Dispute about hospital discharge & Social Services funding

[Catherine_15042]

My 90 yr old Father has a long list of health issues. He has a visual impairment, extremely deaf, COPD, a small lung module deemed to be cancerous, heart valve disease, atrial fibrillation, heart failure, prostate cancer, a permanently fitted catheter, kidney failure, arthritis in his feet and hands and can’t use stairs any more or walk more than 10 steps without having to stop while he catches his breath. He has regular falls and infections mostly resulting in hospital admission. He lives alone in his ground floor flat with Carers going in 3 times a day.
Recently he had a fall and was found by a carer. He then was found in a very poorly state in his living room one morning and he was admitted into hospital with a very serious cardiac situation. He then had another fall which resulted in a small bleed on his brain and a haematoma on his brain which caused twitching on the opposite side arm and hands. He has become incredibly weak & frail and has said he no longer wants to live like he is and wants to live in a care home. Besides the care aspect he says he needs some company & the reassurance of Carers around for 24 hrs.
The hospital nurses, doctors & Consultant all agree that he needs residential care. Unfortunately his assessment for CHC didn’t bring up a bigger score for him to have a full assessment so it was passed to social services to consider their input to care. They have suggested that he returns to his flat with 4 Carers a day but this does not address the dangerous problem of him falling again when there is no one around especially at night. He can’t press an alarm pendant as he has pour dexterity in his fingers due to arthritis and numbness due to poor circulation. He has previously fallen and not been able to move to pull the emergency pull cord to get help.
Despite him not scoring highly on the CHC checklist the Consultant has refused to discharge him from hospital as she feels he is going into a very vulnerable and unsafe situation. Social Services are not improving the care package to residential care. My Dad would be paid for by social services. So we have the situation where my Dad is technically ready to leave hospital but not to his unsafe situation and social services are refusing to fund him a place in a care home. What do we do next? I’m impressed that the hospital are so caring and concerned for his situation but frustrated by S Servises to take my Dad’s unsafe situation seriously. Help & advice please!

[Chris From The Gulag]

Hi Catherine ... a holding reply until the calvary arrive.

Very quiet on here for the past few weeks.

Hospital discharges ?

From the NHS web site :

What is meant by minimal or complex discharge?

If the assessment determines you will need little or no care, this is called a minimal discharge. But if you need more specialised care after you leave hospital, your discharge or transfer procedure is referred to as a complex discharge.

If you need this type of care, you will receive a care plan detailing your health and social care needs. You should be fully involved in this process.

A care plan should include details of:

the treatment and support you will get when discharged
who will be responsible for providing support and how to contact them
when and how often support will be provided
how the support will be monitored and reviewed
the name of the person co-ordinating the care plan
who to contact if there's an emergency or things don't work as they should
information about any charges that will need to be paid (if applicable)

From your posting , the process has broken down at this point ... NHS and the LA at loggerheads ... not unusual , in fact quite common.

Care plans ?

https://www.nhs.uk/conditions/social-ca ... are-plans/

Basically , it sets out who does what.

CHC not granted ?

Anyone mention NHS Continuing Healthcare as an alternative ?

Main thread for CHC / NHS Continuing Healthcare :

https://www.carersuk.org/forum/support- ... inks-32532

The GOLDEN RULE quoted at the top is your guiding beacon.

In essence , NO care plan ? NO discharge !!!

I trust others will add to this over the course of today.

[bowlingbun]

Lock up dad's flat so that no one can get in. Change the locks if necessary. Then sit back and let the hospital and Social Services fight this out between them. Social Services know that they MUST sort this out, or they will get fined. Dad is clearly very frail and may well be approaching the last phase of his life, when he will be increasingly dependent on others.
I've had many fights with hospitals over our 4 parents!!
What YOU can do is look at the nursing homes nearest to you, and you decide which one you want dad to move into. Talk to the Matron of each home, and check before you visit that they take SSD funded patients.
DO NOT SIGN ANYTHING WITH EITHER THE HOME OR SOCIAL SERVICES.
DO NOT BELIEVE ANYTHING EITHER THE HOME OF SOCIAL SERVICES TELL YOU ABOUT "TOP UPS".

(Both have a vested interest!) Come back here for further advice is needed. Many of us know how tough this all is.
I'm assuming dad rents, not owns the flat?

