DM in hospital again - what if she's sent home again?

[ZaZathecat]

Me again...

DM, who has dementia, was in hospital for 2 weeks as she fell and cracked a bone. After 2 weeks she was shuffling around with a frame so SS deemed her fit to go home with a care package, though I was doubtful. However she seemed to improve physically though still needed help with everything.

After 3 weeks the pain worsened, I took her to GP who said she would get the physio to visit. The next morning the carer found her on the floor crying out in pain. So she's back in hospital and apparently the fracture has opened up more.

To get to my question: when she starts to get better, I suspect SS will again say she can go home with a care package but I think it will just lead to a series of falls and hospital stays until the penny drops. (I have personal experience as exactly this happened to my dmil in the same hospital only months before). What I'd like to to is move her from hospital into respite care and see if a) she gets used to it and stays there or b) gets back to normal mobility and goes home.

If we go against SS advise and put her in a care home obviously it would be self -funded. That is OK as she has a property to sell so she would be self-funding anyway. But what happens when after say 2-3 years her money runs out? Would SS say 'we never said she needed a care home so we're not funding her now.?

To give a complete picture, dm has mixed dementia (about mid-way I'd say), the above mentioned mobility issues, and very poor eyesight (cannot read anymore or see photos). Since her first hospital stay (which sent the dementia into overdrive) she is also afraid of being left alone.

TIA for any advice.

[Needmoresleep]

We paid for my mother to have five weeks convalescence after a fall. (Yes she was supposed to go home, despite dementia and being clearly unable to look after herself.) She improved immensly. A combination of good food, nursing care, company, organised activities etc. It was fiendishly expensive. After that she was able to go into very sheltered, though in her case she had to buy the property. But could have moved to a cheaper non-nursing home. Or might have managed with a suitable care package plus alarms etc.

The thing is that you have no idea where she will plateau. A hospital stay is really difficult for someone with dementia as they lose their routines. I would look for some short term convalescent help and have the care home management guide you as to what might be a good next step, and help pursuade SS.

It was expensive, but rainy day money is for a rainy day.

[ZaZathecat]

Unfortunately we couldn't afford to pay the £6000 per month respite care ourselves. DM would have the money if her flat were sold but obviously we'd only do that if she was not going back. I don't know what to do. Do you think I could persuade SS to decide she needs at least temporary full time care, to be reviewed after a few weeks?

[maryso]

Everyone has their unique world, so like needmoresleep I can only say that when I was very young and frail (with no prospect of a future, or any sense of appreciation) my young DM would have done whatever was needed to increase the chance of improving my quality of life. Thankfully she had an excellent death.

SS is the option of last resort for those who cannot help themselves. One can only hope that fear and pain are eliminated by dementia, however that is almost always wishful thinking. She appears to have suffered for five weeks now, it is amazing what another five weeks of high quality convalescence (not bog standard 'care' that is often low value and costly which is all SS can offer) may do. I wish you all well.

[LilaTheTiger]

The ward should have occupational therapists attached. Speak to them. Get them on side that she is not safe to return home. Hospitals do not want failed discharges, very bad for figures.

Tbh, in your position I would sell her flat, and move her into self funded care. Dementia is a progressive disease, when the money has run out its likely your mum would be more than eligible for funded care.

In the circs you've described reablement packages don't sound appropriate, buy they might be worth asking about.

[ZaZathecat]

Thanks all.
maryso all the homes that take dementia patients around here are roughly £1500 per week. I really don't know if they are what you'd call bog standard or quality - they are on the councils list. We don't have money to pay for it ourselves so it could only come from dm's flat sale.
Lila I think I'll have to hope you're right there. SS have already ruled out re-enablement last time because of the dementia.

[whataboutbob]

I agree with Lila the hospital will need to take a relaistic approach and it sounds as if your DM is struggling at home. Sadly dementia is progressive. If you sell her home to fund care then SS have to step in when her assets are down to £23000 and provide funding. Or she may begin to qualify for Continuing Health Care at some stage in her illness, in which case the CCG (the NHS) pays.
To make sure everyone is on the same page, ask the ward to organise a discharge meeting involving all the involved parties- maybe OT, physio, social worker, doctor and possibly discharge nurse if the ward has one . Spell out your concerns about home not being suitable and the fact that she'd be likely to be unsafe.

[CMOTDibbler]

As Lila says, the way I'd go is to engage the ward OT, social worker and falls team while your mum is in hospital. Discuss her falls risk (especially with her visual impairment), and your concern about keeping her safe overnight with the combination of impaired mobility, VI and dementia.

Ask outright about temporary respite care, a step down unit, or a community hospital placement - and say that you think that it is time for residential care in your mums best interests. Then they have to argue why this isn't appropriate. Document everything.

[SummerSazz]

Can you get a Telecare monitor for her - has a falls alarms and fire alarm etc. If she's in difficulty she can press the button and talk to the central staff. (sorry I her dementia wouldn't make this a possibility)

Also how about carers for 1/2hr in the morning - this made a massive difference to my parents and didn't completely break the bank!

[ZaZathecat]

Thanks CMOT.
Summer she had 3 carers a day plus me and an alarm pendant after the first hospital stay. She fell early in the morning before the first carer and did not remember to press her button.

[Needmoresleep]

I am no expert but I still think you need to thing of this in two phases.

