Non mobile Mum being discharged from hospital: what care?

When DM was discharged from hospital with 4x career a day we spoke to the discharge team and told them it wasn’t safe and she would be back in a day. We were told quite literally that she had to fail in order to move up the next level of care.

The first set of carers didn’t turn up, she fell trying to get to the bathroom and was indeed readmitted within 24 hours.

She was eventually discharged into a care home where at least she is warm, fed and safe although desperately miserable. The first time she went into hospital was after a fall but she was relatively mobile. After stagnating in a bed for about 9 weeks with no physio or encouragement to move she left hospital unable to stand unassisted. She’ll never walk again sadly.

It's a tricky situation because I imagine the therapists feel that your mum has reached a plateau and isn't going to improve further within a hospital setting. People often do improve much better within their own homes. The maximum care that will likely be provided by SS is four times a day, if this is organised through the hospital it will not take into account any of your Dad's care needs. I understand why you are concerned about in-between the visits, is your mum able to get herself to the toilet/onto a commode between visits independently? If not then I would request a meeting with the social worker, OT and Physio. However it's much more likely that they will then look to residential care as unfortunately a package of care in excess of four times a day often exceeds the cost of a residential home. Do you/they have any concerns about your mum's capacity to make decisions regarding going home/her care needs? I know CHC has been mentioned by a previous poster but I would say it is highly highly unlikely she will be eligible based on what you've said so I wouldn't get your hopes up for that unfortunately.

My parents were in similar situation but we’d already had a year of 4 a day home care visits when dad broke his hip and then the news came he was unlikely to regain mobility. We looked hard at full time care at home but also at the practical issues about how their lives would be, and ultimately decided on nursing home instead. Care at home was too restricted by the physical environment itself and the practical logistics of us keeping the house going. The carers were amazing and did a lot of cleaning on top of care but we had to organise shopping, house repairs, prescriptions, hospital trips, endless phone calls. My parents both have dementia and the risks of being at home were starting to outweigh the benefits.

They’ve now been a year in a nursing home and it feels right. But all very tough and you have to make the decision based on your own realistic assessment of the possibilities.

TBH think you would be better leaving her upstairs in the short term did this with my dad after his hip put arm chair and tv in spare room as more important that they can get to the bathroom . If she's bed bound make no difference if up stair or down . But you do have to make an effort that they don't feel isolated or abandoned up there.

Was just about to say what Mere said - has your dad been assessed for care too? Also are they both getting attendance allowance?

This stage is a complete nightmare I’m afraid.

Have you had your father's care needs assessed? Your Mum will have been assessed on her needs only. If your father needs any help with feeding/washing/eating, then you may be able to get a carer for him too.

How is your mum going to the bathroom?

Sorry if stating the obvious, but have you spoken to Adult Social Services?

We refused to have MIL back in similar circumstances, so she went to a reablement centre, the plan being that she would regain her confidence e and be able to walk again. Unfortunately, she has been there a week and now has pneumonia, so we have been warned to 'prepare ourselves', but at least we tried.

The fact you have 4 carers a day agreed sounds like she’s had continuing care assessment/funding approved. Overnight care not provided- I say this just waking up in my dad’s house following my ‘shift’. We’re in a similar mess, currently trying to muddle through with diff relatives doing nights and trying to work out how much of his health is recoverable medically and how much is long term deterioration ...good luck

Unfortunately, live-in or overnight care would have to be paid for privately.

But talk to the social worker/OTs etc ASAP

They may manage with 4 calls a day as in all honesty it sounds like they will both need assistance during those calls, so they are likely to be lengthy-my aunt has two people each morning for 45 mins then a second and third visit for 30 mins (again 2 carers as she need two to transfer) and then 45 mins at night to go to bed (plus meals on wheels delivery so someone else checking in) so with two people to see to, it’s going to take longer than that. Then your only worry is over night. You would have to look into privately funding overnight care though.

Read this:

www.ageuk.org.uk/information-advice/health-wellbeing/health-services/leaving-hospital/

Why is it you feel 4 visits would not be sufficient? They will provide food, change pads, toileting etc?
I understand that you think full time care is best as we all want what’s best for our family.

We have also been negotiating the minefield that is Social Services/elderly care etc. My advice would be to contact the Dementia UK helpline or Age UK. They are full of advice on just these situations. We found that our rights were very different from what we had been led to believe and that the options were greater. Sadly Mum has gone downhill before we could make the necessary arrangements.

Sorry that you are in this situation. 💐

You need to ask to speak to the discharge planner and/or social workers at the hospital. Your mum may be giving them the idea that you may be moving in with them. You have to make it clear that it’s not happening.

I doubt they will get more than 4 visits. She might get an extra night visit but not live in. As others say speak to the social worker and delayed discharge team. Ask for an ot to visit their home to see what adsptstionscsn be made. Also ask your dads gp to arrange an assessment for him as they can no longer look after each other safely and are both st risk.

If she cannot stand and walk then refuse the discharge. There must be a convalescence hospital in your area where she will be encouraged to walk/redevelop life skills.
We are in London and had similar when FIL broke his hip. He eventually got home 4 weeks after they wanted to discharge him.
Don't let them walk all over you as they will, to free up the bed.
Insist on a multidisciplinary meeting/review.

https://www.nhs.uk/conditions/dementia/social-services-and-the-nhs/ hopefully this link works!

Truth is you have few options in this situation (I've been a community nurse for 21 years). State will only provide up to 4 calls per day, the rest will need to be self funded. If there is not enough money then there is nothing extra, it falls to relatives I'm afraid. A care home maybe the only round the clock option.

Have she had a continuing health care assessment? If not google it and maybe discuss this with her social worker. There is a massive gap in care provision in the community.