Does my father need nursing care?

majorwally

Hi Guys,

My Father (84) is due to have his leg removed through diabetes.
I can't look after him and live some miles away.
He lives in a council flat (first floor, no lift) and gets his pension and a small private one.

Does he need a care home after the amputation?
Who pays for this.
I've had a quick look about assessments but finding it very complex.

Any advice greatly appreciated.

Jackieboy

Being an amputee needn't mean moving to a care home but it may well mean getting a transfer to a ground floor flat or somewhere with a lift.

Jamiesmum

He shouldn't do. But as previous poster said he will benefit from being in a downstairs property (unless he was already housebound?) but even then for health and safety (fire ect) it would still be better.

He will need some kind of help for the first while, carers that go into his home probably. I know an amputee of almost 90 and he does everything himself just has help to assist from wheelchair to bathroom.

How is dads upper arm strength? You will get help from your local adult services and the hospital should be able to put you in to contact with these and get everything he will need in place.

It's very common for fresh amputees to still think they have the limb, so I would personally recommend a home help alarm/life line type of thing. It'll cost your dad himself as far as I'm aware but it means he just has to wear a wristband and should he fall out of bed paramedics will be called.

Go to his next appointment and they should give you a bunch of leaflets and numbers to keep hold of.

PasturesNew

Firstly, there are two situations/terms:
- a Care Home provides care, care is washing, feeding, doing laundry. While people at care homes shuffle about and might have dementia they just need "watching over/looking after" and occasional helping here and there. They'll also have their regular meds etc dispensed - care homes will all have a member of staff shoving the drugs trolley round, this isn't "medication/nursing" it's just the day-to-day type of drugs old people need to take.
- Nursing Care is when their medical need is such that each time medication is given to them it needs a "qualified eye" to do it and to check that the amount is right and spot when it needs changing. There might be, say, complex drugs, or dangerous drugs, or drips etc. That's nursing. Nursing is when nurses are needed to look at things, to check, to inspect, to notice and adjust items of a medical nature.

With a limb missing he doesn't necessarily need either. It depends what he's like. If he's happy to live alone and just "make do" and has mates etc and can sort himself out, then no need for any care home at all.

Moving him might be wise/useful, to a sheltered home, or a ground floor flat, or some supported living, where he can continue to "live his life".

In short, it comes down to what he's like, what he wants. You can choose to stay at home; you can't choose to go into care unless you're paying. You go into a care home when "they" decide it's the only place for you. If you're not paying, you can ask ... but they choose.

FrugalinShropshire

First thing he needs is an OT assessment. That will be done before his surgery to assess his ability to manage. If he is in a first floor flat with no lift that will need to be sorted before surgery. It may be that he will have to be rehoused first. Once he is home he will be in a wheelchair until his stump has healed and he can start rehab. When he gets his prosthesis he will have to show he can manage safely before the phsios let him take the prosthesis home. It is about learning to put the prosthesis on too. He will have stump socks and a stump cast that fit into the leg with a roll up silicone sleeve to create a vacuum. There are lots of things to consider as he lives on his own. With men it is easier to toilet at night using a bottle. Not so easy to get up and put your leg on to walk to the loo at 2am if you are older. The wound may take longer to heal with diabetes and he may be in a wheelchair longer therefore he may have a greater need for a care package. The OT should be able to assess whether his needs can be met in the community.

Savvy_Sue

majorwally wrote: »

I can't look after him and live some miles away.

That's fine, but if your father is of the 'I can cope without help' mentality, then making sure that he and the hospital staff know you are not stepping in to provide care would be wise.

Same goes if your father has the 'my children should be looking after me not strangers' mindset. In that situation both he and the hospital staff need to know that you are not stepping to provide care.

margaretclare

FrugalinShropshire wrote: »

First thing he needs is an OT assessment. That will be done before his surgery to assess his ability to manage. If he is in a first floor flat with no lift that will need to be sorted before surgery. It may be that he will have to be rehoused first. Once he is home he will be in a wheelchair until his stump has healed and he can start rehab. When he gets his prosthesis he will have to show he can manage safely before the phsios let him take the prosthesis home. It is about learning to put the prosthesis on too. He will have stump socks and a stump cast that fit into the leg with a roll up silicone sleeve to create a vacuum. There are lots of things to consider as he lives on his own. With men it is easier to toilet at night using a bottle. Not so easy to get up and put your leg on to walk to the loo at 2am if you are older. The wound may take longer to heal with diabetes and he may be in a wheelchair longer therefore he may have a greater need for a care package. The OT should be able to assess whether his needs can be met in the community.

Thank you for this in detail.

DH may be facing above-knee amputation. Yes, he has Type 2 diabetes but it's not because of that. He had R knee replacement in 1999 which has been absolutely fine, no problem at all, but the L knee has been replaced, and revised...3 or 4 times, can't think how many. In 2008 it blew up an infection which went to septicaemia and nearly killed him. He was admitted again on 9th Nov for 2-stage revision, but only one stage has been done. Now, to cut a long story short, he's been referred to a specialist orthopaedic centre in Oxford and is to have a reconstruction of leg, not just revision. It will mean orthopaedics, plastics and venous all working together. However, if for any reason it doesn't work, he'll have amputation. The consultant at Oxford warned him that because of age-related muscle loss - he's 82 - he may not progress to prosthetics but be in a wheelchair for life. DH has other ideas, and he has a lot of upper-body strength remaining, so we'll see. Surgery on 3rd Feb, much earlier than we could have hoped for.

Some Type 2 diabetic people do still have good healing, depends on general health as well as the diabetes. Smoking is of course an absolute no-no and - thank goodness - DH has never been a smoker. Also, essential to maintain strength in upper body - arms, shoulders, chest etc, to lift own body weight off the bed, out of the chair etc.

Yes, male urinal is a godsend. DH had one from when he had benign prostatic hypertrophy a few years ago now. Oddly enough, we had a home assessment recently and they insisted on delivering a commode, didn't mention a urinal! We managed to get the commode re-collected, unused. Many of the things we were told DH would not be able to do, like using the loo normally, he does!

Much depends on the person, the will to get better, how he sees himself, whether he wants to be helpless, or independent.

HTH

PS: I would have thought that a first-floor flat with no lift is a no-no. Fortunately we live in a bungalow.

KxMx

I think a move to a ground floor place is essential.

Even going somewhere first floor with a lift is not viable IMO, they can break down, he could be trapped inside the flat or even outside if the lift broke while he was out shopping etc.

GlasweJen

I lived 5 floors up (with a lift) when I got my chair. The hospital might send him to a rehab centre for a few weeks to learn to use a wheelchair and how to cope with life sitting down more. Most of the people I was in rehab with were diabetics with amputations

majorwally

Hi Guys,

Just a quick update.

Unfortunately, my Father died a week after the amputation.
Not from the amputation but from Hospital Acquired Pneumonia
He was in really good spirits after the amputation and I think the relief of being pain free for the first time in years really perked him up.
But then 7 days afterwards he started having terrible difficulty breathing. They called us in 6am and he was dead 11am
I still can't believe how quick he went.

Anyway, thanks for the advice.

kpwll

So sorry for your loss, condolences to you and the family.