Mum in hospital - can I refuse to take her home so she gets more help?

[sandyballs]

Brief background - mum is 84, diagnosed with early stage alzheimers in May this year. She still lives alone, very resistant to any help but it has become increasingly obvious lately that she is not coping very well - unpaid bills, dirty home, dirty clothes, increased confusion.

My brother and I do our best with help but we don't live near her and both have busy jobs, kids etc which I feel very guilty about as I feel we are letting her down and neglecting her.

Popped in yesterday to see her and found her asleep in bed, fully clothed, and I was unable to wake her. Lots of over the counter medicines scattered about, like beechams, benylin which she has always overdone and I worried if this time she had seriously overdone them so called an ambulance.

Hospital said she was severely dehydrated, had a urine infection and are worried about her chest scan so kept her in last night. My brother and I have been chatting this morning and are very reluctant to take her home to the situation she has been in as it is now obviously at the stage where she can't cope - we were reluctant to force her to go into a home or have carers popping in as she was so against it and it would distress her but this has reached the point where we go against her will unfortnately.

So, what can I do if the hospital say 'off you go', can I refuse to take her home. No room for her at my home or my brothers . She looked like a tiny lost child sitting in that hospital bed last night.

[Northernlurker]

Ring the ward and say you have serious concerns for her well being. Ask for a referral to a hospital social worker and be very clear that you cannot support your mum on a daily basis.

Tbh I would start looking at care homes near you or your brother.

[saggarmakersbottomknocker]

Your poor mum. You need to tell them that you are unable to give her the level of care she needs and ask them to have her assessed before she's discharged. You may need to be quite forceful though. Good luck.

[happymole]

Can you ask the hospital to contact Social Services to arrange help for her?

In my job I encounter Social Service contracts (either temp or permanent) to provide carers for vulnerable adults a lot.

[tibni]

Request that an assessment is made on her need and a care package is put in place. The hospital will have social workers and discharge teams in place

My dad had to stay in hospital until they could put in place a level of care that met his needs. This is about your mums safety and wellbeing so you have every right to express your concerns. Good luck.

[Notquitegrownup]

Tell the ward that she is not safe at home, and is not managing her medication at all. Tell them that you believe that she is at risk at home. I believe that the hospital have a duty not to discharge someone into a life threatening situation. (I work with the elderly in sheltered housing and have had to have these conversations before.) Ask for an urgent referral to the Occupational Therapy department for a full assessment. In our hospital the OT has the legal responsibility for ensuring the patient is safe to discharge, so if you use words such as "at risk", "Vulnerable", "in dange


Be calm and clear. Ask also for a referral to either social services or to the hospital social work team, and then make sure that it happens. Follow up with phone calls to the named nurse who should be looking after her each day, and ask if anyone has seen her yet and if not, when they will be doing so. Send in a sheet of paper with your contact details on and ask for the social worker to contact you as and when they need to.

Best of luck

[Notquitegrownup]

PS It's not about being confrontational, but it's about asking the experts to assess her, so that they are able to confirm that she will be discharged into a situation which meets her needs. You can co-operate with them, but please do keep on asking them to make the decisions. In our experience they will do this, but being busy they don't tend to volunteer their support, you have to keep on asking for it, and keep your eye on what you know to be true. She is safe in hospital, she needs a care package in place to be safe somewhere else.

[sandyballs]

Thanks so much everyone, this is all very helpful. Such a worry but I do feel happier knowing she's in hospital and even being given a cup of tea this morning and breakfast which I think was hit and miss at home recently.

[OriginalPoster]

It is helpful to the staff if you are clear about what you can and can't do. Try not to feel guilty, no one is judging you, they just want to organize appropriate care for your mum. The reality is she cannot manage alone at home, so you are doing your best for her if you arrange for her to be looked after. Her disease is affecting her decisions, and she needs help from you and your brother to make the best choices for her.

[PIMSoclock]

Does your mum still have capacity to make decisions?
What does she want?
At the end of the day, you can't refuse to take her home if she is still able to make decisions for herself.
It would be useful to know her take on things. How does she think she is coping??

[OriginalPoster]

PIMS
It would not be possible to assess mental state for capacity meaningfully when a patient is dehydrated and has an infection on board. She would have to be over the acute illness before this could be done.

[edam]

The hospital should be drawing up discharge plans anyway - it's a routine responsibility. Sadly it's not always that straightforward, so you need to follow the advice here to make sure it's done.

[PIMSoclock]

Op, capacity has to be assessed even in the acute stages otherwise we may potentially be assaulting our patients.
That's what temporary adults with incapacity acts are for. it would obviously then be reassessed, though as u rightly say, most mental health teams would not consider this untill she is at least 6 weeks clear of any potential causes of acute delerium.
Capacity would have to be considered BEFORE she could be discharged to independent living. It would be simply wrong to discharge a patient home without a care package and advocate if they lacked the capacity to make safe decisions.
It's a reasonable question to ask if her capacity has been assessed up to this point. (she has a diagnosis of cognitive impairment)

[OriginalPoster]

Pims I agree totally. I didn't explain what I meant by 'meaningfully'-I meant her capacity to decide on long term placement would be better left until she was over this episode, not that she has no right to make decisions about her treatment during her hospital stay. Apologies for my lack of clarity.

[PIMSoclock]

No worries op x
Ss, I have delt with patients like ur mum before. It can be incredibly difficult particularly if they are set against accepting help.
Capacity is important, particularly if there is a question of safety however, u may not be able to get an absolute answer for the reasons discussed.
I would suggest a multi disciplinary team meeting would be most helpful.
Occupational therapy should do a full kitchen assessment and home visit. They will make an assessment of her cognitive ability (this may improve as her acute problem resolves or may deteriorate with her general mental health but a establishing a baseline will be important)
They will be able to assess if she can look after herself in any capacity and recommend and arrange home help, removal of gas cooking devices, medicine safe, door alarms, panic alarms whatever is necessary to keep ur mum safe at home (if that is the best option)
The consultants on the group can alter and simplify her medication and the physio's will examine her mobility.
The group will also have a nurse from the ward who will report any night time confusion or wandering as well as her ability to function on the ward. A social worker will also attend to make sure that the transition back to the home is picked up by their system too.
Most older adults wards will have a multi disciplinary meeting to discuss the in patients at least once per week.
Find out when hers is and speak to the nurse or make an appointment to speak to the consultant before. This way all ur concerns are sure to be addressed.
Hope this helps x

[PIMSoclock]

How did things go sb??? X