Strokes

I'm sure many people won't agree with me but it sounds as if he needs to consider going into residential care unless he can afford private care at home. Even if this is only on a temporary basis. It doesn't sound as if carers coming in for 20 minutes 3 times a day will provide enough support and if you are not careful you could find yourself tied down and trapped. My experience is that hospitals want people out and social workers aren't much help. They just want to tick a box and move on to the next case .( I understand they are overworked etc).
When my father had his first stroke he could not walk and lost the use of his hands but they wanted to send him home with a commode in his lounge even though my mother would not have been able to lift him onto it.
Can you call on his family for help and support?
This may all sound harsh. I appreciate that you want to be supportive and help this man but you have to think of yourself as well as what is best for him.
Let us know what happens.

Sorry to hear this Elizabeth1. All I can say is that there are huge pressures on NHS staff to discharge patients. When my cousin, well into her 80s had a brother in hospital last year the staff were trying to get her to take responsibility for his discharge as this was easier than dealing with the son and daughter who were not visiting as frequently (lived at a distance). Fortunately she is a powerful woman (although not physically) and was able to "push back" when they tried this. So I guess you need to have a serious think about how much you are able to do and how much you are willing to do. Good luck.

Elizabeth1, Your brother in law cannot be discharged from hospital until a full discharge assessment has taken place. This has to be done by Social Services. Just make sure you are not included in the report as providing any form of support. As * JessM* says resist all emotional blackmail to include you in the care package. Sound, to them as cold and indifferent as you can, when they ask you to help.

I was pressured very hard by a psychiatrist to take my uncle home with me on discharge. I lived 'out of area' and it meant they could wash their hands of him, no follow-up, no care, no assessment. He played (or tried to play) on my affection for my uncle, shown by the support I had given him in the crisis leading up to and during his hospital stay. He threatened to just load him into an ambulance and dump him outside his home. But I just said NO. In the end he went into a Care Home for convalescence and as he had enough money could afford to decide to stay, close to friends in the town he had lived in for 35 years.

However, once he is discharged home with a Care package monitor it, and do not hesitate to try to get your BiL into a Care home if you think he is in danger in his home on his own.

Update - BiL's nurse was challenged when I asked why he was always in his pyjamas as previous nurses advised me to bring his clothes in to see if he would feel a little motivated. Must say she responded well as Bil was in his clothes next day looking better and no sign of his lower half being exposed to all and sundry if you know what i mean. I have referred BiL to Social work and set the ball rolling for a forward plan should he be considered for discharge in the near future. BiL unhappy now and wants to go home however he is continuing to be sick each day and he had a fall last night. Must say I saw this coming. BiL's name is down for very sheltered housing but until then he will need a care package in his own home should he be dis charged but I certainly will be unable to dedicate all my time to him. It's a blessing I have retired otherwise Dont know what would have happened. Things are uncertain at the moment and we are taking each day as it comes and I am hoping he will be transferred to the nearest rehab hospital as was suggested earlier. It's as well I have a background in social care so will have much input into any multi disciplinary meetings and be able to make my voice known.
Thank you for your comments and interests, I'll keep you informed of any further developments.

Is he having physio?

We have an excellent stroke unit at our local hospital (Southend-on-Sea) which has received all sorts of accolades since it was set up. Early diagnosis and brain scan is crucial - is it due to a clot, or a bleed, because the initial treatment will be different. Following the initial treatment, physio is crucial. Don't write him off as a lost cause yet because, with good care and, again, physio!! - people can recover a lot of function.

If his left arm is affected DO NOT allow it to hang down because this is painful and damages the shoulder-muscles. It must be propped on a pillow if he's in bed/in a chair.

There should be no excuse for someone being allowed to stay in nightwear all day with, as you said, all his lower end on show. No excuse at all.

HTH

I have worked in this field - it is absolutely vital that you press for a referral to a specialist stroke rehabilitation unit - do not take no for an answer.

I have seen so many people make brilliant reoveries to functional life after a period in one of these units, but we always had to fight for the referral - local CCG will balk at the cost, but the units are there to be used. They work on physical recovery, functional skills speech therapy and cognitive rehab.

We have the skills to help stroke patients but they are only doled out to the lucky few.

Whererabouts are you/is he? - I may be able to suss out the nearest unit.

It is only after a full course of rehab that home care packages or residenbtial care should be on the agenda.

Had a very busy day talking to social work, nurses and local MSP regarding discharge planning.Pressure coming out of my ears at one point. Outcome after visit to hospital is that BiL going to local rehab unit after all. Only I believe after OT found he struggled to make toast and tea and the strength of my input into the concerns I had. It s found that BiL also hurt his back when he fell over last night so that gave further concern.
Was advised the social work have a waiting list for assessment into home care however after a very long chat with them was invited to phone back after hospital visit. I think in case he was sent home some individuals were becoming a little apprehensive. That was encouraging and I think all are now on alert. Applications are into supported living housing associations and the local authority, however, present home is all on the flat and with home care BiL may continue to be able to stay there safe and secure once the rehab have worked with him. (Here's hoping) now relaxing after an eventful day. Thank you all once again.

