (50 meters ish) He was tired afterwards but it was not that difficult to get him to do it. I needed to wait 15 mins as he was tired. But he then walked a further 20 metres to his bay. Physio says he can only walk a few steps.

The ward and social worker want a best interest meeting on monday with a view to discharge.

He wont get physio on a nursing home and is unsuitable for rehab beds.

Do you think I have a right to to say ' ok he can go to intermediate bed in Emi Nursing BUT only if physio is available 5 days week' for the 6 week re-enablement period that those going to rehab unit would get?'

 

[AlsoConfused]

I think it might be important to have notes of this success in walking put down in your Dad's own medical records / hospital notes ... and to keep a record (timed, dated) on your own computer.

Having got these records made, suggest you speak to the Ward Manager and Physio to say that your Dad appears to have more potential for mobility than had been estimated. Perhaps your Dad's apparent improvement in mobility is because as a close relative you know how to communicate with him better than strangers could and know best how to encourage him. If practical, suggest another "practice" with them watching. At that stage, start asking questions about the amount of physio he needs to get him walking as well as possible again .. and try to ensure it happens! Good luck.

 

[flossielime]

I asked the staff nurse who witnessed him walking to document it.

Interestingly a care assistant casually said 3 things
1. Your dad has been too tired for physio the last couple of days
2. Your dad has been really stroppy and unco-operative this afternoon
2. We are not allowed to let your dad walk, he is too much of a fall risk, he has to stay in the chair.

 

[susy]

Is there any progress with your dad flossieme?