Dad with dementia in hospital - Can they force him home

ian16527

Just been reading the other thread about Care home after a stroke but does not answer all my questions
Sorry for the long post

Dad has mixed dementia (Alzheimer's and vascular) and is getting frailer - he will be 90 in May and was diagnosed in August 23 after having a few falls and I asked for an assessment, although we have known for about 7 years that his memory was getting worse. He lives alone and I visit daily.

I wont go into full details but last week he went next door saying that there were men in the house. Then on Wednesday had fall on the night which I found out about the next day. The house was like a bombsite as he had been looking for something but cant remember. 
I went on Friday lunchtime and he was OK initially but then just collapsed and was out for about 15 secs. I think it was cardiac related but has certainly upset his brain function

He has been in hospital since then, very disturbed since talking gibberish although today a little more like himself. He had a another fall in hospital yesterday evening. 

Speaking to the doctor today they cant find anything wrong and I think they will try to send him home. I don't think he can cope with living by himself in this state due to his memory loss and more so with the frailty. Its a disaster waiting to happen.

Will they have to do a care assessment before they discharge him and can I object if i think its incorrect. I have applied for LPA but it wont be issued untill after the 29th Jan.
He would have to self fund care as he has some savings.

I am afraid of being railroaded by the hospital

njkmr

Sorry to here your difficult situation.
From what you have said no doctor can send your father home on his own.
He is clearly not in a position to look after himself any longer by the sound of it.
You will have to get social services in to assess him and just refuse to take him home if they say he has to leave.
They will assess him in the hospital i would have thought.
Do not allow them to discharge him.

elsien

Even if the doctors can't find the medical cause of his confusion, the hospital still  need to take account of his cognitive impairment and current confusion when deciding whether he is safe to discharge and where. They also need to consider the falls risk for someone who will be living alone - even if carers are calling in there will still be long periods when there is no-one else there.

You probably need to be asking questions as to whether he may have any nursing needs as well as social care needs. In my area, people like your dad would either move from an acute bed onto a rehab/geriatric ward or be discharged into a short term health bed for further assessment. A CHC assessment would be completed in the nursing home and then if his needs fall more under social care then the care act assessment would take place before any further accommodation decisions are made.
But there are different discharge pathways depending on the level and type of need and also geographical area.

So your questions to the ward need to be about what assessments he needs and where/when they will take place. Falls risk, occupational therapy, home environment, nursing needs (DST). 
If you are concerned about unsafe discharge then speak to the ward manager. Raise a safeguarding. Or both.
However although wards can be keen to get people out, they are also aware of their duty of care and safeguarding obligations so I wouldn't be panicking just yet. Make sure everyone is aware of the limited support at home, your safety concerns, and if you need to then ask them to complete a proper capacity assessment around discharge and remind them that if he lacks capacity the law says they have to make a decision that is in his best interests in consultation with you as his son - even if there is no LPA in place they still have to involve you in that process. 

(FWIW your dad's symptoms could be dementia but they could also be a symptom of infection/UTI. Sometimes when the antibiotics have kicked in and there's no physical signs of infection the confusion remains. This can be given a catch all name of delirium - for some people it clears up over time, others stay a bit more confused. Just in case anyone mentions that to you at any point.)

tetrarch

Prepare for a battle, but you need to be holding the cards, or in this case, keys. Has your Dad given his keys to you and will he do so willingly?

They cannot force entry to the home and you cannot be forced to let them in. WIthout the inspection they cannot just release your Dad home. He cannot be discharged anywhere but a safe place such as a care or nursing home.

This buys you some time

In our experience passing a CHC funding assessment is almost impossible if there is not some severe impediment that needs nursing care. Any (apparent) level of dementia does NOT lead to a clinical need that will force the NHS to pay.

