Mum told she has to pay for care home but can't go home

Ok so having read latest I understand

She has a nasty complex break in her leg that will take more than 6 weeks to recover
She's staying in hosipuralfor then to review in 4 weeks whilst giving break time to heal , passive leg movement exercises , to plan to start active physio rehab once she can put weight on her leg.

Then she can move to a discharge to assess bed - rehab/ reablement care in care home for up to 6 weeks. This is usually non chargeable in many areas, but other areas of solely provided by social care it may be chargeable. She cannot stay there longer than 6 weeks though if it's a rehab bed in care home-so the timing is important . They can't send her there too early as she'd end up being moved to an ordinary care home which wouldn't have level of MDT rehab support.

With that plan that she could be well and mobile enough to return home with care package as she further recovers. She may not need the care for ever but may need it initially when she goes home to be re-able a bit more

It was a failed discharge first time she went home, I find it shocking that she wasn't offered at least 4x daily care at home for meals drinks toilet personal care, causing her all those risks and to fall many times which may have undone some of previous leg repair. Surgeon won't be happy!!

How old is your mum? What's causing your mum to have frequent falls?

A care home is not usually suggested upon discharge from hospital unless its a permanent option usually. You said your mum is medically fit but aside from the non weight bearing issue can your mum look after herself and cook her own meals?

No-one can keep your mum in a care home without her consent. It sounds like she has capacity to make decisions for herself, even if they are unwise. Push for rehab and ensure this is active rehab ie plan for regular physio when the break has healed to get her weight bearing again, physio in to assess equipment at home afterwards plus care package.

I fostered a dog for very elderly chap who wasn't weight bearing for 5.5 weeks, after leg operation. He went to rehab not Care home. Back home 6m ago, now.

But... that doesn't make any sense! If she's got exercises and is being sat out and will be reassessed, that's rehab! They sound as if they have put her in the box marked 'no rehab potential' in order to discharge her, but are either in fact giving her a sort of crappy rehab as either a not very good attempt to improve things, or as a sweetie to throw at her to stop her asking for more funding or input.

My experience of the medical team and the social worker when my mum was being discharged was that they spoke 2 completely different languages. It was almost impossible to marry up what the two teams were saying. The discharge I'm afraid was disastrous, though we got a good outcome in the end; only because my sister went absolutely postal on the entire system. She saved my mum.

I'd definitely keep questioning it OP. Age UK site was invaluable when I was going through similar.

Will the care home provide any sort of rehab? What's the long-term prognosis with her leg - I take it she's to be non weight-bearing until it heals up a bit and the infection clears, but what about after that? The worry here is that she goes into a care home supposedly on a temporary basis and then becomes deconditioned, which happens very easily with elderly people if they don't get physio or exercises, and loses so much mobility that she can't go home. It sounds to me that if she's not going in specifically for rehab then she probably won't get any unless you push for it. It is very very common for elderly people to go into care homes for what is supposed to be temporary step-down care and then they lose their independence and stay there.

I'm still not sure this is correct, my mother was most definitely non weight bearing as she was in a wheel chair and she had a 6 week free care package.

I’m another saying this is rehab and should be covered by the NHS for 6 weeks - mum may not be getting the full story - I’d suggest you speak to the discharge team at the hospital

If carers were booked to provide meals but didn't then you should be straight on to the care company/LA and complain. That's one of the core reasons for having them!

and while all this is going on, sort out Power of Attorney for both health and finance if you haven’t already. Hopefully the confusion will just be because she’s overwhelmed, ill and a bit scared and anxious, but if it’s the start of something more profound you want those in place asap.

Slightly different tack but if you haven’t already got POA them try to get both I.e. Health & Welfare and Property & Financial affairs.

The POA will make it easier to get information direct from HCP/SS and to advocate for your Mum.

I would ask about a step down bed. If she is medical well then this would be an option

If she's unable to go home & they need her out of hospital then she may be transferred to a bed in a care home as a rehabilitation option but nhss hould pay for 6 weeks for this. Happened to my MIL , she did end up staying in the care home actually & paid for own care once she/we had made that decision.

Care home beds are often booked by NHS for rehab purposes.

Enablenent care is arranged by the NHS as part of a discharge package. It is not means tested. It sounds as if she should not have been discharged the first time without this package.

I would call the hospital and ask to talk to the discharge co ordinator. Express your concerns and be factual about what your Mum can and can’t do.

Ongoing (Continuing) care is under Adult Services and is means tested. Age UK have a really good guide on their website.

I agree with many others.
By the sounds of it this is rehab!
She needs a rehab ward or rehab placement which is paid for by NHS.
Chat to occupational/physical therapy with your mum in the hospital regarding what the long term baseline is likely to be.

Ring up the hospital and speak to her social worker

You're not getting the full story from mum and you've some worries that can be addressed

Has your mother had any investigation into the cause of her falls?
You mention confusion, my MIL was confused and suffered several falls. The worst one was in Spain, she’d fallen once again, a friend of my in laws was concerned and persuaded my FIL to bring her home and take her to her doctor.
The confusion was in fact vascular dementia caused by a series of small strokes, the cause of the ‘falls’.

If she is unable to return home because of her weightbearing status I would try and argue that this is a 'health' need, rather than a 'social' need and this should be funded by NHS and not means tested.
It was quite clear cut in my trust regarding this pre covid but is less so now unfortunately.
'Reablement' social services care is no longer a thing in our area either post covid.
It is unfortunately unlikely she will make much progress whilst unable to stand on that leg so it may be that a rehab hospital is not appropriate, however in my area they are being used for that purpose at present due to the fact they are the only 'NHS funded' non acute hospital beds. It is a bit of a mess of processes at the moment so make sure you don't just quietly agree and ensure they clarify what your mum is entitled to.

If no-one agrees to pay for her placement, then she has to stay in hospital until a safe discharge can be arranged.

The difficulties with social care is the biggest problem facing the NHS right now - if you cannot safely discharge people, hospital throughput becomes blocked.

I think her best bet would be to be discharged home, and then to pay for carers in addition to the basic package. In a carehome there are always people around, but not always immediately to help a specific individual at any particular moment.

I agree,it sounds like continued care which is free. Look into it some more.

This isn't true. We had people on the free six weeks who had to use a rota stand to transfer where I used to work and we had one lady who was already a resident who used the free six weeks for extra calls after she had broken her leg and was unable to weight bear. The calls were used to help her dress and transfer using a rota stand and then later (once she was able to weight bear) to walk short distances with her to build her confidence up.