I am desperate I don't know what to do

Sasky

Registered User
Jan 29, 2014
103
0
Ashford, Kent
My darling mum who lives with my husband and I fell last week and broke her hip. She is now In Hospital but is not progressing well, she refuses to try to walk and gets agitated with the nurses and physios. As they want the bed They Are now discussing options for discharge, which are.

1. Step down in a care home for rehabilitation
2. Discharge to home to see if she will walk and go up the stairs !!!!
3. Permanent care home placement

Firstly option 1 is a non starter as the hospital told me today they won't take her because she gets agitated won't do anything they ask and keeps undressing herself

If she comes home and then can't walk/get up the stairs then what will happen !!!

I have always said to my darling mum that I will always care for her so option 3 is a particularly difficult thing for me to agree too

I adore my mum and haven't stopped crying since I got home from the hospital. When I left I said to her bye mum see you tomorrow I love you very much, and she said I love you very much too!. OMG that made me sob all the way home.

I just don't know what to do all I want is my mum home so I can care for her. Trouble is my house isn't that big downstairs I have one room lounge/dinner and kitchen, no downstairs toilet. If I bring her bed down and have a commode she will have no privacy and no washing facilities. Also as she gets really agitated through her dementia I don't know how she will react

Seems to me despite all this talk about helping dementia sufferers reality is a different kettle of fish

I can't desert my mum what can I do please help me
 

marionq

Registered User
Apr 24, 2013
6,449
0
Scotland
I think a temporary placement in a care home you have chosen will have to be a starting point. If you talk with her about having her back home once she can walk then she will see it as more of a convalescence. You are committed to her well being and she will know that but will also realise that she cannot climb stairs at present. You are not abandoning her but looking for a solution. Good luck.
 

Neph

Registered User
Jan 27, 2014
179
0
I think you have to be realistic and look at at least temporary stay in a care home, don't beat yourself up about it, you may find she actually likes the company of others.
 

jj1

Registered User
Nov 26, 2012
13
0
mum

My darling mum who lives with my husband and I fell last week and broke her hip. She is now In Hospital but is not progressing well, she refuses to try to walk and gets agitated with the nurses and physios. As they want the bed They Are now discussing options for discharge, which are.

1. Step down in a care home for rehabilitation
2. Discharge to home to see if she will walk and go up the stairs !!!!
3. Permanent care home placement

Firstly option 1 is a non starter as the hospital told me today they won't take her because she gets agitated won't do anything they ask and keeps undressing herself

If she comes home and then can't walk/get up the stairs then what will happen !!!

I have always said to my darling mum that I will always care for her so option 3 is a particularly difficult thing for me to agree too

I adore my mum and haven't stopped crying since I got home from the hospital. When I left I said to her bye mum see you tomorrow I love you very much, and she said I love you very much too!. OMG that made me sob all the way home.

I just don't know what to do all I want is my mum home so I can care for her. Trouble is my house isn't that big downstairs I have one room lounge/dinner and kitchen, no downstairs toilet. If I bring her bed down and have a commode she will have no privacy and no washing facilities. Also as she gets really agitated through her dementia I don't know how she will react

Seems to me despite all this talk about helping dementia sufferers reality is a different kettle of fish

I can't desert my mum what can I do please help me

hi there i know this is a difficult time for you but from what youve said i think you got to go for option 3.my mum bust her hip and this was the only option i had too.altho this is your mum you will run youself ragged and the strain on your family and life wll be to much to cope with.my wife and i have both been treated for deppresion largely down to the constant running about for mum.she didnt live with us which was thinking about a blessing and acurse as she was some distance from us.how old is your mum?i know this must be doing your head in but try and think of this as globaly as you can.regards john.ps there is no wrong or write way.
 

Oxy

Registered User
Jul 19, 2014
953
0
I am deeply sorry for your predicament and feel option 1 is needed. Without physio the walking is clearly not going to improve. Your mums agitation in a non understanding environment will also not be helped.
I would push for 1, would it help if you and her husband were there when they do physio/OT. Try to ring The helpline on Admiral nurses direct 9.15-4.45. They are so kind and helpful and are trained nurses for dementia. They are best qualified I feel and will go through the options with you and help you see the wood for the trees and how you could maybe adapt the house. It also depends how mobility was prior to fall.
I so feel for you as I always dread my caree in that position. Please ask them for advice. I don't know if they are in your area and could come out to you. They aren't in mine. Very best wishes to you all for a progression in walking. Stairlift-just thought. Social services should help as a matter of urgency and rapid response team BUT don't allow discharge until these things are in place. Hospital is sabre rattling but needs to be acted on quickly so they don't act in way you don't want.
 

Jessbow

Registered User
Mar 1, 2013
5,679
0
Midlands
A nursing for rehab sounds like the best option- no way can you have her home if she cant walk.

