DM about to dangerously discharge

Like you say you dont know anyones qualifications or what their day jobs are

No worries HappyHammy
Good luck to you two setting the world to rights 😀

(Just please don't encourage OP to go in guns blazing when the services are already doing their job as it really isn't a safeguarding (except for the missed call part) at this stage. It might damage OPs credibility with her mum and the services to misunderstand her Mum's rights and where she's up to right now)

[quote HappyHammy]www.ageuk.org.uk/globalassets/age-uk/documents/factsheets/fs78_safeguarding_older_people_from_abuse_fcs.pdf[/quote]
Thankyou for linking an age Concern leaflet in response to my post that It wasn't safeguarding 😄😁 (That tickled me!!)

You might not be aware, that voluntary service booklets like this are written in simple terms, paring down something that is vastly more complex, for the general public. They are no substitute for the legislative acts themselves, HMGov guidance and a good knowledge of case law (how SG & CA works alongside MCA and HRA, and DOLs and what level of seriousness self neglect would need to be at for it to trigger a necessary safeguarding response, as a S.42 Care Act SGC, rather than sit at level of case management, capacity practicable support and client choice and rights)

I appreciate it's an anonymous site HappyHammy so you don't know what anyone's qualifications and day jobs are.
You’ve just not spotted the several professionals giving soft but expert generic advice and support.

There are key differences to the situation you described of your relative and OP’s DM’s current situation, in terms of behaviour, cooperation, capacity, needs and severity of risks.

However I read OP say she’s feels you’re being helpful and she is enjoying talking to you. So even though she’s had better advice and you may end up unintentionally misleading her, I'll leave it there. Any SG will be screened by the LA anyway and they’ll do a CHC checklist if needed.

Thanks for info. I think i got confused because isnt it written C in the first box then B then A.

It only becomes High, Medium Low and No as scoring categories at the next stage if you get a positive checklist to be able to progress

Mostly Cs and a couple Bs is unlikely to meet criteria for positive CHC checklist. But that would be a professional decision by which nurse or social worker completes it .

What did you believe the score was OP out of curiosity ?

If I recall C is the high risk score for chc then B. A is low risk. Do check. I remember thinking it got confusing being back to front.
Depending on the amount of C and B the links above will tell you what qualify for an assessment

www.ageuk.org.uk/globalassets/age-uk/documents/factsheets/fs20_nhs_continuing_healthcare_and_nhs-funded_nursing_care_fcs.pdf

'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.'

Hi OP, I just wanted to re-iterate this post from earlier in the thread in case you'd missed it. Please look after yourself too.

we were in exactly this same position, refusing to go into a carehome, high risk of falling, fell twice in one day at home and same ambulance crew sent out each time, refusing admission to hospital, demanding to go home, refusing to let carers in and when they did eventually agree it was 4 x 30mins a day and an apparent night visit which rarely happened. Also diabetic so meds missed, carers often didn't turn up, everyone made aware and decided it was their decision as had questionable capacity which was eventually deemed to be lacking. The final straw was on discharge from rehab, fell as soon as the front door was shut, emergency services still in the drive, went back to hospital and sent to a carehome that same day, the week before a safeguarding cause for concern raised for self neglect, potential harm at home, frequent falls, risk of long lie on the floor, pressure sores and diabetic coma.

www.ageuk.org.uk/globalassets/age-uk/documents/factsheets/fs78_safeguarding_older_people_from_abuse_fcs.pdf

Ah the irony that he is now unlikely to end up with a penny if we go down the care home route and her tiny bungalow is sold to fund it!

It is an irony, if that was DB's worry !

But it's lucky for you, that you didn't. Can you imagine how frantic you'd be if she were living with you in an annexe and how much higher the expectation would be from DM & DB on you to look after her 24/7, despite such a health deterioration and increase in her needs.

It is however an ongoing assessment of needs issue - based upon what support a client who was assessed with capacity will accept- which it sounds like ASD (SS .: AH&C) are reviewing via reenablement team

I would imagine her nurse intends to (or has) raise(d) her case at their ICT meetings (or whatever their integrated primary health teams are called in their area). OP can always ask nurse if her case is being discussed and how aware GPs are.

It's a shame DM didn't want to stay in the reenablement bed she had in the NHS unit she'd been discharged into.

