Unsafe discharge from hospital

In my experience a care package was organised for my parent before she left hospital and the carers started as soon as she got home. Unfortunately, they were quick to withdraw once they think they can cope on their own. My parent hated being put to bed at 7pm and then could be left in bed until 11 the next morning, wet and hungry. In desperation she forced herself out of bed and is extremely unsteady and an accident waiting to happen. But she convinced the carers she could cope on her own so they withdrew support after 10 days. Re-ablement after hospital is a short term thing so you need to make your own arrangements for when it stops. We are trying to do that now at short notice and in the meantime my parent is vulnerable.

It's good to have an update @PaintYourDreams and am glad a number of us helped you.

I hope your MILs rehab goes well and that things progress positively for her

Great news. I really hope it works for her.

I am very glad that the bed was there for her to return to and hope that the rehab goes well.

This all sounds so familiar. I was "manhandling" my OH onto a commode too. Sending round a commode ticks a box - but who is there fit to help him use it?

Mother of Terriers' experience is almost identical to mine- except I'm in Suffolk. DF also lived on the South Coast and said I went in to see him every day.
Social worker ignored the POA as she deemed that the test she did meant he had capacity- even though he didn't. Deciding that he was coming to stay with us for Christmas, involving 2 changes of coach when he couldn't stand to go to the loo without help should have given her a clue.

My mother was discharged after breaking her hip and spending 10 weeks in a ‘rehab’ centre. The sum total of physio was a printed sheet left in her bed for her to do exercises. She has Alzheimer’s.

She couldn’t stand or walk unaided and as every manoeuvre involved 2 staff members and a rotating trolley I was sure they had mixed her up with another patient when the discharge co-ordinator insisted that she was going across to the toilet independently at night. In the end they phoned and said she was on her way home on hospital transport and was someone there to let her in. I was 3 hours away.

My sister had to rush from work and with a neighbour get her bed brought downstairs. We had to wait 3 days for the care package to arrive, during which my sister and I slept on the living room floor so we could hear her and manhandle her inexpertly on to a commode.

But with both parents we have also had examples of discharge and an enablement package working as it should.

I would put something in writing and ask for a meeting with the discharge team/social worker/OT about specific concerns you have and ask what they have planned to do about them. E.g. cannot get upstairs to bedroom or toilet Cannot prepare food or get a drink Cannot wash themselves. These should have been assessed at the hospital by a physio/OT check that they have. If a hospital bed, recliner chair,commode, perching stool may be required insist these are in place before discharge - as they are keen to discharge they are more likely to be fast tracked. Many years ago I was an OT when assess to discharge was not allowed. It can work but only if you have a swot team ready to supply equipment and care within 24 hours. I have recent experience with a relative's discharge and found I needed to very firm in spelling out what would be needed and they were not to be discharged unless a plan was in place.

Well there we are - not just me!

Sorry you had this bad experience.

Hi, no she was discharged from a ward not A&E
And yes I should have complained but I was stretched doing what I could to support them long distance
In the end I moved mum up here
The quality of care was just appalling

He got the fast track when he was nearly dead. My appeal concerned the year or more of care that preceded that. The appeal was successful because of my tenacity and knowledge. How many other people are slipping through this net? - or simply do not know that this funding exists? My OH only got an assessment at all because I knew the system. No-one mentioned it to me.

I truly believe that MotherofTerriers's experiences are not unusual. It is very important that those with some control over this system do not disbelieve this, or improvement will never happen.

Have had experience with this with MIL, FIL and DM.

You know that list with the 3 most stressful things you can experience -
death of a loved one,
moving house
divorce ?

Well I put Discharge of an elderly frail relative up there too.

The bar for judging someone has capacity is low - can the individual express an opinion - yep they have capacity. Even if the opinion is deluded and complete fantasy - just like Motherofterriers's father.

The only additional thing I would mention is about night time care, or rather the complete lack thereof. My DM has dementia and a night time waker and wanderer. Couldn't get any LA support for this at all.

I can only offer my best wishes to you

To be fair I have spoken out of turn, as don't know your mums age or how she presented . It's not usual practice to discharge anyone in middle if night if they may have care needs or present as confused . But I don't know if this was midst initial covid lockdown period when hospitals may have been working differently to avoid admissions due to high pandemic infection risks. So please ignore my initial reaction to that as I don't know context

That's terrible @MotherofTerriers !!
Those things should be easy to double check!

