assessment of nursing needs.

soolin

Sorry I have another question as well about Dad.

The hospital are currently doing a discharge/needs care assessment for him and i am allowed to have some input. I understand that if dad needs 'nursing' care as opposed to just social care then I have a chance of getting some of the nursing home fees covered.

However what constitutes nursing care, what do I need them to actually assess and what should I make sure they don't overlook?

Sorry to post and dash but off to view nursing homes now.

margaretclare

The difference is, what a qualified nurse could do.

'Caring' as opposed to nursing, is AFAIK what any family member could do - the basic things like washing, helping to get dressed etc.

What do the qualified nurses in the hospital do for your Dad, that you, for instance, wouldn't be able to do?

Savvy_Sue

sorry about your dad soolin.

I fear you need to look at this thread. sadly you will discover that getting your dad's needs properly assessed and the information passed to you will probably be a battle, but if you know what OUGHT to be happening it's at least possible to see that it does, once 'they' realise you know and won't settle for less.

soolin

margaretclare wrote: »

The difference is, what a qualified nurse could do.

'Caring' as opposed to nursing, is AFAIK what any family member could do - the basic things like washing, helping to get dressed etc.

What do the qualified nurses in the hospital do for your Dad, that you, for instance, wouldn't be able to do?

I suspect it will all be considered social needs apart from the catheter. Even though the current home have been on a course for catheter care they still need to call a qualified nurse to remove a permanent catheter and flush it through every day, that's why they can't have him back. This is why dad goes to hospital so often, even the nurses can't cope with the blockage as dad's catheter bag is nothing but blood and the clots just block up everything so he can't pass anything at all.

The home I've just been to see is unlikely to be suitable either as the only free room is at the top of a flight of stairs and no one seems sure whether dad wil regain his ability to walk or not. If he does walk again then the room is too dangerous for him, such a shame.

Errata

Soolin - If your dad is assessed as eligible for the nursing care component, it will not reduce the weekly fee amount as it's to pay for the extra care he will need. My stepdad's was paid direct to the care home, and pa continued to pay the same amount as previously.

margaretclare

Catheter care is most definitely a nurse's responsibility.

Anyone on a catheter should also be on a fluid chart because it is vital that he takes in enough fluids.

In my nursing career, male catheters were mainly dealt with by male nurses, and I've mainly been in midwifery, dealing with women obviously!!!

However, I would want to know WHY he is bleeding, and passing clots. http://clinispot.blogspot.com/2010/01/bleeding-during-catheterization-of-male.html

You mentioned earlier IIRC that Dad had prostatic enlargement. And bleeding? I would want to know more about this. Doesn't sound right to me.

BTW my DH is going for something called HoLEP in 3 weeks' time. This is done for benign prostatic hypertrophy (enlargement) in older men. Some of the men I've been reading about having this had bleeding beforehand, and it was taken seriously.

soolin

margaretclare wrote: »

Catheter care is most definitely a nurse's responsibility.

Anyone on a catheter should also be on a fluid chart because it is vital that he takes in enough fluids.

In my nursing career, male catheters were mainly dealt with by male nurses, and I've mainly been in midwifery, dealing with women obviously!!!

However, I would want to know WHY he is bleeding, and passing clots. http://clinispot.blogspot.com/2010/01/bleeding-during-catheterization-of-male.html

You mentioned earlier IIRC that Dad had prostatic enlargement. And bleeding? I would want to know more about this. Doesn't sound right to me.

BTW my DH is going for something called HoLEP in 3 weeks' time. This is done for benign prostatic hypertrophy (enlargement) in older men. Some of the men I've been reading about having this had bleeding beforehand, and it was taken seriously.

The explanation i have for Dad is that dad refuses to drink in sufficient quantities to keep his bladder flushed. His current home, whilst absolutely wonderful, admit it is a struggle getting more than a few cups of squash or tea down him a day. He bleeds internally as the balloon end of the catheter permanently agravates his bladder and as he passes very little urine the blood eventually clots and blocks the system.

The doctors have explained this to me twice now and each time they made it sound reasonable but I don't know as it is all disjointed. He has had myriads of scans, apparently they show the prostate as enlarged and solid and permanently blocking his ability to pass urine without the catheter. dad is also not a candidate for any operation , however minor as he also has a heart condition.

The current home call in a district nurse when they realise he isn't passing any urine (it got to be about every 36 hours) and the whole thing would be removed, flushed and a new catheter put it. However about once a month dad still could not pass urine so he would have to go to hospital and they use a double tube system with liquids going straight into the bladder, but even now the catheter bag is a very deep red all the time.

I know I am being lied to, I have even taken to trying to photograph his medical records whenever I get the chance and in some ways I am hoping to achieve something this afternoon with the care needs assessment. I'm getting a lousy migraine though with the worry and am trying to judge how much medication I should take to leave me still legal to drive, but well enough to fight my corner this afternoon.

You've gotta love stress I just want to do what is best for dad

margaretclare

If your Dad doesn't/can't/won't take in enough fluids by mouth then shouldn't he be on intravenous fluids? That would most definitely be a nurse's responsibility, as opposed to a carer's.

I know your Dad couldn't have what DH is to have. There are investigations that have to be done beforehand and these require the patient's co-operation, also his heart condition means he couldn't lie flat on his back for surgery. DH has had biopsy of his prostate to rule out malignancy. External scans will only show up enlargement but will not tell whether that enlargement is benign or cancerous - that could only be established by a biopsy.

soolin

margaretclare wrote: »

If your Dad doesn't/can't/won't take in enough fluids by mouth then shouldn't he be on intravenous fluids? That would most definitely be a nurse's responsibility, as opposed to a carer's.

I know your Dad couldn't have what DH is to have. There are investigations that have to be done beforehand and these require the patient's co-operation, also his heart condition means he couldn't lie flat on his back for surgery. DH has had biopsy of his prostate to rule out malignancy. External scans will only show up enlargement but will not tell whether that enlargement is benign or cancerous - that could only be established by a biopsy.

I don't want to stray into too much medical stuff as otherwise I'll have to ban myself from MSE for breach of rules. However I have long suspected that Dad has prostate cancer and that as there is nothing that can feasibly be done the professionals have wisely decided it is best not to try to hard to confirm it.

I am just grateful he appears to be in no pain apart from tenderness in his abdomen , his only distress is the constant changing of a permanent catheter which must be very nasty indeed.

As for a drip it isn't apparently hospital policy for dementia patients but I am hoping that once I get him into a home again that I can discuss this with them for when he has a particularly poor compliance drink wise to save on the hospital admissions.

Savvy_Sue

soolin wrote: »

As for a drip it isn't apparently hospital policy for dementia patients but I am hoping that once I get him into a home again that I can discuss this with them for when he has a particularly poor compliance drink wise to save on the hospital admissions.

well, without a medical background I can sympathise with the hospital policy: Dad didn't have dementia but towards the end he wasn't always on the same planet as the rest of us, and might have hung on longer if he hadn't yanked his drip out in the middle of the night, presumably because it was rather irritating! and having had tubes attached to my hand and foot lately I can vouch for that: I yanked the hand one out by mistake myself!

it must be very difficult to keep drips in place when someone doesn't know what's what and keeps pulling them out.

ukmaggie45

Soolin, I don't have anything useful to add, but just wanted to say that I feel for you. Well done for doing the very best you can for your Dad. :A It's very difficult fighting the corner for an elderly parent. My very best wishes to you. I hope that you can find a decent Home where your Dad will have the care he needs.