Maybe it will have the effect that she will , if she is able to think such things through, give her the desire to put some effort in and get walking again.

You may well have to stand firm, she cant come home if she cant walk- end of.
 

AlsoConfused

Registered User
Sep 17, 2010
1,952
0
option 1 is a non starter as the hospital told me today they won't take her because she gets agitated won't do anything they ask and keeps undressing herself

From what the hospital have said, it's going to be really, really difficult to find a care home able to take your Mum, whether for rehabilitation or permanently.

The home you can offer your Mum isn't suitable because you have no downstairs loo or bathroom and your Mum (who needs peace) wouldn't have any privacy. It would be totally unsafe to transport your Mum and her broken hip up and down your stairs so you must not try it. Even if there was a stair lift I don't think your Mum would be safe using it.

The hospital won't like it but they can't discharge your Mum until there's somewhere safe for her to go, where her rehabilitation can be continued.

In your shoes, I'd be exploring with the hospital the practicality of moving your Mum to a quieter community hospital with comparatively good physio support to give your Mum a better chance of making some progress with her rehabilitation. You might be able to offer some supplementary family support by the bedside to encourage your Mum to cooperate with the physios.

A nursing home with physio input might also be acceptable. I imagine it's very difficult to find such homes (especially homes within family visiting reach) and they won't often have places.

I think you'll have to talk to your Mum's consultant and the hospital Social Worker and say you need their help in sorting out the best / acceptable options for your Mum - is it the community hospital or a nursing home with good physio support and near 1:1 carer to patient ratio? And once you've all got the "target" accommodation precisely defined, you want their active participation in finding somewhere suitable for your Mum which can actually offer her a place in the near future.

My Dad didn't want family members at the "Best Interests" meeting :mad:held to discuss arrangements for Mum on leaving hospital when she cracked her pelvis. To safeguard Mum and Dad I wrote out a document for the consultant and hospital social worker politely pointing out to them the fatal flaws in their and Dad's plans for Mum's return home (like your situation, the accommodation was wrong, the patient uncooperative and the amount of supervision that could be given totally inadequate). The result was that Mum stayed in hospital for a lot longer until she was almost healed and a good care package was put in place.
 

garnuft

Registered User
Sep 7, 2012
6,585
0
I'm afraid I would take the view that it's not for the hospital to dictate what your Mum's future care will be.

I would say to them...

'Coming home is OUT of the question but you have not reached a place where you are considering permanent care, when you reach that place...you will seek help for that issue.'

So it lies upon THEM, NHS to find a suitable place for her, without regard to permanent care.

It's a person-centred care that applies...even though they will try to persuade you otherwise.

Don't despair. Your Mum needs to be either in hospital or in a suitable caring environment that meets her needs.

When she's recovered from her current issues, you will re-evaluate.

Stair lifts and dementia are not friendly. You really can't have your Mum home, she needs to be supported until she recovers.


They may as well assume it's OK to take us all straight from the maternity ward to the grave yard. :mad:
 

copsham

Registered User
Oct 11, 2012
586
0
Oxfordshire
Dear sasky,
I feel for you, so so difficult. There is potential hope and development though. 18 months ago my mother (vasc dementia) was in hosp refusing any help, physio, rehab. Eventually she came home with 24/7 care. Showed minimal improvement but not sustainable at home. She went in to a nursing home and developed from two steps to 20, learnt how to toilet herself, began eating again. This was thanks to the kind and gentle staff. We have had little ups and downs but overall she has blossomed, when I thought she only had a few weeks to live. so good luck in to the future!
 

nita

Registered User
Dec 30, 2011
2,651
0
Essex
This is from the point of view of a person who has kept their mother at home with limited mobility.

She had a lumbar vertebral fracture in November, 2011. After trying to cope with her for a week at home while the doctors wouldn't agree to her to go into hospital as they said it was just a nursing issue, she did finally get referred by the Re-Ablement team and spent 3 weeks in hospital. She was able to be rehabilitated in hospital (I don't think this fracture is as severe as a hip breakage) and came home with the Re-Ablement team visiting for 6 weeks, then a care package. We had a stairlift which she used reluctantly and needed assistance as she walked to and from it with her frame.

After about 6 months, her mobility had decreased greatly and she couldn't make the short walk to the stairs. I called in Social Services and they advised she should sleep downstairs. We, like you, only have the one large living room downstairs. The WC is also downstairs but she couldn't make it. We had to have her bed and a commode in the room. This could be a step too far for some people! But I was determined to keep her at home in whatever way was possible.

Another 9 months later and she couldn't even stand so the OT recommended having a hoist. She also had a hospital profile bed at this stage and airflow mattress. She went into respite while we made changes to the room and got the equipment in place.