And discharging an older person in a taxi at 1am in the middle of the night, is not recommended practice at all. I'm assuming she was in A&E, was admitted alone and no A&E staff noticed she was confused?

i hope you raised a complaint about both of those poor discharges. Both of those situations should not have happened so please please complain.

Often cases that go wrong simply bypass social care and safe hospital discharge processes because it's not been recognised by whatever ward/ or A&E , as potentially an issue.

I always tell families ring in to the hospital or A&E and insist on giving them the background info. Of course if someone is already a social care case and if we get notified in the community, we quickly jump on those cases and alert the hospital s/w teams

But it's those people without social care involved, or no one tells us, or family don't realise if not under social care already, that we can't alert for.

My father was discharged from hospital on the basis that he told them I came in every day and took care of everything. He lived on the south coast of England and I'm in Scotland. They are under pressure to free up beds and are much too happy to accept the "story" they are told by an elderly person who wants to go home.
My mother was discharged at 1am and sent home in a taxi. Fortunately the taxi driver realised that she didn't know where she lived and took her straight back to the hospital.
I'm sure there are caring people working in the discharge service and we were unlucky, but I wouldn't rely on them

mischance you did very well to be successful in CHC appeal. As it was backdated a year then that wasn't fast track end of life CHC or it was a bit of both "complex etc" and "EOL fast track" CHC grounds. S/W do only the social care assessment for CHC, which is an important but limited part of the MDT assessments as most of evidence relied on by CCG for CHC decisions is MDT health info. The bulk of CHC assessment evidence is on someone's actual health MDT needs, as it is about having complex, intense, of a nature , unpredictable, health needs. It's wonderful that you got that resolved in a satisfactory way.

I won't comment on the rest of your post, as you are absolutely entitled to have your own views . I said my piece as have other PPs. And what this thread was about, was an OP who was feeling overwhelmed asking for some online support and general advice during a discharge planning experience. Which hopefully - as indicated- she feels has had now.

I think there is a lot to unpack in your experience mischance and maybe that can form a new thread that you may wish to start, as with a different title specific to your experience- as I can't help but think you may find others nationally or globally (whilst unusual for us, in our experiences) and a specific title may be enough to find that bigger potential range of support for you, who would really also appreciate the chance to download and discuss those bigger issues when it doesn't work.

That's what MN is good at, when the title shows what is being discussed and people can see it clearly to choose to participate.

As i said before, I don't doubt you did not have a good experience. I really feel for you as I can hear your frustration and anger about it still. I regret for you that you don't feel you ever got a resolution (even if later) as you didn't feel up to putting a formal complaint in at that time. If it happened in the last 2 years, I wonder if you would feel it may still be worth putting a complaint in? From what you describe there must be some important learning in there.

Anyway, I suspect you have some excellent skills in appeals of CHC decisions. Something none of us realise are important until we have to face it.

CHC is indeed a health responsibility. I am aware of the fast-track route, which he got briefly while he was alive (well, as near as dead really). I know the system inside out as an appeal requires you to have detailed knowledge, or it would not succeed. The appeal granted the funding from the start of his illness's acute phase - about a year - because it had been wrongly refused twice. How many people would have known the system well enough or had sufficient awareness to put in the appeal? It was a vast effort on my part. SWs need to make sure that people have information about this and support to appeal where appropriate. The SW involved in the assessments of my OH just lay down and capitulated to the health assessor's decision. When the appeal was heard it was granted on the spot as it was so blindingly obvious that a wrong decision had been made. The SW was complicit in this, so, although it is a health decision, the SW is usually involved, as it is a decision about which authority is taking responsibility.

I do think that part of the problem is that professionals do not always grasp what is really going on with families. They have gone through the process, the box is ticked, their line manager has signed it all off, but truly those of us living this experience do not feel it is sorted.

Whenever this issue crops up on here or on Gransnet, the advice to family members is "Do not agree to do anything." It is good advice.

I have talked at length about the bad experiences I had and I really have to say that I am not alone - the hope that mine is an isolated case truly is a vain one.

