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.

One option is for her to go home with care in place while she recovers. Hospitals are not a place to assess how well someone will manage at home. She’s massively out of her normal routine, probably sleeping badly, and recovering from a broken hip as well. Many many people live at home safely with very little mobility. For her, no one knows yet how well she will recover. She’s probably petrified that her whole life is going to change and she’s never going to see her home again. If she has rehab/physio while supported by a package of care over a period of time, everyone gets a breathing space to see how she goes on. Don’t rule it out yet!

Ime the amount of physio you get on a home care package(sometimes callled interim Care or Reablement) is way less than in a rehab unit - once a week/fortnight compared to daily.

This happened to me with my dad and you need to put your foot down theyre too keen to just move people on

The issue being all old people say "I want to go home" and if they are deemed to have capacity then that goes no matter how unsuitable this option is in reality.

I would be phoning social services and explaining your concerns but from the sounds of it perhaps some respite care in a nursing home would be better as this would buy you some time to fully assess the situation and to then see how she was before coming home - that would be my honest advice

I know nobody wants to go into respite care but sometimes it's the safest option for people.

My Dad was at home with carers and there was huge chunks of the day not covered and then he fell, went into hospital and wasn't safe to go home. He was adamant that he didn't want respite care but it was the best thing they were amazing and although sadly he passed away it was peacefully in his sleep and not because of some awful accident or incident.

Have the hospital discharge team not talked to you about anything? Get proactive with them. There are various options - rehab hospital (free), care home respite for 'reablement' (free for 4 weeks) or home care reablement (also free for 4 weeks). This is the "Discharge to Assess" process where these are short term plans to get people out of hospital, with the view of putting longer term plans in place a few weeks later when there's been time for a bit of recovery/decisionmaking.

Best things you can do have been touched on above - work out if she will be self-funding once past reablement; be very clear what you as a family can and cannot do for her; dig out your POA documentation or get it in place asap.

PS - the hospital perspective is that as soon as there is nothing more they can do for her in terms of treatment then she needs to be discharged. And you do want her out to somewhere safe ASAP - hospitals are really bad for frail people.

@EmergencyHepNeeded

it is hard. after several false starts, DH and SIL had to coach FIL to say clearly and out loud that he couldn’t provide the care that MIL needed at home. He kept telling the hospital staff he’d do it 🙄 or just nodding along when they suggested it. She was unable to walk, doubly incontinent, couldn’t feed herself or dress or anything really. There was no way this could happen safely, no matter how much they both wanted her to go home. The hospital staff OTOH were all for it though, to the point where they delivered wheelchairs and other equipment etc to his house. We were lucky that a social worker finally stepped in and said it was madness to think of her going home, even with a full care package. It was a narrow escape. It showed us that you really need to be so so clear with the hospital staff about exactly what you are able to do and how often.

Not sure where you are OP, but in England her main options are bed base rehab for up to 6 weeks or home with care +- therapy (physio, occupational therapy) this is called home base rehabilitation, again for up to 6 weeks. If she needs longer term care then her finances will be assessed and if she has enough savings then she’ll have to pay. She’ll be entitled to free community therapy (physio, occupational therapy) though. Other options are interim placement (at a care home) again initially the council would fund this or permanent placement (but this is big jump for someone who was previously independent) with both of the final options she can have community therapy, but this won’t be as intensive as bed base rehab or home base rehab. They’re of course fully private/ self funded respite options. In terms of some of the other responses I don’t get why people don’t want to pay anything or help with care at all. 🤷‍♀️

My friend's father had to go into hospital and on his discharge the SS put him into a care home to give him time to get better, and paid for 6 weeks. Any time stayed after the 6 weeks he was liable to pay for himself. The SS decide on the home but I think if you'd prefer somewhere else you can request a different place and if it's more expensive, you can top up the difference.

We've been going round a lot of homes recently to be prepared for my mum going into one. Lots of residents just went into the homes for the six weeks originally but enjoyed the lack of responsibility for everything and never went home.

Hi. So sorry. Your poor old mum . This happened to my mum three years ago aged 87. After two weeks in hospital she was sent to a rehab centre locally. There she had physio but progress was very slow, she ended up staying 10 week. They sent an OT to her house when she was ready for discharge, they made a few changes to her first floor flat. They sent her home with a package of enablement carers 3 times a day to assist with meals and personal care, that lasted 6 week, they were free.
It was then decided she would need carers 3 times a day. They did a financial assessment. she has to pay half their hourly rate. She still needs them now at 91 as she has developed further health problems.
Hope your mum gets to stay at home with help. It’s all mine wanted. Good luck.

My mum had a period in a rehabilitation unit to help restore her mobility and independence after a particularly bad fall, this was really helpful. On another occasion she had intensive support at home for 3 weeks as part of the discharge plan. An OT visited within 2 hours of her arriving home to check if any extra equipment was needed. Both were health provision and therefore no cost and allowed time for her needs to be properly assessed and longer term care package to be put in place.

These were the good examples - we also experienced unsafe discharges when there was no planning or communication of any sort. The worst was mum being sent home in a taxi on a winter evening after a 6 week stay in hospital - cold house, no food in, care package not restarted. I knew nothing about it until the neighbours rang, despite visiting the ward in the afternoon and being told she was going no where as she had developed a chest infection and needed oxygen.

From bitter experience, I would say secure the house keys so discharge cannot be done without you/family being involved. Also take a note of the name of everybody you speak too and keep in close contact with any other relatives the hospital may call so you don't get played off against one another.

If you do go down the route of a respite placement (and there are some excellent ones around), be clear about the purpose of the stay i.e. to get her ready for going home rather than limiting her opportunities for independence.

Are you sure it wasn't just the doctors saying that medically she doesn't need to stay in hospital. They are forever making families panic by saying patients can go home when they mean from the medical point of view but the OTs/physios are the people that say whether someone is safe and make the decision on best place for them whether discharge to assess bed (formerly known as bed based intermediate care) or home based intermediate care where patients have carers and therapists in their own home. As other posters have said these are funded by health and therefore free. If people are sure that they don't want to go home and want a care home then they can go to what is called in my area a complex discharge bed in a care home whilst a permanent placement is found, again initially free. All areas have some form of these options although may have different names. Please don't panic just ask to speak to the therapists on the ward, they may already be deciding on the best option but haven't fully decided or got around to speaking to you yet💐

Actually in hospital no, but any time spent in a rehab hospital is included in the 6 weeks free care.

If your experience is anything like ours, the discharge team are v enthusiastic when it comes to handing responsibility over to family. You really have to push back.