Agree with Mishap above, in spades.

I am horrified that, so soon after a stroke, less than a week ago!! - discharge is even being thought of. I couldn't emphasise it more. He must go to rehab before return home is considered. He may get back a lot of function, but only if the people who know what they're doing get a chance to work with him, and that doesn't mean leaving him sitting on a ward all day, virtually unattended except for the very basics.

Some of us on here have been there, seen it, done it....

Elizabeth - I am glad that your BIL is going to a rehab unit - it is absoluitely the right thing.

They cannot discharge him from there without a full assessment of his needs when he returns home, and an assessment as to whether the NHS should pay for that care at home (Continuing Health Care funding).

They must not send him out until that care is in place. If he is in a rehab unit they will have a good grasp of this and know the systems to set in train to make sure he will be able to manage at home. There is far less chance that they will make a sudden discharge, so you can rest easy.

I am puzzled by what the social worker has said about needing to wait for an assessment for home care input - hospital discharges take priority in order to avoid blocking beds with people who could be at home.

If he will be funding this care himself (because he has savings) you can set this up yourself, although you might ,ike to ask your local Social Services Dept to give you some advice - they have to do this, even if he is paying for himself.

If he does not have savings and needs their financial input, they will need to make a full assessment.

I do hope that he makes a good recovery - he is in the best place.

Thank you everyone it's so good to hear how others have experienced this sort of thing and listening to how best to manage a difficult situation. After a chat with Tricia Marwicks (MSP) office this morning I am determined to keep her in the loop as a back up in case all my manoeuvres fall down. Yes an assessment will now be carried out after the rehab feels BiL can go home but only with support.

On the whole I commend the nursing staff at the Victoria hospital Kirkcaldy as being second to none. Brill!!! So many negative words spoken about health care. but not in his case.

My BiL has Received a letter okay from the community OT in relation to my referral to the home support team saying they will get in touch with him within 4 Weeks. Why would they send that to his home when they know he's in Hospital duh!!

Sorry should read today and not okay.

My mum had a stroke just as I finished university. I remember organizing speech therapy n other physical therapies for her. To be honest we got her home and I moved back home and cared for her there. We did loads of speech and physical therapy every day all day.Her speech n physical well being returned really quickly with lots of effort. Her personality was changed forever, unfortunately.

Sorry laidback to hear your mums personality changed after her stroke. It appears brain injury can lead to all sorts of behaviour and personality changes leaving loved ones being "different" to what was previously known. I commend you for all you did for your mum.

It's just as well you have the background in Social Care that you do have, Elizabeth1. So many vulnerable and frail people are turfed out of hospital long before they are ready, because of not having anyone to argue their case, after which time they fall through the net. As you say, if you hadn't just retired, goodness knows what would have happened. However, you must also not take on too much - are your brother-in-law's family able to help at all? Are they too far away?

Marelli I'm afraid BiL has no family in Scotland. Three adult children in London and one in Australia. So no real help there. I'm afraid they are not so good at recognising the daily needs of their dad even when he is in hospital. Who's going to collect his daily washing, a crushed fruit juice from the cafe and his paper? Simple pleasures for him while he can hardly sit up. Two days ago we managed to take him in a wheelchair to the cafe. The day after he said he thought he was dying that night as he felt so ill. Something to do with his stroke nurses said. Another day and where's the may I ask?

Hurrah BiL being transferred today to the local rehab unit.

Now the fun begins. BiL's adult eldest son now advises me from afar to put BiL's 14 year old wee dog into the kennels while dad is in hospital.Wee dog loves his home and gets access to the garden each day via the cat flap. (You can tell from the scene on the lawn) We pop in to give food and a daily cuddle each day.

Eldest son insists on daily hospital visits to cease as his dad is not my responsibility and he uses that word liberally. Eldest son doesn't take into account short term needs such as who washes the jammies, who takes in the daily newspaper, who wipes his forehead when he is being sick (and thats every day) when there are no nurses about etc etc etc. However now that BiL is closer to home his friends are starting to visit and provide additional support and my daily visits have already ceased.

So different thinking to where my loyalties lie. BiL's needs will change and evolve over a period of time and where would he be without basic contact with those who love him. My sister would "turn over" as they say if she heard the condescending approach from this son. I'm not on my own here as there are other in laws who will be there for there our dear BiL. And there is at the end of this rainbow.

Any advice from my friends on Gransnet will be warmly welcomed.

Sad news BiL had another stroke and is so very poorly. Staff are now just helping him to feel very comfortable. All ill feelings with the family have been dissolved and far away. Think of me x

My thoughts are with you and your family Elizabeth

Elizabeth and best wishes.

Sending thoughts and best wishes Elizabeth and the strength you need to get through this difficult time. Your sister would be so grateful for the love and care you have shown to your BiL.

Elizabeth1, somehow I'd missed your posts of later on in the week. So much hope, then to have them dashed so suddenly. BiL will have gained so much comfort from your visits and will no doubt have known you'll always be there for him, no matter what.
Sending you love and to get you through this next wee while. xx

Thinking of you Elizabeth