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Original poster

Hospital Discharge - how do I insist on help?

61 replies

DorsetCamping · 03/05/2020 17:37

DM (75) is currently in hospital officially with a chest infection (non COVID) but in reality alongside many other problems.
One concurrent condition she does have is severe lymphodema and leg ulcers (diabetes and obesity related). Her feet are also dreadfully cracked and massively painful to walk on. This has been going on for 3 months.
She has been having a (social services) carer come in daily for 30 minutes to strap her legs but that is it. She has been told she needs to keep the weight off of her legs (ie sit down) but needs to get up to prepare meals etc, causing dreadful pain.

The physio has spent 20 mins today to assess mobility and has suggested more grab frames are installed at home but that's it. She also said that because of where DM lives support will be limited Confused

An OT will be seeing her in the morning with a view to discharge. I am petrified they will just let her go home without an adequate plan in place and she will just end up back in hospital. Obviously I can't go the hospital at the moment to discuss a care plan either.

Has anyone else faced a similar situation or has advice on what I should do?

OP posts:
LangClegsInSpace · 05/05/2020 21:09

That's really good news Smile

Make sure you make it clear to the 'asist to go home' team what level of support you can realistically offer. You need to manage their expectations as well as your mum's.

Inituntiltheend · 05/05/2020 20:50

Glad you have got the ball rolling.

Could you get her a lifeline to give both of you a sense of security?

LilacTree1 · 05/05/2020 11:13

Good that she’s feeling better

Need to tackle her expectations of you though obviously!

Original poster
DorsetCamping · 05/05/2020 10:45

Quick update, DM is still in hospital but feeling much better. I had a long chat with the OT yesterday who has put in a referral to their 'assist to go home' team. She won't be discharged until the assessment has been carried out and discussed with me.
Big relief as consultant wanted her discharged yesterday morning. It was the OT who blocked it until a support assessment has been done.

Unfortunately DM very cross at still being in hospital. Desperately wants to go home (which I totally understand) but doesn't grasp the risks of doing so too soon or the anxiety it causes everyone else.
As an aside we (DB and myself) have tried to discuss longer term plans with her but she just shuts down and says we're taking away her control. I just want what's in her best interests but she doesn't see things that way. I suspect in an ideal world she'd like to stay in her own home and have me care for her 24/7 Confused

OP posts:
Hairyfairy01 · 04/05/2020 13:18

But vertigo isn't something the hospital can just 'fix'. Unfortunately I can't see any of your reasons justifying a prolonged hospital stay. She needs to be able to access the right support once home I agree, eg district nurses for dressings (if unable to leave the house), maybe carers morning and evening to help her get in and out of bed, washed dressed / undressed if she is unable to do this for herself. You need to be clear on how a prolonged hospital stay would be in her benefit. If she is medically stable they will want her hone ASAP.

Original poster
DorsetCamping · 04/05/2020 11:10

DM was originally admitted to hospital following a
a severe attack of vertigo. She has had several episodes over the last couple of years which alongside dizziness (doesn't seem the right word somehow, more like being thrown around a boat during a storm), results in uncontrollable vomiting and diarrhoea.
The paramedics were called this time as she couldn't be moved and concern regarding dehydration/blood sugar levels.

When I phoned her this morning, she told me she wanted to come home but then went on to say she'd had another vertigo attack 1st thing. Throwing that into the mix In my opinion there is no way she can come out yet. I totally get that hospitals are the last place anyone should be at the present time but I believe she is safer there than at home.

I have told the clinical update team that I must speak to OT/discharge team before any decision is made because I think DM will be pushing to come home.

In the meantime I will contact her GP and be very clear that once DM is home the District Nurse needs to visit regularly to attend to her leg ulcer (which is getting worse)

OP posts:
cptartapp · 04/05/2020 11:03

What did she tell the nurse who rang to see how she was getting on? Did she tell them she was struggling/unable to do the legs? Or that someone else would do it for her?
Did she ask for help? If you wait for it to be offered during overstretched teams during a global pandemic, she'll have a long wait.

cptartapp · 04/05/2020 10:56

Methotrexate doesn't necessarily put her in the highly vulnerable shielding category. I'm currently treating many of these patients in clinic,
That aside, if housebound, she needs a DN for the legs.

Inituntiltheend · 03/05/2020 20:53

Sorry to hear about your mum. What region do you live in? 6 week trial is likely to see if they can establish level of care required. You would imagine AM and PM at the least if the straps need removed before bed?

