Care for the elderly within NHS - does it exist?

[rara67]

Apparently, no matter how ill you are there are only two choices: rehabilitation or a care package at home. MIL is not well enough for either.

Since the end of May she has been admitted to hospital, moved to ambulatory rehab, admitted back to hospital with ascites, sent home with a care package, readmitted to hospital as her GP said she wasn't safe at home and he couldn't look after her there. GP said she would need 6 months to recover and 10 days later (yesterday) the hospital phoned me to say they are trying to get her into rehabilitation again or failing that another care package.

I now assume that if she needs some convalescing then we have to take her out of the system and find somewhere and fund it? Can anyone advise if this is the case otherwise I can see this pattern being repeated. She has refused care packages in the past as recently as April this year. She has cirrhosis, so does not feel very well and isn't eating. DH is an only child, away on a well deserved break, so I am at home waiting for the hospital to ring. My only argument for not sending her home is that the GP needs to be in agreement. Is there anything else I can say?

[Needmoresleep]

The simple answer, I think, is no. Treatment is for the NHS, Care for Social Services. The latter is means tested.

Where the line is drawn is a different matter. The hospital will argue that it needs the bed for a new admission rather than someone who is chronically ill. Social services budgets are desperatly stretched and so they are only likely to offer the minimum needed. Throw into the mix the fact that your mother in law may refuse care and there is a real problem.

It becomes easier if she has money, assuming you have access. If there ever the case for spending rainy day money, this is probably it. Hospitals are not the best place for people to get well, as opposed to stopping being sick. A few weeks in a good nursing home with good food and out of the hospital environment can make a huge difference. But it comes at a price. Over £1,000 a week for the one we used. But it was like a five star hotel, and my mother was then able able to bounce back to a level where she has managed, with care, in sheltered housing. (Ie it bought us some thinking time and a chance to move her out of her own home.)

[IAmTheWhoreOfBabylon]

If she has capacity and refused care nobody can do anything even if it's available

[Penfold007]

The NHS has never provided care for the elderly beyond medical care. You need to ask for an assessment under the Care Act including a financial assessment. You will then have a written report of your MIL's care needs and can act accordingly. That may mean a care home if she is willing.

[CMOTDibbler]

I think it sounds like your MIL isn't ill enough to be in hospital though - what is it that her GP feels like he can't treat at home?

Rehab is designed to be the convalescent phase as a bridge between hospital and care at home, but you may have to have strong words with MIL about accepting carers as it comes to a choice between her having them and staying at home or going into care.

My parents both have very significant health problems and have been in and out of hospital many times, but are coping with daily district nurse visits, carers, and the intervention of the Integrated Locality Team who specifically intervene to keep people out of hospital

[rara67]

Thank you so much for all your replies. It really does help and hopefully will give me the strength to have the conversation with DH which will lead him to having those "strong words" with his DM. We do need the "thinking time" and there is some rainy day money and DH has POA, so I think convalescence is the way forward. We will then be out of the system regarding care packages from social services, but to be honest there are people who desperately need that so MIL will just have to pay privately and then we will have more input. According to the OT she is responding to the physio at the hospital but happy to let the nurses do everything else for her. It may well be that she would want to go into care for a while but it's not that simple as we can't get to the hospital more than once a week to actually as the question. The OT can't ask because they won't be funding it. Let's see what today brings. Thanks again for your continued support at at very difficult time for my family.

[Banana99]

We are having issues with a family member who doesn't understand how her father isn't now permenantly in hospital - he is in and out certainly, but mostly he is old and has ongoing issues but he isn't actively ill. He doesn't need to be in hospital but isn't well enough to be at home with an elderly wife.

We had another family member who was able to stay in their own home with a mixture of family support and social services help - ultimately it wasn't ideal though and would have been okay for short term but long term it didn't do anyone any good. Really they should have been in a care home, but they were so unwilling. Without someone standing over them they wouldn't eat so being home alone was not good.

It's incredibly hard to find something that works I think. Even my friends gran who has been in care homes for over 10 years has had to move several times as her needs have changed.

What ever you decide I think it needs constant reviewing as what they need changes, there's no single solution sadly.

[Needmoresleep]

We sold the convalescent care to my mother as short term and a chance to get better so that she could return home. And that it was either than or a live in carer (which she would have hated.) We never told her how much it cost. it was like a five star hotel.

Speak to the hospital discharge people and to SS and see if they can "suggest" some nursing homes you might look at. (They can't "recommend", but will have an idea of wehich are the better places so word it carefully.) Then phone them, and quiz them on everything. Finding a room at short notice is not easy, but if they have one you should find that they will look after a lot of aspects of the discharge. The one we found essentially went straight into the hospital for an "assessment" and then based their costs on what they found. They also handled the discharge, picking my mum up and along wth medication, discharge notes etc. Your MIL need never know she is leaving hospital! We were only give three days notice of a discharge on Christmas eve, and over a weeked, but managed it. The hospital failed to inform either Social Services or her GP that she had been admitted. We later discovered that her hospital notes said she was very confused. It sounds as if your MiLs hospital are being kinder.

The six weeks it bought were invaluable, not least because the nursing home were then able to signpost me to suitable very sheltered housing and away from the McCarthy and Stone option my mother wanted. We needed the crisis, and when clearing the flat it became obvious what a state my mother had got herself into, to get her out of her own flat, so it proved a blessing in disguise. My mother will admit that now, but I endured three months of absolute abuse. I let her flat on a six month lease so she could "move back when she was better" and the breakthrough was me then offering to move her back. The standard tirade stopped, and she confessed she had been really isolated and stressed on her own and she was happy living somewhere with support and a good cooked lunch.

It can be done, but you need to get her somewhere safe and stable so you have a chance to think and decide next steps. And sadly her views are only part of the picture. The NHS do not have beds for the elderly infirm, and you cannot give up your lives, so her wishes can be met.

[rara67]

Thanks again. Banana we have the same problem with eating, or rather not eating. Found out today that MIL would only have two visits from SS per day, which wouldn't be enough. We live 50 miles away so the most we can do are weekly visits and that would put a massive strain on DH. Especially if he has to do the shopping, feed her and change her bed (she does have a cleaner but she won't let her do the bed). She also needs to take medication which could increase once we know the extent of the cirrhosis. She refuses to take it unless someone is standing over her.

I think if we do go for the care home option that we should look here rather than where she lives. We have a massive elderly population so the quality of care provision locally is high. It would mean she would see me and DH more, my DM would visit and I would like to rebuild her relationship with our two DSs. In her home town she has two friends, both in their eighties and neither can drive so if she went into care there she wouldn't get the visitors. This could be the big selling point. I might consider having her here for a few days until we could get something arranged....

[rara67]

Just a quick update, DH spoke to nurse on MILs ward and she thinks MIL has given up and may only have a few months to live. They want to move her to a nursing home which specialises in palliative and end of life care. I won't believe it until it actually happens but the relief at knowing that she will be cared for 24/7 is immense. Also she won't be forced to do physio and we won't have the risk of her being sent home before she's really ready, if indeed that ever becomes an option, which looks very unlikely. It's sad, but positive. Thank again for your supporr.

[Banana99]

A change of scene might change things for her you never know. Hope you get somewhere close to where you live as well.
Glad to have been sorted - it does sound for the best.