She has now been bedbound for a year. I would emphasise that, apart from extreme pain from her arthritis, controlled by morphine, she does not have behavioural problems. I don't know if I could cope if, like your mother, she was undressing herself and very agitated. In that case, others may be right and it is best left to the professionals. She may have to go into a nursing home, rather than residential, for them to cope with her mobility problems. When Mum had the fracture, the doctor was frank with me and said there were limited possibilities for her walking again afterwards. I was distraught at the time but, in the event, she did manage for a further 6 months, until she was restricted to being assisted to an armchair in the day, and then another 9 months before she couldn't walk at all.

So, just to say it can be done but with a lot of modification made for her needs and compromises on your part. Can you manage her mobility and dementia needs? As others have said, the hospital have to make sure she has a safe discharge and if, going home comes into the equation, there will be a home visit to see whether this is feasible. I would start thinking seriously about her being placed in care somewhere nearby where you can visit often. I know if it is a huge adjustment to come to terms with and something you wouldn't wish for. The SW kept saying glibly to me "no one likes change" but I don't think they realise the terrible emotional toll such things take.

I would just add that you can't always tell how things will go when a person has been in hospital. The fracture and hospitalisation did have a detrimental effect on my Mum and for some time after she had agitation and behavioural issues but these did settle down after some months.

Just to add, my Mum has had four visits a day by carers for the past year. She hasn't been able to use the bath for years due to her arthritis, so she is just given a wash down (when she agrees!). We leave the room for the carers to attend to her when they come. She also has to wear pads and be changed each time. I dreaded this making her incontinent but without her being able to move independently, this has had to be done.
 
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Nebiroth

Registered User
Aug 20, 2006
3,510
0
I have always said to my darling mum that I will always care for her so option 3 is a particularly difficult thing for me to agree too

There is a huge difference in breaking a "promise" because it is the right thing to do and breaking one for selfish reasons.

Even if your mum had to go into a care home at your instigation - this is still you caring for her - caring, as in, making sure that her welfare is provided for in the best possible way.

Sometimes caring for someone means giving over some of the caring to a professional environment, because the person will have their needs bette rmet that way. Care can and does go beyond what one or more informal #, family carers can provide.

It does not mean you don't care for your mum. It is just that you are not seeing to some of her care needs because they can be provided for in a better way elsewhere.

If you mum had something like an infection, a broken bone, cancer or needed dialysis you would not hesitate to pas sover some of her care to professionals, because you would be doing it with her best interests at heart and would not be able to do it yourself.

This is no different, except that her care needs are classed as being more "social" than "medical" and therefore family members often feel that they should be as well able to do it as a professional. Whereas they would not hesistate to hand over to a doctor, knowing a doctor was better equipped to deal with a need than they were.

In such situations family member so ften feel they are violating a promise, betraying their loved ones in doing so, then feel guilty accompanied by a sense of inadequacy. These feelings are only natural, but they are misplaced.
 

susy

Registered User
Jul 29, 2013
801
0
North East
Sorry to hear this.
Has your mums hip been fixed? Either by a replacement or a nail/pin? Is it that she should be mobilising but due to her Alzheimer's and her being in a foreign place that she is scared and won't do it?

Things that can be put in a home are a commode for toileting, a stair lift if necessary (if her hip is fixed she may well be loads better at home as it's familiar) use of bed bath wipes or a bowl of water and cloths and towels for washing. For toileting and seating she will probably need a raised seat.

A care home should be able to accomodate and care for her but mobilising seems to be the issue.... Massive dilemma for you.
 

Soobee

Registered User
Aug 22, 2009
2,731
0
South
Mum broke some ribs but the pain and the result was like she'd broken her hip. She was moved to a community hospital for 3 months but she didn't recover her mobility there despite having physio. After that she came home but she was then chair/bed bound and had to be hoisted.

I think the advice is good here - you can't have her home, it is up to the hospital's care team to find a suitable placement for rehabilitation.
 

GeordieGirl

Registered User
Aug 1, 2014
6
0
Hi

I worked in an NHS rehab unit for people who had fractures and strokes, etc. We definitely did take people with dementia for physical rehab, so you are being fobbed off if you are told they can't take your mother due to her "refusal" to co-operate.

Yes, it might take longer to get there. And, it might involve staff being a bit more patient and creative with their techniques.

You said your mother had the fall a week ago! It is inhumane to expect her to be all set and ready for discharge this early. You should point out to the staff that they are dealing with a person here. Just because she has dementia should not exclude her from her right to the same treatment as anybody else in the hospital.

As for the "needing the bed" claims. Well, that is true. Hospitals are under great pressure to keep the throughput high. Their budgets depend upon it. However, this does not rule out your mother's rights.

It is far too early for you to have to be in a position where you are told to look for permanent residential care. And, clearly you can't adapt your home in a few days if this is what is needed. Have you considered a stairlift? Ask the hospital OT about it. But, insist upon the rehab option! Your mum deserves this chance.

