My step father (74 with dementia) fell last Friday and broke his hip. The surgery was successful and I’ve just been given forms to fill in about the height of chair, bed and toilet. I’m pretty clueless as to what happens when he leaves hospital. I also look after my mum (89, dementia & Alzheimers) so I need to be able to hit the ground running, so to speak.
Can anyone explain what I should expect and what I need to do.
YOU should not be dealing with aids forms. The Occupational Therapist must do this after a home visit. You must have a Carers Assessment! How can you keep well and look after mum and dad?! Tell them dad needs Reablement Care in a nursing or care home for a couple of weeks. No one can be forced to care. Stick up for yourself.
Thanks, bowlingbun - is that standard practice everywhere?
The note attached said he will not be able to reach the lower part of his body for 12 weeks, but says nothing about his ability to walk, climb stairs etc. Perhaps I’m jumping the gun and someone will contact me and explain everything. I just panicked when I saw the forms and thought the hospital was getting ready to discharge him.
Tracey - I have had two hip replacements one at age 30 and one in my 40s; the first few weeks after surgery are tough.
I honestly don’t know how you’ll manage to support your Dad and your Mum. I agree with BB, it would be a good idea to push for a rehab placement for him - not in a care home - but a rehab unit/ ward etc
It’s essential he does his physio regularly after a hip replacement and practises his walking. What was his mobility like before the op? He will be walking with a Zimmer frame or crutches when he comes out. Unless things have changed, he will have restrictions in place hence the potential need for chair and bed raisers and a toilet frame/seat. Does he have to go upstairs to use the toilet/ bathroom / go to bed?I found stairs doable but not easy and I was much younger than your Dad, I was very glad of our downstairs toilet.
It varies from hospital to hospital but many prescribe an anti clot injection to self administer daily, he will also likely have surgical stockings that will need putting on for him. He won’t be able to bend etc beyond a certain point to protect his hip from dislocating. I had a sock putting gadget (didn’t work with the stockings), grabber stick, perching stool, special trolley, gadget for lifting my leg into bed …
Decent pain relief is needed in the first few weeks.
I will enquire about a rehab placement. I know the hospital has a unit but not sure how to go about organising. Up to now the only people I’ve spoken to are the surgeon and ward staff.
Hopefully physio will get in touch in the next day or so. Perhaps they will let me come onto the ward to observe their physio routines as he won’t remember.
I do have a downstairs toilet but his bedroom is upstairs - how difficult did you find it getting up and down the stairs? And what about getting in and out of the car?
So many questions and really grateful to be able to learn from your experience. x
Looking after 2 parents with dementia and one immediately post-discharge with serious mobility issues requires an assessment as per BB & Melly’s advice.
I completely agree with them that you shouldn’t assume or take on the responsibility automatically - the hospital may push for this because their goal may be (as I’ve experienced) to ensure minimum thresholds & care are met to reclaim the bed…sorry to be so cynical but experience dictates that you need to advocate for support, get your local services & GP activated.
I’m afraid to say it’s a postcode lottery about how supportive services are, & how connected they are. My mantra is to never assume and never ‘expect’ that things will be joined up, comms connected or that things will happen automatically. So Please, don’t defer to ‘expertise’ you know the needs of your step father, your mum AND what you can manage at home better than anyone else!! I’m polite but also straight, direct, and bottom-lining things ‘so just to be clear…’ all the time
To that end - here are some links I saw recently here on the website:
on discharge problems
Sorry to say discharge was 99.9% of the time problematic for each of the numerous hospitalizations that my Dad had …the very minimum I tried to get
- details medications ( what, when to take it, with/without food and how many times he could /was expected to take it in the day)
- what & when he was last given medications in the hospital - blood thinners or others
- blood results (haemaglobin)
a checklist: Coming out of hospital checklist | Carers UK
What to expect FAQs post discharge Coming out of hospital | Carers UK
As well as the physical physio and exercise, I think the change in the routine, disorientation and frustrations are likely to compound the dementia for both of your parents. Making your caring for them even more intense & difficult and highly stressful…which I’m sure you already realise.
