Very worried about elderly dad and geriatric hospital ward

Your father himself, or you and your mother are entitled to demand that the hospital discharges him.

You are also entitled to demand a second opinion from the hospital and a reasonable explanation as to why they have stop his heart medicine.

In your place, I would phone your father's GP at once and fill him or her in on the whole situation, so that your father can resume taking his heart medicine upon coming home.

Whether he will get better or not, is impossible to judge from your post.

A lot of old people do stop responding to treatment for pneumonia, which actually is a fairly easy death, if your father has decided that this is his time to die, but he should be given every chance to live a little longer if that is what he wants.

My father, himself a doctor, chose the pnuemonia way out, so I know it was an easy demise for him, although hard for the rest of us.

I am so sorry that you and your mum are going through this,

Bring your father home with carers coming in and his own GP to see him immediately.

Caleothat's brilliant sounds as if you are very determined and looking after yourself. Hope you continue to improve.
My mother actually broke her pelvis and spent three months in hospital. In spite of a UTI, a hospital acquired infection, a bleeding stomach ulcer which had to be cauterised, no one was thinking about end of life. Her team were planning her discharge and organising a care package when she suddenly caught pneumonia and died. She had signed a DNR. All the staff were devastated, even though they knew she wanted to die, they didn't want to give up on her.
How hospitals differ.

PS while in the actual hospital(not the assessment unit) the consultant stopped my antihypertensive drug, as a low BP surge caused me to faint and fall. The thinking with which I agree is that a fainting-type fall is more dangerous for elderly than high BP surges.

Maybe your father's heart med was discontinued for similar reason.

I am currently emerging from a situation like your father's. I also am 91 and five weeks ago had a fall and went to hospital suspected fractured pelvis. I was assessed over ten days and sent home with temporary carers twice a day.

Throughout the period my appetite has been almost non existent and I have subsisted mainly on whole milk with a cod liver oil capsule once daily. I had no fracture, and was highly motivated to resume my independence, encouraged by the better carers.
I am now able to hobble around the ground floor of my house , toilet myself, feed myself on a little more than milk, ensure my hydration, and amuse myself with TV and computer. I even washed a few dishes today.
I currently have an upper respiratory mildly febrile infection with right lung involvement but expect to survive it.
Febrile conditions are very debilitating, and the severity of your father's infection will determine the outcome for him

Your mother and you are rightly concerned, and you should be advised by the prognosis of the specialist in charge.

I thought before any patient was put on palliative care it had to be discussed with them and their relatives, or at the very least the family had to be told exactly why it was happening and asked for their views. Approach the consultant in charge of the team looking after your dad and demand to know why this is happening and exactly what led to the decision.
But as has been said old people do not do well in hospital. Your dad may improve once he is home.
If you need help with him he is entitled to care www.nhs.uk/conditions/social-care-and-support-guide/care-after-a-hospital-stay/care-after-illness-or-hospital-discharge
Do hope he improves at home.

LRavenscroft

Reading your post what concerns me is that you do not have adequate information about Macmillan being introduced. I went through a similar situation with my 96 year old dad about five years ago and was kept fully informed about his lack of progress. You need to ask detailed questions about what is actually wrong with him. Are there notes at the end of his bed or at the nurses station which they could read out to you and explain. As a family member you are well within your rights to demand an exact explanation. How is your dad? Is he still talking and commenting? To be honest my dad was very much in and out of sleep and could not sit up or hold his head up anymore. It broke my heart but the doctor gave me an end of life form to fill out i.e. next of kin, religion etc. It was then that I knew it was near the end. How is your mum in all of this? Are you in charge as the daughter or does you mum make the decisions? Could you take him home and both care for him with a visit from your GP district nurse with the GP overseeing his prescriptions? A lot will depend on your mum and dad's mobility and independence re personal care. I hope all goes as you would wish. Sending many good wishes.

My mum and I have Lasting Power of Attorney over my dad for medical matters. The hospital are aware of this and it is on his records. That is why the various calls from Macmillan, doctors etc have involved me. I did speak to Macmillan team on Friday but all they said was that they would be setting a care package in place and mentioned EoL care. First and only time I had heard this - neither the doctors or consultants had said as much to me - only that care would be palliative. We have not seen dad's records or had a full explanation of how or why they have been treating him or any reason as to why treatment seems to have been withdrawn - save to say he had not 'responded'. Even the consultant's name is not written over his bed only know her as a young girl called Anna on the one occasion I met her.