The next process will be a financial assessment that decides who and how the care required is to be paid

Regards and best wishes

Tet

lr1277

My dad some of the same things as your dad. I too won’t go into too many details, but here are some pointers/suggestions.
The falls could be related to a fall in blood pressure. My dad’s blood pressure would drop for 15-60s. Initially this might result in a fall, but as the years went on, he would appear unconscious. Usually by the time you got a blood pressure monitor on him, he would have recovered. There are drugs for this condition.
The visions might be scary (to him) or not. Some of dad’s hallucinations scared him and he would take action. There are drugs for this but sorry can’t remember their names. After the dosages of these particular drugs was increased, dad continued to have these hallucinations but they did not frighten him.
@elsien is right about the infections. In my dad’s case, after each bout of infection and recovery, the confusion would be worse. His confusion never got better. Btw my dad had Lewy body dementia. I called it a step down disease as after an infection he might recover to be almost at the same level as before the infection, but usually worse. When I say worse, I mean both cognitively and physically. He would always be less mobile after an infection.
if you want to see more details about my dad, feel free to look at my older posts.
HTH

pollypenny

You will have a battle, which won't be helped if your father is like mine and full of pride, maintaining that he was fine and able to cope. Stick to your guns. 

tooldle

As the LPA is not yet granted, in my area a social worker would be allocated and an assessment of need (sometimes nursing assessment depending on the condition). If the recommendation is some sort of intervention is needed then a best interest meeting takes place. My mum recently died of dementia. She was in hospital with an infection and delirium for four weeks just prior to her death. She was assessed for CHC and not awarded despite not being able to stand or walk, not being able to eat or drink and completely unable to communicate (she hadn’t spoken for a while and used noises to signal her needs), doubly incontinent, sleeping a lot, covertly medicated, basically all the signs of end stage dementia. She was discharged to a nursing home (had previously been in residential care) with a £200 contribution each week towards nursing needs, she died 12 days later. 

I wish you luck and strength OP, for the journey

EnPointe

tooldle said:

As the LPA is not yet granted, in my area a social worker would be allocated and an assessment of need (sometimes nursing assessment depending on the condition). If the recommendation is some sort of intervention is needed then a best interest meeting takes place. My mum recently died of dementia. She was in hospital with an infection and delirium for four weeks just prior to her death. She was assessed for CHC and not awarded despite not being able to stand or walk, not being able to eat or drink and completely unable to communicate (she hadn’t spoken for a while and used noises to signal her needs), doubly incontinent, sleeping a lot, covertly medicated, basically all the signs of end stage dementia. She was discharged to a nursing home (had previously been in residential care) with a £200 contribution each week towards nursing needs, she died 12 days later. 

I wish you luck and strength OP, for the journey

what is the continuing HEALTHCARE need  in  this scenario  above that  offered by a Care  home with Nursing  ( and attracting the current rate of NHS  contribution for Nursing care ) ? there has been  significant misinformation   about CHC and dementia,  often related to cases where CHC funding  was granted for peopel with particuarly  challenging behaviour  to  fund  1:1 superviusion and greater than 1:1   for personal cares   (where for most Nursing home residents  additional staff   are only  required for  some moving and handling  activities )

An LPA may be a problem for the OP  unless it was completed and if drawn up by a professional,  the professional in question was happy with the  Capacity of the OP's Dad at that time. 

the Reality  is that much of the problem the  Acute  Sector   faces with   patient flow is down to a lack of avaialble  care provision in the community whether that  is rehab beds  in step down.,  Care home beds ( with or  without Nursing) or the provision of Domicillary care.  

pre-brexit when  these  issues were not quite as acute  are  suitable care was  arranged saw some people attempting to  keep their  relative in the Acute hospital  despite there being no clinical need for  Acute Hospital care - ultimately  there are legal routes  an NHS trust can go down to  have someone  moved from an acute hospital bed to a suitable placement   be that a care home  or  back to thweir own home with a care package.  

EnPointe

pollypenny said:

You will have a battle, which won't be helped if your father is like mine and full of pride, maintaining that he was fine and able to cope. Stick to your guns. 

