Elderly care/safeguarding question (1 Viewer)

Otis · Mar 18, 2023

Don't know if anyone has been in the same boat here.

So, my dad is 93. He lives alone and ended up in hospital after falling twice in two days just before Christmas. He got discharged after 6 weeks, with a care package of 4 care team visits a day. He was told not to walk and for the care team to transfer him about the house for his needs

Since, though (as he won't listen) he has fallen at least another 4 times since. He is so stubborn and if he wants to go to the porch to pick up his newspaper, he will go to the porch. He has been wandering around, convinced he can walk, when he clearly can't.

Anyway, I found him on the floor one day a couple of weeks ago and a social worker just happened to be there at the time, as she had come to discuss a long term care package for him.

She said I had to call an ambulance, as the carers are not allowed to pick anyone up off the floor (they were due that morning)

So this was two weeks ago and he's still in hospital, but they are ready to discharge him.

He is of sound mind, so my question is, what happens if he refuses to go into a home (he has totally intimated that) and the hospital don't feel they can discharge him to an unsafe environment (back home).

Not sure what happens who has the overruling jurisdiction, the social worker, or the hospital.

Anyone had a similar issue/scenario?

What happens if someone is of sound mind, but in hospital and it is deemed unsafe to send him home?

chiefdave · Mar 18, 2023

Feel for you mate, it's a horrible thing to go through. My Dad refused any help, canceling things I'd arranged, until he ended up in hospital and got a dementia diagnosis and they said he wasn't capable of making his own decisions about his long term care.

They said this was a very common issue and there's not much they can do, people just refuse the help offered and end up in the position you're in now with calls for an ambulance and hospital stays.

If he's deemed to be of sound mind and capable of making decisions himself then there is absolutely nothing anyone can do. You can end up in limbo with the hospital refusing to discharge him was they don't feel he will be safe at home but ultimately he can discharge himself if he wants to.

I can't remember what its called but you can get 6 weeks free care upon discharge, its not going into care as such but its supposed to be to prepare you for going back home and being independent, might be worth asking about that. You never know, he might then realise he can't actually cope.

Otis · Mar 18, 2023

chiefdave said:
Feel for you mate, it's a horrible thing to go through. My Dad refused any help, canceling things I'd arranged, until he ended up in hospital and got a dementia diagnosis and they said he wasn't capable of making his own decisions about his long term care.

They said this was a very common issue and there's not much they can do, people just refuse the help offered and end up in the position you're in now with calls for an ambulance and hospital stays.

If he's deemed to be of sound mind and capable of making decisions himself then there is absolutely nothing anyone can do. You can end up in limbo with the hospital refusing to discharge him was they don't feel he will be safe at home but ultimately he can discharge himself if he wants to.

I can't remember what its called but you can get 6 weeks free care upon discharge, its not going into care as such but its supposed to be to prepare you for going back home and being independent, might be worth asking about that. You never know, he might then realise he can't actually cope.

Cheers. Yes, that was my thinking.

My one thought though on that is, if they say he is not safe to go home and he discharges himself, would he still get the package of care? Or would the care team refuse to take him on because it's not safe?

I have no idea

eastwoodsdustman · Mar 18, 2023

Otis said:
Don't know if anyone has been in the same boat here.

So, my dad is 93. He lives alone and ended up in hospital after falling twice in two days just before Christmas. He got discharged after 6 weeks, with a care package of 4 care team visits a day. He was told not to walk and for the care team to transfer him about the house for his needs

Since, though (as he won't listen) he has fallen at least another 4 times since. He is so stubborn and if he wants to go to the porch to pick up his newspaper, he will go to the porch. He has been wandering around, convinced he can walk, when he clearly can't.

Anyway, I found him on the floor one day a couple of weeks ago and a social worker just happened to be there at the time, as she had come to discuss a long term care package for him.

She said I had to call an ambulance, as the carers are not allowed to pick anyone up off the floor (they were due that morning)

So this was two weeks ago and he's still in hospital, but they are ready to discharge him.

He is of sound mind, so my question is, what happens if he refuses to go into a home (he has totally intimated that) and the hospital don't feel they can discharge him to an unsafe environment (back home).

Not sure what happens who has the overruling jurisdiction, the social worker, or the hospital.

Anyone had a similar issue/scenario?

What happens if someone is of sound mind, but in hospital and it is deemed unsafe to send him home?

