Home care v nursing home, considerations?

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?

sullivlo

Baby01032012 wrote: »

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?

Your budget will be important.

In my experience, the district nurse decide on the home care package & what you're entitled to. Then you can top it up if you feel your dad needs more hours.

You should probably start by talking to him. Get a sense of what he would like. Then speak to his medical team - explain what your dad would like, and ask them if this is possible medically. They'll have a fair idea of what he needs and is capable of so they should be able to give you an idea of the practical side of things.

The social worker will have information to hand about the options available to him. It's important to include him in any/all discussions because if he's not onboard with it he can make things difficult in the long run.

I guess you need to ask them to be honest with you. What is his situation - what are his limits and capabilities. Will he be able to make it to the toilet unaided? Will he be able to make himself a cup of tea? Would he need a stair lift installed? Would any modifications be needed to the bathroom? Is he capable of taking his medication unsupervised? What measures are in place if he were to take ill - GP or hospital? If his mobility is reduced does he need a physio to go help him move to reduce a build up of fluid? Practical things. Then it comes down to whether it's feasible to do that at home, or whether he would be better in a facility - some of those sheltered accommodation where there's a nurse on site 24/7 but they still allow some independence (there are panic alarms in case they're needed and regular check ins and social interactions, but the person remains responsible for themselves and everything), or a full on home.

Good luck with it all.

Baby01032012

sullivlo wrote: »

Your budget will be important.

In my experience, the district nurse decide on the home care package & what you're entitled to. Then you can top it up if you feel your dad needs more hours.

You should probably start by talking to him. Get a sense of what he would like. Then speak to his medical team - explain what your dad would like, and ask them if this is possible medically. They'll have a fair idea of what he needs and is capable of so they should be able to give you an idea of the practical side of things.

The social worker will have information to hand about the options available to him. It's important to include him in any/all discussions because if he's not onboard with it he can make things difficult in the long run.

I guess you need to ask them to be honest with you. What is his situation - what are his limits and capabilities. Will he be able to make it to the toilet unaided? Will he be able to make himself a cup of tea? Would he need a stair lift installed? Would any modifications be needed to the bathroom? Is he capable of taking his medication unsupervised? What measures are in place if he were to take ill - GP or hospital? If his mobility is reduced does he need a physio to go help him move to reduce a build up of fluid? Practical things. Then it comes down to whether it's feasible to do that at home, or whether he would be better in a facility - some of those sheltered accommodation where there's a nurse on site 24/7 but they still allow some independence (there are panic alarms in case they're needed and regular check ins and social interactions, but the person remains responsible for themselves and everything), or a full on home.

Good luck with it all.

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.

Skyfarm

do not allow your father nursing/home till you have in writing what they will do and provide,the nursing home element needs a lot of research as some can be hit and miss ..

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.

Graces7

Baby01032012 wrote: »

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.

So very very sorry and this is indefensible. And yes make a formal complaint. They have the facility for this online and the do follow up.

https://www.hse.ie/eng/about/QAVD/Complaints/

They have to deal with it within a set time too.

Blessings and prayers

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.

smjm

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.

Glad to hear something's going right for you at last. Really wish you and your Mum and Dad all the best for the future!