Mum still very independent and capable - she doesn't want the disruption of a huge care team in her house - but we have to see how she can accommodate the new situation. Dad was perfectly able to shift for himself before he went in the hospital but obviously now that has changed. He was awake, eating and drinking and chatting a bit when I saw him at the end of last week but was dozing off and on. Not eating or drinking a lot for the last couple of days although my mum has persevered in at at least getting some nourishment down him.

Can't see my mum signing any EoL forms as you describe until she has had him fully independently assessed - am waiting to hear on that score.

Sorry to hear this, you need to speak to the Doctor on the ward or Nurse in charge. They do know what they are doing, plus will not let him go unless there is a support package in place.
The staff on that ward are looking after him, but sadly they won't sit there like your Mum holding his hand.
There are various reasons why he might not be responding.
If he has had a Cardiac issue in the past he could be end stage Heart Failure, you need to be completely in the picture, they will be honest.
The GP at this stage can't really help.
Thoughts with you.

I only wish I had observed such care in the hospital where my dad is - I really do. Apart from my mum who has been caring for my dad and helping out some of the other poor souls on that ward, I did not witness any such level of care. The nurses love my mum - she is doing some of their job for them.

Of course geriatric care varies from region to region and hospital to hospital, and it is really the luck of the draw where patients end up. On a previous occasion in that same hospital a few years back when my dad was operated on for a completely unrelated problem, the post-op care nearly killed him - catalogue of medical errors and poor treatment. The day my mum got him home my dad perked up within the hour and fully recovered in no time. You can appreciate I hope our concerns over what is going on now and see where I am coming from.

Dad is in a bad way - I'm not so foolish to believe otherwise - but we just want to give him a chance out of that place.

Not managed to get through to anyone anywhere this morning, but just had a call from the Local Care service who have advised that they have been asked to be in place at 5pm this evening - district nurses will be round to monitor meds, Macmillans providing support. After that will be getting GP and cardiac nursing team in to assess him.

I do thank you all for your advice and support over this matter. It's frightening and stressful to say the least when you are having to deal with such events and you can feel very helpless and alone.

Reading your post what concerns me is that you do not have adequate information about Macmillan being introduced. I went through a similar situation with my 96 year old dad about five years ago and was kept fully informed about his lack of progress. You need to ask detailed questions about what is actually wrong with him. Are there notes at the end of his bed or at the nurses station which they could read out to you and explain. As a family member you are well within your rights to demand an exact explanation. How is your dad? Is he still talking and commenting? To be honest my dad was very much in and out of sleep and could not sit up or hold his head up anymore. It broke my heart but the doctor gave me an end of life form to fill out i.e. next of kin, religion etc. It was then that I knew it was near the end. How is your mum in all of this? Are you in charge as the daughter or does you mum make the decisions? Could you take him home and both care for him with a visit from your GP district nurse with the GP overseeing his prescriptions? A lot will depend on your mum and dad's mobility and independence re personal care. I hope all goes as you would wish. Sending many good wishes.

My mum's instinct entirely along these lines and if it were not for the fact that he still in nasal oxygen which the hospital or Macmillan team are responsible for setting in place we would have done just that.

Hopefully we will get him discharged today and then we can get the GP and cardiac nurses round to assess him. My mum has been sleeping next to him at the hospital all this time making sure he is cared for - no stranger to all the work needed and very determined. Cares for him better than anyone could. She would have made a fantastic nurse.

I volunteer in care of the elderly wards. One for palliative care and one for those with dementia. The Consultants' care for the patients is striking. The wards are very hard work for the nursing staff. So many bedridden patients are not easy to look after. I'm always struck by the little details, the small kindnesses in evidence. All I do is chat to people or try to involve them in various diversional activities. Patients often say how kind everyone is and how well looked after they are.
As a personal observation its the nursing assistants and ancillary staff who seem kindest. The qualified staff are very taken up with technical things, various devices like drips, paperwork, care pathway documentation and drugs rounds.
Families are welcome to visit any time. I can't agree that old people are just abandoned in geriatric wards.

Garnetto I have to give the other side of the story my 87 year old friend was recently in hospital for three weeks she loved all the attention and was everyone’s friend she thought she had wonderful treatment from the ‘helpers’ nurses physios doctors she loved them all and they her I should add she was very ill but got excellent treatment

If you think you and your family can cope with him at home. Take him home. You do not have to wait for a formal hospital discharge

Some 40 years ago, that is what my MiL did when she was concerned that her DH was just being left to die in a hospital ward. Her brther went with her to push the wheelchair down to the car and put him in it and took him home, where he lived for another 18 months, cared for and loved. Once home the GP visited and arranged for him to go to a Day Centre twice a week.