[Henrietta]

Hi Catherine
Very sorry to hear how poorly your dad is. My dad had similar complex needs and also failed to get CHC. Just a thought , any chance of hospice help- they can help with earlier input sometimes and not just the last few days.
I am glad your dad has the safety net of a caring hospital. If dad were self funding , he would be thrown out immediately and told to pick up the tab of £1500 per week for ongoing full residential care and when the lifelong savings run out to sell the family home to pay for it- the whole system is crashing down it seems.

[Catherine_15042]

Thank you everyone for your replies. It’s helped a lot. I’m just so grateful that the Consultant is refusing to discharge Dad because she thinks his care package isn’t safe. I think they’re worried that he will die. My Mum died suddenly two nights ago so that has been a terrible blow to Dad. We are all devastated. I fear that now he’s so ill and Mum has gone that he will give up on life after her funeral. At least he is safe and being well looked after while Social Services get their act together! It’s also very hard trying to keep up with what’s happening about Dad’s care when we are now mourning Mum and arranging a funeral! Anyway we battle on. Thank you for your help & advice.

[bowlingbun]

Catherine, I'm so, so sorry to hear that mum has passed away. I was widowed at the age of 54, even at that age it was difficult to pick myself up again, so much worse in dad's situation. He simply CANNOT go home to be alone at this time.
You have more than enough to deal with making arrangements for mum. Feel free to ask us here "what do you do about...?" if we can help in any way.

[Catherine_15042]

Hi! Dad was moved from the Acute ward to a Rehab ward luckily in the same hospital as I was very concerned that he would be moved to another part of the city at a time when he is so frail and in grief. He has finally had the full CHC funding assessment and was deemed not eligible for any nursing funding. Since then a Social worker has seen my Dad. Dad was told that he is not sick enough to qualify for a nursing home but too poorly for a residential care home. Needless to say Im livid and have asked to meet the social worker again tomorrow which he’s agreed to! The doctors still insist that they can’t discharge my Dad as he needs 24 hr care and the hospital is now talking again of him being moved to another hospital and that worries me greatly. My Dad is a frail 90 yr old man with a long list of failing health issues, is wheelchair bound, out of his home being passed from pillar to post and only just lost his wife of 66 yrs! The last time he fell 3 weeks ago he suffered a bleed on his brain, and temporary left sided fits due to this trauma. The doctors say the next fall could kill him! The social worker said that Dad could fall anywhere! How crass is that? I replied but if he’s in 24 hr care there’s more chance of someone helping him more quickly than the possibility of him being at home and lying on the floor for hours and possibly dying. I’m so angry with all of this and I keep saying that I’m not taking him back to what I know now is his unsafe flat and I’ve also said that I refuse to allow him to be discharged which I fear I might not have any control over anyway! I am prepared to take this to local councillors and MP but has anyone got any advice for me in the meantime to help me make sure Dad is not discharged home alone to his flat?
The whole thing is a nightmare especially following on from Mum’s death and funeral!!

[Henrietta]

My condolences on your the loss of your mum, such a difficult time to be going through such a battle. It is cases such as your father that make CHC such a farce. Is it worth challenging their decision? CHC is not just for nursing funding but also for social care funding when needed.
I know there are solicitors who specialise in CHC type disputes although I never pursued it myself.

[Catherine_15042]

Thanks Henrietta
I’m meeting the social worker again this afternoon and I will raise that point with him. Im battling for my Dad not to be sent home as he himself doesn’t want to go as he feels too ill! So I’m constantly stating the facts that he’s frail,vulnerable and at home would be unsafe!! It’s a terrible way to treat a very old man at the end of his days!

[bowlingbun]

Look at the LA website, search for "Adult Social Services" then "Complaints". This will go to the County Complaints Office, not the local office. Consider also complaining via email to the Director of Social Services.

If the Social Worker is saying dad is too ill for a care home, get that in writing/email. White lies are OK. Say it "would be helpful" if they could explain briefly in an email, so that you can share this with your cousin/aunt even if they don't actually exist!

If dad is too ill for a care home, he is too ill to go home!
If he is too ill for a care home he MUST be ill enough for a nursing home.
Does dad have an advocate? If not tell Social Services that they MUST give him one before there are any further discussions.
Insist you have one too, as they are clearly not listening to you.

SSD and I have been at loggerheads for years, getting an advocate for me and my son certainly changes the balance of power.

Do not be afraid to say at the meeting "I'm sorry, but if you are not going to have a proper discussion with me, I will leave now" or something similar. Remind them that it cannot be an "unsafe discharge".

Good luck, it's such a horrible situation to be in.