Hospital want to discharge 90 year old

RAS

Suggest he goes to the hospice short-term as they are much better at sorting out pain management than hospitals. He may have to move from their into a nursing home.

getmore4less

I have been here twice.

Under no cicumstances even hint that any family member is available.

If the GP, and community care services are poor resist that option as well.

Some hospitals are good at manageing EOL and can find suitable places but some are useless, will sit on it doing nothing letting the bed be blocked if they have no palitive care inhouse.

Do some research for what palitive care is available in the area and see if there is a way to steer the direction of dishcharge to the best.

In the hospital we were dealing with the pain consultants also worked in one of the local palitive care hospices which had a good reputation.

The pain guys were much better at sorting things out than the oncologist.

Also be prepared for the Liverpool care pathway if used in your area, it can be quite a shock.

Goldiegirl

I just wanted to add some reassurance.

My dad died in May 2004. My mum had Alzheimers and my dad was acting as her carer. At the time he died, she was becoming much more than he could manage. She needed 24/7 attention, was becoming incontinent and if she could she'd escape from the house - the police had to be called on at least one occasion to find her and bring her back.

I lived 50 miles away with a full time job, so it was very difficult for me to help on a day to day basis.

Anyway, when my dad was taken to hosptial, my mum went into respite care to start off with.

When my dad died, it was clear my mum needed proper long term care, so she was initially placed into an assessment unit.

But a couple of weeks later she had a heart attack and had to go into hospital. After a week or so she was well enough to leave, but she'd lost her place at the assessment unit. They had a special team of people dealing with the discharge of patients, and it was clear that my mum could not go back home, and it wasn't even suggested that she came to me. I could not provide the round the clock care that she needed.

So she stayed in hospital for six weeks, effectively 'blocking a bed', until another place came up at the assessment unit. They gave her very good care until she could be discharged

The people at the hospital see these cases all the time, and will not discharge someone until they know that there is somewhere suitable for them to go, where their needs can be met.

I'd suggest that you disregard comments about 'if the children WON'T have them'. It's not a case of WON'T - it's can't. Many older people need a high level of care and attention by qualified people in an environment suitable for their needs, they simply couldn't get this at their children's house.

Also, it's very wrong to suggest a hospital would knowingly allow someone to die a 'miserable death', just to get them out of the way

z.n

Sorry to burst any bubbles here but you cannot rely on the system to do the right thing. Suposedly 'terminal' MinL was discharged to an empty house on a Friday night (about 10pm) immobilised in bed despite our desperate pleas not to discharge her at the weekend. F inL was meanwhile bluelighted onto the ward she to be discharged from but she was not told he was there (and nor were we)- they just asked him if they could borrow his keys/ where might the spare key be hidden at home. So in the end they let themselves in and dumped and ran!

She was in an appalling state (bedsores, UTI etc from where she had just been left once they decided she was going home to die (their words!)-we had not seen her for 6 days as every day they had said she was coming home so we had been waiting there for her (50 mile round trip)-it was the stress of this that sent FinL into hospital early Friday morning) and no heating on.

The care assessment had recommended certain equipment that had been delivered (hoists etc) but an incorrect matress (no account taken of her immobility and new bedsores) and no personal care items/food replacements/ feeding equipment at all which caused problems. Carers had been booked to come in three times a day and they did turn up even though it was out of their contracted hours-great girls the lot of them, but the fact they were arranged meant there was no bar to discharge even though the house was otherwise empty and she was immobile laying in bed. She could not even reach for water.

The care package was a disaster as it had been prepared about 5 weeks earlier for a much healthier woman and the carers were stuck trying to implement something that no longer made sense or risk being sacked/sued by straying from the strict wording. The carers were unprepared as were we for the practicalities- for example, the fact she could not eat or swallow at all yet the hospital had provided tablets. I had to take personal responsibility for preventing the carers giving them to her and get (fantastic) help from the local pharmacy to urgently obtain liquid versions instead and administer those. She had no discharge notes and the GP had not been told how ill she was. She was dehydrated and needed antibiotics urgently. It was a major fiasco for a Friday night and the saving grace were the district nurses and GP who once launched into action got her taken back into hospital a week later when it was clear the problem was a UTI, not that she was dying. They called it a failed discharge.

At one point we were told to get a social worker for her urgently as she was unable to communicate but that all took too long as they just assumed alzheimers and that there was plenty of time whereas we were dealing with severe and urgent illness.