In far more trivial circumstances, I too have discharged myself from hospital. I just signed a disclaimer form and walked out.

Nanatoone

I don’t know, you say your dad was perfectly ok but he wasn’t really was he? He has pneumonia. I’ve just recovered from a bout of that at age 66 and it’s taken me (fit and healthy previously) months to get better. I feel you are being unrealistic in your expectations. The lung damage I have left over from my bout still leaves me breathless and with low oxygen from time to time. Just putting another point of view. Obviously I hope your dad comes home and does well, but I suspect what you see as abandoning your lovely dad is simply long experience of how it goes with the elderly.

Me too - a perfectly healthy 74 but it took me several weeks to get anything like back to normal after a bout of pneumonia that hit me like an express train. I was very weak and wobbly for the first couple of weeks afterwards,

Having said that, I do hope you get satisfaction for your dad very soon, drubledu23 - 🤞

You must talk with the consultant responsible for his care to find out the rationale behind the decisions being made. There may be good reasons - there may not. But either way you need to know and to be involved in the decision making.

I don't think hospital is the right place for the very elderly.
DMiL had a stay recently aged 98. She was bored and there seemed a lack of communication between the staff as well as with the family.
She had gone in with severe constipation and a UTI but wasn't being given nearly enough drinks!
The laxatives worked and her pain subsided but she was now immobile and incontinent
She. went downhill in hospital.
She was discharged from hospital and was a lot better, almost back to her old self
She was frail though and quietly passed away a few weeks ago. At least it was at home surrounded by her loving family

Talk to your dad's GP and cardiac nurses asap and tell them your justifiable concerns.
I wouldn't want to leave my Dad on that ward from what you say ☹️

I would try to be there in person if this was possible.

Thinking of you

drbledu23

sukie

This is indeed very concerning drbledu23 and it seems that time is of the essence. It would be good if you had an emergency number for your dad's GP so you could reach out immediately rather than waiting until morning. Monday mornings can be busy for GP's.
I hope you are able to relieve your mum some tonight so she can get some sleep but it would be good if one of you can be with him and alert through the night.
I will be thinking of you and wish you all the best.

No service of that kind at my dad's GP unfortunately but am prepared to hang on the phone Monday. I want to speak to the senior GP and not one of the locums on call.

My mum will not leave him and I am 100 miles away - was there on Thursday and Friday but had to leave temporarily for work reasons. She calls me each day from the ward.

Unfortunately your GP isn’t the right person to seek information from if your dad is in hospital, because he won’t know how he is until he is discharged. I would contact the ward sister and request a meeting with the consultant in charge of your dads care. You should be able to join in by Zoom or Microsoft Teams while you mum meets them in person as long as the ward knows in advance.

Sorry, posted before I saw Sukie’s post.

Hithere

Does this hospital have similar complaints as yours?

There have been some - yes.

A situation in which you and your mother seem to have no involvement in the decisions being made about the care your father is receiving, and precious little explanation, must be very concerning for you. I would feel as you do.

Before things go much further make a formal request for a meeting with the consultant responsible for your father’s care, and I would contact his GP and outline my fears about the situation, in the hope that you can have a conversation with someone you are more familiar with, too.

Proper communication may put your mind at rest, sad though it may make you, but confusion and lack of information is bound to raise your suspicions.

sukie

This is indeed very concerning drbledu23 and it seems that time is of the essence. It would be good if you had an emergency number for your dad's GP so you could reach out immediately rather than waiting until morning. Monday mornings can be busy for GP's.
I hope you are able to relieve your mum some tonight so she can get some sleep but it would be good if one of you can be with him and alert through the night.
I will be thinking of you and wish you all the best.

No service of that kind at my dad's GP unfortunately but am prepared to hang on the phone Monday. I want to speak to the senior GP and not one of the locums on call.

My mum will not leave him and I am 100 miles away - was there on Thursday and Friday but had to leave temporarily for work reasons. She calls me each day from the ward.

Sorry you find yourself in this position, it’s very hard. However I don’t think you should assume the doctor who saw your dad last didn’t know what she was doing, or that the withdrawal of some of his medication was inappropriate until you’ve spoken with the doctor in charge of his care. Unless you are fully in the picture regarding test results, clinical diagnosis and observations and the reason for the drugs regime changes, as the medication put in place since his admission may have contraindicated the medicines he was taking at home, it’s easy to assume they aren’t looking after him properly when they may be doing everything appropriately for him.

CocoPops

If I were you I'd ask the nurse in charge of the ward to clarify the situation and if not satisfied ask her/ him to make an appointment for you and your mother to see the consultant.

Absolutely this.