Shambolic discharge from hospital

Sadly, poor care seems to be par for the course these days.

My elderly relative (88) was in the last stage of heart failure. On 27 December he was admitted to hospital as he was struggling to breathe and had very low levels of iron and needed an urgent transfusion. While there, he contracted flu, needed oxygen therapy, and could barely walk, even with a zimmer frame.

On 31 January he was discharged and sent home in an ambulance, despite the fact he lived alone in a house with four flights of stairs, meaning the bathroom and kitchen were inaccessible to him. The hospital was aware of this fact, but a physio said she'd managed to get him to walk along the corridor with a frame for eight metres and he would cope "just fine". He was discharged with a care package - three visits a day for a week to make sure he was taking his medication properly.🙄

On 1 March a nurse found him in the floor at home; he'd fallen and broken the top of a femur bone and had been there all afternoon. (None of the family lived nearby and the speed with which he was discharged caught us by surprise before we could make plans to visit him.). He was taken back to the same hospital where they operated on his leg on 3 March.

He never recovered. Having operated, the surgeon had "the talk" with us, and my relative was placed on end of life care with a syringe driver in place. He died on 10 March.

While there's little doubt he would have died within months rather than years, I do feel what was certainly an unsafe discharge contributed to, and accelerated, his death, which was far from peaceful.

The problem is money, but on this occasion an unsafe discharge cost the NHS approximately £14k (based on 2023 figures) when the costs of an emergency ambulance, surgery, and subsequent palliative care are taken into account.

The cost of human suffering is incalculable.

You were lied to @Jothesquirrel so they could get the bed
Wonder what Wes Streeting is going to do about unsafe discharges

In hospital , the way it works is that if the therapy team feel that patients have potential for rehab then they are referred to community hospitals or inpatient therapy beds.
If they are too frail or unable to engage well with therapy , they go straight home or to a nursing home but essentially very little is done at home.

I suspect you have been lied to. Your mother would not ‘do better’ from a mobility point of view by going straight home. I do think you need to get PALS and your GP involved - it is completely unrealistic to expect you to organise care with a week’s notice. Use the word safeguarding as it is unsafe for her husband with cognitive impairment to be left as the carer.

I haven't trawled through all the responses but if you haven't been advised so far, then I would encourage you to place an online safeguarding referral to your local authority ASAP too.

In my experience the GP was next to useless. And as you have two parents to be concerned about you have reached what is termed "crisis" point. Both parents need social care involved as much as the hospital discharge team (in fact they should have been working together on this).

On top of that PALS complaint, and your GP. You need to make as much noise about this as possible. It is appalling, but sadly happens.

Op you are rightly angry. Very poor discharge coordination by the sounds of it. I work in community health, I think you are well withing your rights to complain about this as there is definitely a learning need and a need to review how they are providing information and cross over services.

This leaves a very vulnerable frail lady at risk of malnutrition, pressure damage, further falls or incidents if she tried to get up, continence needs etc the list goes on.

I have no answer for your particular area but just to say that it would be very reasonable to complain.

Previously worked as a community nurse. They had rapid response team for a short time then during this time patient was assessed then passed over to care company which you pay for. Is this the same where you are

They've basically over promised and under delivered; it was the same with my DHs aunt. So sorry but not altogether surprised this has happened to you; these people will obfuscate to your very face.

I would be now looking at care homes for your mother as home in the longer term does not sound sustainable.

Well they don't know that for sure

anyway, if it helps, I am literally at mum's now, looking at the very real possibility of her dismissing carers because she no longer needs them. (Not good for me but that's a whole other story). She doesn't even need a stick at home now. I hope your mum recovers well.

If you're self funding there will not be any guidance, you are left to it. But the care companies you choose will visit and do their own assessment of your mother's needs.

The same applies if you decide on a temporary (or permanent) placement in a care home. You will have to do all the work yourself, and the manager of the care home will assess to check they can meet her needs.

It does feel like being thrown in a the deep end but the good news is that it gives you choice. I have been through this with my mother and I was glad that I was able to choose the right type of care for her because she was paying for it, rather than being stuck with what the authorities offered.

In terms of physio, it is possible to rehab a frail elderly person, my mother was successfully rehabbed after a broken hip when she was in her 80s with moderate dementia. So it would be worth pursuing that avenue.

I’d say to the hospital it was an unsafe discharge and that you will be making a formal complaint.

In the long term, it sounds as if your dad needs to be in a care home if he can’t even deal appropriately with his wife falling.

I’m not surprised you’re so angry and upset. It sounds like a really difficult time for you.

I really want to assure you that your experience is not the norm, sadly I can’t, had very similar issues after my mum had a fall age 86, hospital genuinely did more harm than good, the initial rehab placement in an NHS rehab bed achieved almost nothing, it’s a sad reflection of the state of the NHS that the best care she received was from a care home as part of the ongoing rehab package and that wasn’t brilliant. Carers one back home varied from good to dreadful, mobility was quite poor and she seemed to lose all her abilities to do pretty much anything, prior to the fall she was 100% self caring. Carers would make her a sandwich for her dinner but leave it in the kitchen so she just didn’t get it, had a second fall which just compounded the problem, in the end my sister effectively sacked the carers and moved in to look after her for her last two weeks, hope your experience does turn out better.

