MIL sectioned, hospital want her to return home

[crunchycrispy]

This isn’t really an AIBU but I (we - my husband and I) need some help/advice today/tomorrow really.

Background:

My lovely MIL is schizophrenic - has been for 40 plus years. In and out of mental health hospitals and units on and off for years. Sectioned many times over the years. Pretty much always medicated.

Over the years she has done things to herself which have caused serious injury and are part of the reason she isn’t so mobile anymore. Various medications to stabilise mental health have also contributed to additional conditions she now suffers from too.

My lovely FIL has stood by her all of this time, looked after her when she is home (of which there have been periods of a several years at a time), whilst working full time and bringing up 3 children.

They are both now in their mid-70s and FIL has his own health conditions. He would struggle to help her if she falls again. Plus her last episode last year which saw her sectioned again and back in to a mental health ward has really taken its toll on him. His stress levels are extremely high all the time with worry. I’m not putting too much detail in so I hopefully don’t give away who I am if family members are on munsnet. But basically if MIL returns home it will probably finish FIL off - he cannot cope anymore.

MIL has been in the hospital for going on a year this time. During that time she managed to fall quite badly and had to be transferred to the emergency unit in the hospital for a bad head wound. She stayed in the main hospital for a week deteriorating and on a lot of oxygen but thankfully got better and was transferred back to the mental health ward.

For some time the hospital have been working with Social Services to find MIL a place in a specialist care home that can cater to her mental health needs. This would be a permanent place and FIL and my DH and both my BILs support this.

Then this week my FIL is informed by the hospital that they want to meet him on Friday to discuss her release home to FIL, where she/both will be supported by local team and social services! Apparently she has told the drs / social that she is refusing to go to a care home and wants to go home. She is also arguing constantly that she shouldn’t have to take her medication and so of course FIL has that worry again that if sent home she will relapse very quickly and he will have to wait days again for them to take it seriously and come back and collect her - and help him!

I believe she is still under section but we have to have a chat with FIL today and double check that.

FIL cannot and will not cope now with having her home.

DH and my instincts are that they can barely keep her stable on meds, as her condition seems to have worsened with other ‘old-age’ maladies, and want the bed for someone they can treat; and that social services are struggling to find her a specialist care home/don't want to fund it.

However, my aging, and really not in that great health, FIL cannot care for her and himself adequately now.

DH has been invited to attend meeting in person with FIL at hospital or to join via teams call. I can be with DH on teams if he doesn’t make the journey (4 hours away) to be with FIL on Friday.

I/we need the collective wisdom of mumsnet to give us the right things to say in this meeting to the Dr/care team and social services to stop them discharging MIL to FIL. He is very stressed out and we hope they are not literally going to drop MIL home in a transport ambulance or similar.

Does FIL have any right to refuse MIL discharged home to him?

Off to work myself shortly so I will say thank you now to those who answer and will check back in as soon as work permits today.

I’m sorry, I don’t have any wisdom I can share on this but just wanted to bump this to keep it in active for you. I really hope you get some good advice on everything. What a bloody difficult situation.

yes, your FIL can say that it would be an unsafe discharge if your MIL was to come home to him.

does your MIL have capacity? In a legal sense? If she does, she has a say in where she goes. If she does not have capacity, then your FIL and the hospital can decide. Ask about a Deprivation of Liberty order too.

FIL needs to tell them , very forcefully that he will not have her home.

I’m sorry. It sounds like a really tricky situation, but the hospital should have experience of this and should be able to advise. I’d also ring Age UK for advice - they are helpful.

I am no expert but yes your FIL must say he can not care for her at home. If one of you can physically be with him at the meeting I think that would be best to try to stop him feeling guilted.

I don’t know if it would make a difference but I would also put your concerns in writing to everyone involved so it’s on record that it’s a dangerous idea.

good luck to you all sorting it.

You could try contacting Age UK to find out if he has the legal right to refuse to allow her to return home. Funding a permanent place will be very expensive so the authorities would rather she returned home. But keep saying no.

He can say no. If they think she is ready to discharge then they will be planning it and inviting you to be part of that discussion. Social services will do a Care Act Assessment to review what care she needs and your FIL can say no to coming home as he cannot meet her needs and the stress is to much. The care act assessment can’t start until she is ready to come home so her needs are clear, it sounds like this is what the meeting is to think about.

I'd have DH at the meeting and you on teams recording it.

Use the words unsafe discharge.

Sorry I have no other advice but wishing you all the best.

Has he had a care needs assessment himself? If he needs care and support he clearly can't care and support someone else

The hard thing is there isn’t many placements so she may be in hospital for longer whilst they find one and the one they find may not be that close to home.

Has MIL been assessed as having Capacity to make decisions about her care ? If she has, and has been found to have Capacity, and wants to go home, SS need to try to make that happen.

That’s the first thing you need to find out.

See eg https://www.ageuk.org.uk/siteassets/documents/factsheets/fs62_deprivation_of_liberty_safeguards_fcs.pdf, https://www.ageuk.org.uk/information-advice/health-wellbeing/health-services/leaving-hospital/

contact Age UK on tel:0800 678 1602 0800 678 1602. Lines are open 8am-7pm, 365 days a year.

This, it very much hinges on her capacity, has it been assessed by a consultant psychiatrist?
If she lacks capacity, legal powers will require to be in place such as a Deputyship, which would also have powers to say where she resides and care she receives.
Unfortunately should she be deemed to have capacity and she wants to return home, legally she can. This would be hard, but I'd make sure you and FIL played no role in supporting this, as it would clearly be reliant on him. Could he come and stay with you for a short spell?

