Hints and tips to support hospital discharge

If possible, it is best for the person to be sat in an armchair and not a sofa as the armrest will give the person something to push down onto when standing up.

The hips and knees should be at a 90-degree angle. You may wish to remove any additional cushions (not prescribed pressure cushions) to allow this. Most chairs can also be raised to help achieve this. There are many affordable chair raisers available to buy.

Video guides:

Standing Up From a Chair or Seated Position - Ask Doctor Jo - YouTube

The Sit to Stand Exercise

Before you begin to provide any personal care for the first time, please discuss this with your family member/friend and agree how they would prefer you to support with these tasks. On a daily basis, check how they are feeling and how much they are able to complete for themselves.

Washing

The person you are helping may be self-conscious or distressed so it is important to reassure them and to find the best way to allow them to maintain their dignity.

Advice and tips from the NHS – How to help someone you care for to keep clean

Advice from Marie Curie – Helping someone wash

Video guides:

Caregiver College – Bathing and dressing

Oral Health

Poor oral health can affect people’s ability to eat, speak and socialise. It is essential for the person’s wellbeing that their oral health needs are encouraged and/or supported as required.

• Brush their natural teeth at least twice a day with fluoride toothpaste.
• Use their choice of toothbrush, either manual or electric/battery powered and mouth care products.
• If they are unable to access the bathroom, consider using the kitchen sink or a bowl.
• Clean their dentures (brushing, removing food debris, removing dentures overnight).
• Use their choice of cleaning products for dentures.

Video guides:

Skills for Health – How to brush your own or others’ teeth

NHS – How to clean a denture

Skin Health

Skin integrity refers to skin health. A skin integrity issue might mean the skin is damaged, vulnerable to injury or unable to heal normally. A pressure wound (also called a pressure sore, bed sore or pressure ulcer) is an injury to the skin and surrounding tissue.

If you are caring for somebody who is recovering from illness or surgery at home, confined to bed, chair or a wheelchair seek medical advice immediately if there is:

• red, swollen skin
• pus coming from the pressure ulcer or wound
• severe or worsening pain
• a high temperature

Video guide:

Pressure ulcers (pressure sores) - NHS (www.nhs.uk)

Toileting

Depending on the location of the toilet you may wish to consider a commode and purchasing commode liners. Disposable Commode liners are more hygienic, alternative to cleaning a commode pan after every use.

If the person is able to access the toilet, then please use the principles on standing from a seated position guidance above. There are numerous pieces of equipment to raise the height of the toilet and rails the person can pull up on. The person should not be pulling up on radiators, heated towel rails or toilet roll holders as these can come away from the wall and could cause injuries.

Whether a person is normally continent or not, it is important to maintain their personal hygiene. If the person has problems controlling their bladder or bowel functions, they are at risk of developing infections or skin problems. As such, it is important to ensure that they have the correct continence aids and that these are changed regularly.

It does not take long for unpleasant skin conditions to develop if a person is left in a wet pad or wet underclothes. Sometimes limited mobility can contribute to a person having “accidents”, and they may be embarrassed about this. The person’s GP can put you in touch with a continence advisor who can advise you about dealing with these issues.

Further information:

Helping seniors use the toilet – safety tips

Video guides:

Care sourcer – helping the elderly use the toilet

British Red Cross – How to use toilet aids

Dressing

• The person should choose what they wish to wear but you may want to offer choice or advice. For example, you may want an extra layer if it is cold, or a skirt may be easier to access the toilet. The person may choose to stay in nightwear as this is warmer or more comfortable.
• Check clothes fit and are comfortable as people may change shape, particularly if they have been unwell. Be aware that Stoma’s, catheters etc will all affect the fit of someone's clothes.
• Encourage them to do what they can they do for themselves. Only help when they need your support. For example, they may be able to dress top half but not the bottom half or put shoes on.
• If the person has a one-sided weakness, then start with that side - that arm goes into a sleeve first, then the other side.
• If wearing multiple layers check that the bottom layer (sleeves especially) do not ruche up when you put the second layer on, its uncomfortable and could affect circulation.
• Check underwear is straightened, comfortable and fits -including continence pads correctly placed.
• When putting on socks roll them on from the toes up (don’t try to pull up, this can catch toenails and effect skin integrity.
• Check socks are not too tight at the top, again this can affect circulation in vulnerable individuals.

