Discharge from hospital!

[SweetPepper]

Mum has been in hospital for 24 nights tonight, after an innocuous fall. I visited twice and then got covid, and when I was finally clear it was 16 days between visits. I was very shocked in her decline, in an hour and a half she talked non-stop about lots of people she knew, but most are dead for many years. She was upset I hadn’t visited her parents (died in 1986 and 1997) and said that lots of the people in the hospital had known her at Sunday school. I know none of this is unusual, but it was all new behaviour. Then a nurse came to check if she needed her pad changing - hang on, she was continent when she went into hospital! Well she isn’t any more.

I have been ringing the ward, speaking to OT’s, physio’s, nurses, saying how concerned I am, I visited a really nice care home and lined up a room for her if required (mum is self funding and I’ve made this known), but the hospital has been adamant that she goes home with care 4 x a day (I normally only visit once a week).

I had a phone call at 5pm today to tell me that mum was being discharged the next day and would be home by 10.30am. I have worked all evening and just got home, had to cancel tomorrows work, and need to be there to but milk, bread etc, and the Urgent Care Team are coming around lunchtime and I really need to be there for that.

I am as you can probably tell a bit traumatised about the whole thing.

What do I need to do tomorrow that I’ve forgotten or never knew about please? I will ring the Alzheimer’s nurse contact that I already have in place.

 

[JHA]

I am sorry you find yourself in this situation. Was your mom receiving some sort of care package prior to hospital admission?

When my mom was in hospital with a suspected infection I refused to allow the hospital to discharge her home with a care package and as a result they discharged into a care home for further assessment. She was then deemed to have capacity to make the decison to go home. Before she returned home her bungalow was assessed and lots of aids/adaptations were put into the house (key box, grab handles on front door/back door, step on back door, grab rails in bathroom, wheeled table, bed guard, bath board etc). Has something similar been done for your mom?

 

[SweetPepper]

Hi and thank you for replying. Mum was having a daily welfare check from a local care agency. I don’t have POA for welfare, only finance, so don’t seem to have any clout with decisions. The Urgent Care Team is going to assess the house tomorrow, there will need to be a lot done!

 

[JHA]

I did not have any POA's in place when I refused to allow discharge home I just kept reiterating that they were putting a vulnerable adult at serious risk. Surely they should assess her house prior to discharge not after - if I were you I would be speaking to whoever said she was being discharged that the necessary assessments need doing first.

 

[Sarasa]

Hi @SweetPepper , I agree with @JHA, see what f you can delay your mum’s return home till at least the house has been assessed. Mentioned failed discharge, something the hospital won’t want, I assume the hospital know about the room in the care home? It would seem sensible for your mum to go there at least for a while to ‘convalesce’ . Hospitals are not great places for people with dementia and it may be that after a few weeks in a care home she would manage with four caters a day at home.
I’m sure others that have been in this situation will be along soon. I moved my mum into care straight from her home so didn’t face quite the same challenges.

 

[canary]

the Urgent Care Team are coming around lunchtime and I really need to be there for that. ......... <snip>.............. What do I need to do tomorrow that I’ve forgotten or never knew about please?

Make sure that the urgent care team know that you do not live with your mum and that you work. Explain that you have taken the day off, but normally you would not be able to leave urgently, so there will be many hours when you are unavailable.

It sounds awful, but you may have to allow this arrangement of 4 carer visits a day to fail before you can move her into a care home.

 

[SweetPepper]

Make sure that the urgent care team know that you do not live with your mum and that you work. Explain that you have taken the day off, but normally you would not be able to leave urgently, so there will be many hours when you are unavailable.

It sounds awful, but you may have to allow this arrangement of 4 carer visits a day to fail before you can move her into a care home.

Very sadly I think this is what will happen. The hospital were adamant that the Urgent Care Team would assess today at lunchtime, but I think mum was ‘hostessing’ very well to start with in hospital- I spoke to an OT and reminded them she hadn’t showered for months and she said well your mum has a wet room so she’ll be fine… I said she has a 30cm step up into her shower with nothing to hold onto going in or out! OT went a bit quiet then.

I am finding it very stressful (as I know you all understand) but will reiterate yet again today that I visit mum once a week.

