Mum in hospital Care Package not yet confirmed

Angel Heart

Registered User
Feb 22, 2020
35
0
Hello,

My Mum was recently rushed to hospital and it later turned out she had Pneumonia! She’s been in hospital a few week’s and although a little better not quite out of the woods and struggling with eating and mobility - needs have increased and the hospital were going to discharge early without a package of care in place! I raised my concerns and have now set up an in person meeting with the hospital end of this week.

Mum is still in hospital atm and they won’t discharge without my consent as next-of-kin and that all of us that are LPAs are also not agreeing to discharge as she is not recovered fully - to the point where the physios struggled with her mobility and nurses struggled also!

Contrary to what I’ve been told in the past by social workers, I.e the professional belief that assessments are meant to be paid for if over £23k savings this is not necessarily the case if there are lots of complex needs and this is actually meant to be assessed first on the medical needs - been fighting this for years and hitting a brick wall!

However, I think Mum would be entitled to a 6 wk continuing healthcare package via the NHS but this has not yet been confirmed or in place as an assessment is needed first. Plus, I’ve told the Hospital I won’t be able to cope without something in place due to needs increasing with eating and choking and mobility.
I am usually Mum’s 24/7 carer with an agency filling in ad hoc - as I also have a full time shift job that my employer lets me mainly work from home at their discretion, due to the complex personal circumstances!

I normally have a relative who until recently helped me but he is also elderly and a few week’s ago said he was struggling to cope with Mums mobility. He is my rock but now my only other support is the ad hoc agency who I have to book a fortnight ahead or my young relative who lives the other side of the country!

I’m also meant to be on an overseas trip in less than a month that I pre booked months ago and is non refundable - of course if Mum isn’t better I’ll cancel.

Mum and I are incredibly close and I think of her as my Best friend. I’ve always been an advocate for Mum being independent at home which she has always said is her wish and I want to respect her wishes.

However, my other loved ones think permanent care home and I’m thinking if she gets the nhs package of care for 6 weeks, to try to see if they can implement this as temporary respite to see if her mobility improves?

My fear is, if she is moved straight into permanent care, I feel it’s too late to reverse the decision, whereas if temporary respite first, there’s more flexibility.

Has anyone been in a similar position?

If so, what did you do?
 

canary

Registered User
Feb 25, 2014
25,363
0
South coast
Hello @Angel Heart

The six weeks temporary care paid for by the NHS is called Discharge to Assess (D2A) and is designed to see whether they would improve. So, yes, I think this would be a very good thing for your Mum and I would push for it.

This is not to be confused with Continuing Health Care which is awarded when they have very high medical needs and the NHS pays for their care. This is indeed assessed before discharge, but the bar is set incredibly high and very few people with dementia are awarded it.
 

Angel Heart

Registered User
Feb 22, 2020
35
0
Dear Canary,

Thank you so much for writing back so quickly and for your kind and helpful reply.

Will certainly take all of this onboard ahead of our hospital meeting later this week!

Thank you again! 🙏
 

Jessbow

Registered User
Mar 1, 2013
5,825
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Midlands
We were told that D2A beds were for people to progress and continue to improve their condition/mobility and etc
Is your mother likely to improve her mobility now?
Otherwise maybe increasing/implementing care calls at home may be the solution
 

Angel Heart

Registered User
Feb 22, 2020
35
0
Hi Jessbow,

Her mobility has not yet improved e.g the physio team were trying to get me to go in to help them when they are the professionals and I’m not trained to lift. The nurses are lovely but they asked if I could stay a little longer on one of my evening visits to see if I could encourage mum to stand, so that they could put her into the hoist.
Things won’t be clearer till we have our meeting at the hospital this week but my quandary is, that I’m meant to live at my flat with my husband but have spent the past plus year giving 24/7 care to mum so that she didn’t wander off and to keep her agency care costs down.
I also work full time shift work on top (not always 9-5).
Biggest dilemma is I’m meant to be flying abroad in less than 30 days! 😬
Extra carers would usually be helpful but my post on here was not knowing what to do for the best as everyone wants an answer from me (hospital, as hoc care agency we use plus their other branch where younger relative lives), the dr at the hospital won’t discharge mum without my consent but I can’t guarantee her safety re mobility as her needs have increased off the scale and the hospital will soon want me to tell them where is safe to discharge her to and my elderly relative who helped so much before can no longer cope.
I’m also meant to go into work in the office twice a month in between working from home for them but don’t know what to tell them as package of care not yet in place. It’s causing a lot of anxiety 😥
 

canary

Registered User
Feb 25, 2014
25,363
0
South coast
I think you have to tell them exactly what you have told us about the problems in providing care and be very clear that you cannot provide the level of care that you have done previously.

