Elderly Dad in hospital - should he be discharged?

woodyt

Hi there,
My Dad's been in hospital for nearly 6 weeks with severe anemia (caused by bone marrow cancer) and heart issues.
He is practically bed bound due to lack of mobility over this time (not helped by him refusing to get up some days!).
He has blood transfusions every month and since being in hospital it's now every fortnight.
A couple of days ago, they said he's medically fit for discharge.
There's no way he can go home (he lives on his own and I go in everyday) so realistically he will have to go into a nursing home.
His blood pressure is very low and he suffers with atrial fibrillation aswell.
If he goes into a nursing home, will they keep track of his blood pressure and do blood tests to know when he needs a transfusion? Then will they transport him back to hospital?
I guess they consider him a 'bed blocker' because he's been there so long but does anybody have any input into whether it's 'fair' to send him home?
Any advice will be greatly received.
Many thanks.

Flugelhorn

What would normally happen if he was discharged to a Nursing Home is that a care plan would be drawn up to monitor his blood pressure - if it was abnormal they would probably discuss with the GP

Re the blood tests - discharge letter usually gives details of follow up, may ask for blood tests to be done at specific intervals - these can either be taken by the NH staff or more likely community nursing staff. the results can be viewed online by both the GP and consultant. Some areas have nurse specialists who visit patients at home (or NH) and would do bloods and liase with consultant 

I have looked after people who became anaemic because of varuous illnesses and if they needed transfusion then blood was taken by community nurses for cross match and then patient taken to hospital for the transfusion - reduces waiting around as blood is there for them. Transport would be patient transport and would be arranged by the NH or the GP (depends on local policy but TBH people go back and forth between NH and hospital for things all the time)

elsien

What does your dad want to happen? What’s in “fair” doesn’t come into it. It’s about your dad’s needs and wishes and where those needs can safely be met. 

Medically fit just means that people don’t need to be on an acute ward anymore. It doesn’t necessarily mean they’re ready to go home. In those circumstances, people could be moved to a rehab ward so the acute bed is available for someone who really needs it while discharge options are considered. 

What are the hospital saying about his health needs and the plan for those - has he had a CHC assessment. Sometimes people can be discharged into a nursing home on a short-term basis, pending further assessment.

If they are trying to send him home and you feel there is insufficient support in place, you need to raise a concern with the ward manager about unsafe discharge.

gm0

If they don't have a place to nursing and monitoring in a different ward - then they will be super keen for him to be "well enough" in acute medical terms. And for him to "want to" go home to his own home.  And for that decision to be defensible at least at a point in time when they do it - based on his mobility - and assumptions about family and other existing support. 

He has a few better days and is "mobile" to the bathroom (perhaps because they said (to him) he could go home if he showed he could do it). And if they can get him home - they push the issue of getting future LA Social Care (home visits or nursing home options) and any delay in provision of these back onto your family.  Acute bed free. Patient safe (ish). Next please.

Immediate social care upon returning home drops via emotional blackmail default onto you. As the daily family visitor - until you get other help moving. 

If your father agrees to a hospice (prognosis) or a nursing home option - this makes it easier in some ways as you can help him arrange that (and visit/choose - which is an essential step) and maybe you can get it to be a discharge directly to there.  As a self funder with NHS nursing element paid.  You get to choose (from where there are any rooms free now) - it is worth knowing your local care homes and their reputations.  And definitely visiting. 

If he wants to go home and to try care visit style support there - which MANY people do strongly prefer and for good reasons.  Cheaper as a contribution. A lot nicer for the patient while it is practical. 

Having observed it up close - I don't think home care works particularly well for a sole bed ridden patient unless there is an albeit frail partner or a live in relative overseeing the flying visits and patching up the continuity of it. 

People do what they need to do and make the compromises they make to get through it in the way that they prefer.

Best wishes to your dad and to you on your next step on a difficult journey

RAS

Do discuss this situation with any relatives and friends who might visit. On three occasions our oldie was sent home with friends when they visited.

The friends were told the oldie wanted to go home, and said they had friends and family who could support them. We only found out when the friends rang to tell us about their triumph. On one occasion the discharge was not supposed to happen without DT or GP twice daily visits, but neither knew of the discharge, late on a Friday. On only one occasion had any OT assessment been done and that was only to identify adaptions that were needed, but were irrelevant to the oldie's actual abilities and ignored the fact that we'd just discovered the boiler was on the blink, in winter. In all cases, no home care was planned before discharge.

