Mum - hospital to hospice - hospital Resisting referral

Sorry to be blunt, but because she is still alive

Sorry you’re going through this OP. As others have said it may be because she’s plateaud and expected to live too long to meet criteria. Say there are 20 hospice beds in your area - if they were all filled with people who lived 3 months then there would be no beds for 3 months to admit anyone into. Often people go into the hospice right at the very end when their symptoms are very difficult to manage in any other environment.

This was FIL. There wasn’t a hospice bed available and hospital is for the acutely ill, he couldn’t stay there indefinitely, quite rightly. He went to a nursing home where he died peacefully.
As an ex district nurse of many years I would never choose to die at home. Too many gaps in the service. Promises of help that can’t be met. I wouldn’t want it for my family either.

I’m so sorry.

My local hospice only takes people who have symptoms that aren’t managed. So pain that isn’t under control, unmanageable confusion etc. it sounds as if, given the plan in place now (right equipment, right staff, right medication) your dm can get by. The local hospice in that more stable situation would work towards discharge to a nursing home.

I certainly think it would help if the nurses and others would tell you the truth as they see it, rather than using euphemisms.

Whether she can be referred to a hospice or not, you need to state that you have concerns about the discharge, your worried that it will be an Unsafe Discharge, that you don't understand what is being suggested and how this package of care will meet her needs. Ask what kind of mobility assessment had been done - she needs the assistance of two just to be repositioned so she can't go home. The choices are a nursing home, or the hospice, but if she has a syringe driver then I suggest a hospice is the most appropriate place? Ask what the criteria is. You can also ask to visit any placement before accepting and decide then. If they want to discharge and say you have no choice this is not actually true. You must have good reasons, but there is legislation in place to push back against this. I sought an emergency Best Interests decision in the Court of Protection and won. And the social workers, everyone, were supportive because it was being suggested because of 'the system' not in my dad's best interest.

Be very polite but also very firm. It's OK. You state over and over that you are advocating for your mother, that you want to know how her needs will be met in a suitable environment. Put it in writing to the hospital social work team who will be facilitating the discharge. There must be a whole host of assessments done, from assistance with eating, washing, mobility etc Ask how these can be managed in nursing home.

But start with the criteria for a hospice, criteria for a nursing home and then see.

Your mum needs to go into a nursing home. You can’t take her home and do that level of care and you should resist all pressure from hospital. If she goes home she will need two carers 24/7 from the sound of it. Hospice is definitely only for people with a few weeks left.

I'm sorry to hear you and your mum are going through this. It is very hard. As above pp said, it can be about the hospice guidelines. Our local one will take referrals from people not expected to live more than 3 weeks. At times, they have needed to shorten this. With my M in law, who was in hospital with terminal cancer, she was given a package of support at home through social services, Macmillan care and family filling the gaps. She lived for a further 3 months. I would push back and ask what care from outside agencies is available. Take care of yourself.

I am sorry for what you are going through.

It may be that there are very few hospice beds available and that they have criteria that your mum maybe doesn't meet? Lots of places around the UK don't have in patient hospice beds as they are not nhs funded.

Your local system likely funds a number of nursing home beds for patients who require palliative care. And this may be what the nurse is referring to.

If you and your mum are adamant that this type of care is not something she will consider then the next option is to return home with a package of care from carers and support from community nurses to manage the morphine.

Hospice admits are normally for patients who are only expected to live for a set number of weeks (unless respite). You need to find out the hospital admission criteria and if your Mum meets this.