what is possible at a care home?

Brie

tooldle said:

Does the hospital  have a social work team?

Good question!  I'll ask when we are there tomorrow.

lr1277

This post has turned out much longer than I had anticipated.

My dad was diagnosed with a type of dementia in late 2017. For the last 9 months, he has been eating less and less. At one point as well as refusing to eat he refused to take his medication in pill form. So had to switch to patches and liquids. Patches worked. But he would sometimes refuse the liquid medication.

As mum and I have POA, we asked and he agreed to go to hospital. There we were told that people have a sensor in their throat that detects whether the persion is hungry or thirsty. For some older people this stops working. Nothing we can do about it.

But after a 2 month stay in thehospital he is back home and eating.

Part of that could be some of his medications (prior to the hospital admission) reduced his appetite. So at the hospital they stopped the appetite reducing medication and kept him on essential medicines. They have reintroduced some of the appetite reducing medication one by one, slowly increasing the dosages. He isn't on all the medication he was on before his admission, and of the ones he is on, they are all not at the dosages he was on before.

Just to be clear the appetite reducing medications are intended to medicate other issues. However they have the side-effect of appetite reduction, which in some can be quite pronounced.

Now that he is home, mum is managing with 4 care visits a day, with 2 carers for each visit. They do all personal care including giving him his medication and food. That is because he will refuse medication and food 95% of the time when mum tries to give him some.

On the food front dad has had both Ensure and Forty Sip. If you are not aware, these are small portions of liquid that contain lots of protein and vitamins/minerals (I think). 4 Forty Sips a day is 1200 calories. And he eats on top of that. The advantage of these is because their volume is low, dad tolerates them more than actual food and drink. The GP is now prescribing the Forty Sip.

We were strongly advised to keep dad moving and stitting out. The sitting in a chair is to strengthen his core muscles. Also if he stays in bed all the time, fluids don't drain from his lungs and so infections develop there, which necessitate a hospital visit. So the sitting in the chair helps drain the fluid in his lungs.

The walking is to prevent his joints seizing up and stopping pressure sores developing. If these did develop, it would necessitate another long hospital stay, possibly the kind of stay from which he wouldn't return. They are really bad news apparently. Also moving to the chair, sitting for an hour or longer and moving back helps reduce pressure sores deveoping in the first place.

So 3 of the care visits are to feed him and give him his medication. Also attend to his personal needs. And perhaps move him from the bed to the chair or back again.

The 4th care visit is specifically to get him to do some walking, if he is in the mood. But the carers are very good and are persuasive.

I know OP you are not looking at a home care solution. But for others, we got a hospital style bed, crash mats, commode and a hospital style table that goes over the bed from social services.

Our county doesn't provide riser recline chairs so we had to hire such a chair from a firm that happens to be quite local to us.

As an aside, dad was in an NHS hospital earlier this year after having some falls in a short space of time. I mention this because he had an assigned social worke for 1 month after his discharge and they helped get the equipment I mentioned. After the month was over he was dropped as a service user. So the hospital admission due to not eating and drinking, no NHS hospital would have taken him as it was neither an accident nor emergency. Also this isn't really elective care. So he went to a private hospital. Social workers did not want to help after his private hospital stay. I guess these are the rules they follow.

HTH

elsien

In my area, if the person doesn’t need to be in hospital but isn’t well enough to go home, or there is a concern about how safe it is for them, then if they have health needs they are sent to a short term assessment bed in a nursing home.  While there, the CHC nursing needs assessment is carried out to identify whether primary needs are health/social care or both.
A social worker would not be involved until the DST meeting, and would then step in to do a care act needs assessment if the decision was the person is not eligible for full health funding. Social workers don’t get involved while the person is still in hospital, if it is likely they will be discharged on a health pathway. 

You need to be speaking to the discharge team. 

Having said that, I’m not aware that any of the nursing homes I visit are willing to do IV drips - if that becomes necessary they sent people back into hospital so you need to ask what the long term plan is so that she isn’t bouncing back and fore. 

Spendless

I can only tell you what happened in my Grandmother's case. Some of it is familiar with what you and others have put. It's a few years back but this is the best of my recollection

Nan was taken into hospital in Nov/Dec 2014. I can't remember now the chain of events that led to this but she was suffering from dementia. She had had carers coming in twice a week for about 6/7 months prior to this

 She stayed in hospital until my Mum also got a phone call 30 minutes (max) beforehand on Xmas Eve  saying Nan was being moved to an assessment centre. My Mum wasn't thrilled about the lack of notice as doing this hadn't previously been mentioned (maybe because at that point she didn't have POA either) and also because they were sending someone with dementia to spend the following day which was Christmas in entirely new surroundings. 

During the time at the centre, Nan was assessed. The last part of that was they intended visiting Nan's home  with Nan to see what would be required. They also requested my Mum be present, which she declined to do as Nan believed my Mum was 'putting her in a home'  and my Mum felt if that was the (likely) outcome, it would just make that belief worse. Mum took a phone call later the day that the home visit was meant to take place saying they had decided not to go ahead with it, had judged Nan not capable of  returning home and instead Nan would need to be in a care home. From memory Mum then attended a couple of meetings about it, and she looked round a few care homes before finding one that she felt would suit Nan the best. Nan moved to her care home on Valentine's Day 2015, and is still there.


I hope by time-lining some of this and the order in which it happened is of some use to you. 

Brie

@Spendless, @lr1277, @elsien and anyone else I've missed

Thanks for your comments and advice.  Visited today but didn't get a chance to talk to anyone - think a lot of the staff was in meetings or otherwise engaged.  Did have a nice time helping MiL celebrate her 96th!  She enjoyed strawberries and squirty cream as well as mini cupcakes and prosecco (ok'd in advance).  She's increasingly confused, didn't know who we were a couple of times, asked about our shop (we've never had one) etc.  Claims she's eating all the food she's given (she isn't) and is able to get up and to the loo without help (again, no).  But she was in a good mood and that's the important thing.  I think we'll continue to take strawberries with us as long as they are in season as she enjoys them so much - I'll need to get some disposal dishes as I expect the ones we left at the hospital with the leftovers will disappear - completely understandable.

Flugelhorn

one thing to consider about the fluids is if a decision is made that she won't be readmitted for an ivi unless XYZ happens - much of fluid intake (if that is all the problem is and she hasn't got a high / low potassium or sodium) can be handled by encouraging fluids, sitting with people while they drink, more frequent smaller drinks, fluid charts etc - sometimes easier in community setting than hospital