Dementia UK & Admiral nurses, may be able to help provide advice and support - hopefully actual practical aid too. I’ve sometimes called Maggies - who are focused on Cancer support but I find that they are well connected with support organisations and in-home care options.
Before you try and make things work at home take a look at the info - I’ve not looked through it all but I hope it arms you with questions for the medics, physio
Can you call your GP practice to get them looped in? I hope this helps arms you with more info. I’m sure others will add more real-life experience too.
I hope you have some friends or other support to lean on as well as this forum. take care.
That’s an awful lot of info for me to delve into and I’m really grateful. I’m going to ring my GP, who is amazing and see if the can support me. You’re absolutely right that I’m stressed and panicked. I will reach out to see what help I can get.
Many thanks for taking the huge amount of time and effort it must have taken to compose your message.
Morning Tracey - you’re very welcome & pls don’t worry it didn’t take me long. I’m glad to hear your GP is supportive - phew! I hope you don’t get too overwhelmed with all that info. If you need someone to talk to like I mentioned the Admiral nurses of dementia UK could poss help: Admiral Nurse Dementia Helpline - Dementia UK I haven’t used them for a while now but just talking & soundboarding could be good?!?
With all the caring, calling & running around, don’t forget to look after yourself too! especially in this heat!!
I’ve had a phone call from the hospital this morning from someone called Ruth - apparently she left the forms for me. I queried if someone was going to come out to the house and she said no, they don’t do that. She said that if the chair, bed, toilet etc were not high enough then they would send equipment. I asked about him getting in and out of a car and she said just get a cushion. I forgot to ask about him going up and down the stairs, the I did tell her his bedroom was upstairs.
Based on the conversation I asked if step dad was going to be discharged from hospital directly home and she wasn’t sure. I told her I was already caring for my mum with mobility issues and didn’t feel comfortable with him coming straight and wondered if he would be able to go to the rehabilitation unit at the hospital and she said she didn’t know. She is going to get Jackie to ring me. Had to ask who that was and she said the discharge nurse.
So I phoned my GP and told them the situation. They had not received anything from the hospital. They told me that I can refuse to accept him home and that they cannot argue. If he didn’t have relatives then they would have to make alternative arrangements. Also said that I shouldn’t feel pressured or guilty and to contact them again if I need to.
So no Carers Assessment either???
Ummm I do wish hospital nurses/physio would say who they are, without you having to prompt! As predicted it all sounds patchy. So I’m glad you got hold of your GP and they’re ‘in your corner’.
My overall thought I’m quick-replying here before I’m offline …perhaps @Melly1 or @bowlingbun or @Charlesh47 or @Chris_22081 could offer thoughts (given their comments on other posts & experiences ) -
The hospital Doctor on morning rounds would ‘decide’ if your step-father is well enough to leave. Ask what criteria determines a poss discharge? Specifically - state of health and mobility (I assume physio/OT inputs to it). Then community care support assessment needs to be done
Understanding point 1, and quite rightly, refusing a discharge to home (for all your sakes & what’s best for him) moves the decision to - can he stay in the ward or is there a vacancy at a rehab ward or somewhere-else & for how long? What set of criteria in terms of the state of health and mobility determines where he’ll be placed? I’m thinking it may be based on his speed of recovery (mobility, pain, exercise etc) so far. Plus, dependent on how challenging the dementia is, how mobile he is & his ability to exercise with pain …ie. this may not be a few days but couple of weeks?!?
The reason I’m doing this stepping-stone thinking is that you may need to think with your GP about getting clarity from the hospital on criteria and places where he can rehabilitate, with a time-frame in mind.
I’d think proactively about & decide with GP/Admiral nurses - when & under what circumstances would he & you be ok for him to come home…carers at home, ability to climb stairs!?!.. something you’ll need to consider
I’d prod at these questions with the hospital - doctors as well as nurses, so no automatic assumptions of returning home are made. Perhaps your GP can offer opinions of where exactly your step-father could rehab and for how long?
