Urgent advice needed about elderly mum about to leave hospital

[EmergencyHepNeeded]

NC as outing and <wave> to anyone who knows me. Apologies for length.

My 93 year old mum fell a couple of weeks ago and broke her hip and banged her head. She's been in hospital since. Because of the 25 hour delay involved in her getting seen in hospital (ambulance delays and delays waiting in A&E) she was very dehydrated and has lost a lot of weight.

She's been very unlike herself since - she can only walk about three or four steps and that's when there are two HCAs helping her and when she is using a walking aid, too. She sleeps a large part of the day. By 6 pm she's ready for bed and can hardly talk she's so tired. Physio is wiping her out, though generally she knows she has to go through with it. She's very stoical.

Before this she lived a very independent life, albeit with regular visitors. She lived alone and cooked for herself and did her own washing, ironing, vacuuming etc.

The hospital is now saying they will discharge her in a day or two. We are assuming they think she'll go back home. They know she lives alone.

Her children are more than happy to help but it wouldn't be possible for two to stay at a time (lack of room). We feel she wouldn't be safe if one of us had to get her out of bed to go to the bathroom.

We could get carers to help but two would be needed at a time. Even with two coming in four times a day (obviously very expensive) then that would leave 22 hours in the day when she was either on her own or, for some of the time, with one of us. As I said, we wouldn't feel safe helping her walk - another fall would be fatal.

What happens in a situation like this? At her first hospital the staff were talking about a rehab hospital, eg where you might go if you'd had a stroke. This new hospital isn't talking about anything except her going home.

We have thought about her going into a nursing home for a couple of months but they wouldn't be able to help her learn to walk again.

Has anyone been through this? Any advice would be gratefully received.

Be really clear about what you and family will do to the hospital. Make sure her home has been assessed and AIDS provided by an ot.
is she saying family will look after her? The phrase” unsafe discharge “ is useful as the hospital will not want her readmitted quickly.
my dm went into a nursing home after breaking her leg at 92 who did help her get walking again- nhs physio visited her there. You could also add private physio visiting her.
make sure communication is really clear with the hospital. Good luck

In this case, with the physio needs, would a respite placement in an appropriate nursing home be more suitable for her needs?

There are nursing homes which can help with this, if you speak to the discharge nurses they should be able to help with which homes could be a good fit. The only issue is that you might need to self fund as a short term measure.

Also social services might fund( and source) care for discharge. Carers are however in v short supply in most places- do not take on sourcing them, let the hosp/ ss do this.

She should have a discharge assessment by a hospital social worker first:

See here

They are so overstretched that if it is clear that family will step in then nothing else may be put in place, I’m afraid. Ask if a discharge assessment has been done and ask for her social worker’s contact details.

You can ask this question on the Elderly Parents Board - lots of very knowledgeable people on there.

Have you told (or even hinted to) the hospital staff that you and your siblings are willing and able to provide care, including overnight care? If so, they won't look any further than that: social care constraints are such that any relatives who indicate even vaguely they will provide care are jumped at. At most a visit from an occupational therapist may be arranged to assess whether any aids are needed - railings, raised toilet seat etc.

If you are not planning to provide care then you really need to be saying this loud and clear to the hospital staff. Find out who is in charge of the discharge process (could be physio, OT, doctor, discharge coordinator or a combination of all). Does your mum have a social worker or any social services input? Does she have any savings that can be used to pay for care? If you are not going to be providing all the care then you really need to push to get these discussions happening now, before she returns home.

Thanks so much for all of your replies. I think a respite placement is exactly what she needs. Does an ordinary nursing home offer this, do you know? She can self fund for a while but we're worried about her going to one place, being comfortable, but having to move on to somewhere else.

We're all hopeful that after a couple of months she could go home, but how realistic that is, we've no idea.

It's at times like this that you realise just how many hours there are in the day, in terms of having someone there with her.

You need to have a meeting with the hospital social worker and OT. They cannot discharge her home without putting a care package in place, visiting to assess equipment and adaptation needs and her passing basic self care assessments. There may be a rehab unit or home where her physio and care can continue until she regains more independence. Be very clear about the limitations on your time, means and ability to look after her though.