Had this with my mother in law. They will give you a 6 week package. She went to the spinney cate home near coundin hall park for 4 weeks and then had two weeks of carers at home. The care home was great for her rehabilitation.
If you can go down that route then you might find he enjoys staying in there for a while.

ceetee · Mar 18, 2023

The problem with care upon discharge is lack of carers, at least in my experience

Three and a half years ago my wife broke a vertebrae in her upper back when she fell. Eventually the doctors decided that she would have to wear a neck and back brace which would have to be fitted before she could get out of bed and removed after she went to bed. This had to be done by trained carers as she had to be carefully "log rolled". I was told that the NHS would provide a hospital bed and other aids (which arrived within a couple of days) and carers who would visit 4 times per day. She spent an unnecessary extra two weeks in hospital while they tried to sort out a care package. They couldn't provide the carers, so eventually, despite being, at the time, 76, I was shown how to fit her brace, on my own, a job done by two nurses in hospital. After a few tries I was deemed capable and she was discharged to my care.

I did pay for a couple of local carers, one who I knew, to come in five mornings a week to wash and dress her, but I had to fit the brace. I'm not sure that I would have managed without their help. Well I would have done but it was very tiring.

Deleted member 5849 · Mar 18, 2023

Yeah the six weeks care home with a view to going home is probably your best bet in the short term.

Then cross your fingers...

Flying Fokker · Mar 18, 2023

I’d be pushing for respite/recovery in a care home. The SW will want to avoid conflict and has to, of course, respect your dad‘s decisions providing he is safe. Make it clear that you are not able to provide support…

I’m skeptical, the hospital may well discharge if 4 calls a day is in place/ bed being blocked. If he has a call pendant, who is the first responder. It may be that you are unable to go round anyway. Does he use a frame without wheels? Has he has a O/T and physio assessment?

Was his mobility poor beforehand? If so there is a strong case for the SW to try and get him in care for assessment.

Moving forward? Is any element of his care to be paid for by health? Does he have assets such as a home?

My MIL has been in a back brace since December due to her breaking a vertebrae in her lower back. She has been in a care home/ recovery home since then. Had three falls since going there/ hospital an and e on each occasion but discharged. They sent her back without a back brace and have still not sorted things.

If you are resigned to dad being independent, then so be it. Hospitals take the path of least resistance. Do not be surprised if he is discharged without you knowing!

ProfessorbyGrace · Mar 18, 2023

Otis said:
Don't know if anyone has been in the same boat here.

So, my dad is 93. He lives alone and ended up in hospital after falling twice in two days just before Christmas. He got discharged after 6 weeks, with a care package of 4 care team visits a day. He was told not to walk and for the care team to transfer him about the house for his needs

Since, though (as he won't listen) he has fallen at least another 4 times since. He is so stubborn and if he wants to go to the porch to pick up his newspaper, he will go to the porch. He has been wandering around, convinced he can walk, when he clearly can't.

Anyway, I found him on the floor one day a couple of weeks ago and a social worker just happened to be there at the time, as she had come to discuss a long term care package for him.

She said I had to call an ambulance, as the carers are not allowed to pick anyone up off the floor (they were due that morning)

So this was two weeks ago and he's still in hospital, but they are ready to discharge him.

He is of sound mind, so my question is, what happens if he refuses to go into a home (he has totally intimated that) and the hospital don't feel they can discharge him to an unsafe environment (back home).

Not sure what happens who has the overruling jurisdiction, the social worker, or the hospital.

Anyone had a similar issue/scenario?

What happens if someone is of sound mind, but in hospital and it is deemed unsafe to send him home?

Having been in the Care Sector (albeit in Wales where we have different legislation), I haven’t come across this directly, however the health board and local authority will not bend if a person is deemed to have capacity. The legislation is very rigid in this respect. And in some cases, unworkable, but I digress.

Like it’s already been stated by previous posters, and I can only echo what they’ve said, he will probably be transferred to a residential/nursing home for short term respite during his recovery. Until he’s assessed and deemed ‘fit’ to return home.

If you haven’t already, I’d recommend perhaps applying for a Lasting Power of Attorney, both health and financial parts, as when the time comes and your dad ISN’T capable of making critical decisions regarding his care (severe illness restriction or onset of dementia) you will have that safety net to fall back on, and be able to legally represent his interests.

The current system for Deprivation of Liberty safeguards (DoLS) is due to change here in Wales, and it may have changed already in England, and this is only applicable to someone who has not got mental capacity and have their interests and care decided for them in a care setting (I think this is accurate, as it is here in Wales I believe) but again, until the dog has bolted, nothing will be done to catch it I’m afraid.

I’m in a similar situation with my own dad, believe it or not, he won’t even accept carers or his social worker, and I live 200 miles away.

If an Occupational Therapist hasn’t assessed him for aids and whatnot, I’d recommend that too, which the last poster touched on. They tend to get things done a lot quicker in Warwickshire and the West Midlands than they do here and they have access to stuff like watches linked into a call centre remotely, so that they can monitor him and check if he’s fallen etc.

