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Hospital discharge to care home

Tumley Snuffim

Registered User
Apr 12, 2014
9
East Yorkshire
Mum is 91, with no short term memory and very poor mobility. She lives alone but has consistently refused to consider moving to a care home.

On Boxing Day she had the inevitable fall and was found by her morning carer, who called an ambulance. From A&E she moved to a short stay ward to be assessed for discharge home. The inevitable conclusion is that she needs 24 hour care, and has no mental capacity to make a decision in her own best interests. The system is now proposing to discharge her to a local care home catering for dementia. As she is self funding, this can happen immediately, maybe tomorrow.

I live 60 miles away, and although I have researched homes in this area I have no knowledge of those in Mum's area, a different local and health authority. The home proposed, only this afternoon, looks OK on paper but does not have a sparkling CQC report.

So the pressure from the Hospital is to get Mum out as quickly as possible, probably tomorrow, while I want to find her somewhere I like, even if it is short term until she can move here. I don't have time to do lots of research and visiting.

Does anyone have experience of this situation? Can I hold up Mum's discharge until I have at least seen the home proposed? Can I hold it up until I've got time to do some research? Availability of places is of course a big problem at such short notice.

Any help would be much appreciated.
 

janemit

Registered User
Sep 7, 2014
30
My mum was in the same situation last year not safe to go home. She was sent to a local residential home as it was the only bed available.
It is the best thing in the short term, you will know that she will be safe until you can then sort out a permanent place. Hospital is never the best place if fit for discharge medically.
My mum was not keen to go but she always said she felt safe, we sometimes have issues with the home but they are easily resolved. Staffing is always an issue in homes
Hope things turn out for the best
Jane
 

Rheme

Registered User
Nov 23, 2013
159
England
Why did your mum go in hospital?

Might be a good lead into whether she actually needs a care home or a nursing home.
 

Tumley Snuffim

Registered User
Apr 12, 2014
9
East Yorkshire
Thanks for the reply. As you say, somewhere Mum can be with people who will look after her as an individual, not just Molly in Bed 18, is going to be an improvement, and give us chance to plan the long term.

We'll see what tomorrow brings.

David
 

Tumley Snuffim

Registered User
Apr 12, 2014
9
East Yorkshire
Hi Rheme, Mum went into hospital because she was found in an incontinent heap, unable to get up. Calling the ambulance was the right thing for the carer to do. Her mobility and Alzheimers can only deteriorate as she gets older (92 next week), and she does need 24 hour care, so a care home that copes with dementia residents is the right place for her to be.

I just feel pressured by the system that wants her off its books, but as Jane says, there will be some breathing space in a better place to make a long term decision.

David
 

clareglen

Registered User
Jul 9, 2013
318
Cumbria
You can hold up the discharge, especially as she is self funding. My mum was in this position in Oct, although I was keen to get her out of hospital as she deteriorated in there, not the best places. I was able to look round 7 homes, as I am local & she had been in respite in 2 homes, 3 times in the year, so I had some expertise in what I wanted & did find her a lovely home, although my 3rd choice after 1st choice turned her down for being too bad & 2nd home procrastinated. 3rd choice (because of location 12+miles from me) turned out to be the best one. My social worker (mine, not hers as she was self funding) told me not to be rushed by hospital & when I was offered a respite bed in a local authority home (but more expensive than private ones) & I was keen to take it meanwhile, social worker suggested not to as moving her not a good thing to do & just not be pressured by hospital. I was fairly quick in securing her a place.
 

nicoise

Registered User
Jun 29, 2010
1,806
My mum was to be discharged to a care home from hospital, self-funding.

I had found the home I liked, but the manager there said that she would only accept Mum once the assessment had been made by someone from the care home in the hospital, and that they were satisfied that they could meet her needs, and that she was fit to be discharged.

The manager also refused to take her before a weekend due to the lack of GP availability/less hospital staff should there be a problem.

This process all takes days at least once you have identified a possible home, so don't feel rushed by the ward staff telling you she will be discharged. Even if self-funding, she has to have a safe place to go to, and they cannot just discharge her.

Whilst it is understandable that the hospital needs the beds free, and bed-blocking is much in the news, the patient's needs come first. Don't panic, you do have time to identify the place you'd like her to move to.
 

2jays

Registered User
Jun 4, 2010
11,598
West Midlands
My mum was to be discharged to a care home from hospital, self-funding.

I had found the home I liked, but the manager there said that she would only accept Mum once the assessment had been made by someone from the care home in the hospital, and that they were satisfied that they could meet her needs, and that she was fit to be discharged.

The manager also refused to take her before a weekend due to the lack of GP availability/less hospital staff should there be a problem.

This process all takes days at least once you have identified a possible home, so don't feel rushed by the ward staff telling you she will be discharged. Even if self-funding, she has to have a safe place to go to, and they cannot just discharge her.

Whilst it is understandable that the hospital needs the beds free, and bed-blocking is much in the news, the patient's needs come first. Don't panic, you do have time to identify the place you'd like her to move to.
Thank you nicoise. That info has helped me. xx


Sent from my iPhone using Talking Point
 

clareglen

Registered User
Jul 9, 2013
318
Cumbria
Yes the home(s) have to assess her first by law. I had a few queuing up for assessments from my shortlist. (It is stressful in itself.) I gave the hospital the information of which home was coming when, but with change of nursing staff they kept giving the homes info I didn't want them to have about other homes coming, staff thinking they were from different home. I told them whichever home comes to do an assessment 'is my favourite' & please don't disclose info about other assessments to other homes. I was panicking as she'd been turned down twice by one home (hospital changed her meds to try & accommodate home but it didn't work she really needed them hence the 2 assessments). One home miffed that another home was coming. You would think the hospital would have more sense if they want people out than to disclose rival info. So yes, it does take time. The home I was successful in getting was the first one that invited me to the assessment, which I thought was good & the owner agreed to take her, but again not before the weekend (I know now there are lots of visitors at weekends at the home) but on the Monday, so yes it is not an immediate discharge & you've to get the drs to agree meds on discharge etc., etc.
 