 

[SweetPepper]

Hi @SweetPepper , I agree with @JHA, see what f you can delay your mum’s return home till at least the house has been assessed. Mentioned failed discharge, something the hospital won’t want, I assume the hospital know about the room in the care home? It would seem sensible for your mum to go there at least for a while to ‘convalesce’ . Hospitals are not great places for people with dementia and it may be that after a few weeks in a care home she would manage with four caters a day at home.
I’m sure others that have been in this situation will be along soon. I moved my mum into care straight from her home so didn’t face quite the same challenges.

I have told them about the care home on more than one occasion but never spoke to the same person twice and of course you don’t know what actually gets added to mums notes. I am generally a good manager but this is getting away from me and work is very difficult at the moment too (not about mum).

 

[SweetPepper]

I did not have any POA's in place when I refused to allow discharge home I just kept reiterating that they were putting a vulnerable adult at serious risk. Surely they should assess her house prior to discharge not after - if I were you I would be speaking to whoever said she was being discharged that the necessary assessments need doing first.

Thank you for your reply, it took quite a fight just to get them to send the Urgent Care Team which is an OT on day of discharge at all! I’m just astounded that I got a phone call at 5pm for a discharge the following morning, it’s been a tough night of a long meeting and then broken sleep worrying.

 

[Muttimuggle]

In March my mother had some innocuous falls which ended her in hospital. She was experiencing some kind of one sided dizziness but nothing was found for the cause. Then because my mother still felt a bit wobbly she was sent home with a home rehab package called ICRAS which I am assuming is nationwide, not just my authority? So this stands for Integrated Community Re-ablement and Assessment. As part of that my mother got a late night care visit(time was her choice), initially from this team and then was entitled to a 6 week subsitute care call from a Local Authority run agency. She also got regular, well fairly regular visits from the ICRAS team of physiotherapists, who also brought the equipment, and an initial assessment from an OT to put in some more rails in her house. I never knew about or expected all of this to be coming. They also, in particular the physio team, communicated with me by phone a lot.
I am surprised that the hospital is adamant that your mother goes home with 4x a day care. I would have thought that it was up to your mother and you to decide what care she wanted especially if she is self funding. If your mother is making the decision to go home then that is the one they will listen to I think. If the 4x daily care + adaptions + your weekly visit doesn't work then something else will have to be arranged. You are not obliged to do more, especially if you have managed to find a care home who would be accepting of your mother.
I was also shocked by my mother's decline and confusion in her latest 3 week hospital stay(This time the fall broke the neck of her femur (note - happened when the carer present making her tea and mother was climbing the stairs!). The operation was done by epidural - so no general anaesthetic but the confusion went on for a long time. Now she is in a Council run Rehab Centre in an attempt to regain some mobility. Although there has been a downward step in cognition she is not nearly as bad as she was in hospital.
Hope you get it sorted and that you are able to feel less stressed about the whole thing soon. It is hard.

 

[SweetPepper]

Thank you Muttimuggle, she is home now. She wee’d herself twice within ten minutes of getting in the door, has taken her clothes off and her pants and pad and left them around the house and gone to bed. She is freezing cold, has a sheet and four blankets and hot water bottle and still has her cardigan on! I suppose I did expect they would send her home with a couple of spare pee pads, but no.

I am leaving all that as it and awaiting the Urgent Care Team at 12.30. I am not uncaring, but I’m not her carer, I’m her care manager and am super stressed by the potential carnage. I have places ready in two care homes now, in case the nhs wouldn’t approve my first choice.

 

[Sarasa]

Hospitals are so stretched that I doubt anyone has really had time to properly assess your mum and they are probably relying on what she tells them, so she may well have said something along the lines of being fine at home because her daughter will be there.
If your mum is self-funding I'm not sure why the NHS would need to approve the home. The only problem would be if it was decided that she had capacity to make decisions about where she lives. From what you've said it doesn't sound like she has
Be brutally honest with the urgent care home and see what they say. You may have to do less than you want for a while so the true picture of her capabilities at present emerges.

 

[Banjomansmate]

You are doing the right thing by leaving everything the way she has, they need to see what is actually happening and to realise that you won’t be there supporting her.