Sounds like he’s a pretty high fall risk, though. Dangerously high. Like the previous poster said, another mobility assessment might be needed.

Otis · Mar 18, 2023

Flying Fokker said:
I’d be pushing for respite/recovery in a care home. The SW will want to avoid conflict and has to, of course, respect your dad‘s decisions providing he is safe. Make it clear that you are not able to provide support…

I’m skeptical, the hospital may well discharge if 4 calls a day is in place/ bed being blocked. If he has a call pendant, who is the first responder. It may be that you are unable to go round anyway. Does he use a frame without wheels? Has he has a O/T and physio assessment?

Was his mobility poor beforehand? If so there is a strong case for the SW to try and get him in care for assessment.

Moving forward? Is any element of his care to be paid for by health? Does he have assets such as a home?

My MIL has been in a back brace since December due to her breaking a vertebrae in her lower back. She has been in a care home/ recovery home since then. Had three falls since going there/ hospital an and e on each occasion but discharged. They sent her back without a back brace and have still not sorted things.

If you are resigned to dad being independent, then so be it. Hospitals take the path of least resistance. Do not be surprised if he is discharged without you knowing!

Right, so he has a pendant alarm. The contact on there is his neighbour, two doors down, but he is not a well man himself, so it's not a great choice, but no-one else lives locally.

He has a couple of frames. One with wheels, one without.

He has a fused door though, so his left foot is almost at right angles to his leg. He was in hospital in St Cross for a while around Christmas time and they said there was nothing they could do really. He shouldn't be standing at all. As soon as he plants his foot, his leg gives way before him.

So, he was discharged with 2 carers, 4 times a day, because they said or would need two carers to move him about.

He has had the OT assesments. They say he is for to be discharged, but only on the condition that he would try to walk. He agreed, but had zero intention of abiding by that. That was just his way of getting out of hospital. The physio says they cannot do much with him at all.

As for paying, he was actually within the 6 week free care period from the last time he fell and was in hospital.

Does that restart if he has gone back into hospital? A new fresh 6 weeks? I have no idea.

Thanks for all the help everyone. It's been great advice/info .

Otis · Mar 18, 2023

Oh and yes, his mobility has been poor for some time.

eastwoodsdustman · Mar 19, 2023

Otis, my mother in law was in st cross and they were a waste of time. She went backwards whilst there. It was only at the care home that they worked with her and got her mobile.
The idea is that the 6 weeks care is to free up hospital beds so i would hope he should get it again. Can you speak to the hospital or the Occ therapist about it? Im sure they have a duty to ensure hes well enough to leave hospital.

Otis · Mar 19, 2023

eastwoodsdustman said:
Otis, my mother in law was in st cross and they were a waste of time. She went backwards whilst there. It was only at the care home that they worked with her and got her mobile.
The idea is that the 6 weeks care is to free up hospital beds so i would hope he should get it again. Can you speak to the hospital or the Occ therapist about it? Im sure they have a duty to ensure hes well enough to leave hospital.

Cheers and yes.

My dad did go backwards at St Cross for sure. They transferred him there for rehabilitation, but he went backwards and got worse unfortunately

ProfessorbyGrace · Mar 19, 2023

Otis said:
Oh and yes, his mobility has been poor for some time.

Just wanted to reiterate, in case you didn’t see in my post, mate, about an LPA.

Sounds to me as though some time on respite (in a residential/nursing home) may actually help him, and if that comes, please ensure you’ve gone over the care plan yourself - too often I’ve seen elderly people come into care homes and the care plan is just miles off, and then the entire legislature on person centered care is unfulfilled.

As for the 6 weeks hospital stay period, that can be for the expert to answer. lol

Otis · Mar 19, 2023

ProfessorbyGrace said:
Just wanted to reiterate, in case you didn’t see in my post, mate, about an LPA.

Sounds to me as though some time on respite (in a residential/nursing home) may actually help him, and if that comes, please ensure you’ve gone over the care plan yourself - too often I’ve seen elderly people come into care homes and the care plan is just miles off, and then the entire legislature on person centered care is unfulfilled.

As for the 6 weeks hospital stay period, that can be for the expert to answer. lol

Cheers. Yes, I saw about the LPA.

Flying Fokker · Mar 19, 2023

MIL also has dementia. LPA was done just in time. She’s 94 now but we’d seen signs 3 years ago. LPA granted 18 months ago. Health LPA generally less critical as NOK are consulted regarding issues such as DNR’s during the hospital stays/ medical efficacy.

LPA Finance may be appropriate where the person has difficulty managing money etc/ making an informed choice On financial issues.

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