Gardening

Registered User
Sep 9, 2014
33
I was in the same situation with my Dad recently. He's not self-funding (well, currently, that's an argument I'm in with them at the moment). We dug our heels in and said we weren't prepared for him to go to anywhere that we weren't prepared for him to stay in, and said that moving him twice would be detrimental to his health. If you emphasise to them that to rush you in to a decision would not be in your Mum's best interests, but that you are proactively looking and are making this as speedy as possible, that may hold some sway. On the other hand, as others have said, hospital is not the best place for her to stay any longer than necessary. My Dad contracted pneumonia while in there and hasn't been the same since. If you can reach the compromise that she stays put while you put every effort into finding somewhere you know she'll stay then all the better. Wishing you well.
 

MeganCat

Registered User
Jan 29, 2013
356
South Wales
My mum was discharged from hospital after 6 months to a home 500 miles away close to me. Getting her into the best place for her is the most important thing, rather than successive moves which could be detrimental - I don't think the hospital can complain if it is clear you are actively seeking that place. My mums hospital didn't - but the home took a little longer than I would have liked. My mums home did a remote assessment due to the distance but they do need to make sure they can cater for her needs. It was the right move for my mum, I've been able to visit frequently. - although stressful at the time! Good luck
 

Tumley Snuffim

Registered User
Apr 12, 2014
9
East Yorkshire
Out of the Frying Pan...

Thanks to all for the helpful replies. There's something to learn in all of them.

Last Tuesday was a very busy day, but through a combination of our preparation, persistence and sheer good luck Mum ended the day in a care home 6 miles from here.

The preparation was the research we'd done on local care homes a year ago. We (me and K, my wife and constant support throughout all this) had a shortlist of three close to here. We kept detailed notes of each visit.

The persistence was in deciding to have one last go at getting Mum into a home near here straight away, rather than her having a move to one near the hospital then another move in a few weeks. We knew that it would be hard to get her to settle anywhere, so one move was better than two.

The good luck was that our second call to a local home produced a result. They had a place. Dementia, poor mobility, incontinence -- all no problem "We deal with those all the time".

The day went like this:
9:00 Calls to the hospital social team to talk to the worker responsible (new to the case) and tell her what we were doing. No local transfer without my express authority.
Calls to local care homes. We find a possible place.
11:00 A visit to the care home with a place to discuss Mum's needs and have another look round. It confirmed our impression that it was a professionally run and very caring place. All the staff we met were lovely, all the residents content. They would take Mum that evening and check her discharge papers on arrival.

12:00 Confirm plans with hospital and insist that all discharge arrangements - paperwork, tablets etc - would be ready for 3pm.

13:00 Set off for Mum's home to collect clothes for her to wear on discharge and to take to the home.

14:15 Arrive at Mum's house to sort through her 30 year nothing thrown away collection of clothes, assisted by a good friend of hers who has helped her for many years.

15:30 Arrive on the ward. Everything is in order. Mum is dressed by her nurse and put into a chair for us to wheel to the car. I tell Mum she is coming home with us, as the doctors say that she needs 24 hour care.

16:15 Leave to drive back here. Mum thinks she is being discharged following an accident she had 13 years ago. She has no idea about her present condition or needs, or that she's been having carers at home for over a year.

17:30 Arrive at the care home. "This isn't your house"! "No Mum, it's a nursing home to look after you until you are well enough to go home." Mum is desperate for the toilet so goes in, to be greeted by the lovely assistant manager who takes Mum to the toilet and generally looks after her.

While Mum had a cup of tea and a biscuit the staff check the paperwork. Everything is in order, and they will take over getting her settled straight away. It is all done in a warm and welcoming manner. Mum now realises she is being left and becomes increasingly grumpy. "I'm not stopping here!!" We all tell her it is only for a couple of weeks until she gets strong enough to go home. "I'm not giving up my home" she says. Of course not.

So then we leave her in their care. We know from our earlier discussions that they prefer family not to visit until they get her settled, which could be a week or so.

We drive the 6 miles home, happy that we've done all we could to get her to the best place possible. She won't be going home ever again, and that makes me very sad. We both lose a lot, but it can't be helped. She needs the care. From what we've seen, we're as sure as we can be that she'll get it.
 

janemit

Registered User
Sep 7, 2014
30
Pleased things have worked out well for you. It is very sad when our parents are unable to care for themselves and very hard for them too. Mum has been in her residential home since March and they have looked after very well but is so hard when you go through so many emotions with them.
Hope everything works out well
 

nicoise

Registered User
Jun 29, 2010
1,806
Dear Tumley Snuffin,

Thanks for your update - I do hope things work out for your mum and your family with this move, and that at sometime she may come to settle and accept the home.

Good luck :)
 

clareglen

Registered User
Jul 9, 2013
318
Cumbria
Well done. I feel like I'm grieving, with mum being in a home, even though she's not dead and I know it's the best place for her. Even though I feel like this it is a 100 times better than when I was caring for her myself. She had hospital appt last week & this week too so that's not good as she's getting so frail for me to get her out & into car. I hope I get used to it. It feels like I'm in limbo. The long goodbye they call it.