Hospital discharge out of the blue

[fortune]

Mum fell and broke her hip in the middle of January. Two rather traumatic and very confused weeks in hospital then sent to local small hospital for recuperation where she's been ever since. She is still on quite high pain relief and very confused. There has been almost no physiotherapy as the physio is off sick and has been for weeks. Mum has made tiny progress with her mobility. After all this time she needs two people to get her standing up. It takes 10 minutes to get her transferred to a chair. She has to be supported by two people to shuffle with a walking frame and each 'step' is about an inch. I wrote to query the lack of physio and got an apologetic letter saying they may get the full service back some time in the summer (!).
Today, out of the blue hospital rang asking me to attend a discharge meeting tomorrow. I really don't think it will be safe for her to come home with such poor mobility. There's only one carer and that's me. And there's only one other bedroom in mum's house. Anyone else been through this and perhaps advise what (and what not) to say at the meeting?
Thank you

 

[Bunpoots]

Hi @fortune.

I found myself in this situation last summer when the hospital told me my dad was medically fit for discharge so they discharged him. He wasn't and ended up back in hospital within about a day and they then tried to discharge him again!!!

Dad had just had a stroke and could barely walk so I refused to let him be sent home again and made it clear I would hold them responsible for whatever happened if they did. You need to talk to the hospital social worker to discuss the most appropriate care for your mum to be kept safe whether that be at home or in a home (dad needed carehome).
Make it clear that you are not able to care for her now that she can no longer walk - and be prepared to fight..

 

[charlie10]

Hi @fortune ....we're very similar in that he broke his hip, was in hospital for several weeks and has just gone to rehab place for physio. Fortunately he doesn't sound to be confused but his mobility sounds the same as your mum's.....I'm not sure how much difference a couple of weeks' physio will make, particularly if he then goes back to living on his own, even with care visits....no motivation to keep up the walking He's self-funding and has capacity so it will be how open he is to 'advice' from family about the safest place for him......sorry, no particular advice to you tho if she doesn't have capacity it probably makes it a bit easier for you as you're fighting 'for' her, not 'against' her. Do you have LPA? Have you ever had a needs assessment/carer assessment done? This is probably a good time to insist on one....and I think I'm right in saying that when they discharge a vulnerable elderly person they have to at least do the checklist for NHS Continuing Health Care (apologies if I'm wrong on that....someone else with more experience will probably comment on it)

 

[nae sporran]

My OH was discharged too early 5 years ago, and ended up back in 6 hours later. They are under pressure to release beds and a carer package takes a bit of time, but the do not like a failed discharge, so warn them of that politely but firmly. Does the hospital have a carers liaison worker who can advise? http://carers.org may be able to help there. Sorry, can't remember what questions were asked in our case, but that was who helped me at the time.
Good luck @fortune.

 

[fortune]

Mum has advanced Alzheimer's and no capacity for finances, and I have LPA for finance. There is no LPA for health. She would be self-funding. If she ends up back in hospital it will be the regional hospital (40 miles away) not the little local one she is in now which only does low priority, recuperation etc. Though more than half the patients there are not local, they're from Cheltenham which is 25 miles away and has its own hospitals. Many thanks to all for sharing experiences and advice. See what happens tomorrow.

 

[Sirena]

It doesn't sound as if she is fit to leave, but then again she isn't going to get any fitter because they are not making efforts to mobilise her. As she is self funding you can make the decision about what care she receives in future, so for example you could arrange for carers to come in several times a day to wash/dress/mobilise her. Or you could arrange for her to move to a care home of your choice. You could also pay for private physio - not that you should have to, but it sounds as if it would be helpful. As she is self funding, social services are unlikely to give much help.

 

[fortune]

Little update. I got email addresses from the staff nurse and wrote to local CGT pointing out the lack of physio, not just for my mum but for all the patients. They wrote back and acknowledged the situation was as bad as I had described. This has really helped! Staff at the hospital give me cheery waves when I go in - it was helpful to them to have a carer formally take the authorities on and a physio has appeared as if by magic. As a result mum is at last making a bit of progress. I asked for a meeting to discuss the best next step for mum and this is being arranged with someone who has good local knowledge of what is available, and a full physio report will be available to help inform the meeting. So moral of the story is try to complain in a way that actually helps the NHS staff - they are mostly trying their best under severe financial restrictions.It seems to be a dog eat dog world and the voice of the patient can have some power.

 

[Kikki21]

Little update. I got email addresses from the staff nurse and wrote to local CGT pointing out the lack of physio, not just for my mum but for all the patients. They wrote back and acknowledged the situation was as bad as I had described. This has really helped! Staff at the hospital give me cheery waves when I go in - it was helpful to them to have a carer formally take the authorities on and a physio has appeared as if by magic. As a result mum is at last making a bit of progress. I asked for a meeting to discuss the best next step for mum and this is being arranged with someone who has good local knowledge of what is available, and a full physio report will be available to help inform the meeting. So moral of the story is try to complain in a way that actually helps the NHS staff - they are mostly trying their best under severe financial restrictions.It seems to be a dog eat dog world and the voice of the patient can have some power.

This is really good news for you, well done!

 

[Shedrech]

well done @fortune
good news for your mum, the staff and other patients

 

[Sirena]

Well done, that is great news about the physio - that should help a lot.

 

[Pouli]

Well done and good news. there's nothing like a constructive complaint! Reading threads here i am constantly amazed at the variety of responses from local care trusts. When my OH was coming out of his rehab hospital, there was no question of discharge until a package of care was in place, vanloads of equipment had been delivered and I had had the gas fire disconnected as he was going to sleep in the living room. Once he was home, we were like grand central station with carers, district nurses popping up, physiotherapists and occupational therapists. I thank my lucky stars we live in Warwickshire.

 

[nae sporran]

Well done @fortune, hope the physio works and your mum is better again soon.

 

[Louise7]

I got email addresses from the staff nurse and wrote to local CGT pointing out the lack of physio, not just for my mum but for all the patients.

Well done on getting a positive result, but who is the CGT?

Reading threads here i am constantly amazed at the variety of responses from local care trusts.

Yes. It's disappointing that there is a 'postcode lottery' with regards the level of help/care provided which can make the difference between someone staying mobile and not.

 

[charlie10]

well done on being proactive @fortune ......my FiL went from a long hospital stay to a rehab unit where he is having physio....at one point he was unable to sit up without being held in position by pillows, and unable to roll over in bed. Now he can walk a few steps with his zimmer and is working on being able to stand up from his chair.....we're cheerleading him, and hope that by the time he leaves he'll be back to where he was before his fall. I do hope that your mum gets the physio she needs and is as successful with her mobility. One thing we did learn was that we needed to give him some motivation (in our case it was, unfortunately, the fear of CH if he was still bedbound).....without it he couldn't see the point of all that effort when he normally just sits in his chair and dozes/watches tv 24/7 but he is making good efforts in the unit now. Don't know if he will keep it up once he's home but we have to try