Good Luck! xx
 

Sue J

Registered User
Dec 9, 2009
8,032
0
I find it incredible that they are expecting your Mum to be walking so soon after a broken hip repair. Of course early mobility is the goal but your poor Mum will barely have got the anaesthetic out of her system, you said it was only last week:eek:, can''t they give her a chance of some recovery first. Most should know that anaesthetics and dementia don't mix well. I'm sorry the hospital are putting you under pressure to make a decision for your Mum but I think the ball is firmly in their court to make the right rehabilatative provision that she needs.
Best wishes
Sue
 

SueShell

Registered User
Sep 13, 2012
395
0
Orpington
My Mum had a fall and broke her hip 18 months ago. Her problem is there are 26 stairs outside to negotiate before she gets into her home. The hospital send in the Occupational Therapist as by their account, not mine, all the patient has to do for the hospital to discharge a patient is get off the bed themselves and get on the bed themselves and that to them means she's fit enough to come home so they discharged her. Her walking before the hip break was fine and she didn't even use a walking stick, now she's so frail and uses a zimmer all the time. I had to nag to get a physio to come home to her but after she'd done the stairs twice the next time Mum refused point blank to do the stairs so the physio stopped coming. Now Mum is housebound and its even more problematic if she needs to go to hospital or the 4 weeks respite a year because I have to book transport so that she can be carried up and down the stairs. With hindsight I would have refused for her to come home as she should have gone straight to a rehabilitation centre. All the hospitals want to do is to free up beds. My Mum ripped out her drip, her catheter and anything else that was attached to her when she was in the ward, and one day they gave her three lots of laxatives by mistake, that was not good considering the amount of time Mum had to wait for the nurses to change her bed/clean her up! Sue
 

Wirralson

Account Closed
May 30, 2012
658
0
My darling mum who lives with my husband and I fell last week and broke her hip. She is now In Hospital but is not progressing well, she refuses to try to walk and gets agitated with the nurses and physios. As they want the bed They Are now discussing options for discharge, which are.

1. Step down in a care home for rehabilitation
2. Discharge to home to see if she will walk and go up the stairs !!!!
3. Permanent care home placement

Firstly option 1 is a non starter as the hospital told me today they won't take her because she gets agitated won't do anything they ask and keeps undressing herself

If she comes home and then can't walk/get up the stairs then what will happen !!!

I have always said to my darling mum that I will always care for her so option 3 is a particularly difficult thing for me to agree too

I adore my mum and haven't stopped crying since I got home from the hospital. When I left I said to her bye mum see you tomorrow I love you very much, and she said I love you very much too!. OMG that made me sob all the way home.

I just don't know what to do all I want is my mum home so I can care for her. Trouble is my house isn't that big downstairs I have one room lounge/dinner and kitchen, no downstairs toilet. If I bring her bed down and have a commode she will have no privacy and no washing facilities. Also as she gets really agitated through her dementia I don't know how she will react

Seems to me despite all this talk about helping dementia sufferers reality is a different kettle of fish

I can't desert my mum what can I do please help me

Sasky,

Before your mum can be discharged from an acute orthopaedic ward (which is where I assume she is), as with any hospital, there must be a discharge plan and onward care plan. As she has dementia and a physical problem (the hip) plus others, this should involve an assessment jointly by Local Authority Social Services, the Acute Trust (hospital) clinical discharge team (they WILL have one even if it is called something else) and the local community provide (is your mum under the care of a community nursing or mental health team for her dementia? She should be. This should assess her care needs, whether it is appropriate for her to return to her previous place of residence, or what alternative needs a re required. She should not in any circumstances be discharged before this has been undertaken. (Can't find relevant guidance quickly but will post if I come across it. The hospital should have a discharge/onward care referral policy in any case, and you can ask for a copy.) IT does sound to me as though they have started that process, but a week is a short time for a fracture in the elderly. They are supposed to consider all the options you outline, though. In practice, given your circumstances and your mother's condition I would expect 3 to be the most likely outcome, as the physio and safeguarding against slips, trips and falls is most likely to be easily provided in such a setting. I'd suggest you seek an early meeting (especially if you or a member of your mum's family holds PoA or deputyship).

There are specialist facilities for rehab, and both the Equalities Act and NHS policy require they should take people with dementia. As has been posted in this thread, you mum deserves this change, and the rehab must be arranged somehow. In fact I'd argue it is MORE essential for a person with dementia, as someone without can, to an extent, do exercises at home. Those with it will find that harder.

W
 

Sue J

Registered User
Dec 9, 2009
8,032
0
In fact I'd argue it is MORE essential for a person with dementia, as someone without can, to an extent, do exercises at home. Those with it will find that harder.

Totally agree.