Nappies

[hamsterwheel]

My 89-year-old father has been in hospital for 5 weeks, due to breaking his arm. As he uses a gutter frame (a zimmer you can lean on) he can't walk without two people to assist, to prevent another fall. A week ago the doctor in the community hospital mentioned an assessment 9 January and, if Dad's arm isn't mended by then, he'll have to have two care assistant for each of the four visits, and wear nappies. As the visits are four hours apart - and longer overnight - he could be sitting or lying in his own soil for hours. I wouldn't have thought that was good on already fragile skin.

Has anyone else come across this? Is this within normal discharge practice?

[LesleyAnne]

Not unusual, my MIL is chair/bed bound as cannot independently weight bear, and is padded all day and night, with 4 daily care visits. Her agency is very good (they do vary) and they check her skin integrity every day, but if the person wants to be at home, 4 daily visits is the norm unless you want to pay for overnight sleep-in carers. Her bedtime visit is normally around 9pm and breakfast visit is 8am'ish, so she has to manage all those hours without getting out of bed.

If its any consolation, the pads they use are very skin friendly, and not quite the same as nappies, but if you are concerned, and your Dad does not have mental capacity to make own decisions, you can insist on care home placement if that would be in his best interests ... even short term whilst his arm mends may be better than going home alone.

[bowlingbun]

What is dad's mental state like? Where was he living before his accident? Whilst I understand he WANTS to go home, he NEEDS nursing care until he gets better, which could take a while. Otherwise, he's going to be calling people to help in between carer calls. How long will these calls be? Long enough to wash him clean, get his meals, drinks etc? Unlikely! Ask for a rehab hospital or nursing home as a temporary measure....or you are likely to regret it!

[G Fraser_1612]

Valid question but point i'd make is would residential care change him o/n unless he was distressed? My guess would be 'no' but others can perhaps clarify.

[hamsterwheel]

What is dad's mental state like? Where was he living before his accident?

He's beginning to have bouts of confusion, though that might be due to an infection. (He's being treated for this). He's rarely awake, but when he is he's forgetful and has no interest in anything. He's been drifting that way since his last stay in hospital, earlier in the year. He has little interest in taking any responsibility for his life.

Whilst I understand he WANTS to go home, he NEEDS nursing care until he gets better, which could take a while. Otherwise, he's going to be calling people to help in between carer calls. How long will these calls be? Long enough to wash him clean, get his meals, drinks etc? Unlikely!

The hospital doctor was talking about him needing 2 carers for each visit. There's no one for him to call between carers. I live ten minutes away but I've reached the point in this where I need to try to bow out of involvement in running his household, as the stress nearly destroyed my relationship with my partner. The problem is, he's not really competent to order groceries/cleaning materials, nor does he have the means to do so.

Ask for a rehab hospital or nursing home as a temporary measure....or you are likely to regret it!

He's in our community hospital, which is rehab. I left a message before Xmas for the SS caseworker to call me, but no call. I guess she's on leave. I'm not due a carer's assessment until the day after the hospital expect to make a decision about my father.

[LesleyAnne]

If his level of confusion would now be detrimental to his welfare in being sent home, even with carers in place, then you need to request a full Mental Capacity assessment. If they deem him mentally fit to continue to exist at home, then they must put the full care package (4 x daily is usually the max) in place before he is discharged. If he is deemed as not mentally able to make his own decisions and choices to maintain his safety and wellbeing at home, you can intervene and request a Best Interests meeting with all concerned - hospital professionals, SW etc, to decide the best way forward for him. This may end up being residential care, and if he fails the MCA test, then you can insist on this as the only safe route to discharge him as he will be a danger to himself and risk a decline in his health, nutrition and daily care if he is left at home alone between carer visits.

If you need to step away, tell them you are no longer able to do his shopping, laundry, household chores etc, as they will assume this will continue unless you make a formal record that you can no longer commit to support his ongoing care on your own.

[D_1706]

Very much depends on the care home/hospital. In principle they should change them if he's awake and aware. When I told the district nurses I would always change a pad if it was used they seemed quite surprised at this. To be fair I usually don't during the night now but that's just one of the compromises Paul's had to accept in order to live at home. In hospitals they often change pads without cleaning the patient or changing wet pyjamas or sheets although they don't even acknowledge they do it, putting it to a one off oversight if they're ever pulled up on it. Whether you should wake someone to change or even check their pad is a more difficult question. Sleep's pretty important too and not being unnecessarily disturbed seems like a good idea to me.

[Melly1]

Some of the children in my class wear pads (nappies,) as they are incontinent. They get them provided free by the NHS. There monthly delivery allows four per 24 hour period. We use wipes to clean the children's skin when their pads are changed. Unless the child soils, we only change the pads once during the school day. They are very absorbent and even if the child has urinated, the pad against the skin is dry. The children in my class are active (very active!) so pressure sores aren't an issue and their skin doesn't get sore. In another class there are immobile children, the staff vary the children's position throughout the day.

Melly1

[hamsterwheel]

If his level of confusion would now be detrimental to his welfare in being sent home, even with carers in place, then you need to request a full Mental Capacity assessment.

Thanks for all the advice.

If they deem him mentally fit to continue to exist at home, then they must put the full care package (4 x daily is usually the max) in place before he is discharged.

He's had this since July.

If you need to step away, tell them you are no longer able to do his shopping, laundry, household chores etc, as they will assume this will continue unless you make a formal record that you can no longer commit to support his ongoing care on your own.

I'm trying to speak to the SS caseworker to do that.

[hamsterwheel]

In another class there are immobile children, the staff vary the children's position throughout the day.

This is one of my concerns. My father only has two positions - sitting in his chair or asleep in bed.