I’m sure somebody will be along soon with experience who can give you good advice.

I just want to say good luck in this difficult situation. It’s heartbreaking that our services are in such a state and that caring responsibilities are forced onto those who just cannot do it.

If your DH can support FIL in the meeting, so much the better. My instinct was to suggest going in person, but sometimes it is easier to feel pressured when speaking in person? They might find it easier to say “no” over Teams.

As far as a specialist care home, have you started looking yourselves? When hospitals talk of discharging to a care home they expect families to find one (and then the nhs may be paying under continuing healthcare rules) but definitely we had to source it. Ask them whether her care comes under this and you can also clearly state no to having her home

Also ask about 'contingency plan'... so goes home, and in 18 hours refuses meds/eat/personal care/ is aggressive/falling.... what happens?

Yes he can say he cannot physically or mentally care for her anymore and that they need to find her a residential facility. She does not have capacity to make the decision that she wants to come home. Do they have poa for her medically? My mil had dementia and was in hospital whilst they awaited a residential facility and wanted to come home. The family eventually decided to let her and it went tit's up within one day and they found a residential facility the next day.

In this situation social work and the facility will be trying to push responsibility for her on to each other but you need to remain steadfast that coming home is absolutely not an option due to your father in laws personal health needs and he now lacks the capacity to care for her in the way she needs. It is all very well having carers coming in x number of times a day but they won't be there during the remaining hours when caring for her will be too difficult for him.

Has your father in law had a social work assessment for his own care requirements?

Was she under a S2 or S3? If a S3, she will need a S117 aftercare plan which is completed by health and social care. This will detail how her needs will be met in order to prevent readmission under section.

As others have said, if she has capacity around care and accommodation she can make the decision to return home, however you have to be clear there will be NO support from family and she will need a full package of care to meet her needs. Highlight any risks you can see and request a carers assessment for FIL which will detail the impact of his caring role on him- it will then be documented that he will not continue his caring role and will highlight further risks they will need to mitigate if she has capacity and wants to return home.

If she lacks capacity and there is no deputy/LPA in place, it will be a best interest decision made and you will be consulted on your views.

Your husband needs to be there in person. He needs to be your Father in law’s advocate and stick strongly to the line that he cannot cope with her coming home and that a residential placement needs to be found. You have evidence - her refusal of medicine etc - that she needs to be in a specialist setting.

Hi OP - my sympathies as my own mother suffers from extreme mental illness and has also been sectioned on occasion. My father is dead and I’m an only child, so whenever she was discharged from hospital the presumption was that the majority of her care would fall to me.

After a particularly severe episode several years ago - when I also had 2 toddlers and a baby to look after - I had to be explicit with the doctors and social services that I could not be providing any care for her and I believed she was at severe risk to herself. Other extended family members (my aunt and uncle) came to meetings to back this up. Essentially you need to be very firm - as many people as possible need to say the current situation is unmanageable, you need to point out that she presents a risk to your father in law’s safety as well.

Re capacity- this can be difficult, because in my mother’s case she could present as quite capable/lucid to doctors etc, so we had to also be explicit about the reality of the situation and her condition. It might be helpful to go armed with a list of previous medical episodes and what happened - don’t presume they will have accurate records from the hospital.

My own mum essentially never came home after the last time in hospital, and was moved into a care home, which is by far the best place for her. Ensuring she can be there permanently was a bit of a battle with social services and the whole financial issue , so you might have a bit of a journey ahead of you on that front - but at all times, it’s important to be clear that you don’t think it’s safe for her to come home.

good luck OP, it’s very hard and stressful I know xx

You can and must refuse. Care homes with a dementia focus are your first port of call. And it is likely that MiL will be under a lesser form of section and come under NHS continuing care.
Your FiL should have a carers assessment in conjunction with any plan to discharge so contact LA to get that in train.
Budget and bed pressures will be uppermost in any decisions so the family’s role is to check and question medical and social care decisions to the utmost

Not mental healthbrelated, but, not sure if this helps....

My grandfather had cancer, he was a big man and the hospital and social services wanted to send him home to small terrace and said the second room downstairs would be changed to a bedroom, and his wife, buiolt like a sparrow, could help him.

The omly way this got stopped was by our parents moving our gradmother into our house before the planed retrn home date and telling social services they had moved her ou, the house would be empty if hevreturned and noone would be there to chec on him, that he was safe, that he was taking meds etc.

Part of this was down to him needing a wheelchair, so nay not work for you op, but this was the length the family had to go to to prevent a ridiculous return home.

Basically if social services can get them home and out of services providers hands they will, so dig your heels in.

Apologies for the terrible typing!!

You will want to ask them if they have assessed her capacity to make decisions about her care (capacity is decision specific, they don't assess just general capacity. I'm assuming they have though. Ask if she has a care plan under the CPA - this will detail her needs etc - and say that you need input into it. Is she safe on her own? If not I assume she may need a LPS (which used to be a DOLS).

I think your DH needs to go in person and support FIL because it won't be easy for him. They will absolutely be pushing this due to bed pressures. You need to stay firm and say that FIL is unable to provide the support she needs and that it isn's a safe discharge. If she does end up coming home she will probably end up being readmitted at which point they may choose to send her to a care facility (but I know that is stressful and not good for FIL).

Maybe she can’t be prevented from going home but that doesn't mean your FIL has to be there to look after her. If he moves out, even temporarily, SS would have to consider whether she can be safely left alone. My guess is not.