If she would be self-funded then you can purchase as much care as is needed, but if she will be reliant on Local Authority funding, then the maximum that they will usually fund for care in their own home is 4 care slots a day and I am not convinced that you would be able to plug the gaps
 

Collywobbles

Registered User
Feb 27, 2018
361
0
Agree with canary. In fact your trip abroad might be the blessing in disguise here. It will give the professionals a set deadline by which they must have some kind of arrangement in place, which doesn’t involve you. Once they’re on that path, they’ll struggle to pass your Mum back to your sole care. Mainly because you can then refuse to restart when you get back.

Be very clear on the dates of your trip, and also that there will be no friends or family to step into the care gap this will leave. Also that you will be completely unavailable to them. Ignore any calls/texts/emails from them while you’re away. Your Mum will be safe without your input - family will let you know about anything genuinely urgent. Make it clear that you won’t return to your previous caring role when you get back. I know feels counter to what you’d ideally like to do for your Mum, but she now needs more support than you can offer - as evidenced by the physios and nurses struggling, in an environment supposed to cater for this type of need.

As a side comment, others have found physio of limited use for some folks with dementia. They can’t remember the exercises they’ve been shown, can’t remember the new, safer ways of moving around, and can be actively resistant to “yet another person ordering me around!” as my Granny put it 🙂
 

northumbrian_k

Volunteer Host
Mar 2, 2017
4,682
0
Newcastle
Is there a prospect of improvement in mobility, eating and other issues to a level where your Mum could reasonably be able to return home? That might mean with (say) up to 4 short carer visits a day but would still place the onus on you to meet her needs most of the time. Is that sustainable given your other commitments and a reasonable expectation of a life not entirely consumed by caring?

These are questions for you to consider rather than answering them here. You have said that you cannot cope without a package of care. If your Mum's needs have grown to the point where they demand round the clock care and support, then a move to a care home may be the best way to fulfil them. Delaying this (or calling it respite) in the hope of sufficient improvement may not be what is best for either of you. Having said which, even care home stays that are classed as 'permanent' can be ended if circumstances change.
 

Angel Heart

Registered User
Feb 22, 2020
35
0
Thanks for your reply Northumbrian. Once we have the family hospital meeting hopefully things will be clearer. Always usually happy to support Mum and have been her round the clock carer til recently but it’s not yet clear that the mobility has improved, if it has then more then happy for them to discharge her home provided hoist and package of care in place but if mobility not improved and as she loves her home so much I feel that temp respite would be best next step to see how she gets on in that environment and if there’s an improvement, I manage the rest of the care at home otherwise we’ll need to reassess the decision but this Thursday we have the meeting so will be good to get some more clarity from the hospital on how she is doing.
 

Angel Heart

Registered User
Feb 22, 2020
35
0
Agree with canary. In fact your trip abroad might be the blessing in disguise here. It will give the professionals a set deadline by which they must have some kind of arrangement in place, which doesn’t involve you. Once they’re on that path, they’ll struggle to pass your Mum back to your sole care. Mainly because you can then refuse to restart when you get back.

Be very clear on the dates of your trip, and also that there will be no friends or family to step into the care gap this will leave. Also that you will be completely unavailable to them. Ignore any calls/texts/emails from them while you’re away. Your Mum will be safe without your input - family will let you know about anything genuinely urgent. Make it clear that you won’t return to your previous caring role when you get back. I know feels counter to what you’d ideally like to do for your Mum, but she now needs more support than you can offer - as evidenced by the physios and nurses struggling, in an environment supposed to cater for this type of need.

As a side comment, others have found physio of limited use for some folks with dementia. They can’t remember the exercises they’ve been shown, can’t remember the new, safer ways of moving around, and can be actively resistant to “yet another person ordering me around!” as my Granny put it 🙂
Dear Collywobbles,

Thank you so much for your reply. You’ve raised some really good points.

I will be taking the stance that I cannot guarantee her safety if needs have increased but not sure im emotionally ready enough to hang up my carer reigns completely. Always been caring since I was a little girl, so I think it feels naturally part of me but I will be raising to the hospital if the opportunity presents itself, I.e the facts that they struggled themselves and whether they can do a package of care in a respite facility to see how this goes. Fingers crossed all will work out ok. It’s been a tough ride lately all round. 😢
 

sdmhred

Registered User
Jan 26, 2022
2,416
0
Surrey
Hi @Angel Heart

It sounds like a discharge to assess placement would be ideal in your scenario …..you may have to really push for that however if they were willing to discharge your mum without a care package. I hope I’m wrong, but I wouldn’t expect dynamic stuff from the meeting on thursday - they will be wanting to free your mum’s bed asap. You will probably need to go in and argue for that as others have said.

I wanted to pick up on what you said about your caring role. I am similar. I had to move mum into residential due to her lack of mobility but i have carried on caring. I’m very much the odd one out in mums home but I visit to help with meals, influence the care plan and am often present during personal care. It’s raised some eyebrows but it works for us!
 