When my mum had a stroke a few years ago and was discharged, they put a care package in place with 4 carers a day for about 6 weeks that the state paid for. Don't know if it's the same now, but I hope you can get something like that.

So sorry to hear about your mum.
Your mum needs to be fully assessed as to whether she can wash, dress , prepare food independently, go to the toilet etc. Make it very clear to the hospital that she currently lives alone . Above all else speak to your mum and find out what she wants to happen. No doubt she will want to come home but ask her how she is going to manage. Usually a home care package is put in place with any personal aid requirement such as hand rails etc put in place before she is sent home.
TBH OP after an accident like this at her age - make the very most of the precious time you have left together. If a beautiful nursing home is viable in the short to medium term while you assess her recovery then I might do that. Quality of life is a vital consideration at this juncture. X

I don't think she's hankering after going home. I think she knows she hasn't a hope in hell of coping there. She seems to be shutting everything out, in terms of decisions etc. Even deciding what to have for lunch is stressing her out now because she hasn't the energy to think about it.

Yes, I have with my dad, five years ago so not sure how all the cutbacks may have altered things, my dad was 95 at the time, had a bad fall which landed him in hospital. He too lived alone in his little cottage & had always been fiercely independent doing all his own shopping, cooking cleaning. Always very smartly turned out, great pride in everything, ex wartime RAF pilot “ one of the few”.
It won’t be easy, feel I must warn you, but you must stick to your guns. She really needs to have a discharge package put in place, there’s usually a meeting, she shouldn’t just be sent out willy nilly. Ask at the hospital for her to be allocated a social worker. We had two, the first was dire & no help at all but the second was a terrific help. He sorted for dad to go into temporary care, just for the few months he needed to be able to manage. While there they made sure that he would be able to cope, got him walking, able to make tea, wash & dress again. Then when he was able to go home carers were arranged ( dad & I paid) daily .. actually they weren’t that great as they used to turn up at 10am “ to get him up” by which time dad was up, washed & dressed since 7am as always. But at least they put the washer on & hoovered.
You really can’t cope alone when she first comes out though you will later if she hopefully gets back to normal. I really had to be very firm( which isn’t like me at all, found it quite daunting) as they really just wanted to save money I think, but I was terrified of what might happen in the hours when I had to leave him alone. I was running my own business & just couldn’t be there 24 hours, only child, so no to family help, even though I called early morning & after work to cook his evening meal with him. Good luck, it isn’t easy

Obviously people far more knowledgeable than me have replied while I was writing before posting so sorry if I’ve stepped on any toes.

That meeting will be tough as essentially we'll have to say we are limited in what we can do. It's so awful and my heart goes out to those of you who've gone through it.

@VeryQuaintIrene I hope your mum has made a full recovery. I don't think that sort of care would be enough for my mum - she had something similar when she broke her wrist but she just can't walk more than a few steps now and that's with massive support.

@HerkyBaby Thank you, we're really aware that she might not last long and we have to cherish every minute. It's so awful to see her go from independence to this in such a short time.

@LIZS Thanks, I think that meeting will be tough but there's no point in us saying we can do things we just can't.

@workwoes123 Thanks, I'll get it moved to that board. I posted here for traffic given the hospital seem to be making this decision very quickly. Nobody has said anything to staff about care - we're shocked they are talking about discharging her so quickly, given she's in such a bad way. We're lucky in that we could make sure she gets regular visits and overnights, but it's too much for us to promise 24/7 care for the foreseeable future, as we don't live in her area and we have jobs.

She doesn't have a social worker and has no other health needs. Hospital staff always assume she's got dementia when she tells them she doesn't take any medication except two paracetemol every couple of months

@Darklane I think your situation sounds very similar to mine and I really hope my mum has the same outcome as your dad. Some of these old people are incredibly tough!

I'm a carer of nearly 15 years.

