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Husband can't come home from hospital - Carers UK Forum

Husband can't come home from hospital

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My husband has just entered his fifth week in hospital. He was admitted with cellulitis and sepsis markers and he has leg ulcers which are not healing. He has been on bed rest during his hospital stay and his mobility, which was poor to begin with because of osteoarthritis and poor circulation, has been reduced to nothing. The physios in hospital have been trying to help him to stand, but it's very hit and miss; sometimes they can get him upright and sometimes they can't. Even when they do manage to get him upright, he is unable to move his legs to take a step. They have suggested that a period of rehabilitation (probably 2 weeks) would be the best next step for him, but he is refusing point blank to agree to it. So, they came up with a care plan for him to have carers 4 times a day at home, with a physio visit once a week. He has agreed to that, although previously he has always refused to have carers in the house (and I'm concerned that, once home, he will refuse again). One of the physios came out to the house last week, to check whether we could have a hoist (we can't) and she also checked access to the property. There are two shallow steps leading up to the door into my husband's room and she took the measurements of these.

It was decided that my husband could be discharged on Friday, but the hospital telephoned to say that he couldn't come home because the transport company wouldn't be able to get a stretcher up the steps. They said they would need to send someone out to conduct an assessment and this has happened this afternoon. The result is that there is no way they could get my husband into the house: not only is there the problem of the steps, but there isn't enough room for them to turn the stretcher to access the door and, even if they could, the doorway isn't wide enough for the stretcher to go through. (My husband is obese and the stretcher therefore needs to be wider.)

They said that, if my husband went into rehab and regained sufficient mobility to stand so that he could be transferred to a wheelchair, they would be able to bring him home. I've tried saying this to my husband, but he's adamant that he won't go into rehab and he becomes very angry when it's mentioned. He says they're having a meeting at the hospital in the morning, to try and find another option, but I don't see what else they can do. Everybody agrees that the best thing for him would be rehab and the physios seem to think that he is likely to regain some mobility with intensive therapy, but he's just not listening. He supposedly has the mental capacity to make decisions, so how can we persuade him to do what's best for him?
Hospitals must ensure a safe discharge, if they can't even get him in the house, then going home is NOT an option! The hospital either leave him where he is or make alternative arrangements. As his carer, you should be part of their discussions. To help his legs gain strength, a Circulation Booster might help, depending on his other issues. Might also help the ulcers too.
Thanks for your response, bowlingbun. I know he can't come home unless they can get him into the house safely and they're really trying hard to find a solution. Two more physios came out this morning to check again and they were talking about a different kind of hoist - one that used to be used a lot but isn't used much now. If this is a possibility and if my husband can be transferred into a wheelchair, then they could bring him home. They have to have a meeting with their manager tomorrow morning (she doesn't work Tuesdays) and then they'll let me know the outcome. Goodness knows what will happen if this plan doesn't work!
Jackie,
What about you? Do you feel you would manage with him at home and four care visits a day or do you think it would be better for you and him if he went to rehab?

Melly1
Hi Melly,

To be honest, I'm dreading him coming home! I've only just been coping for around 7 years. His mobility has been poor and getting gradually worse, he has had repeated episodes of cellulitis, some requiring hospitalisation and some responding to antibiotics at home. He also has repeated ulcers on his left ankle which are extremely slow to heal - he's had the current one for well over a year and it's still not healing - as well as occasional ones on his right leg. He has to wear compression wraps on both legs, although he's often in compression bandaging on his left leg because of the ulcers. He has always refused to have carers, saying "we can manage". The first time he was hospitalised with cellulitis (as well as a UTI and sepsis), he agreed to have carers when he came home, but at their first visit he told them he didn't need them, so they didn't come again. Since then, he has refused point blank to have them. He has agreed to them this time, but I'm getting the impression that he thinks that once he's home, everything will just go back to normal. He keeps trying to convince me that he can stand and that he is mobile, but the hospital won't let him be. He still seems to be quite confused and is forgetting a lot of things; he keeps telling me that no one is treating him or dressing his leg, etc.

Quite apart from his physical problems, he's very difficult to live with. He's very demanding, he tries to control everything and he has to have everything he wants. He takes no account of the effect he has on other people and he is very good at gaslighting. He has alienated both our children (both adults, but both living at home with us). I could go on, but I guess you can see why I'm dreading him coming home! At the same time, I'm feeling so guilty.
You must tell the hospital that "at the moment" he needs to go into rehab. Even if he has carers 4 times a day, that still leaves you as the only carer for 20 hours a day! His confusion needs to be investigated before he leaves hospital, especially as his mobility is non existent. Do you think it's the beginning of dementia or...? You know him better than anyone else.
In that case Jackie, you must let the hospital know this. The hospital think he needs rehab anyway. Your home is not suitable for a non-mobile, bariatric man. Care workers four hours a day leaves most of the care to you and you won't be able to move him. Allow the hospital to put in place their original plan.

Don't feel guilty. He needs more care than you can give and if rehab can get him mobile again - you and he will have a much better quality of life once he does return.

Melly1
Jackie, if the house is not suitable and your husband is difficult, then he should not come back home.
Your situation sounds just like mine with my brother, who I 'looked after' for three years until his death. But unlike your husband, he realiized that he needed carers and he was very nice to them, a popular patient.

He was massively obese. He did occasionally have leg ulcers.

Problems included getting a hospital bed, which we bought ourselves, so the carers could turn him without hurting their own backs (they used slide sheets). When I first found bariatric bed suppliers for him he would phone them up and if they couldn't deliver the next day, he turned them down. There were other aspects of his health he didn't accept, and every time we went on a hospital appointment things went wrong. So it was fairly stressful. But I don't think I could have managed if he hadn't accepted it and if our house hadn't been suitable for him. He was bedridden and in one room and I had several rooms, but it's stressful having carers at all, because their understanding of the problems varies.

I'm sorry to read of your situation where your husband is likely to refuse to accept the situation at first, but you are doing the right thing establishing it wouldn't work at home, and you need to get it established
now, while various professionals understand the problems, because it's hard to get help once a situation is established.
It's important to realise that NEEDS are more important than wants.
It might help you come to terms with your situation to write down everything he needed you to do for him firstly, before he was admitted, and secondly, what extra he needs now.

For example, think about pressure sores and ulcers.
If you look at the NHS Direct site, it gives all sorts of useful information.
From memory, patients have to be turned regularly, every two hours. Is this realistic at home? Can he even help you roll over? The carers aren't going to come frequently enough to achieve this goal. How will he urinate and empty his bowels if bedridden? Who will manage this care?
Honestly, I think he needs 24/7 care and he's only going to get that in a nursing home.
I struggle with my weight, he must accept responsibility for what he has put in his mouth, and the consequences. You are not to blame for his weight.
We are all responsible for our own happiness. It sounds like he's not been pleasant for a long, long time?
You have a right to enjoy your own life too. You are wife, not slave or nurse.
Jackie
My circumstances are slightly different to yours. My late husband suffered strokes and vascular dementia. His consultant strongly advised me that a nursing home was in his best interests, and mine too, as he would have been impossible to care for even with some carers coming into the home. It broke my heart and our families too. However, it was his needs that were priority, not my emotions. I feel you must be very strong, and insist you can no longer cope. Your needs are extremely important, and if you dread the thought of him being home with you, then don't. You have nothing to feel guilty about ( I understand guilt!) He will be safer having full time care, and so will you.