An autumn of mounting health problems results in my 87-year-old father having emergency bowel surgery just before Christmas. For 10 million reasons it is stressful - his initial refusal, the appraisal of his chance of survival, saying goodbye as he’s wheeled off, the resulting post op pain and despair. A Christmas spent in hospital – his first Christmas since the death of his wife of 60 years.
Nearly as bad is what follows. How do we get him out of hospital? In many cases his care is exceptional but there’s something about the hospital experience – being done to – which is debilitating and institutionalising. Couple that with the anxiety nay fear associated with a stoma and all that entails – it’s not good for my father. He frequently says he wishes he’d died and he doesn’t want to live. He both wants to leave – and to stay – fearful of life on his own with a frightening new rigmarole, fear about being on his own, having enough money for care. It is understandably hugely stressful for him. His four daughters do their best to support him, we make sure someone visits every day, we seek advice from the doctors and nurses about his multiple medical needs.
There are light moments. My father mishears the name of the physio and thinks her name is catheter. Then he jokes, oh that’s my daughter’s name! (Sorry Catherine). He has a lovely line going with the nursing assistant who comes to shave him – because of his name - Ike - they work with the idea that he was in command of the Allied forces on the western front in the Second World War, before his career in hospital.
My day job involves describing the experiences of older people based on the evidence we amass from as our helpline and in-depth casework advice. I have personally given evidence to two parliamentary committees on unsafe and delayed discharge. I have at my fingertips the Department of Health’s policy guidance on discharge, I understand the interface between health and social care, our advisors describe it daily to callers. But when it comes to my father it is bewitchingly difficult to navigate. He ends up staying for 4 weeks as we struggle to find out the discharge process and how he will be supported on his return home.
It probably doesn’t help that it isn’t one relative going in every day – we all seem to get a different story and different advice. My sister is phoned by an occupational therapist who tells her that on discharge he will be set up with visits by a district nurse and a stoma nurse on alternate days. The next day when I say this to the ward sister she suggests that won’t be what happens. Another day we are told that he will get the Red Cross home from hospital service – despite it being a great service we know that won't be sufficient for his stoma and personal care needs. So we line up a private agency in case nothing is put in place. We sense the mounting pressure to free up the bed – my Dad starts referring to himself as a ‘bed blocker’ – it doesn’t help his low mood as described by the psychiatric nurse summoned to assess him. One day a social worker turns up and gruffly tells him that he won't get any help on his return home as he’s too well off. The next day a ‘nice’ social worker turns up and says he will. She rings my sister, who misses the call but the social worker leaves no number to call back. As discharge looms (we think), we are none the wiser about what care if any, will be provided.
Finally, after so many frustrations I email social services and the Patient Advisory Liaison Service asking who is the Patient Discharge Manager. I ask about a care assessment, his eligibility for re-ablement services and the planned date for discharge. I mention my professional interest in this area. An hour later a social worker is on the phone, an assessment has already been done, a plan is in place, agency sorted. He can finally come home. It presents its own problems – hospital weakens physical strength but also weakens resolve and undermines confidence. We know it’s a long road to recovery, independence and mental well-being. But it’s a relief too.
I never did find out who was responsible for discharge on his ward.