Do you understand the Mental Capacity Act ? 

if an individual has Capacity that can refuse / reject/  state they  require  less input than the professional assesmsent  says  and  there  is nothing whatsoever that can be done  in law about it 

tooldle

EnPointe said:

tooldle said:

As the LPA is not yet granted, in my area a social worker would be allocated and an assessment of need (sometimes nursing assessment depending on the condition). If the recommendation is some sort of intervention is needed then a best interest meeting takes place. My mum recently died of dementia. She was in hospital with an infection and delirium for four weeks just prior to her death. She was assessed for CHC and not awarded despite not being able to stand or walk, not being able to eat or drink and completely unable to communicate (she hadn’t spoken for a while and used noises to signal her needs), doubly incontinent, sleeping a lot, covertly medicated, basically all the signs of end stage dementia. She was discharged to a nursing home (had previously been in residential care) with a £200 contribution each week towards nursing needs, she died 12 days later. 

I wish you luck and strength OP, for the journey

what is the continuing HEALTHCARE need  in  this scenario  above that  offered by a Care  home with Nursing  ( and attracting the current rate of NHS  contribution for Nursing care ) ? there has been  significant misinformation   about CHC and dementia,  often related to cases where CHC funding  was granted for peopel with particuarly  challenging behaviour  to  fund  1:1 superviusion and greater than 1:1   for personal cares   (where for most Nursing home residents  additional staff   are only  required for  some moving and handling  activities )

An LPA may be a problem for the OP  unless it was completed and if drawn up by a professional,  the professional in question was happy with the  Capacity of the OP's Dad at that time. 

the Reality  is that much of the problem the  Acute  Sector   faces with   patient flow is down to a lack of avaialble  care provision in the community whether that  is rehab beds  in step down.,  Care home beds ( with or  without Nursing) or the provision of Domicillary care.  

pre-brexit when  these  issues were not quite as acute  are  suitable care was  arranged saw some people attempting to  keep their  relative in the Acute hospital  despite there being no clinical need for  Acute Hospital care - ultimately  there are legal routes  an NHS trust can go down to  have someone  moved from an acute hospital bed to a suitable placement   be that a care home  or  back to thweir own home with a care package.  

I’m not clear myself, other than various professionals expressing certainty that mum would get CHC. Mum was on 1:2:1 care. She was in hospital with an infection and delirium (on anti psychotic drugs prior to admission), other than skin and monitoring her meds and food. GP recommended readmission to hospital within days of her being discharged, I’ve shared the scenario to give the OP some context, both on CHC and the dementia journey. 

ian16527

Thanks for your replies.
Update is that last week they moved Dad to a step down bed. His delirium hasn't returned, but is back to his more normal state of demetia, i.e no short term memory. He knows he is in a hospital sometimes. They are still watching him all the time in case he has another fall. I havent seen him walk about yet.

Had a social worker phone this morning suggesting to send him home with 4 carers a day. I have no problem with this but he is not an early riser and He locks the doors and puts chairs behind them which would cause entry issues. I cannot stop this behaviour.   

If I removed the keys this would send him into a search for them ultimately phoning me. She has not seen Dad and did not realise his level of logical thinking is zero. She said she lives too far away. 

The next suggestion was a temporary care home, which I think is the best step, which he would have to fund. The Social worker
I have no idea if they have done a care act assessment or done any capacity assessment, but I will try and find out today.

My wife has cancer and just being diagnosed with angina( never smoked or drank alcohol) and cant do much now and I have Crohn's disease and just had an ablation for AF so not up to providing the care he now needs. Conversely, if he can get home with carers safely then I would facilitate this as best I could. But we can only do so much but need some life of our own as well, which at the minute sounds selfish but there is only so much we can do. 

Not sure if they have decided he has capacity yet, but the LPA's will be issued after today.

Its very difficult when you dont know the process.