I would say she needs to go into a care or nursing home for respite and rehabilitation. It's too soon yet to establish whether or not she is likely to be able manage even semi independently at home.
I would refuse discharge on the grounds that she wouldn't be safe at home and there isn't an appropriate care package in place/ she won't be safe.
I would then look at severs homes which she might be able to go to both short and longer term if need be. They are few and far between but those with attached assisted living might be appropriate as she could potentially transition back to being more independent.

In terms of her walking. In my experience 50% of the battle is confidence. Which takes time to build back up and seconds to loose.

What's her living situation? Is she in a house, bungalow, flat? Where's her bathroom? If she does want to go home I'd be getting the occupational therapy team in to put in things to make that possible. A wheeled commode so she just needs to stand and transfer from bed/chair to commode and then be wheeled to the toilet or shower. There are pieces of kit that can help in these situations so might well be worth chatting to the OTs to see what is possible. If nothing else they will be able to rule out her coming home if needs be.

Good luck and hope your mum recovers well.

I would ask about bed based rehab. This type of facility offers care for people who are medically well but require more therapies support to return to sufficient mobility to return home independently. There should be a discharge team in the hospital who can go through the options with you and your mum.

She is absolutely entitled to go to a rehab hospital, and is entitled to free care for six weeks. That can be however long she is in rehab, then the remainder for free carers visiting at home.

This new hospital is trying to wash their hands of her too soon, probably because they know there is a shortage of rehab beds in their area, and they don't want her to be blocking their bed while she waits for a place to come up in rehab. They don't care what happens to her when she gets home, they are palming her off onto you and the wider family. DON'T LET THEM DO THAT.

Don't let them bully you into letting her come home yet. And DEFINITELY don't let them bully you into paying for care whilst she is still entitled to have it for free. DO NOT SIGN ANYTHING SAYING YOU WILL PAY. There will also have to be visits to her home before she is discharged, so the care team can put proper things in place beforehand (checking access, suitable toilet, where her bed is, you name it). DH had to go round MIL's house measuring everything, even things like the height of her mattress from the floor.

(I have recent very similar experience of 95+ MIL and broken hip).

This. You MUST say that you believe this to be an unsafe discharge and want that noted in writing. Ask to see their assessments and do not offer to do things unless you can feasibly undertake to do them for the rest of her life. Sorry to be so
blunt but right now you have more “power” than you’ll ever have again if she goes home without the right care in place.

@takeitandleaveit That's very interesting about the six weeks of help. I assume her three weeks in hospital won't be part of that?

Oh sorry, I've just read the end of the article @SparklingLime linked to - thanks so much for that.

this has recently happened to a friend of mine who knows the system well (ex social worker) and she still had to push hard to get the hospital to do the right thing. You need to be prepared to fight for her.

Be VERY clear, there are no carers at home. Be VERY clear that you cannot do the care required.
Insist that a care assessment has been done and ask to see it. Question it if necessary.
Be clear about money. If they suggets a care package, ask who is paying (you and she shoudl not be paying for it, it is medical care)

Phone Age Concern and they have an amazing help line.
There should be 6 weeks of rehab care, but if you think this will not be long enough, they push for her to go into a temporary care home.

I can't thank you all enough for this help. I didn't know where to turn to.

The hospital should not be discharging her without an ‘enablement’ care package. Basically up to 6 weeks of carers coming in up to 4 times a day to help with personal care, meal prep etc.

OT should assess.

And after 6 weeks Social Services assess for ‘continuing care’ . Incl a financial assessment.

But it doesn’t sound as if they can discharge her safely if she isn’t independently mobile.

Does she receive Attendance Allowance? It is not means tested and can be used to pay additional care, a cleaner, whatever would help her.

That’s the absolute maximum anyone would get. So sorry @EmergencyHepNeeded but it sounds as if your mum’s days of independent living are over. A hospital stay at her age can have a devastating impact as you’ve discovered.

Ask for a step down placement in a care home, where I live that would be arranged and funded for about six weeks. But do be prepared for it to be permanent.

Having been through this, I feel for you. It’s really tough on everyone.

Thank you so much. As someone said, it's all a matter of confidence. She seems too tired to be confident now but when she broke her wrist and earlier still when she broke her shoulder then she was determined to make it work for her and she succeeded. She's a chapter of bloody accidents that one!