However I work in this field as do other PPs who have replied similar - and I and any professional in these field can assure you we wouldn't be quiet and complicit in any unsafe system. I hear that - anyone who enters the SW profession does so for good motives. But ........ I can truly say that on the ground, in the home, it is a dreadful experience. And I am not alone.

I appreciate your thoughtful posts but have to say that the experience of those steeped in it day to day is not good - not good at all. And I believe that it is important that professionals do not close their eyes to this, which is what I believe they do.

Anyway mischance you are absolutely right to share that you had a terrible experience. I am so sorry to about your distress.

mischance
I appreciate you have had a terrible experience and have anecdotal evidence of others who have had a bad experience too. It is really sad that you personally felt so worn down that you didn't put in a complaint. Is it too late now?

However I work in this field as do other PPs who have replied similar - and I and any professional in these field can assure you we wouldn't be quiet and complicit in any unsafe system.

It's that we in our many teams work with thousands of people - over the country that'd be hundreds of thousands of people - and we all see how beneficial it is and that it usually works well, so I have to disagree respectfully.

We can see the unusual times for various reasons that something did go wrong. It isn't a huge proportion of times compared to most discharges and we work incredibly hard to jump on top of those cases. It does really worry me that you and your OH had such an awful experience.

In terms of CHC funding it is a health (CCG) decision not social care department one, whether someone is eligible, with strict criteria. It may possibly be that your OH ultimately was awarded possibly a different type of CHC, the fast track (end of life and deteriorating rapidly ) CHC funding that would have relied on a consultant (health) or GP identifying that and their being willing to sign off on fast track CHC application to the local CCG. Or different if it was awarded in complexity and the original evidence supplied didn't support it but more was requested and did support it. But none of that is social care led it is entirely a health CCG CHC specialist decision.

I agree about capacity. It is often very hard to assess, especially if it is done on a one visit basis. It is very frustrating to have someone pronounce that someone has capacity when you are aware of what happens day-to-day.

I would exhort people to talk with their elderly relatives about organising a Power of Attorney (or indeed do it for yourself for the future) - it was a godsend when I found myself in a difficult situation with OH. It does not override the concept of capacity but it does mean that you have to be consulted.

One of the problems with the concept of capacity, is that legally people are allowed to make decisions for themself over and over again, no matter how stupid or dangerous it is - until someone steps up to say that they DON’T have capacity after all.
Your MIL will do everything she can to avoid being moved. (Makes sense.) She will lie to whoever asks. You need to speak to the head nurse now and explain that no neighbours will be doing meals or helping out, and you will NOT be stepping in.

And there is huge wastage of money - OTs, physios, district nurses all came round over and over again. Different ones saying different things. We used to joke that they "hunted in packs", as they did not come alone - why not? - because it needed two to move my OH! - but I was having to do it on my own! They would come in, assess what was needed, then vanish into thin air! Provision of what was needed fell between the cracks of all these different people, who were trying to get things done within a very cumbersome system.

OP does need to be reassured that there are systems for care in the community - but I think she also needs to know that the system is imperfect and that if she and her OH do not make it clear what they can and cannot do, MIL will finish up with insufficient care. I know how hard it is for them as it is also likely she will turn care away.

I actually think that there were good things in the previous system as well as bad. Community hospitals played an important role in helping people to get home - they were a refuge, a stepping stone. The rush to get people out whether they are able to manage or not is not an improvement. There were good, properly managed residential homes run by the LAs where rehab could happen and the SWs could have confidence that there were properly trained and supported staff.

I am sure that good stuff does happen, but my experience (from my own and talking to other carers) is that it is achieved at the expense of the family - if I had not fought every inch of the way my OH would not have had what was needed. And it took a huge toll on me and my DDs.

And no - I have not raised any complaints - you may rest assured that after fighting his corner for months on end, when he died all I wanted was some peace. Further banging my head against a brick wall with the statutory authorities was the last thing I could cope with. And doing so only to be gifted with the inevitable platitudes would not have helped one bit. I let my appeal against the refusal of continuing fare funding run and it was granted posthumously - not a surprise as he clearly fulfilled the criteria and there had been unprofessional conduct on the part of the assessors.

Please remember that when a "case" is closed - bed cleared, patient gone home, job done - the family have to battle their way through the system to make sure that needs are met into the future. And I can vouch for the fact that it is very hard indeed.