1. Short term. It can take weeks for any anesthetic to work its way out of the system, and for an elderly person with dementia to adapt to new circumstances. My mums houusing said to allow her two months to settle which was about right. And major trauma can also be expected to leave its mark, so even when things have settled expect her to have taken a further step down the dementia route. My instinct would be to throw as much support in at this stage, to help ensure she plateaus at as high a level as possible and properly recovers from her falls. If I had not managed to find a nursing jhome place for my mother, and her discharge was with two days notice on Chrstmas Eve, my plan had been to go and stay with her for however long it took, in part to look into longer term solutions. (Luckily my DC were 14 and 16 at the time so could cope, indeed it was probably not a bad thing for them to show a bit of independence.)
   

1. Longer term. Money! Work out how much there is and ensure you have access. If you don't have POA arrange for her to sign a third party mandate on the main account and set up internet banking. Have a good idea of how much she has coming in and how much in liquid and illiquid assets. Apply for Attendance Allowance, and then Council tax relief. Then ask everyone you come across, be in health professionals, SS, and people like the vicar, what they think might be a suitable longer term setting for her. Speak to home managers about whether they have SS clients, ie that she could stay in the same setting when the money runs out. You have two competing objectives. One is to keep her in a setting which uses as much of her capacity that she is capable of. My mother is in very sheltered and almost certainly has declined less slowly that if she were surrounded by people with less capacity and if more were done for her. And it is cheaper. The second is to keep any moves to a minimum as any move willl require her to learn new routines.
   

If a move is likely to be needed soon this might be as good a time as any to make it, as she will have to readapt to home anyway. However if staying at home is feasible then this is probably her preferred option.

If you are moving her, I would be tempted not to have her move home after hospital. Instead I would grab a friend and arrange for four estate agents to come round at half hourly intervals one morning. Interview them, ask about the market, what needs to be done to the property for it to appeal to a wide market, how long does property take to sell etc. Explain that it may take a while to get everything sorted, and then when you are ready to roll you will know which agent seemed the most on the ball and most able to handhold through the process. One advantage of doing this early is that selling the flat becomes a bit more of a process and not another hurdle. Plus you get an outsiders view on what needs to be done to gain maximum value from the property. Having a friend there makes interviewing easier and gives you someone to confer with - there is something weird about treating your parents home as an asset. (I did this with a fellow MNetter when she was drowing in parent related problems and it was fun. We both heartily disliked one agent, were underwhelmed by another, found the chain professional but cold, and liked a well established local guy who we could see was popular with elderly people who formed a good portion of the local housing market.)

[ZaZathecat]

Thanks for taking the time Needmore.
I do have financial POA for her, though until now I haven't had the need to use it. I am well aware of what she's got though as I've done everything like that for her for at least 2 years, and I applied for and got AA on her behalf.
I agree it's very important that the setting is right for her. I just visited my first care home that deals with dementia and all the residents were in the advanced stages so no-one was talking to anyone else. It would be hell for dm and I think she'd quickly catch up with the others dementia-wise.

[Marmitelover55]

She might be entitled to NHS funded nursing care if she is not entitled to NHS continuing care. This is paid directly to the nursing home and is I think £112 a week. My mother received it when she was discharged from rehab after breaking her hip (she also had Alzheimer's).

Would it be possible to rent out her home rather than sell it? Maybe the rent plus pension plus attendance allowance plus NHS nursing care might make the weekly bill more affordable?

[ZaZathecat]

I will ask about the nursing care allowance Marmite. If we rented her flat out and added her pension and attendance allowance it would come to about £1800 per month - nowhere near the £6000 needed, so selling is the only option.
Saw another home this afternoon. Same cost as this morning but polar opposite in every way - it looked amazing. I'm now minded to get her a room there on a month's trial and hope she likes it. OT at the hospital said she should be discharged in a couple of days so it's all a bit sudden. I was excited earlier but now am feeling doubtful and scared!

[SnuffleBadger]

From your first post OP I am assuming that your DM has been assessed as not having the capacity to make decisions about her discharge destination and future care needs? If this has not been formally assessed please ensure that the ward do this before any discharge decisions are made.

Do you have access to any schemes locally that will assess your DM in her home environment for a period of 48-72 hours where carers stay with her 24 hours a day? Usually run by the older persons mental health team these schemes specialise in working with people with dementia. This would be the most accurate way of establishing if home is a viable option for her. If she is deemed unsafe at any point during the assessment period she would be placed into a 24 hour care setting such as a care home pending a permanent placement being found.

The other option for your DM is likely to be an extra care setting where residents have their own apartment but carers are on site 24 hours a day to provide support. This is kind of a mid point between home and residential care. Much more like home and there is usually lots going on to stimulate the mind and keep the residents active.

[ZaZathecat]

Haven't heard of such a scheme Badger. I think I have a plan now though so will stick with it. One of the problems at home had been that she's bored and afraid of being alone, so I think a good care home may be better than being at home. I would rather take her straight from hospital too and dress it up as convalescence, because if she goes home first it will be a lot harder to persuade her to give it a try and we'll end up 'waiting' for the next crisis.

[Marmitelover55]

Sounds a good plan and think convalescence is a good way to describe it. My mum's was a lovely nursing home and the staff were great. Sadly she passed away 2 weeks ago and it was her funeral today. X

[ZaZathecat]

Sorry to hear that Marmite.