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Original poster

DM about to dangerously discharge

262 replies

DorsetCamping · 14/06/2020 15:18

Apologies for the continuing saga but am at wits end.

To be brief DM (74) has been in hospital 3 times over the last month due to various conditions and the last admission being for 10 days and near deaths door. All pointing to her continuing decline and inability to cope independently.

She reluctantly agreed to go to a rehab unit last week and seemed to be making reasonable progress, no doubt due to be constantly monitored and with the 24/7 care.
Tentative Plans were being discussed for her to go home with an enhanced daily care package.

However, yesterday she had a fall, whereby her walking frame tipped and she banged her head. Thankfully she is ok but naturally it raised deeper concerns about her safety and needs when she goes home.

Onto this morning, she said she is self-discharging and that if I don't go and get her tomorrow she will call a taxi Hmm. Said that there is no way she is staying, hates it and is exhausted.
I have spoken to The nursing staff who are adamant that it is not safe for her to go home, especially with yesterday's fall and that her care package needs a new review. More worryingly is that no carers will even be available in the immediate future given COVID and calls on resource.
They have told DM all of this but she it's falling on deaf ears.

I am so cross her with, it's like dealing with a toddler. She has no clue about the worry this is causing or the implications with lockdown. All she keeps saying to the staff is that either I, or her elderly neighbours will help if need be.
I mean, WTF?!
They did ask me about her mental health as she seemed so low today but ultimately it is her decision.

I am so exhausted with her. All she is being asked to do it sit and recover - you'd think she was in a prison cell the way she goes on. I can pretty much guarantee that if she goes home tomorrow she will just end up in hospital again and we'll be back in the same merry go round.

OP posts:
Original poster
DorsetCamping · 15/06/2020 09:02

Spoken to the nurse in charge. A capacity assessment has been competed which DM passed and they are waiting for the COVID swab results to come back.

DM still adamant that she wants to go home but the care package is not likely to be in place for another day or so. The nurse (a different one to yesterday) is going to try and talk to her again but will tell DM that I will not be going in to pick her up. If she wants I will drop her purse and key over but that's as far as I will enable her.
DM hasn't actually phoned me yet this morning so bracing myself for the fallout!

OP posts:
TitianaTitsling · 14/06/2020 22:42

The hard thing is and I absolutely agree with all happy has said above, if she is deemed to have capacity they have no legal powers to hold her in hospital, make her take any tests or accept carers. If she has capacity so is making an 'informed choice' absolutely step back- do NOT get sucked in!

Rinsefirst · 14/06/2020 21:55

Dorset You sound a lot more empowered to hold your ground tomorrow. Good luck.

Original poster
DorsetCamping · 14/06/2020 20:31

It's been made so much harder due to lockdown. Wish I could just eyeball her to get some some sense to go in.

OP posts:
forgetthehousework · 14/06/2020 20:07

I know it seems horrible but yes, as pp have suggested, don't go and get her!

If she doesn't understand the potentially dangerous situation she's putting herself in then she needs to be reassessed. If she does understand then she's being incredibly self centred and you will be encouraging her to believe you are at her beck and call forever. There is a world of difference between being a loving daughter and being a servant.

Original poster
DorsetCamping · 14/06/2020 19:52

so only about 90% not in place then!

OP posts:
HappyHammy · 14/06/2020 19:49

To go home she ideally needs
Covid negative test
Medication
Discharge letter
Careplan review
Falls review
Care agency agrees to look after her
Money or transport home
Key and clothes
Food and heating on
Falls alarm and maybe other equipment
Careline alarm and keysafe

Original poster
DorsetCamping · 14/06/2020 19:38

When I spoke to the nurse in charge earlier this afternoon all she said was that DM must have a negative COVID swab before she'd be allowed to leave, nothing else.

OP posts:
romdowa · 14/06/2020 19:30

Honestly I agree with a pp, dont give in to her. Two years ago my father fell and broke his hip? After 10 days once he had started to walk with the walker he tried to discharge him self , I calmly told him and the nurse who rang that of he did so , I wouldn't be taking care of him or coming to get him. He knew I meant it as I had done the same when he tried to discharge himself after a previous stroke. Sometimes you have to be cruel to be kind .
It's clear that she is discharging herself knowing you will relent and assist her. I know it's hard but its time to show her that her actions have consequences.

HappyHammy · 14/06/2020 19:27

Dorset. Yes ring them tonight and ask for the nurse in charge. Ask them is they have a discharge planning meeting tomorrow and will she be seeing a doctor or nurse practitioner before any plan is made. Tell them you are worried about her and do not think its safe to go home unless carers are back in place. Ask for the nurses name just so you know who you spoke to. Ask if they would like you to drop keys and her purse in as they are her property. Good luck.

