Mum sent back to hospital

Discussion in 'ARCHIVE FORUM: Support discussions' started by angied, Jun 3, 2005.

  1. angied

    angied Registered User

    Jun 3, 2005
    1
    Hi New on this forum! Mum is in the later stages of Alzheimers. She has been in the Elderly Mental Health Hospital ward for the past few months because of her deteriorating behaviour and continual night wandering. They assured us that
    her medication had been sorted and that her behaviour had stabilised and that
    she was ready to be discharged to an EMI residential care home. She went on Weds and was promptly returned today because of her aggressive behaviour and abusive language and her wandering into other residents bedrooms at night. We
    have been told that they will not have her back.
    She has alzheimers - these are symptoms - it was an EMI home!
    What happens when the care homes won't have the residents?
    What do we do now?
     
  2. Sheila

    Sheila Registered User

    Oct 23, 2003
    2,259
    West Sussex
    Hi Angie, difficult as it is, the problem is not for you to sort out. The hospital obviously painted a rosier picture than was the case. It is down to them to sort it out, make sure you let them know this, it is not your problem, they are the professionals here. If the home had been a bit more leneint, possibly she may have settled in time. As it is, the hospital is back to square one and must deal with the situation. Occasionally people just do not settle and hospital is the safest option for them. This must be extremely upsetting for you all as a family. I do hope you find TP a useful means of expressing and sharing your worries, we are not experts, just fellow travellers, but we are always here for you. Thinking of you, love She.XX
     
  3. KarenC

    KarenC Registered User

    Jun 2, 2005
    122
    Los Angeles, USA
    Different? in the U.S.

    Sorry to hear you've gotten such a run-around from the health services. I don't live in the UK, and am not real familiar with your national health care, but get the gist of your situation.

    Here in the U.S. we don't have national health service. Instead we have a bunch of private insurance arrangements, including HMOs (health maintenance organizations). My parents' HMO is Kaiser. In general I've been pleased with Kaiser doctors, but the bureaucracy is frustrating on a good day and in my more cynical moments it seems their sole goal is to do things as cheaply as possible.

    My mom had been living in an assisted living home for over a year as her dementia progressed. This home openly said they did not really handle dementia -- a certain amount of fuddly-ness and forgetfulness they could cope with, but not the tough stuff like wandering or aggression. (This home, by the way, was on a purely private pay basis and was unrelated to Kaiser.)

    As my mom's behaviour got more difficult to deal with, the home coped as best they could, but finally an incident in the middle of the night was way more than the nurse could handle, so she called an ambulance and had my mom taken to the hospital. She was taken to a hospital that was probably in fact the right sort of place for her problem. We'll call them Hospital No. 1. The first thing Hospital No. 1 did, however, was check Mom's insurance, see that she was with Kaiser, and Kaiser does not contract with Hospital No. 1. So Mom was transferred a few hours later to Hospital No. 2, which does contract with Kaiser. Hospital No. 2 appeared to just be a general purpose hospital, and in retrospect, we realize that they had no idea why Mom was there. They kept her in a general ward for a couple of days, monitored her physical condition, and of course found nothing really wrong with her. We kept asking when she would see the psychiatrist or neurologist; that did not seem to be high on their priority list. After a couple of days, however, we got a call from a Kaiser person, who had heard from the hospital, that Mom had slapped a doctor, thrown her pills on the floor, etc., and Hospital No. 2 was therefore essentially kicking her out. She needed to be transferred to Hospital No. 3, which had a psychiatric lockup ward.

    We went down and checked Mom out of Hospital No. 2 and into Hospital No.3. The lockup ward was a kind of scary place, and I was not thrilled about leaving Mom there, but that was the only option. There at least she was seen by a psychiatrist, who made sweeping changes in her medications. Well, OK, maybe that was in order. But this doctor did not follow up; a couple of days later after cursory examination she declared Mom ready to be discharged. (There is a lot of pressure from HMOs to keep hospital stays to a minimum, since it is expensive to have someone in hospital. I'm sure that figured into the doctor's decision to release Mom so soon.) They said they would put Mom in a cab back to her assisted living home. I had some misgivings about that, but it seemed OK (my husband and I both work and are not real close by). A few hours later I got a call from Hospital No. 3 to the effect of "You need to come get your mother." Seems Mom (who is now all sorted out, remember?) refused to get in the cab, refused to leave her bed, clawed the nurse, etc.

    My husband dropped everything at work and went down there, checked Mom out and took her back to her assisted living home.

    They stuck it out about a day and a half. Mom was quite depressed -- wouldn't get out of bed, eat, take pills, etc. So they said she has to be hospitalized again immediately. Then they called Kaiser, who said she has to go through their psychiatric evaluation.

    We dropped everything again, went and took Mom to the Kaiser psychiatry office. There a pleasant social worker talked to us for about an hour, consulted with the doctor, and tried very hard to sell us on the plan of "the doctor will just adjust her meds and send her home." I said she had to call the assisted living home, which she did; the home told her no, Mrs. P cannot come back here. Period. So, with an old lady with nowhere to spend the night, Kaiser relented and admitted her to Hospital No. 4. This hospital had a geriatric psychiatric unit. They did keep her a few days, but nowhere near long enough to see if she was stable on the latest medication regimine.

    In the meantime my husband and I realized we had about two business days to find a new residential situation for Mom, since the previous home would not take her back and Kaiser would not pay for her being in hospital for long. The previous home fortunately steered us onto the place we selected, and we got lucky that they had an opening (and we had a checkbook when we interviewed them and wrote out a check for $3000 on the spot), and we had a solution.

    Mom had been through 4 hospitals in 2 weeks, had her medications changed several times, and ended up in a new home. :eek: I've no practical advice for you, just sympathy.

    Karen
     
  4. Sandy

    Sandy Registered User

    Mar 23, 2005
    6,847
    Dear Angie and Karen,

    I agree with Shelia's advice Angie, you can only do so much. I have only encountered this aspect of EMI provision once, when checking out prospective homes for my father-in-law. Although all the homes we visited were registered as EMI homes on the Comission for Social Care Inspection web site http://www.csci.org.uk/registeredservicesdirectory/RSSearchCategories.asp?Action=SearchCats&Type=CRH , one home did tell me when questioned closely that they accepted residents with dementia as long as they didn't present "challenging behaviour".

    One aspect of care home provision that might make a difference is whether or not it has nursing care included. These homes have nurses (usually psychiatric) on tap and can make changes to medication as needed. They also sometimes have higher staffing ratios.

    Karen - Firstly, welcome to Talking Point! I can relate to your post too. Anyone attempting to embark on even a very basic explanation of the American health care system deserves a medal for bravery. I say that as a native Californian (born in San Jose) who has lived in the UK with my British husband for over 15 years now.

    The situation in the UK can seem equally complicated. I think part of the problem is that because we do have a National Health system, and a fair level of welfare benefits overall, most people expect a higher level of support when someone is diagnosed with dementia.

    The government has got itself into the schizoid situation where it defines some care as "personal care" (washing, dressing, etc.) and some care as "medical care" (changing dressings, dealing with broken skin, etc.) - even if an underlying medical condition is to blame. If someone has assets over a certain amount (something like £19,500 - including their house if they are the sole occupant) and if their care needs are classified as "personal", they will be expected to meet all their care costs themselves. This can mean weekly care home fees of £400 - £500. Once their capital drops below £12,000, the state will cover the costs.

    It is a terrible tragedy that when person-centred care is what is required, finances and resources should play such a large role.

    Take care,

    Sandy
     

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