Unsafe discharge from hospital

gogohm
You are right about if the person is judged to have capacity they don't need to speak to you, however deciding on capacity is a moot point.
The test used routinely isn't much use. DF was a retired salesman and a politician. Even when confused he knew who the PM was and a lot of the current affairs stuff, and for about 20 minutes was able to do the chatty old gent bit. The reality was very different, especially when he was tired, and he had brain scans to prove it and he didn't do well on more complex tests.
However he told the social worker I went in daily, and she made all her discharge arrangements accordingly. Never approached me and then argued with me when I said I lived a long way away and had a full time job and kids at school because he had TOLD her I visited and it was in the notes. It got down to " can you read out the phone number you have just used, and do you want to google the dialing code.......And now try puting the town name into Google Maps and plan the route? Which way round the M25 does it suggest?"
She said I was unreasonable and negative when I said I gave him a week at home post discharge. I admit I was wrong, it took 4 days for him to be back in A&E.
Sorry rant over- it still angers me after nearly 10 years.

They will have assessed her as medically ready for discharge and assessed any definitive ongoing personal care needs prior to discharge, the in home assessment is quite new and it's to make sure the person being discharged coped in their actual home environment. If your mother has capacity they are under no obligation to speak to you

If you go for a stairlift, try reconditioned. Stairlifts are rarely in use much more than a year.

My experience pre Covid was: Dad arrived home about 3pm on a Friday; within 30mins an OT arrived followed by a Social Services coordinator. There was then a hectic period of both inspecting the house and firing questions at me simultaneously. Meanwhile the doorbell kept ringing as equipment arrived - zimmer frame for upstairs and downstairs, perching stools, etc. We got him to bed if I remember correctly, but carers arrived to get him up next morning. Requested meals on wheels and they started on the Monday.

In other words, both NHS and Social Services are capable of moving very quickly.

@Mischance I don't know how long it's been since you were a hospital social worker but you are out of date. Assessments for social care now take place AFTER. discharge - it's called "Discharge to Assess".

OP, be very clear that you can't offer any support. Ask the hospital discharge team if your mother qualifies for Reablement. That would provide for up to 6 weeks of care at home whilst the relevant assessments can be made.

[quote FelicityBeedle]@TriciaMcMillan
Apologies, clearly the trust I work in has a very different idea of it. It’s a definite assessment and bed is held for them until they get the go ahead to finish the discharge from the rehab team[/quote]
No need to apologise. That is very unusual and certainly not the recommended policy and approach. Just wanted to ensure the OP is under no illusions re. the bed being available once her MIL is discharged (unless she's in your trust!).

@TriciaMcMillan
Apologies, clearly the trust I work in has a very different idea of it. It’s a definite assessment and bed is held for them until they get the go ahead to finish the discharge from the rehab team

The discharge co ordinator will have asked your MIL questions about her living arrangements and will hopefully access her whilst in hospital. You need to tell them about your concerns regarding the stairs. They should at least provide a commode. We’ve been in this situation with parents/in laws and it worked out ok. With my father, the carers rang me to set up an appointment to discuss what care he needed, when he was still in hospital, I told them that we didn’t have a discharge date yet, but they had. With regards to equipment try and get this arranged before she leaves hospital as it’s a nightmare trying to get anything additional, if any aids are offered, take them even if she won’t use them, I would at least ask for commode, walking frame, etc, then if she has carers come in, they can sort other things out.

It's a shit state of affairs.

[quote FelicityBeedle]@TriciaMcMillan
The idea of D2A is that the bed is held, otherwise it’s just a discharge.[/quote]
Sorry, meant to quote @FelicityBeedle in my response above.

No it isn't, it's to assess patients post discharge to ensure they don't spend time in hospitals unnecessarily. Once they are 'medically optimised' and an acute hospital bed is no longer required they are discharged home/to community rehab/or to a care home where they can be assessed or the next phase of their rehab can begin.

The bed is not held as if the acute site was the suitable place for them to remain (i.e they needed further medical treatment in hospital) they would not have been considered clinically optimised and ready for discharge!

www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/systems-resilience/overall-approach/discharge-to-assess

@TriciaMcMillan
The idea of D2A is that the bed is held, otherwise it’s just a discharge.

Argh
Longer term care package (ie on going) and support not supper, Sheesh my phone hates me!

Sorry about auto incorrects- you can guess what I typed before phone changed it!

So it's ok to talk to discharge team and give context as family, as that's all useful info to be discussed with your mum. . Sometimes the reality of background will indicate if someone has or should be assessed for deteriorating short term memory loss.