 

[SweetPepper]

Hospitals are so stretched that I doubt anyone has really had time to properly assess your mum and they are probably relying on what she tells them, so she may well have said something along the lines of being fine at home because her daughter will be there.
If your mum is self-funding I'm not sure why the NHS would need to approve the home. The only problem would be if it was decided that she had capacity to make decisions about where she lives. From what you've said it doesn't sound like she has
Be brutally honest with the urgent care home and see what they say. You may have to do less than you want for a while so the true picture of her capabilities at present emerges.

I completely understand they’re over stretched - an OT to,d me mum would be find to shower when she got home because she has a wet room, oh no she doesn’t, she has a dangerous to use shower cubicle!

I have said so many times that I’m not the carer, but yep will be battering it into them again, thank you!

 

[SweetPepper]

You are doing the right thing by leaving everything the way she has, they need to see what is actually happening and to realise that you won’t be there supporting her.

Yep, I even have my laptop out - I should be working today. I was so stressed last night I even shouted at one of my parish Councillors that they were bat**** crazy (they are, but I shouldn’t have done it)!

 

[Hours Away]

Given your mother previously wasn't having 4 visits a day I assume there wouldn't currently be a detailed care plan in place with an existing care company which would just need to be reviewed and updated. So how has the hospital managed to safely organise 4 home care visits for today, particularly given "hostessing" issues and a PWD who lives alone? The care company would need to heavily rely on your input to put the care plan together. Have you been given any info about when the carers are arriving later today and how long their visits will be? If not she'll surely be safer in a care home tonight.

 

[Jaded'n'faded]

What's your mum's opinion about where she lives? This is crucial! As she's self-funding, you can move her to a care home yourself, if she agrees to it. Maybe you could wrap it up as a few weeks convalescence? Or tell her the boiler needs fixing so it's just till that's done. (You don't need POA for health to do this.)

Getting her there is the first thing, and you've found a couple of places so you could just go ahead - you don't need permission from SS. However, once there, it depends what happens next. If your mum is happy to stay there that's all good. If she decided she wanted to go home and got vocal about it or tried to escape, the home would have to get a DoLS to keep her there. This is s Deprivation of Liberty Safeguarding Order and is a standard requirement in locked care homes. It gives them permission to keep someone there, effectively against their will but for their own safety. If this happened, good old SS would become involved again. They would assess your mum's capacity to decide if she was able to understand her care needs. If she doesn't and the DoLS is granted, all well and good. But... if she insists she wants to go home and SS deem her to have capacity to decide, they will then allow her home with a care package and you'll be back to where you are now. i.e. waiting for something really bad to happen that proves to SS she needs a care home.

If you wanted to try this now, you could wait a few days (till the OT has gone...) then do it. But as I say, much depends on what your mum wants (or says she wants.)

 

[Violet Jane]

I'm afraid that the more you prop up an unsatisfactory arrangement the longer it will last. Hospitals just want to get frail, elderly patients out of the beds and the hospital social workers are put under pressure to facilitate this. I fear that you will end up popping round repeatedly or even staying with your mother for long periods of time because four short visits a day are inadequate. You have to be very clear with SS about how much you are willing and able to do. Don't promise more than you are happy with. If you can only visit once a week or can't go round at the drop of a hat if there's a problem then tell them this. SS will try to make you feel guilty but it doesn't matter what they think. Visiting carers have a very limited remit. They can tell you about a problem but can't solve it as they have to move on to their next client / don't have the authority or wherewithal to do things.

 

[Sarasa]

Hi @SweetPepper I hope the meeting made it clearer what support is intended for your mother. Are they expecting you to organise four care visits a day as my understanding is that care companies are so stretched it might not be easy to get help in that quickly.

 

[Muttimuggle]

Sorry to tag on to your thread with my own little update SweetPepper - but you might find it relevent. My mother had yet another fall within the rehab Centre today - fell when getting off the toilet.Mum said she banged her head. The rehab centre managed to get an ambulance there very quickly. I met the ambulance and my mother. She is fine actually. At A&E, where I just got out of, she wasn't really feeling any pain from the recent fall and no worsening confusion. The only reason she is in for scan and monitoring is because she is on the dangerous blood thinner, Edoxoban. It just shows though - you or the carers can't stop the falls happening. You just have to hope that the next isn't fatal. The more falls like this though, the more evidence there is that she needs a place in a care home. Once again, my mother said today - "I'll have to sell that house." Fingers crossed I get one sorted too.