My advice is phone the hospital tomorrow and ask to get out through to the OT dept then ask for the OT covering your mums ward - the likelihood is the OT would ring you anyway but just encase.

It is the OTs job to facilitate a safe discharge from hospital - if they deem
Her as requiring assistance with tasks they will let the social worker know what care to apply for.

Here in Northern Ireland we have a lot of community groups/local shops providing meals to the vulnerable/shielding etc - the hospital staff have lists of the shops. I’m sure wherever you are this is happening?

Hope your mum is ok. Good luck

lostfrequencies · 03/05/2020 20:39

Would your mum agree to meals on wheels so she doesn't have to get up to prepare food? Or could she have a perching stool in her kitchen so she doesn't have to stand for long periods?

TitianaTitsling · 03/05/2020 20:35

I do agree with hairy if your mum is telling them all is fine and family will help, and she has capacity, they can't just decide not to believe her. Speak to the ward, ask about discharge planning, let them know your are not there to help. I know people love to think we just chuck patients out of the hospital and don't care, we can't put care in for someone who has capacity and tells us everything is fine.

Hairyfairy01 · 03/05/2020 20:29

Whilst I understand your concerns I'm presuming your mother has capacity, therefore she can make her own choices over d/c planning?

What exactly are you expecting the hospital to do? Is it to arrange more carers each day? In which case what tasks are you expecting them to do that your mother cannot do herself or needs help with?
To be honest a hospital is the last place you'd want to be right now. I would be enabling her to be d/c home ASAP as much as possible.

cookingmywaythroughlockdown · 03/05/2020 20:06

Methotrexate for RA probably doesn't actually put in her the shielding category. It puts you in the more vulnerable category as far as I've seen. It's irrelevant tbh as her age and frailty already put her in the shielding group.

Original poster
DorsetCamping · 03/05/2020 19:46

Thank you everyone

@cptartapp DM is genuinely housebound. She has not been out of the house for 8 weeks. Not only is she in constant pain from her legs she also takes Methotrexate for R.A. which puts her in the highly vulnerable COVID category (but hasn't received any 'shielding' letter which yet again makes me cross).

IIRC she received one phonecall from the Community Nurse 2 weeks ago to see how she was getting on but no offer to come out to her.

OP posts:
cptartapp · 03/05/2020 19:21

And as an ex district nurse of 14 years they cannot just not attend to her leg ulcers if she is genuinely housebound. Do not take this on yourself. Put requests in writing to them, the GP and the practice manager.
The service though is on its knees, sadly there are probably very many people like your DM on their caseload which do play second fiddle to palliative cases.

cptartapp · 03/05/2020 19:17

Make it very clear you will not be backstop here and massively play down what input you will have. If they get a whiff of family helping out they will discharge her and leave you to it. Be very careful here. You have to put your mental health and DC first.
You also need to have a serious chat with your DM. Her expectations of you are selfish and unrealistic long term.

Original poster
DorsetCamping · 03/05/2020 18:57

Am so cross with the GP and surgery in general. They have displayed zero concern

OP posts:
foodtoorder · 03/05/2020 18:56

Sorry that should be GP

foodtoorder · 03/05/2020 18:55

If there are no clinics/no way of attending then they have a duty of care to attend. Ask her go to make referral?

foodtoorder · 03/05/2020 18:54

There is no cost for the interim care but your mum will need to claim attendance allowance and any other entitled benefit based on disability/age or have a grasp of her finances to ensure she can contribute or pay for a long term plan.

Original poster
DorsetCamping · 03/05/2020 18:54

Tried week after week to request a district nurse come to the house treat DM's leg ulcers. Not interested, always other priorities. Insisted she attend a clinic which of course has gone out the window since COVID

OP posts:
foodtoorder · 03/05/2020 18:52

Additionally once the intermediate care is approaching stepping down someone will be assessing for future needs and an on going package of care,

foodtoorder · 03/05/2020 18:50

Ask for her to be referred to district nurses for care of her lymphodema/leg ulcers. She will need to be housebound because of covid so they can assess/ apply compression to improve her legs. I would expect her pain to improve once this is being treated.

LangClegsInSpace · 03/05/2020 18:39

Yes you can have up to 6 weeks 'intermediate' care on discharge from hospital without facing any costs. It can be provided by NHS or social care.

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