Questions/considerations: home care v nursing home care

Baby01032012

Hi all, many thanks for taking time to read this.

My dad is 82 years old. He has been in hospital for nearly 2 months. He will no longer be independent in his own home. Recurring infections and very poor mobility.

Ideally I'd have medical care for him at home. However given his needs a nursing home may be best. What questions or considerations do I need to give to decide which is best for his needs. What do I need to ask agency or nursing home?

Meeting hospital med team, social worker etc this week, what should I be asking them?

Sneidi7

The social worker in the hospital will be your main support and help you and your dad with every step of finding a nursing home. One thing to bear in mind is that your dad needs to be on board with going into a nursing home and consent to the fair deal (considering you will be applying for this).

Most nursing homes will come in and assess your dad once all the paperwork is through, the main things to bear in mind are what your dad likes, does he like activities, private room, does he have a cognitive impairment, location, staff. There is a list of nursing homes on the hse website, you can contact them and request to be shown around, also HIQA reports are available online. The main thing to follow is your gut, some of the nursing homes are purpose built so quite clinical and hospital like, some are converted houses, some are family run, these are all things that you need to experience. Also word of mouth is helpful to point you in right direction.

If you have any questions or concerns your social worker will be available to help.

Best of luck

Baby01032012

Many thanks for your reply.

I've been dealing with the medical team and social worker, well actually 3rd social worker as they keep switching them.

Home help app has been signed and funding applied for, will take another month given the level of funding needed. Started to look at nursing homes as realistically having my dad at home even with high level of care day and night may be high risk, plus the hospital have been against it.
We looked at one nursing home in great location near to home. A vacancy arose, my dad was assessed and offered a place. However we had not started the fair deal application. On the one hand I'm not sure fair deal would be any less than paying privately due to his assets and income. However if he takes the nursing home place and leaves hospital he won't be able to start the fair deal application. Also hospital will have to inform home help that he has now left.
If he doesn't take nursing home place, there are no other available places on south side of Dublin which is where my parents live. This is a one off and there is no telling how long before another place comes up. The hospital is against home support given his risk.

I have to make decision on nursing home by tomorrow morning. I've spoken to my dad tonight and he is against going to the nursing home. I have to respect that. However I'm concerned if he comes home and it doesn't work out how long he will be waiting for a nursing home place that is not the other side of Dublin.

Any thoughts would be much appreciated.

Sneidi7

Baby01032012 wrote: »

Many thanks for your reply.

I've been dealing with the medical team and social worker, well actually 3rd social worker as they keep switching them.

Home help app has been signed and funding applied for, will take another month given the level of funding needed. Started to look at nursing homes as realistically having my dad at home even with high level of care day and night may be high risk, plus the hospital have been against it.
We looked at one nursing home in great location near to home. A vacancy arose, my dad was assessed and offered a place. However we had not started the fair deal application. On the one hand I'm not sure fair deal would be any less than paying privately due to his assets and income. However if he takes the nursing home place and leaves hospital he won't be able to start the fair deal application. Also hospital will have to inform home help that he has now left.
If he doesn't take nursing home place, there are no other available places on south side of Dublin which is where my parents live. This is a one off and there is no telling how long before another place comes up. The hospital is against home support given his risk.

I have to make decision on nursing home by tomorrow morning. I've spoken to my dad tonight and he is against going to the nursing home. I have to respect that. However I'm concerned if he comes home and it doesn't work out how long he will be waiting for a nursing home place that is not the other side of Dublin.

Any thoughts would be much appreciated.

Hiya

Sorry to hear you are having a difficult time.

How about if your dad wants to trial at home with a back up of long term care that is quite a common choice as the Fair deal has been started and your dad still gets to try at home.
I'm not sure what your dad's level of dependency is which of course creates risks, but going straight to a nursing home from home without any supports can be quite a big step for people, if your dad is able to pay privately for a nursing home how about subsidising his home help with private care. I'm also not sure what you and your family situation is, so whether maybe a roster could be made to phone him or drop by, meals on wheels, day centres? If your dad really wants to go home and is able to understand the risks then perhaps your social worked could go through plan a of home and get the community nurses in to have a meeting and private agencies also to outline what care he would need coming into the house?

There is a huge turnover of nursing home beds and perhaps if he does trial at home he may have to go back to hospital to wait for a nursing home if it doesn't work out but at least he will have had a chance and perhaps he will come to the realistation himself that he can't manage at home. Maybe also discuss that he may have to go to a different nursing home whilst he awaits his first choice? He would be admitted back as a social admission through ED if it came to that and not coping at home, again not ideal but at least then when he is readmitted he can make an informed decision as he has trialed at home, knows it hasn't worked and that he requires more care.

I'm sorry I can't be of more help but just remember that the hospital has to keep your dad at the centre of any discharge plans and fair deal can be done quite quickly in hospital but can also be done in the community by the community nurses. It's unfortunate that there is a space in the nursing home now before you have really had a chance to make a plan. Another option is he could go to the nursing home as convalescence also and pay privately, whilst awaiting the home help to be approved and in place and then whilst he is there if he likes it he can stay?
I would ask your social worker to ensure the home help application has been assessed and that you are just on the waiting list. Get contact details of who to contact if you do leave the hospital so you can follow up on the home help if your dad still wants to go home.

