Hospital Discharge


#1

Hi I’m new to this forum and am in need of advice. My 90 year old father, who lived with me, has Parkinson’s, only diagnosed in 2015, but I suspect it had been going on for some time. Anyway he has recently broken his hip and had a half hip replacement, which went well, but he had other complications which considerably set back his progress because he wasn’t being mobilised. He was moved to the local community hospital for rehab about 2 weeks ago and the Physio said he was doing well and the Occupational Therapist have discussed his discharge with me, suggesting an additional package of care of 4 times per day initially, aiming for about 6 days time. My father has been relatively mobile previously, walking without a stick or frame mostly and only having only one carer visit in the morning to help him shower and dress and I’ve prepared all of his meals, leaving his lunch in the fridge and taken care of household chores, finances, appointments etc. I then witnessed my father walking to the bathroom in hospital last night and realised he is nowhere near where he used to be. He could barely walk and needed a nurse to get him up to the frame and to support him to get him to the toilet, for which he wasn’t quick enough, so had an accident. So now I foresee he will be dischared him to sit at home in his chair all day. Unable to get himself to the toilet, so will have to wear pads or sit in his excrement if the carer isn’t there at a time he needs to go. He will be far less mobile as he will be completely inactive and it seems that this will be the extent of his mobility and life now. Im also concerned about how on earth I get him to appointments, as I doubt he could get in and out of my car any longer. Is there anything I can do to get him further rehab, or to help him get back to the level of mobility he had previously or do we just have to accept this?


#2

Hello Lisa

So sorry about this, difficult for you and your father too. Firstly don’t assume that your father won’t get any better as two weeks after a hip fracture is early days even for younger people. My husband who is 20 years younger fractured his hip two years ago, was sent home 3 days later, 48hours post-op (it was Christmas and beds were closing). The first month was horrendous and included several episodes of urine retention coupled with a grossly swollen leg and poor mobility so I do understand your worries, but 3 months later he was almost back to his former self.

Your father is much frailer than my husband was so you really do need to discuss your fears properly with the discharge team - physio, OT, GP, community services, whoever it is in your area. Do you know if there is an integrated care team in your area? Do not underestimate what is involved for you as well as your father, it was hard for us both physically and emotionally plus weeks of being sleep-deprived. Make it plain to whoever is in charge of the ward that you will not agree to your father’s discharge until everything needed is in place, including continuing physiotherapy - my husband was visited at home by a community-based physio for several weeks.

It is likely that hospital staff have made assumptions about how fit or not your father was before the accident, assume he was always less mobile and slow, so you do need to ensure they know this isn’t so & things have changed drastically for you.

Best wishes & good luck in fighting for what you both need.


#3

Thank you so much for you reply and for sharing your experience, it has been a great help. I have since had a home visit from the OTs and spoken to the Social Service health liaison and the Physio and I have raised my concerns. I should clarify, my father has been in hospital for 5 weeks now since his break, 3 in the general hospital due the complications and 2 in in the community hospital for rehab. We do have a community reablement team, but they aren’t looking to put this in place, just increase his package of care, which in my view will do the opposite of reable him. So my dad seems to be written off in terms of further improvement. Despite having told Social Services contact that he only walked with a frame, if he felt a bit ‘wobbly’ which was rare, she then ‘oh well he’s reached the baseline he was at before, because he was using a frame before’. I did put her straight on this and explained that he is way off how he was before, he only occasionally used it and could get himself up and to the frame and walk around without someone else helping. She then proceeded to say that maybe he didn’t feel like doing the physio and him the question in a leading way ‘How do you feel about the physio is it too much for you? Do you feel it wears you out?’ (Grrr!) Fortunately my dad ‘No, it’s fine I can cope with it’ It seems like the Physio has given her the impression that dad won’t get any better, that the deterioration is due to his Parkinson’s. I then also raised concerns to the Physio and said that I didn’t see any other deterioration of symptoms, just his walking, which has happened before when in immobile in hospital (albeit a shorter duration) and had got back to normal. She said the carers could be instructed to get him up, but I know they’re only interested in safety, so will use the riser chair to it’s full extent not ‘sit to stand’ etc, which does help reablement. I asked if he could have community physio? She said there was a long waiting list and it probably wouldn’t help just a couple of visits a week and asked if I could take him for a walk. I said I didn’t feel safe with his mobility as it is currently, so she invited me in for a physio session today, so I’ll see how that goes and then maybe request that he goes home with CRT in place.

Thank you so much for taking the time out to reply and provide some very useful information and a bit of hope now that we might achieve a better outcome.

Lisa


#4

Hello Lisa. Pleased you are making progress even it not as much/fast as you would like. I find dealing with the services one needs considerably more difficult than dealing with the disabilities of the affected person. If services were available and readily in place, no problem!

Best wishes to you and your father, he’s a lucky man to have a daughter like you.


#5

Thank you. I’m pleased to report that Social Services have now agreed to the community reablement team to come in for a couple of weeks initially, before they assess his ongoing care needs. I’m so very grateful for your advice! Many thanks again.


#6

Brilliant. Persistence often pays! :blush: