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?

Okay, I'm a nurse and I just want to clear a few things up.
If your mum has capacity, then she is able to self discharge, make unwise decisions, self neglect etc. The assessment is more than seeing if they know who donald trump is, it ensures they can take in and retain information, as well as understand it. Providing your mum can do these things, then she has capacity to make decisions about her care/life.
In regards to POA, this would not help you in this situation. POA is only relevant where the patient lacks capacity.

Keep saying “I am not her carer” and “Unsafe discharge”. this statement would also not help you in anyway, as she is self-discharging, they are not discharging her, she is going against medical advice.

I understand how frustrating it is, and i have had a patient in this exact scenario previously with the daughter screaming in my face telling me I'm abusing her mum by allowing her to self discharge. But she had capacity, and unfortunately there is very little we can do in those circumstances.

I hope things improve, and it does sound as if residential care may be appropriate, or will be at some point.

I’m amazed to hear about the serial sevens

My father would no way have passed that test. But to be fair, I’ve got friends in their 20s who wouldn’t either.

I was genuinely horrified at the fact they considered my father to have capacity when he barely had consciousness. Something is very wrong here.

It sounds a really difficult situation, and I hope some good comes out of the meeting. But, health and social care professionals have really limited scope if someone is refusing advice/treatment and they do not meet the criteria for sectioning. Even if they assess her not to have capacity it's difficult.

Have you thought about counselling for you? Your mum seems on a path of self destruction and you need to distance yourself for self preservation. I mean this kindly and I get it's not as easy as saying it.

Just stress at the meeting that you are neither willing nor able to be her carer and will be taking no responsibility for her if and when she goes home .

It is a positive they are doing a best interest meeting however if your mother does have capacity, they cannot force her to stay in hospital against her will. However, all professionals will have a duty of care towards your mother even if she is refusing services.

Just remember that the medical team's primary 'plan' will be the family. They will focus on 'the family can...' and 'the family should be able to....'.

I hate to bring this up again (a pp did previously), but is it at all possible that your mum has just decided she's tired of life? I only suggest this as my own mum is far gone in dementia and if she had known her life would take that path she would have made the decision to stop eating and drinking and 'let nature take its course'. I apologize if you feel this post is out of line.

@acrossthepond no need to apologise, i understand. If you had said this two weeks ago I would have agreed with you. In fact this very thing happened with FIL who decided he had enough and that was pretty much it, they did section him to hospital and he chose to go into residential care. He absolutely decided to die, as was his right.

My mum is so difficult though that a care home would be awful for her. What I am hoping for is a better care package - someone heating up a ready meal and leaving it for the next carer to throw it away isn't what she needs.

I feel she needs

• dietician
• physiotherapy
• psychotherapy
• endocrine review
• access to support groups in the community, although she says she doesn't want that.

She only has a microwave at home as she dismantled her cooker because she thinks her sister tried to poison her.

A care home would be found that would be able to take someone who has mental health issues, delusion, paranoia, and being old issues too. Dementia patient with similar issues are found places all the time. She would not be allowed to go into any old care home which couldn't cope with her, they would have to take account of her complex needs. This is completely doable in a care/nursing home setting and MUCH easier than at home as they won't want to pay out for more home care, so unless you want to do it all yourself, a care home is going to be cheaper than having people in for most of every day and possibly night for your mum. She is not thriving at home, please listen if they suggest a good care home and jump at the chance of her getting better care.

It's breaking my heart

I know, I can hear that. I know that despite everything you want the best for her.

Let the lead consultant take these decisions though, with your mum and you, but I suspect your mum does not have complete capacity- if she has delusions and paranoia, plus issues with remembering to eat/appointments etc, it is likely she has capacity in some areas, like deciding whether to wash or not, but not necessarily the capacity to fully make complex decisions about where best to live to keep herself safe (as she does not do this).

A care home would take away some of the day to day issues, they may also help with getting her medication in her on time as if she is not eating/drinking regularly, she probably isn't taking her meds either. This then makes the mental health worse. There's no reason for her to be in extreme distress or agitation or paranoia, there are meds to help with these things.

It is really hard for all of you, but I think this is a transition point for both of you to realise her current way of life isn't sustainable (or you could keep it up another month before it all collapses again). The NHS is super-stretched and they won't put in the things you would like for your mum except the endocrine review possibly, otherwise they are looking at basic care needs which are not being met. The rest would be appropriate if those were met and she was living an active and enjoyable life in the community. She isn't and I think you need to listen to the lead consultant now and get her somewhere (care/nursing home) she can have those basic needs (heat, food, drink) and her medicines done properly taken care of and then see what happens. They are used to dealing with aggressive patients or people who have delusions, though, this is bog standard stuff in many nursing homes!

If she has capacity you can get LPA

I think we discussed this before and the OP felt her mum wouldn't give her LPA (she is quite paranoid). You have to have the GP or the consultant sign off on the LPA as well to confirm capacity, and if they are having a 'best interests' meeting, then it's likely they feel she does not have capacity.