Sorry if I'm rambled on, if anything is unclear please don't hesitate to say

Thanks and all the best

looksee

Is your dad against that nursing home, or any nursing home?
Do you have intensive home care (including hoisting accessibility, suitable bathroom accessibility etc) available?
Is there someone (such as yourself or a rota of family) to supervise the care service?

If your dad is really against going into a nursing home my opinion would be - and it is strictly my own opinion based on my mother and my husband and their respective preferences - to let him be at home. The hospital is obliged to tell you about the dangers, and of course if he does take another turn he could be back in hospital, though that could happen in a home, depending on the situation. There is a possibility that he might survive a little longer in a nursing home, on the other hand if he really does not want to be there it could have the opposite effect.

Only you and he can make this decision, but you may have to balance quality of life, and the comfort of being in his own home against a possibly slightly longer life in a place where he may not want to be.

If you have any possibility of caring for him at home, and that is what he wants, then listen to him.

Baby01032012

Hi all,

I'm the OP and need to update and get advice.

My dad spent over 6 months in hospital between James and then mount Carmel as a step down short term care. A nursing home place did come up somewhere we were happy with and convenient but he didn't want to go at the time.

He came home last Wednesday. It feels like the hospital system washed there hands of him and I'll explain why as concisely as I can.

He has a high level of care needs. He has certain amount of dementia, he can not walk, he has a catheter in. He is incontinent. However no acute medical needs to keep him in hospital. He is a very weak 83 yr old man. Originally he was assessed and it was decided he would need 2 carers adding up to 45 hours a week. Things moved very slowly. Then mount Carmel reassessed him as needing one carer so 21 hours a week.

He was put in a wheelchair taxi and sent home to his 82 yr old wife, my mother. He was given a letter which summarised his stay in hospital and list of prescriptions. He was given no catheter bags or incontenance pads. The care provider immediately rang me to say 1 carer was inadequate and they were putting in place 2 for their own staffs safety even though 2 had not been approved for the home are package,. There was no communication from hospital to care provider as to his level of ability.

At times since Wednesday he's refused medication, he's rejected the carers. At other times he's been fine. While I accepted we would try having him at home I completely underestimated how much he would need. When his home support was reduced I questioned but I accepted the hospitals judgement. My 82 yr old mother has been overwhelmed and hasn't left house since Wednesday. I'm an only child. With work I only got to them yesterday and the weekend has left me tired and stressed trying to get things, feed him, do things for him. I have my own family and Job to look after. I'm very worried for both my parents physical and mental health if he continues at home.

I have to talk to GP tomorrow, local health nurse, mount Carmel, carers, hse, all nursing homes. I'm just not sure where I stand. On one side I want to complain to hse over how my dads discharge and needs were assessed just to get him out of the system. I am angry and upset to be honest for my parents. More importantly I need to get my dad into long term care asap.

Sneidi7

Hi,

I am so sorry to hear about your dad. It must be so hard for you and your family.

The hospital won't really help you at this stage as your dad is in the community. My experience of Mount Carmel is that they are missing a social worker and that these situations are arising more and more.

Your best bet is to contact your health nurse and flag your concerns. I'm guessing that as there was a Nursing home bed offered, your dad's fair deal funding has been released? Could you ring around nursing homes, if so, to try get him a bed immediately, his fair deal can transfer so even if your first preference nursing home has none available, your dad can go to a different one first if home really isn't working?

looksee

Don't waste your discussion time on the way the hospital treated him. Make your point then move on to what can be done. State categorically that the current situation cannot continue, then move positively on to what is to be done next. Good luck, it is a very difficult situation.

infogiver

Just want to offer words of support OP. This is all very very stressful.
And your poor mam.
I'm afraid hospital is not the place for your dad or home.
I've found that the concept of the nursing home is far far worse then the reality.
He needs specialist geriatric care.
Good luck.

Baby01032012

Hi all,

OP here. Thank you for your posts. My dad went back into hospital yesterday, severe blockage in his catather. They thought he might also have infection but thankfully not and he was released this morning.

I had viewed a nursing home on Saturday which I liked. They had a bed. Brought him straight there from the hospital. He seemed happy with it and wanted to move in straight away which he did.

Been in and out of work between hospital and getting him sorted in nursing home. It's been an emotional and stressful time. Hopefully he will be happy there.

infogiver

Baby01032012 wrote: »

Hi all,

OP here. Thank you for your posts. My dad went back into hospital yesterday, severe blockage in his catather. They thought he might also have infection but thankfully not and he was released this morning.

I had viewed a nursing home on Saturday which I liked. They had a bed. Brought him straight there from the hospital. He seemed happy with it and wanted to move in straight away which he did.

Been in and out of work between hospital and getting him sorted in nursing home. It's been an emotional and stressful time. Hopefully he will be happy there.

I hope he'll be happy and comfortable there and that yourself and your mother can look forward to a less fraught more peaceful period.

looksee

So glad you have got sorted OP, and I hope it continues to work well for you.