He fell and broke his shoulder 5 days ago. He has an ostomy and twin sided neph tubes for 8 years now and since falling will not care for them, clean them or himself. He presently pees on himself (shorts still on since emergency room), has an open wound at stomach/hip fold and since has decided he cannot stand or pivot to wheelchair or bath stool because he needs 2 hands to hold on to walker. I tried pulling him up by him holding onto my neck (the same way we got him up from the er bed, in my car, out of my car the same day of the accident. It was demanded at the hospital someone be near 24/7 for 3 days. I am seriously thinking of asking the parametics to help when they can as a non-emergency. 2 days ago, I expected an in-home nurse to reaccess his progress, order meds, physical/occupational therapist. This is the first time while caring for him for years I feel helpless.
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It certainly sounds like the 24/7 care will have to go on more than 3 days. It sounds to me like he should have gone to rehab, not home, until he was able to transfer himself at least. You absolutely need the nurse to order meds, and arrange for therapy. I'd start there. Who promised you this? Call and politely but firmly demand that you get this service. Call his doctor. Call the hospital patient services. Call your Area Agency on Aging. Keep calling until you get a nurse in your house.
The nurse's reevaluation may determine he is worse and should not rely on one person to care for him. Explain how helpless you feel and why. Perhaps right now he is a 2-person lift.
Does your father have any signs of dementia? Peeing on himself and refusing help in getting cleaned up, not caring for his open wound, and general disregard for his own health are, of course, not general issues of old age. Hospitalization does not cause dementia but sometimes if it has been simmering in the background a trauma like a fall and the ER can bring it to the forefront. Just something to be aware of.
How wonderful that he has been able to live at home with his various special needs for 8 years. You truly must have been an amazing helper! If it turns out that he needs more care that one person can provide in a private home, either temporarily until he regains his strength or long-term, do not even consider feeling guilty! Dismayed? Probably. Worried? I don't know how you could turn that off. Overwhelmed as you make all the arrangements? Maybe. But unearned guilt is a stress you don't need. The state of your father's health is Not Your Fault. His broken shoulder is Not Your Fault. His current mental health status is Not Your Fault. Keep that firmly in mind!
Keep us informed of how things progress. Almost everyone here knows that feeling of helplessness. We are definitely cheering for you!
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My husband (dementia) was being released from the hospital. They suggested he go to transitional care for a few weeks before going home. We'd done that once and it was harder on me than having him at home. (TCUs are not necessarily set up to deal with dementia.) I said would need a besides commode. They promised to write the order for that immediately.Do you know when it came? Day 9 after he was home. He was fully able to walk to the bathroom by that point, but the first few days were a nightmare. I stored it in the basement and used it when he was on hospice.
They were willing to send him to tcu right that day. This would have cost thousands of dollars. A good commode is less that $200 and they couldn't provide when it was needed. What kind of mess is that?
Anyway, keep pursuing it until you get that nurse.
Has anyone from a home health care agency contacted you? This usually happens the first or second day after hospital discharge. If you haven't been contacted, call the hospital discharge planner for the room your father was in and ask what's happening with the home health care agency referral. The planner may have to pull his chart, but that was her responsibility and it should have happened.
After reading CW, CM's and Veronica's posts, I agree that you should take him back, NOW, but ask for a different attending physician. Was the attending physician one of his treating PCPs, or someone who didn't know him?
Did you get a notice explaining your rights to appeal to Medicare if you disagree that a discharge is appropriate? I experienced this, and with controlled outrage raised the issue with first a nurse, then went up the chain of command.
The attending was replaced, Dad stayed 3 - 4 more days longer, and was released when more stable.
If you're an RN in a hospital, you've probably seen this form. If not, it provides for the right to appeal if you (or the patient) thinks discharge is occurring too soon.
You'll need to contact the Quality Improvement Organization (QIO) "no later than your planned discharge date and before you leave the hospital."
contact info: KEPRO (I don't know what this stands for): 1.855.408.8557. Fax: 844.834.7130.
Source: "Message from Medicare about Your Rights."
If you have access to a fax or can do so from your computer, you might start now as it seems as though it would be very difficult for to actually get to the hospital.
I hope you can at least get a reprieve for long enough to find proper care at home, and I also hope that discharge planner gets to work on this situation, NOW.
Good luck. Please let us know what happens.
BTW, I asked a similar question in 2015. This is the thread:
There are a lot of helpful answers, some directed toward specific remediation, some toward moral support. It's clear that I wasn't alone in experiencing this at a hospital.
https://www.agingcare.com/questions/appealing-a-doctors-decision-to-discharge-188205.htm
Please start making noise NOW. Contact the Social Servies department at the hospital where Dad was and tell them he was discharged with no plan and no help. Keep after them until you get satisfaction. And, know that we do care! Keep us updated. Xoxo