The trouble is the people most affected are the least likely to complain, due to their vulnerabilities and stoicism. Dh was in rehab for over a month before discharge home. Promised Physio at home several times a week which was actually fortnightly then monthly at best for three months until he could be driven to them. There is a huge disconnect between identified need and the reality.

I feel for you. I'm a carer for DH. He was in the acute hospital, discharged to community hospital. They want to discharge him but a close relation has just died so basically I'm not here. They said carers four times a day, but with his mobility issues it wouldn't have been safe. So he's going to a respite care home for three weeks, funded by NHS. I found out two years ago, when DH was sent straight home, that they just want older people out and you have to tell them the reality of the situation. If I had known then what I know now I would have insisted then on a spell in the community hospital. Homecare is not adequate in many circumstances.

as an ex rehab/older adults physio, please complain! it's disgusting .i'm fed up of families and patients being effectively lied to as regards future care in order to get people out of a hospital bed. trying to get someone elderly in poor health mobile again when they are bed bound involves a lot of hard work by staff and patients.i have managed to get certain people mobile again once in their own home but this is when they live with family who are effectively able to be part of the rehab team . Community rehab services are as shambolically underfunded and under staffed as the rest of the nhs.

Unfortunately I think this is not untypical. An elderly family member was discharged without notice or checking partner would be home when they arrived. In fact they went to the ward to visit only to discover they had been discharged and had to rush back home. They too are bedbound, eventually had a hospital bed and aids delivered after OT home assessment , but after six weeks the funded carers stopped and they have been left very much to organise and fund care themselves. No physio, no slt, no reablement and minimal nursing input. Social care is appalling now.

Something else worth noting possibly...

Physio doesn't really amount to much. I don't blame them for that. In fact, I wonder if they are being set bonkers targets because in my mum's case she was 84 and too frail to really do much. But I think they get set really stupid targets. With my late father, they wouldn't admit that he was dying at one point - bizarre - and a physio came round every day to try and get him out of bed. I had to basically tell them to stop harassing him. Meanwhile, there will be other patients in the hospital who really needed a physio.

I just see the NHS as being a vortex of insanity now. I think the staff suffer with this as well. They can't keep up with the constantly shifting bureaucracy.

My late mum fell in her residential home and broke her hip.
She had dementia and wasn't able to understand any instructions about walking.
The hospital insisted that they were doing physio every morning.
Every day the nurse said she was tired after the physio. I kept asking if I could attend when they were doing it and was told no one is allowed on the ward outside of visiting. It was a Matron led ward and she was a stickler for rules.
After a week they were going to discharged back to the residential home and told them that she was walking around the ward with a frame.
I informed the RH that she couldn't get out of bed.
They went to see for themselves and they were disgusted to have been lied too.
The physio said they got confused with someone else with the same name.
Mum had a very unusual name and he then admitted that it wasn't worth doing physio as she couldn't understand what to do.
I got PALS involved and there was going to be an investigation.
After 3 more weeks she was discharged to a nursing home and never walked again.

The investigation showed a few issues but not serious enough for a disaplinary.
Hate what they did to mum and anyone else on that ward.

Not the same hospital but my parent (lives alone) was discharged via the Hospital to Home Team and AgeUK. The former organised district nurses and physio the latter dealt with cleaning, shopping and transport but also provide carers- their service is free for 4 weeks and then they can recommend approved companies to continue provision for a fee. Does your Hospital have anything similar?

Took them two days to discharge my dad home because they hadn't arranged the oxygen team to fit oxygen units in his home at one point they tried giving his bed to someone else and sending him to discharge area to sit and wait fortunately a nurse intervened realising he couldn't sleep in a chair in his condition

I'm sorry to read this but not surprised. You feel like you've been misled, lied to, misinformed. Hoping you can make progress.

I've had similar experiences with mum a couple of times

The short version is, this is the way it is. I didn't even bother making a complaint.

Ironically, one time I took her out of the hospital and sorted out private care straightaway - and they kept telling me it was a problem because it meant she was being removed from the system. Actually, if you have funds, being removed from the system is the best thing that can happen.

I am not sure how much a physio can actually do. But the physio did turn up weeks later. That's obviously the state of their waiting list. So we didn't pay for private physio. But by the time the physio turned up, they just said she was fine and there was nothing they could do. She was still wobbling around with a walker, but that was actually progress for that stage.

Sorry not to have better news for you, but community care is pretty much non-existent. Especially if they are aware you've got funds. I don't mind paying for things. But I thought it was very odd the way they kept almost trying to warn us that coming out of the system was a problem. It isn't a problem because the system has nothing to offer!

Her GP didn't know anything about local services in the area. Have you spoken to adult social care? They seem to be the ones with the information.

Yes it’s probably because you’re not a health professional- but your GP can refer no problem, I think in the future it may be changing where patients and families can refer themselves but that talk is only in the pipeline x