In our LA, after having re-enablement care package on discharge for up to 6. Weeks which includes OT (occupational therapy) supper- if needed they assess and refer for longest term care package (which is chargeable, hence my comment about threshold £23,250 for ASD funded care that person pays toward under a financial assessment )

You've had excellent advice on here. I'm a social worker

I used to do hospital discharges pre covid when hospital social workers went in to ward. It's done slightly differently in acute hospitals with discharge teams often now

So - I cannot comment in your DMs case, this is not legal nor social care advice

But
If she has capacity to decide on discharge arrangements:"/ care plan- she will decide and you don't have a say in that.

But as relqtuves you can say a little bit and share your concerns as that is background they can use in discussions with your DM and in terms of capacity if she understand can retain, weigh up under MCA 2005, as that information is helpful for them to know. Ring the discharge team and ask is a S/w assessing her or can you speak to someone leading her case. Decisions are only as good as Input (information) in that gives a more rounded picture

I won't repeat some of the advice other than to say that threshold level for adult social services / adult community care is £23.250. And that star lifts are dependent on DFG loans which have their own threshold or what someone needs to contribute at what point. Stairlifts are not done prior to discharge as that is a long process.

My first thought is can she have a re-enablement pack wage to go home with if she can do downstairs living if unable to do stairs - that's up to 6 weeks of (multi agency support) including carers support and OTs, but I don't arrangements in your particular area

Time to talk to DM and the ears in more detail - bullet pointed emails are always really useful when you get email addresses from ward of discharge liaison be it hospital S/w or discharge nurse,.

No - this is not right. I used to be a hospital social worker and the assessment comes BEFORE the discharge. I sometimes used to organise a home visit with the OT to see how things went, but the patient went back to the hospital until everything was in place.

Bed-blocking I know; but there is absolutely no point in sending someone home if they are going to fall/burn themselves/become malnourished - they just finish up back in hospital.

As I understand it, hospitals are not allowed to send people home without proper care in place - I am assuming the same is still the situation.

Unfortunately getting the care you need often involves a battle. I speak from the bitter experience of trying to get proper care for my OH in a similar situation.

I am sure that this apparent new way of doing it is a wonderful scheme on paper, but I would not be at all happy with it - like you OP it is totally arse over tit.

Beware of being the assumed carer. Make it clear what you can and cannot do. As the wife it was assumed that I would do everything - but I had my own health problems and had to be very firm about what I could manage.

He qualified for continuing health care funding (where someone's needs are so great that they are treated as though they are in hospital and the NHS funds it) but this was refused twice. I appealed and it was granted - he had died by then.

It is not a good system at all, and the priority to get people out overrides their safety and well-being. It is a huge problem that needs radical reform to find a solution - but no government will bite the bullet on this.

Please make sure you get all the advice you can. Age UK are good.

My experience is nearly a year old but the services were nearly all in place on the day of discharge. I wouldn't have believed it if I hadn't seen it. The key safe appeared before mum got home, the carers were in within two hours of her getting home, the district nurse was scheduled for the next day. My phone was ringing non stop all day. The one thing not there on the day was the fall alarm, that took about three days.

The assessment of her home situation was a phone discussion between the OT and me, by then mum wasn't up to answering questions. Before covid they would have come out to assess but at that time it wasn't happening. There was a six week free package of care, after which she would have picked up the cost. The agency had an online recording system and once mum had given permission I could log on and see that someone had been and what they'd done. It was a far better system for family than the paper file that MIL had.

I agree with those saying that you need to make it very clear you can't provide care. My late DF was so determined to go home, he told the hospital social worker that I went in every day to assist him. I live 150 miles away, needed to go round the M25 to get to him, while doing school bus drop offs and pickups and holding down a full time job. She believed him, and made arrangements and was a bit surprised when she rang to tell me about her plans...

I cannot emphasise strongly enough that you do NOT say you can visit at weekends.
Tell them you are not in a position to provide ANY support whatsoever. This might seem obstructive and uncaring, but if you say you can make a cup of tea for her ,they will expect 3 course dinners 3 times a day!!!
They have duty of care, and should not be sendjng her home without an appropriate care plan in place.
Stay adamant in this.

I would also say be wary of hospital staff trying to get you to agree to provide care. You need to be absolutely clear that the patient lives alone and will not have anyone to call upon.

Does she have dementia? I would ask for a capacity assessment prior to her being discharged into the community. That can delay things a bit to allow you to work out next steps. Provide written evidence of unsafe choices and her inability to self care.

Has your GP been involved at all OP? This happened to my Dad. He had short term memory loss and advanced bowel cancer. He was 90 and had lost my Mum three months earlier.

He was discharged home with the expectation that my Dsis would look after him even though she works and has her own family to look after. She was totally distraught and called the GP who had known him for years. She came round and said he was not fit to be left on his own and called an ambulance immediately.

His case was a bit different from your Mum because eventually he was moved to a hospice but I think you have to be very forceful because the hospital just want to discharge them. The state of elderly care in this country is dreadful, although having said this, the staff in the hospice were excellent and very caring (as were the staff in the hospital geriatric unit).