Video guides:

Care Sourcer - helping elderly relatives to get dressed

Using Hand-under-Hand™ to Assist with Getting Dressed - Shirts and Coats - YouTube

How to dress someone in bed

• Are there any rugs or other trip hazards which could be removed? For example, trailing wires.
• Is there sufficient lighting (particularly at night) to help the person see where they are going? If not consider some plug-in or battery operated sensor motion lights.
• Can they turn their own lights on? If not consider a timer on a lamp.
• Can they answer the front door? If not consider a key safe (please consider carefully who you give this number to).
• Can things be moved to reduce bending over or reaching up? Consider leaving items which are needed daily within easy reach.
• Can the person carry a cup of tea or carry their phone around with them? If using a walking frame a buddy may be helpful (speak to an Occupational Therapist). If walking with no aids, then a trolley may be appropriate.
• If the person is making their own drink, is the kettle too heavy? Consider using a jug to fill the kettle with water rather than carrying the kettle to the sink. Also think if a travel kettle may be a temporary solution as its lighter in weight.
• If the person isn’t able to make their own drinks, consider using a flask.
• If the person needs to use the stairs, do they have banister rails either side of the stairs? If not ask an Occupational Therapist about getting an additional rail installed.
• If the person has a personal alarm encourage them to wear it at all times.

The Hampshire Bobby Scheme (run by the Blue Lamp Trust) carries out crime prevention and fire safety surveys for people who are over 65 or disabled. When appropriate, fitters will fit such items as locks, spy-holes, door chains and smoke alarms, etc. This service is completely free.

The Blue Lamp Trust can also supply and fit police approved key safes at a cost.

See the ‘Stay steady on your feet’ section on this page which includes information about chair-based exercises for people with reduced mobility.

If the person has a fall:

• It's important to keep calm. If they are not hurt and they feel strong enough to get up, ensure they do not get up too quickly.
• The person should roll onto their hands and knees and look for a stable piece of furniture, such as a chair or bed.
• The person should hold on to the furniture with both hands to support themselves and, when they feel ready, slowly get up. They should sit down and rest for a while.
• If they are not hurt and you are able to help them without injuring yourself or them, please do so. Move a chair closer to them to help.
• If they are hurt and/or you can’t help them up, dial 999 to ask for an ambulance. It’s important to keep them warm while you wait for an ambulance and if they can, encourage them to change position every 30 minutes.

Video guide:

How to reduce your risk of falling | Age UK - YouTube

It is essential that your friend or family members maintains their nutrition and drinks enough fluids. See the ‘Eating well and staying hydrated’ section on this page.

Prescribed medication must be taken at the prescribed time of day. If they are taken at the wrong time, it could stop them working properly.

Make sure you know if the medicines should be taken with food or in between meals. Again, if they are taken incorrectly, it could stop the medicine working properly or cause side effects.

To make medicines safer:

• be aware that over-the-counter medicines should not be taken with prescribed medicines unless a doctor or pharmacist has confirmed it's safe to do so.
• be aware that if a dose of the medicine is missed, it's dangerous to take a double dose later on to make up for it.
• return any leftover medicines to the pharmacist for safe disposal.
• always speak with the pharmacist or GP if you have any questions about the medicine.

When taking medication, it should always be:

• taken at the right time of day and at the dose prescribed.
• checked to the instructions to make sure it is being taken properly. Some medicines should only be taken before a meal, or with water or food.
• the persons own supply and never medication prescribed for someone else.

It's important to let the GP or pharmacist know if the person experiences any side effects as they may want to change the dose or try a different medicine.

If the person you care for keeps forgetting to take their medicine, there are several ways you can help:

• telephone them when they need to take their medicine to remind them.
  
• arrange to visit at the same time as the person is meant to take their medicines.
• get them a medication alarm or reminder or an automatic pill dispenser – this beeps when it's time to take the medicine and a small opening allows access to the correct pills at the right time.
• ask the pharmacist for advice on other ways to remember medicines.

If they refuse to take their medicines:

• If, for some reason, the person you care for is unwilling to take their medicines, talk to their GP or pharmacist; they may be able to suggest a form of the medicine that's more acceptable than tablets.
• Some painkillers can be prescribed as a long-acting patch that you stick on the skin.
• Never give medicine to someone without their consent or try to force them to take it. People have the right to refuse medicine.
• Check with their doctor or pharmacist before you crush tablets or open capsules and mix the powder with food or drink. It's not always safe to do this.

Medicines: tips for carers - NHS (www.nhs.uk)