Unsafe discharge from hospital

Ask to speak to the occupational therapist covering the ward and I'm sure they will be able to reassure you. This is normal practice over the last few years and is called discharge to assess. She will have been assessed on the ward to establish whether she is suitable for the scheme and carers, if needed, are part of the scheme along with further therapy input at home. If she has stairs then she will have practised them in the hospital first. You will not get a stair lift for discharge. If your MIL is unable to do the stairs they will liaise with family to see if downstairs living can be arranged, ie bed brought downstairs and commode supplied by the OT if no toilet downstairs or she will go to a discharge to assess bed in the community (in our Trust this is an 80 bedded care home) until she improves enough to go home. This is all funded for a few weeks. Do not worry, the occupational therapists are experienced in older people saying they can manage but will do their own observations as to whether the patient is able to get on and off bed, toilet themselves and stairs if applicable.

Be very careful here. I agree, make it very clear there will be no family help. Ignore any guilt tripping. Don't mention going round every weekend, how sustainable (or fair to you) is that anyway? Think long term. As an ex district nurse I saw this scenario play out many a time, usually compounded by patients refusing to pay for care and subsequently in and out of A&E like a revolving door.
Unfortunately, it's often only letting things fail and a crisis develop which forces change permanently.

From experience I would try to keep her in hospital until the care package is in place and ready to start from the moment she arrives home.

We had a terrible experience with a relative where there was several days after going home before the care package stated. She couldn't get out of bed, couldn't wash, couldn't use the toilet etc, and we are not trained in lifting and helping elderly people about it really was a struggle and not very dignified for her.

Whatever her level of savings she is entitled, if it is needed, to ‘enablement care’ on discharge from hospital.

See if you can talk to the Discharge Coordinator. Do not make any suggestion that you or neighbours can help, and be emphatic that anything your MIL says about this is not to be taken seriously.

If she needs care, you should in any case apply for Attendance Allowance, which is not means tested, and is paid to the recipient to spend how they like: cleaner, help with personal care, etc.

Usually they do not discharge a patient until the required Enablement Care is in place. Sometimes the NHS run out of carers and have to call on Adult Services. But that is for them to sort out, not you.

The first thing is to have a capacity assessment, that gives you more of an idea. At some point the therapists would have either gone to her home to do an environmental check with or without her unless she self discharges. They need to see what she can do.

Do you think we just have to accept that there will be a period of a few days or more when the help just isn't in place but will be soon?

Don't assume anything will be in place soon (or at all). If a care package was being organised, the hospital would have informed you and they would be keeping her in until it was available.

Also, leaving the hospital to arrange her transport home isn't necessarily a good idea as it can be a bad (cruel) experience for patients. If you can take her home and settle her in, that would be better for her.

There is a massive crisis in social care and what someone is entitled to is not usually what they get.

As soon as she is home, you need to call Social Services, tell them she can't get a meal or look after herself.

There should be a social worker involved in her discharge at the hospital.
Try to contact them to discuss the plan for discharge.

If she has capacity then she can go home with or without care, thats her choice. You need to make it clear to her, the discharge co ordinator, the ward manager and social services what you feel she cannot do and that she is unsafe at home on her own and that there is no family or neighbour support. Do you have power of attorney. Do not offer to take her home, let the therapists and ward organise it. She will have had some assessments in hospital like walking, toilet, washing and dressing but they need to see how she is at home. There is always the danger that if she has an assessment at home and fails then she refuses to go back to hospital. They may suggest she lives downstairs and has carers and equipment in, stairlifts are expensive and not always the safest option. She will need a capacity assessment while she is in hospital.

The taking her home for an assessment sounds like discharge to assess, the bed is held and if she isn’t safe at home they will take her back to hospital.

The hospital will also help organise carers if needed

I think the question is does she have capacity? If so, what has she said to the hospital? They can not force her to go to eg a nursing home for an assessment if she does not want to. And they are not obliged to guarantee a “safe” discharge if she insists on going home. It is different if she lacks capacity.

On the positive side she should qualify for up to six weeks free LA care after a hospital discharge. This could be up to four visits a day to help with basic medical needs, personal care, shopping, preparing and eating food etc. They can also organise a key safe, grab rails, fall alarm and help with making shower etc more accessible (at a cost) . IME this can all be done within 48 hours. Thereafter she will have to pay for carers herself if she has assets of over c£30,000 but LA will pay if she has no money and they assess she has ongoing needs. But again she can refuse this if she has capacity even if this is the wrong decision.

It is difficult as a family member but I would make it clear that there will be no family support. Obviously you can still offer it going forward, but do not let the LA shunt their responsibilities in your direction.

Please make sure the hospital are crystal clear on your position. Your mil may well have said that x and y will be doing this and that/ staying over etc etc. what support do yo7 want to give? Be v careful.

Yes this is a new thing basically anOT home visit but they don't have to go back. What do you feel she needs daily carers to actually do? If you feel she needs personal care then you can ring the discharge coordinator back and tell them so. She may need an occupational therapist assessment on the ward which would establish her care needs. But if she is self caring on the ward this would not be necessary. If she has over £23000 in savings she would need to be paying towards her care in any case so if she agrees you could just contact a private care agency. Stairlifts are done through occupational therapy at the council but usually take minimum 6 months. You can refer her to get the ball rolling. A sime straight stairlift costs around £3000 try ascendit or higher elevation if she wants to pay for it herself. Avoid acorn. Discharge coordinator s are usually experience d nurses.

Yes, this sounds standard (it is in my county). Contact your local Age UK as soon as possible for advice and support. They may have services specifically for people coming out of hospital.