Angel Heart

Registered User
Feb 22, 2020
35
0
Thank you so much SDmhred.

Now apart from how the meeting will go on Thursday my last quandary is my pre planned trip abroad which is in less than 30 days! Friends and relative telling me to go and that I really need the break as they can see I’m absolutely exhausted but other relative thinks I shouldn’t go with everything going on and he’ll refund cost of my trip and my gut doesn’t feel right but it’s non refundable and I’m worried sick about mum but at the same time desperate for the break! I’m not usually this indecisive but feeling very overwhelmed.
:-(
 

canary

Registered User
Feb 25, 2014
25,363
0
South coast
Honestly, hun - I would take that holiday

You need it and you can't continue caring once you are scraping the barrel of your energy. Don't let people who have not been involved in the hands-on caring guilt trip you into cancelling
 

Violet Jane

Registered User
Aug 23, 2021
2,114
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Push for a discharge to assess placement in a care home covering the period that you are away. If your mother's mobility doesn't improve then it's probably time for a care home. Dementia plus poor mobility are very difficult to manage even where the person is living with someone else.
 

Collywobbles

Registered User
Feb 27, 2018
361
0
Take the trip and use it as leverage with the care professionals, so they have a greater interest in making the proper provision and not just automatically dumping responsibility back on you.

The family member asking you to cancel is probably worried that they’ll be asked to step in, in your absence. You can make it clear in the meeting that there is nobody else in the family who will be able to provide care in your absence.
 

Angel Heart

Registered User
Feb 22, 2020
35
0
Honestly, hun - I would take that holiday

You need it and you can't continue caring once you are scraping the barrel of your energy. Don't let people who have not been involved in the hands-on caring guilt trip you into cancelling
Thank you so much for your sweet, kind message Canary.
 

Angel Heart

Registered User
Feb 22, 2020
35
0
Push for a discharge to assess placement in a care home covering the period that you are away. If your mother's mobility doesn't improve then it's probably time for a care home. Dementia plus poor mobility are very difficult to manage even where the person is living with someone else.
Thank you for your msg Violet Jane! They’re currently looking into that D2A and ringing round Care Homes but unfortunately, many are at full capacity or don’t have nursing but I’ve asked them to look into other areas and hoping they’ll come back to me Tuesday morning, otherwise it’ll be likely they’ll instead put equipment in at mums house.
 

Angel Heart

Registered User
Feb 22, 2020
35
0
Take the trip and use it as leverage with the care professionals, so they have a greater interest in making the proper provision and not just automatically dumping responsibility back on you.

The family member asking you to cancel is probably worried that they’ll be asked to step in, in your absence. You can make it clear in the meeting that there is nobody else in the family who will be able to provide care in your absence.
Hi Collywobbles! Thank you so much for your reply. I stood my ground in the meeting which has bought us some more time and I put those very points to them but they’re setting me a deadline of the 28th May to give them a decision. They’re saying they won’t send her home though til something’s In place. I’m sending up silent prayers that they’ll keep mum in whilst I’m away as yesterday, my senior colleague has asked me to deputise all this coming week for her which is some nice news in this tough period and I think the discharge co-ordinator is now being a bit more flexible. I wrote back to say I changed my mind about the deadline and couldn’t yet agree to it til I had further information and figures.
 

My Mum's Daughter

Registered User
Feb 8, 2020
584
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I am really, really concerned about this and I think you should think very carefully before allowing any equipment to be delivered to your Mum's. Have you been told what this equipment is or given training in how to operate it or will it just be a hospital bed?

By saying that care homes are at capacity or don't have nursing, I suspect they're saying that your Mum is now beyond a residential home and only a nursing home can meet her needs. If this is the case, how on earth do they expect you to manage with the assistance of a few carers?

I'm also very close to my Mum but very sadly and to get her the help that she needed, I had to withdraw my care. If I'd carried on caring, I'd have been left with a 24/7 job with 4 x 1 hour care visits a day and Mum would never have wanted that.
 

Collywobbles

Registered User
Feb 27, 2018
361
0
Hi Collywobbles! Thank you so much for your reply. I stood my ground in the meeting which has bought us some more time and I put those very points to them but they’re setting me a deadline of the 28th May to give them a decision. They’re saying they won’t send her home though til something’s In place. I’m sending up silent prayers that they’ll keep mum in whilst I’m away as yesterday, my senior colleague has asked me to deputise all this coming week for her which is some nice news in this tough period and I think the discharge co-ordinator is now being a bit more flexible. I wrote back to say I changed my mind about the deadline and couldn’t yet agree to it til I had further information and figures.
I share the concern above. You can just refuse. I know they make it feel like that’s not an option, but it is. Don’t be there to let them in with the equipment, and make sure they know you won’t be.