Fluffycloudland77 · 14/06/2020 19:14

Are you planning on picking her up?.

I had a resident ask me for a yellow pages recently, I don’t think they even make them now. Last one I had was a cm thick if that.

cptartapp · 14/06/2020 18:53

I was a district nurse for many years and saw the chaos that ensued for families from situations like this. My own DM ended up on BP medication and antidepressants dealing with my GM. I agree with every word knot says.
Think long term. Prioritise your own mental health and step right away. Make social services aware of your decision. Only when a crisis occurs, which it will, will things change.
If she's capable of phoning you, she's capable of phoning social services. Make sure she DM has their number and don't be available.
It's the only way.

PickAChew · 14/06/2020 18:51

Sorry, the thread title gives me images of her exploding. Not helpful, I know.

You've had some good advice, though, and I hope that you, or someone, can dissuade her.

Original poster
DorsetCamping · 14/06/2020 18:50

@HappyHammy yes the unit is NHS
If I ring them at this time in a Sunday will they be able to take a onboard my wishes for a capacity assessment to be undertaken?

OP posts:
HappyHammy · 14/06/2020 18:45

The carers manager may need to agree to take her on again if she keeps falling before she goes home

HappyHammy · 14/06/2020 18:43

Is the rehab unit part of an NHS trust. Is the carehome part of the unit. There will be a discharge co ordinator or a nurse incharge. Just tell them tomorrow you are worried she will not be safe and cannot help. The capacity assessment can be carried out by the dr, a nurse who has had the training, a social worker. It can be done in half an hour. If they say she has capacity then she can make her own decisions but if she lacks then there needs to be a best interest meeting. Do you or anyone have power of attorney. You can ask if shes had a capacity assessment and if not can they do one.

Original poster
DorsetCamping · 14/06/2020 18:40

Does she have a social worker?
Not that I'm aware of, but having had a phonecall last week (pre fall) with social services to discuss her situation, maybe she does? I will ring them tomorrow.

MIL wouldn't be told and she was in and out of and falls. Sadly it killed her. In hindsight we think MIL had was in early stages of dementia which affected her ability to make safe decisions. This sounds spookily similar to DM, dehydration etc- I do wonder about dementia given the unsafe decisions she's making or maybe she's just sheer bloody minded!

OP posts:
oiboi · 14/06/2020 18:29

Yes. It should be done by the most relevant professional who knows her. They will check she understands the risks she is taking and can weigh them up. They need to make sure she understands that if she goes home with support and means of summoning help she may fall have a very long lie and end up in a situation where she may never return home or even die. If she has capacity and makes the unwise decision then the unit may be able to keep her there until they can put some support in place.

It would help if she understood that you will not support her once she's home, otherwise a lot of patients just expect their family to pick up the slack of their poor choices. Have you a family member living with you who could develop fictitious covid symptoms? Then you'd have to isolate and wouldn't be able to see her for 14 days?!

S0upertrooper · 14/06/2020 18:26

Does she have a social worker? If not, I'd request one. Does she have mental capacity, is she able to make safe decisions?

I sympathise with you OP, my DM was very compliant and happily listened to advice which made caring for her much easier but MIL wouldn't be told and she was in and out of hospital with dehydration and falls. Sadly it killed her. In hindsight we think MIL had was in early stages of dementia which affected her ability to make safe decisions. Good luck.

Original poster
DorsetCamping · 14/06/2020 18:16

To be clear it's not a hospital, it's an NHS funded rehab unit next door to a care home

OP posts:
Original poster
DorsetCamping · 14/06/2020 18:15

Thank you, I hear everything you are saying.

@oiboi who instigates the capacity assessment? Can the unit do it and can it be done quickly?

OP posts:
TitianaTitsling · 14/06/2020 18:05

Absolutely agree with posters saying don't facilitate it- I know it will be stressful and unpleasant but it sounds likely her going home and you running around after her would be doubly so. At least in hospital you know she is safe and supervised. Flowers for you Dorset

PotteringAlong · 14/06/2020 18:00

She couldn't get a taxi if she tried - she can't walk anywhere without assistance and I've got her purse!

Then just say no to picking her up and stay resolute in that. If she’s adamant she can cope alone let her cope alone and see that she can’t.

It’s a cruel to be kind moment Flowers

oiboi · 14/06/2020 17:58

I work with patients like this regularly, and I don't mean to be harsh but the most frustrating part is when families say they're really worried about their relatives then support them to make unwise choices and then when they're home we have to pick up the pieces on short notice usually without any safety nets in place.

Have they done a formal capacity assessment?

HappyHammy · 14/06/2020 17:56

You can take the keys and purse in and leave them with the staff with a note for their files saying its an unsafe discharge and you and ndn will not be helping ir arranging a lift home. Is' she in a dorset hospital

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