I’m saying all that because I’d recommend creating a space between him being in hospital and you preparing the house with equipment……once the equipment is being ordered it’s difficult to step back into an interim-rehab solution…if you get caught in heights of toilet seats they’ll focus on discharge to you & not a rehab ward…hit pause, breathe and ask some questions…Right now your Step father is in hospital and ok.
My concern for you is that the natural default scenario - without a proactive pause is assuming a discharge home & auto-ordering stuff (that doesn’t even fit!)
Victoria, thanks for linking me in. I have probably some of the most recent experience of hospital discharge as it is only a week since Graham was sent home from Bath.
My advice is to check the link to the document from CarersUK about Discharge from Hospital. I wish I had read it sooner, but thought I wold be OK.
DO NOT assume the O.T. at the hospital knows what he/she is talking about and INSIST on a Home Visit to check the circumstances before you step-Dad is discharged. We did not get a home visit and as a result the stupid woman order the wrong equipment and that delayed Graham’s discharge by five days Be VERY clear what YOU can and cannot do and what you are NOT prepared to do for him. Don’t be shy about saying NO as it is your RIGHT not to be a Carer even though you may feel guilty about saying no. As BB has said it is NOT YOUR JOB to fill in forms and work out what equipment is needed for him - Professionals are TRAINED AND PAID to do that. Someone is passing the buck!!!
BEFORE discharge ask to see IN WRITING, what provision HAS BEEN ARRANGED for after care - not what MIGHT be on offer. He should have a right to home phyio and probably O.T. visits to ensure he is managing and to give advice on exercise, physiotherapy and to check the equipment he has is suitable in case he needs more or different things.
After Graham’s stroke 18 months ago we had GREAT support from physio’s and OTs for six weeks. This time NOTHING was put in place.
As has been said YOU are entitled to a Carer’s Assessment to check what YOU need (NOT HIM!) and how your health and welfare is likely to be impacted and how you can be supported. DO NOT be afraid to ask for the moon! They can only say ‘no’ and if you dont ask, you won’t get. The same with anything you can think of which would make life better and easier for him.
Consider personal hygiene of bathing/showering/general washing and toileting. How much are YOU prepared to help and how much do you need ASSISTANCE with? Given his age they should be providing Care Support at home and that is something you need to watch carefully. If they are supposed to visit and spend 30 minutes helping him - don’t be fobbed off after ten minutes when they say they are late for someone else. Make sure that they help him wash properly and not like someone local to me ‘gave a quick wipe over with wet wipes and left’…
If when reading all this you dont think yo can manage - say so ! As Victoria has commented - ask for some ‘half-way house’ so he is helped to become more independent again before being returned to home when you might struggle.
Again I agree that a conversation with his GP (you may need to get him to signa Consetn form for GP etc to discuss him with you and that can be a simple note something along the lines of ‘I Consent to - your name - being involved in all discussions concerning my Health and Welfare until further notice’. Ask the GP about District Nurse visits and what else the Practice can do to help - AND - get yourself registered as his Carer and get YOUR GP to note on your records that you ARE a Carer.
Your local Carers Support Centre/Service should also be able to help with guidance and accessing local services. Regrettably many are not obvious and are not proactive so you have to get in touch with them.
On the forum we hear so much, and then often we moan, that carers are not given enough support on Discharge. The hospital wants the bed-space and Ward managers are under pressure to move people out to avoid bed-blocking, but this MUST NOT be at the expense of the quality of life of the patient.
Please ask for specific help with queries as we have a host of experience on here and can alays give pointers.
Also let us know how you get on - it should not be a battle, but I fear it often is. Best wishes to you and keep strong.
to be honest Tracey a normal cushion will probably not be much help ! When my Mum had knee replacements someone suggested a plastic bag so she could “slide” in and out of the car - not a good idea as if I’d had to do an emergency stop she would have slid right off the seat. I found a “rotating” cushion on Amazon and that worked well.
