Elderly mother wanting hospital discharge against advice

[TheoriginalLEM]

My mother is difficult to say the least. She is 85 and has complex medical needs. She is self neglecting and just over a week ago was admitted to hospital at deaths door, she has carers but was refusing food and water.

She agreed to stay in hospital with a view to a transfer to a cottage hospital for convalesence and rehab. She has MH issues and is under the useless psychiatrist.

The self neglect has been going for a long time.

I don't want her to go home, yes she is better than she was but is frail. She was vile to me yesterday (she always is)- apparently the Dr said she could go home but the nurse said this wasn't true.

I'm going today to hopefully speak to the dr or nurse in charge.

She wants to self discharge but i kniw this will just start the cycle of self neglect and quite frankly, running me ragged, and I think it would be a huge mistake.

The issue is I don't have power of attorney (big mistake) and she has capacity - surely though the medics can step in if someone isn't self caring and refusing care?

If she truly has capacity then the choice is hers. If she lacks capacity thrnr "best interests decision" can be made. (Not a lawyer or a dr so this is just my experience)

Oh I had something like this recently with elderly father. I did speak to them. It might help. They discharged mine but yours sounds less well. I asked them for a social services referral, for after he got home (however refuses them as well)...Not easy

Yes, this is how i understand it. The gauge of capacity seems to be if a person can count backwards from 100 and knows who donald trump is

I keep telling them it's mental health, not dementia but they rule out dementia and just leave me to pick up the pieces. I am on my knees

Oh LEM as you’d not posted for a while I’d hoped she’d sorted herself out a bit more.

I see she now has carers i, so are social services involved or have these been arranged privately?

I’d SS can you get them to intervene some more?

The hospital may agree to a discharge if they need the bed. But if she is deliberately saying she can go when she’s been told she can’t then can her capacity be called into question whilst she’s in situ there?

What's the 'running ragged' you end up doing? It sounds as if she is manipulating you and that you need to step back and start refusing to pander to her, whatever the consequences.

If someone has capacity but self-neglects then that's their right - it's everyone's right to make "unwise or eccentric" decisions.

If the hospital have no more treatment for her, she's well enough to be somewhere else and isn't waiting for immediate test results then they will need to discharge her. There will be a discharge team (talk to the ward staff today) so you can see the direction things are going. The hospital will need the bed but they will also be interested in avoiding her bouncing back to hospital within days.

If she has capacity POA for health wouldn't help you anyway.

Oh, hasn't she seen a geriatric psych for a proper assessment of capacity/mental health diagnosis?

You need to tell SS when they assess her you can't do so much stuff for her, maybe need to tell her that too, or she will just lean on you too much

Yes tell your DM and SS that when she is discharged you will not be doing ANYTHING to assist so it will just be whatever the carers provide...

She will end up back in hospital again quickly I suspect.

Capacity is not a one size fits every situation a person can have capacity at a certain place and time to make a decision but then not have the insight or capacity to make a different decision. And as a prestigious poster said she can as an adult make unwise decisions but as long as she has insight into seeing the consequences of those decisions she is free to make them.

POA can only come into play when the individual loses capacity ( That being said if she has capacity now they can still be set up)

It sounds very much like she is dragging you in to sort out her mess, and you have every right to say no.

Mental health law wouldn't permit detention for physical health reasons.

People with capacity have the right to make decisions others consider unwise. You can't just detain people because they're not doing what you want.

We all have the right to be protected from unlawful detention and deprivation of liberty.

That said, capacity is decision specific so those sound like crap tests. They don't determine her ability to understand, retain, evaluate and communicate information specific to the decision she is making.

Is there a safeguarding team at the hospital? They are usually better trained in capacity issues.

Can you speak to hospital sw and make it clear that you are unable to step in and she needs a full care package before discharge or to go to cottage hospital. Chances are she will just tell them you will pick up the slack, as before. Can you get poa now, as if she does self neglect it may reach a point where you cannot sooner rather than later.

Some useful suggestions here.

I am very torn as I don't think hospital is now the right place, however she is still being treated for chest infection and UTI, the nurse said she isn't ready. I need to talk to Dr or ward manager.

Suggestion of safeguarding team is a good idea.

If i could have my own way id like her to go into respite care until she us fit enough to look after herself, albeit with help. However i don't think this is on the table.

I am trying to avoid long term residential care as she would hate this but at the moment her quality of life is 0. Literally on the sofa which is her bed all day, muscle wastage due to this getting weaker and weaker.

I guess if they state she has capacity you can ask to make POA now???

If she still has a UTI then that will be contributing to her poor mental capacity as that is often a side affect of having one, not to mention not having eaten properly for some time?

You need to be selfish enough to not run yourself ragged, she will have the best quality of life if you are in the best state to her advocate, rather than so exhausted you can't see the wood for the trees.

It doesn't sound like you running around will actually improve her quality of life?

It might be worth asking the SW about the local self neglect policy. This is in place, in my experience, for vulnerable people who retain capacity and are at risk of neglect. It mainly about getting agencies to work together GP, Social care etc. As they still have a duty of care.

I’m so sorry OP this must be so difficult.

Just to add to the already excellent advice. No the hospital can’t make her stay and can choose to discharge herself however,the reality is she can’t physicality leave without help can she? Is the hospital going to arrange for her to go home safely? I doubt it if it’s against medical advice which means what she really means is “I want to go home, I’m going to tell the hospital I’m leaving and then I want you to take me home” which OP you don’t have to do xx

Then you need to speak to social services about intermediate care in a step down bed (tho these are often in residential homes) and a full care package

Yes you need to talk to the doctor but IMO the occupational therapist if involved might be a good person to talk to.

Tbh if she self discharges against medical advice you dont have to go and pick her up.

Oh I knew when I saw the title this would be you. Can she even physically walk out on her own?.

Fluffy, she can walk but not far. Things had got better for a while and now back to square one. It doesn't have to be like this - she could have quality of life.

If she stays in hospital things like physio and dieticians can be accessed, once she leaves there is nothing other than the carers who quite frankly, and understandably, are out of their depth with my mother and call me at least every other day to help them calm her down. She talks to them like shit as she does me so they make her food and leave it on the side

It's so difficult my heart goes out to you. I noticed that you said she wasn't drinking or eating anymore, my relative was like this and they had just had enough and said so. It was like a weariness with life. I don't know your back story so apologies if I'm way off the mark but sometimes if people have capacity you have to let them make what we all would think are bad decisions.

When she's at home I can't even get a telephone consultation with the gp let alone an actual appointment

You need a psychiatric assessment, a dementia assessment, a care assessment, an OT assessment and a social services assessment.

BEFORE SHE LEAVES

Once discharged, the hospital will abdicate all responsibility, she must be assessed and have a comprehensive care package in place before she leaves.

Keep telling the doctors, discharge liaison and ward managers - she cannot be discharged until she has had a proper assessment and a proper care package in place.

Her admission was while she was receiving an inadequate care package, to simply resume this on discharge will simply result in a return to hospital.

Do not let them release her, otherwise you'll be in a worse position than before,

She may need convalescence or even a specialist EMI (elderly mentally ill) care home.

There is a thing called anorexia of the elderly