It really sounds like DM needed to go home and try for herself, and wasn't terribly realistic about what she could do. It's really hard to watch when you know how what is likely to happen, but it can take multiple crises for a person to accept their new reality. It's a process your mum has to work through, because any future placement , if she agrees to one, will work better for it really being her decision made after trying at home as much as she feels she needs to.

I'm glad you are talking to her re enablement care team and that they are listening and sharing your concern about DM. They can increase her length of care calls and liaise with the social workers on what else is needed.and can be offered. I'm sure you are feeling frantic with worry, but as I said before it will play out as it does regardless of how much you let yourself worry. She may end up back in hospital or injuring herself. The hardest bit is watching it happen and doing as much as you can to get services working well and together, like you have, but it's also crucial not to ruin your well-being too by feeling you can't stop or feel you are able to fix things outside your control. This MN section is brilliant at helping people see & challenge the FOG processes.

Did you consider reporting the missed care call (that caused her fall?) to Adult services? That was/is a potential safeguarding concern - eek to the talk about the secondary contracted care agency 'having done this before', doesn't make it ok, it makes it worse! It sounds like they put the package in, in a rush as she was imminently self discharging from re enablement unit so there's some mitigating factors but they have a responsibility to inform client and yourselves (family) if there was an essential care call they could not cover at such short notice.

There's not many support tasks carers can do within 15 mins care calls, so I hope that's the first thing they review with her, if she's more amenable to accepting more help now.

I hope anything we all say, even if just the fact we're listening here with you, thinking of Ideas and explaining how some things might work, is helping you keep going and not feel alone! MN hug 🤗

Nothing to add, just to say I feel for you. Sounds like a really difficult situation. Please do what you can to take care of yourself.

I dread this being my future. My mum (ages 65) is already very immobile (as in can barely walk, falls often, can’t stand up from a chair) and already refuses to do anything that helps herself. At the moment my dad is able to do her care but I know it won’t be long before more is needed.

I know it’s out of order but I already feel dressed by it. We’ve had no gap between kids and grandparents needing care. She’s never been healthy enough to do even the most basic task/activities with my kids and I feel so sad about that.

www.ageuk.org.uk/information-advice/care/arranging-care/care-homes/

Is she going to be paying for her carehome. You can look up the chc checklist just to see what her level of nursing needs are and if she qualifies for finances help. If she is high risk you can email the safeguarding lead at ss, her dr surgery and create what is called a safeguarding cause for concern. Say that rehab deemed her high risk, she has fallen since discharge, current care inadequate for her needs, she is high risk of falling causing deteriorating physical safety which will result in repeated emergency admissions to hospital.

It's not bureaucratic to only be able to place into a care home for reenablement up to 6 weeks direct from hospital admission. It's their criteria for funding the placement, tied up with funding streams which include health money set aside to clear hospital beds

If she needs a placement (for 24 hours care environment ) from community as she really isn't coping and she agrees with you, you can request a reassessment of her needs and her ability to cope at home from adult services (adult health and care). So a placement from Community is perfectly possible if needed but it just won't be as a (free) re enablement one to facilitate a hospital discharge (unless she was readmitted as acutely unwell or after a serious fall)

Please don't pick DM up from the floor if she is unable to take her own weight, let the paramedics do it safely. They have the training and can see how poor her mobility is then. You could injure yourself and DM accidentally otherwise.

If she has a re enablement (up to six weeks ) care support package they will be "right sizing" her support package at home.

4x daily of 15 mins care visits indicate they don't think she has significant mobility or personal care needs- it sounds like you should ask the senior carer to discuss with you and your DM your observations of her difficulty coping and what extra you've had to do (which you can't continue at this level?)
Re-enablement is free (up to 6 weeks) but ongoing placements and care support aren't , so she'd have a financial assessment at some point to pay towards her social care support.

Do you feel able to talk with DM about what she wants to happen and how she sees things going for her? Then you can support her to tell the teams- as it sounds like her recent fall may have shaken her too as well.
It sounds terribly tough to have this worry about DM during this period.

I wondered what had happened. Whats her financial situation. Will she be self funding. Its good she has now accepted she would be safer in a carehome. The options might be either she move into a carehome asap as a safeguarding concern or she inevitably falls again and gets taken back to hospital.