My mum lived 6 miles away from me, and after major surgery, I’m under strict instructions never to care for anyone ever again. After months in Royal Bournemouth, I was told by the charge nurse there that even with a live in carer, mum was too frail to live at home any more. She was then transferred to a “Rehab hospital” just at the end of my road. They then said mum had been transferred to them with undiagnosed MRSA, so she was in her own room, being barrier nursed, for a while. Ward Sister decided mum was bed blocking. She told me that she was sending a hospital bed to mum’s house, so mum could go home, without anyone living with her, she couldn’t even roll over in bed!! I told her that wasn’t acceptable, but she went ahead anyhow. I was TOLD when the bed was going to be delivered, I was the only one with a key other than mum, but I didn’t go over. Sister was very cross indeed, said if neccessary she would go over and open the door herself. I said what she didn’t know was that mum had TWO front doors, an inner and an outer, and I was the only one with BOTH keys. From now on I would ensure both doors were locked!! 3 days later I had a call to say mum was bleeding badly, and if it didn’t stop, she would be dead soon! That was sorted, mum again ready to be discharged, in their eyes, but still no bed, sister still cross. Then another phone call, more bleeding. I made it VERY clear that mum was NOT going home. Mum didn’t want to have to poo in a pad and have to wait like that until a carer came. Then I had to find a nursing home bed. I am telling you this so that you are not surprised when you are bullied!
As to the height of the aids etc. tell them very clearly that this is a matter for qualified occupational therapist. Surely dad has one already at the hospital? If no one is listening to you, make an immediate formal complaint about an unsafe discharge, and if dad has a fall on the stairs because he can’t work out how to do this properly with crutches, you will sue them for negligence!
Goodness, that’s terrible for you and your mum and must have strained your relationship with your sister. I do hope your mum is safe and settled. My own relationship with my sister is a bit of a rollercoaster. She is still working and only sees mum and stepdad for a few hours after work on a Wednesday- my brother in law is retired and has them on a Wednesday to give me a break.
This afternoon she has offered for them both to go and stay at their home for a while when he leaves hospital. It’s a very nice gesture, but she won’t be doing all the work - it will all fall on my brother in law and actually contradicts my point in that it’s too difficult to care for two people with mobility issues. I’m not going to mention this to the hospital and I plan to push for rehab.
Got to admit, that made me chuckle. Some suggestions clearly are not thought through are they? I will have a look for rotating cushions though - might even help my mum.
Many thanks for all your advice Chris. I think I’m going to write down a list of questions so I’m better prepared. I hope Graham is now fully recovered and you’re both enjoying life to the full. I’ll let you know how I get on. xx
Thank you so much Victoria. I feel so much better prepared now, hopefully not for battle, but let’s see what happens. x
Hi and good luck. come back if you think any of us can be more help.
Unfortunately Graham is not well and his recovery will be long and slow and probably not full. They thought this latest was a second stroke but have ended up saying ‘probably’ postural hypertension. Only treatment is to TRY to lower his BP and that takes time and is a balancing act so it doesn’t drop too far and then when he stands up it crashes (as happens now) and he collapses and or blacks out.
Life’s fun isn’t it? Not what we planned for his/our retirement!!!
when I was in hospital I was taught how to get in and out of bed, up and down off a chair and had to prove I could do stairs before discharge. However, these days things are different and they just want people out ASAP.
The stairs took effort and in the beginning I only did them morning and evening. I went upstairs earlier than usual due to being tired and the pain feeling worse in the evening.
Getting in and out of the car was very difficult in the early days after my op and I felt every bump in the road. After my first one I came home in an ambulance and in all honesty your step dad would do better having patient transport too.
His speed of recovery depends on how fit he was before he broke his hip as well as the follow up physio. Bear in mind people used to be kept in hospital for ten or more days when I had my first hip done; nowadays it seems to be 3 to 5 days after the op!