The "supporting" relatives lived 200 miles away and had to make emergency visits to cover whilst home care was organised. 

pollypenny

RAS said:

Do discuss this situation with any relatives and friends who might visit. On three occasions our oldie was sent home with friends when they visited.

The friends were told the oldie wanted to go home, and said they had friends and family who could support them. We only found out when the friends rang to tell us about their triumph. On one occasion the discharge was not supposed to happen without DT or GP twice daily visits, but neither knew of the discharge, late on a Friday. On only one occasion had any OT assessment been done and that was only to identify adaptions that were needed, but were irrelevant to the oldie's actual abilities and ignored the fact that we'd just discovered the boiler was on the blink, in winter. In all cases, no home care was planned before discharge.

The "supporting" relatives lived 200 miles away and had to make emergency visits to cover whilst home care was organised. 

I had similar experiences with my father then years later with my aunt. It's not surprising that patients want to go home, but they very often over-estimate their ability to manage and the hospital is eager to get rid of them. 

EnPointe

woodyt said:

Hi there,
My Dad's been in hospital for nearly 6 weeks with severe anemia (caused by bone marrow cancer) and heart issues.
He is practically bed bound due to lack of mobility over this time (not helped by him refusing to get up some days!).
He has blood transfusions every month and since being in hospital it's now every fortnight.
A couple of days ago, they said he's medically fit for discharge.
There's no way he can go home (he lives on his own and I go in everyday) so realistically he will have to go into a nursing home.
His blood pressure is very low and he suffers with atrial fibrillation aswell.
If he goes into a nursing home, will they keep track of his blood pressure and do blood tests to know when he needs a transfusion? Then will they transport him back to hospital?
I guess they consider him a 'bed blocker' because he's been there so long but does anybody have any input into whether it's 'fair' to send him home?
Any advice will be greatly received.
Many thanks.

In a Care home with nursing there will be a Registered Nurse present  in the building  24/7/365. 

His blood pressure  will be recorded ona regualr basis and many Nurses  can take bloods   for the GP practice to send  to monitopr his blood levels  and to maintain a dialogue with his  Heamatology consultant. 

In terms of 'fairness', the decision, as it has been for  several decades, with regard to medical fitness  is aobut   whether someone requires the levle of  Nursing, Therapy and Medical input that only be delivered inan inpatient environment. 

Nursing homes may  transport  peopel to hospital for outpatient appointments etc , or they may ,  as with someone with at  home and  had  severely impaired  mobility , use the NHS funded  Patient  transport  provision 

EnPointe

RAS said:

Do discuss this situation with any relatives and friends who might visit. On three occasions our oldie was sent home with friends when they visited.

The friends were told the oldie wanted to go home, and said they had friends and family who could support them. We only found out when the friends rang to tell us about their triumph. On one occasion the discharge was not supposed to happen without DT or GP twice daily visits, but neither knew of the discharge, late on a Friday. On only one occasion had any OT assessment been done and that was only to identify adaptions that were needed, but were irrelevant to the oldie's actual abilities and ignored the fact that we'd just discovered the boiler was on the blink, in winter. In all cases, no home care was planned before discharge.

The "supporting" relatives lived 200 miles away and had to make emergency visits to cover whilst home care was organised. 

RAS said:

Do discuss this situation with any relatives and friends who might visit. On three occasions our oldie was sent home with friends when they visited.

The friends were told the oldie wanted to go home, and said they had friends and family who could support them. We only found out when the friends rang to tell us about their triumph. On one occasion the discharge was not supposed to happen without DT or GP twice daily visits, but neither knew of the discharge, late on a Friday. On only one occasion had any OT assessment been done and that was only to identify adaptions that were needed, but were irrelevant to the oldie's actual abilities and ignored the fact that we'd just discovered the boiler was on the blink, in winter. In all cases, no home care was planned before discharge.

The "supporting" relatives lived 200 miles away and had to make emergency visits to cover whilst home care was organised. 

Do you understand the Mental Capacity Act ?  do you understand the basis for  assessing capacity?

Do you  realise that  a Hospital cannot detain someone with capacity 

Do you realise  the MCA  allows  competent adults ( even if they  have vulnerabilities ) to make 'unwise' decisions ?