Not understanding 'rehab' procedure

[jugglingmum]

My mum was discharged from hospital into NHS paid for rehab in a care home (all are either rehab or respite beds).

She'd had a fall, possibly caused by heart issues (AF) and pneumonia.

Apparently they are assessing her, but I don't understand what for. She lives in extra care (assisted living) and no one has spoken to them. When I've seen her walk (she is still meant to be using a frame) it is as good as it's been in the last 4 years. She furniture walks a bit at home, which they don't like.

I am worried she will now take time to get back to routine of making her own breakfast, and evening sandwich etc with being out of flat for so long (I may be just worrying over nothing).

I was told when I phoned today that there is an issue with her meds taking now - but didn't seem much different from what I'd told them, and she has a clock in her flat to know what day it is, without this she wouldn't have a clue. I've taken clock up after work tonight. I did state when I spoke to an OT last Wed that I thought she might need supervised meds from carers.

I am struggling to talk to the right person, and she has been there 10 days now. Will I be involved in discharge process, or not? Just feel very confused.

 

[canary]

After a fall, TIA, or similar which results in an admission you get 6 weeks NHS funded rehab. During this period she will be assessed by OTs, pysios, SS and medical staff. At the end of the 6 weeks there will be a review and family should be involved.
This has happened to both my mother-in -law and my mum. MIL didnt have dementia (though I did wonder near the end), but did have heart problems. She had 2 bouts of rehab following different falls and each time, at the end of the six weeks period she returned home, but with adaptation to the house (risers on the chair, a frame round the loo and various grab handles) after the first one and then carers going in after the second one.
Mum had dementia and had a TIA, so she had rehab for the 6 weeks. At the end of this it was decided that she should stay in permanent residential care in the care home. This was also what I wanted as she had not been coping at all well at home and was wandering around outside in her nighty during the night, but she had refused any sort of care. Fortunately, by the end of the 6 weeks she thought that the CH was her actual home (I know it doesnt always work like this), so everyone was in agreement that she should stay there.

 

[jeany123]

We had to pay for our 6 weeks enablement because in this area you only get it free if you come straight home out of hospital and my husband went into a CH to recuperate a bit before he came home,

i'm sorry you are talking about rehab in a CH that is free,I misunderstood canary x

 

[jugglingmum]

Thanks for replies, think I understand a bit better. I know they said normal length of stay is 2 weeks, which is up on Friday so maybe I'll try and phone again tomorrow and see what the score is.

 

[jugglingmum]

Well I got a call from OT today. Mum is being discharged tomorrow. They think she will be better off in her sheltered extra care flat and may be deteriorating where she is. Hmmmm - well I certainly agree with that last statement, as it's what I told them on day 1.

So I'm picking her up tomorrow. They have tried to get her to walk with a frame and use a trolley to move things, but admit she will likely revert back to how she was in her flat. I need to get a trolley like the one she's been using to encourage her to use it - not that I'm there that often with work and kids etc - so dream on. I think she may well end up tripping over the blinking trolley.

I want what's best for her, but unless she goes into a CH she will do it her way (very independent, strong minded etc are phrases I'm tired of) and for now I think she should have the chance to go home. Her walking has been the same for years, so not made worse by dementia (severe arthritis maybe) and fall was caused by pneumonia and atrial fibrillation.

And I'm going to start looking at local care homes just to get a feel as if she would be happier in one, she can afford it.