The district nurses helped with the next hospital discharge by liasing with their resident staff member at the hospital and I cannot praise them highly enough. Moral of the story-do not assume hospital staff are working to the same moral code or priorities as you would in their position. Keep a very close eye on the situation and make no assumptions.

clairemosa

Your options should include or would be down to bringing him in a nursing home. god speed

pulliptears

Do you have a local Douglas MacMillan? They have a hospice near to me which was incredibly helpful when my Aunt was terminally ill. She would go in for respite but did go in permanently for the last 6 weeks of her life. They also provided nurses to help me when I nursed my Dad at home, as did Marie Curie.

Although you don't want him at home both services should provide you with support and advice so its worth a call, especially to MacMillan who will have trained advisors for this.

I hope everything works out for you x

Mr_Toad

The hospital need to discharge him, there's nobody to look after him.

As others have said, do not under any circumstances give the hospital even a glimmer of hope that he can go home. They will discharge him and everyone involved will wring their hands and say there's nothing they can do.

All they want is to pass the problem to someone else. They did this with my father, discharged him home simply because mum got a bit confused and asked when he was coming home.

Dad couldn't walk and the bathroom and bedroom are upstairs. there was no way she could get him to the toilet or to bed.

The ambulance service were fantastic and it was obvious they didn't want to drop anyone in it. But basically the ward got rid knowing that within hours he'd be back via A&E but that didn't matter he'd be someone else's problem.

Less than an hour after he was taken home he was indeed back in an ambulance and back in hospital.

I had to insist that his notes said the he was not under any circumstances to be returned home no matter what mum said. I made sure that they had my number as first contact and they tried several times to discharge him. Each time I made them read the notes. They even tried to tell me they couldn't find the notes, when I then asked how they could treat someone without access to the notes and threatened to make an official complaint did I get anywhere.

In the end they got a social worker, his GP and someone from the hospital involved and he was eventually transferred to a home where he gets looked after properly.

Mojisola

JKJ wrote: »

1. father in law in hospital with terminal prostate cancer that is also in his bones, he is unable to even sit up without help, is awkward, bad tempered and verbally abusive - partly due to pain, partly because he is not a nice person. He has almost constant blood loss and is doubly incontinent. Consultant says nothing further can be done beyond pain relief

2. Mother in law is 84 and has poor eyesight due to macular degeneration and is worried sick that the nursing staff are talking about discharging him home. She cannot look after him.

3. Their daughter lives 3 hours away, and their son (my DH) dare not take any more time from work or he will lose his job. I have 2 ill parents of my own, I also have cancer and as my parents in law have always disliked me (a huge understatement :eek:) there isn't anything I feel I can do.

So can the hospital discharge him under these circumstances does anyone know? Any advise would be most appreciated.

There should be social workers attached to the hospital who deal with these issues.

My father was in hospital for over two months last year. He was assessed by the ward's social worker, the occupational therapist and a memory clinic nurse to work out what care he needed. Everyone agreed that he needed to move into a care home. When the LA's funding committee tried to set up a home care package, the hospital refused to discharge him into what they all agreed would be an unsuitable environment.

If you aren't getting the right service from the hospital, ask at the PALS office to get things moving.

Our hospice doesn't operate a two week policy either - mostly because no-one can give that accurate assessment of someone's last weeks or months.

I've had two people end their days in the hospice recently. Both were in there for several months from the time they needed that level of care to the time they died.

geoffky

thatgirlsam wrote: »

Nursing staff will absolutely NOT withhold care to anyone on the ward, whether they believe them to be blocking a bed or not.

You want a bet? I have seen things happen on a ward that should not have happened to a dog.
I on the same ward seen a bag that was not emptied on a man who had a catheter in burst.It had blood in the urine and went all over the ward..
Three weeks later the stains could still be seen under the bed...
Oh the stories i could tell...

Mojisola

geoffky wrote: »

You want a bet? I have seen things happen on a ward that should not have happened to a dog.
I on the same ward seen a bag that was not emptied on a man who had a catheter in burst.It had blood in the urine and went all over the ward..
Three weeks later the stains could still be seen under the bed...
Oh the stories i could tell...

That just sounds like dreadful care all round. Not the Stafford hospital was it?

In a good hospital where the care is of a reasonable standard, an old person wouldn't be left without care - if only because they would then become ill and need to stay in hospital for longer!