OP I could scream for carers when ive assessed people and they have told me that they have all the help they need at home. I can see through the phrase " my daughter / son does everything " to a tired stressed daughter or son at home. Its really awful. I have had carers beg me to say that their relation cannot go home as when they are in hospital its the first break that they have had in months but when they are medically fit they need to vacate the bed. I just feel so sad for them and always offered alternatives such as rehab where possible or care package referrals.
The difficulty is that some people are quite selfish or dont have the insight to accept help f3om anyone other than their relatives. My heart goes out to you.

@TheoriginalLEM
Please don’t feel upset, your mother has never been well or kind to you, you’ve done nothing but your best.
Stick to ‘I am not her carer, I cannot do it’ you cannot make her do anything, if she chooses this path of self neglect then hard is it is for you, it is her path to choose.
I’m 15yrs NC with an abusive mentally ill mother and I chose this to protect myself and my family, sometimes the hardest choices are the best ones.
Stay strong 🌸

If she refuses to have an oven and accuses people of poisoning her/refuses even the microwave meals, how on earth could a dietician help? She's not going to eat a lovingly prepared meal, either.

But, as every other time when you've been at your wit's end with her abuse, you'll keep putting yourself through it rather than protect yourself. Because you still seem to think that being cared for by professionals in a home is awful. Why? She's miserable out of one. She's at constant risk of the consequences of self neglect out of one. She might as well be in one, be miserable in one and be safe.

If they are having a best interests meeting then she will have already have assessed her as not having the capacity about the decision to go back home. This is a good thing, OP.

Tell her (and the doctors) she is welcome to discharge herself against medical advice but that you will be unable to support her in any form. You will not be checking on her, buying groceries, cleaning etc. See what they have to say then. I bet there will be a lot of back pedaling.

Stinky - is that the case? That is how i understood it before but the dr I spoke to today didn't present it that way.

The reason I am reticent about a care home is twofold. One, my father was neglected in one and it was horrendous (think mp involvement) and two, my dd1 would never forgive me because of reason 1.

I feel like I have let my mum down, i naively thought she would be in the assessment ward briefly before being moved to the local cottage hospital for rehab.

I look at people out for tea with elderly parents and it kills me. This is how it should be for us, but my mum clearly feels ive betrayed her and right now it feels like she's right.

stinky is right
You can only have a Best Interests meeting if she lacks capacity

So is DD1 prepared to give up her life and look after her DGM interests and care?

Obviously you have fear about a care home but there are very good ones out there, history doesn't have to repeat itself?

If she has capacity you can get LPA only if she agrees to it, that is why she has to have capacity. If she no longer has capacity and you do not have POA in advance everything relating to her affairs would need to go through the court of protection. That was what I was told.

If they have called a Best Interests Meeting, then they have already assessed her as lacking capacity.

However you also need to be realistic about outcomes. From your list:

1. Dietician.

They can advise on diet but she can't be forced to eat food she doesn't want to eat

1. Physiotherapy.

A lot of physio is you practising. It doesn't sound as if she will do this. The most they can do is advise on safe mobility. If she refuses to use equipment when alone, this may need to be taken into account at the Best Interests Meeting. But you can't really physio someone who isn't working with you.

1. Psychotherapy

This is really a non-starter. The first thing about psychotherapy is you have to want to do it. She doesn't.

1. Endocrine review

Discuss your reasons with the Care of the Elderly Consultant. They may or may not think it is necessary - it may be something that is within their capability, or they may agree with you.

1. Access to support groups in the community

Bring it up at the Meeting. However you can't force her to go. What there is more likely to be is something like a Day Centre than a support group, and this may be more appropriate given where she is now physically and mentally.

I’m sorry OP but you need to read the thread through as though you were a stranger. You say your mother is vile to you, appreciates nothing that you do and is generally not willing to help anyone else help her.

If she won’t allow you or others to help her improve her quality of life then you need to accept that it is her choice. There are people who desperately want the help that is available and there isn’t the finances or manpower to waste persuading those who don’t want it.

Residential care isn’t perfect and it almost certainly isn’t something anyone would choose for themselves but it can make a huge difference to know that they are warm, safe and fed.

You are wasting your life feeling as you do and she won’t thank you so who are you doing it for? If you were behaving this way to your daughter would you want her to feel the way you do.

Your list is unrealistic for the reasons cited above.
Time to prioritise yourself and your own mental health. Your DM is free to make her own decisions as are you. You will live your life as a result of the choices you make. Time for change.
If you feel as though you're betraying your DM then I question her parenting. You've been brainwashed. Her wants do not trump yours. Thirty years of nursing tells me care homes are very often the best outcome in circumstances such as these. You just can't see it. Time to step away.

OP, you have an obligation to your family first, mother next. How do you bow to your daughter objecting to full time care in a facility that would make her life (and yours) better? Will she do the caring? Genuine question.

I went through all this FOG, Fear, Obligation and Guilt, and eventually got over it, because my family and OH needed me too.

I sense a bit of martyrdom here..... sorry now really, and I felt it myself too for a number of years. But there comes a time when you really have to prioritise yourself.

I really hope this post does not sound cold or anything. If anything it is real. I was that person.