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.

Thia is a great immediate action suggestion.
Your FIL does not attend any meetings and you keep repeating that it is an unsafe discharge.

Unfortunately the truth is your FIL isn't well enough to care for his wife and any release could have a terrible impact on his health.

This is such a heartbreaking situation but unless you hold firm this could become z nightmare situation.

Staying firm and resolute is imperative.
Remember them getting her home is an impersonal bed blocking, box ticking exercise for hospital bed management.

Just don't accept it.
I have known of incidents where family blocked numbers and refused to answer the phone because of hospitals trying to force the release into their care.
These were aunts and uncles they were fond of but had no intention of moving them into their home to care for.
It is very stressful.

I would say the issue here is capacity . If mil is deemed to have capacity and wants to go home, she will be returned home. Can you ask for a mental capacity assessment ?
there are very sadly lots of older people living unsafe at home but they are choosing to be there.

This but with a caveat. If she is deemed to have capacity she can make any choice she likes (even bad ones) including refusing medication and wanting to return home.
However fil can also say no to being her carer and providing any support. He can insist he is removed as her named carer and tell the team that he will not be present in the property at discharge and that they will have to arrange keys/a key safe and a carer to meet her, that they will have to appoint someone to manage her finances/benefits and care... Basically withdraw from his role. Given this has been his role for many years and he clearly loves mil I find it improbable that he will be able to be so firm. In all likelihood the team have been unable to find a solution/suitable care home (or the ICB is exerting pressure to trial a home discharge due to cost). They are pushing for this because of lack of alternatives. They will exert pressure on Fil and he will likely (through obligation and guilt) day yes. If you can support him to say no then do. Talk to him prior to the meeting and attend as his advocate if possible. Ask for a carers assessment and press to assess him for carer burn out. Prep him for the pressure and help him to advocate for the best solution for mil by saying no. If he wants the best for her he really does need to stay firm.

Perhaps your husband attends the meeting alone and says his father is unwell and can't attend? Also FIL coming to stay with you for a while sounds like a good idea.
At this rate your FIL could very well die before his wife with all this stress on top of his own deteriorating health. It happened to a friend, his wife then ended up in a care home after he was found dead in bed one morning.

We've a similar situation, op, and it really isn’t sustainable any more. No idea what’s going to happen. It’s like a horror show for us xxx

He has to keep saying that he refuses to have her back, because it would be unsafe. They will not discharge her if he refuses, but they'll try to bully him into submission so be on the call.

This is hard to say but your Fil needs to refuse to have her back. Social services will have to sort it out .
it’s a hard this to do for him to say that but he has to stay strong .

What section is she held under? Is she entitled to s117 aftercare?

You must all firmly insist that you refuse to accept MIL living in your homes and that you refuse to accept any caring responsibilities for her, when you attend the meeting.

They will try to bully you all and guilt trip you, but no one can legally force you to accept responsibility for another adult. Keep saying no.

They will also threaten that MIL will be discharged to the streets. This is a bluff. The hospital is legally responsible to ensure she is discharged to safe and appropriate care. You are not responsible.

Her care needs have been assessed and the hospital setting has been specified as being necessary to meet these needs. Insist they honour this. Keep reminding them of their legal obligation to ensure safe discharge and that they are legally liable if she comes to any harm due to their failure to meet their obligations.

Tell them if they try to send her to your home in an ambulance you will not let her in the front door. No, they will not leave her on the street. They would have to take her back to the hospital. But they would not try to do this. They are bluffing and trying to bully you.

it will be unpleasant but stick to your guns. It is necessary to ensure the health of everyone is protected. None of her family can provide safe care, and trying to would endanger your own health. And your MIL really needs permanent hospital care.

I went through this with my DF. Advanced Parkinsons with dementia. Couldn’t even sit up unaided and they wanted to discharge him to the care of my 80 year old DM crippled with arthritis. We stayed firm and they found him a lovely nursing home with 24 hour nursing care where he was secure and happy until the end.

I know it’s horrible and much sympathy to you. Thinking of you 💐

I'm really sorry for everyone concerned. We've been in a very similar position with an older family member. In the end, I'm ashamed to say, we had to deceive them that the move to residential care was the first part of a staged return home. The care home had a beneficial impact and they stayed there long term. What was sad was that days out and visits home were impossible for a significant period because they would have refused to go back. All extremely distressing for everyone because the person was much loved and missed. It was just not possible or sustainable for them to have their wish fulfilled. I hope things work out the best they can for your in-laws too.

Ask them why they think that FIL and carers popping in will be able to keep her concordant with her medication regime when trained and qualified nurses and doctors are struggling to do so in hospital. I don't think your FIL can refuse to allow her to come home as such but he can say that he is unable and also unwilling to provide at home care. You or your husband will need to be explicitly clear in that he physically cannot provide care as it will be in severe detriment to his own health.

I would agree with a previous poster that it might be wise if FiL didn’t attend the meeting, and your DH going instead to represent him. With you recording on teams at home.. your DH needs to keep repeating very firmly that FiL cannot cope mentally or physically and MiL cannot come home. That FiL is frail and you are currently having to care for him. That it is not possible for MiL to return home ever and long term permanent care needs to be provided. He will be guilt tripped because the hospital want the bed….but he needs to stand firm. Use words like unsafe discharge. Point out risk of falls etc. Bottom line, she can’t return home as no one to look after her. It will be tough. But you’ve got to think of FiL as well as MiL.

She can choose to live independently alone if she chooses if she has capacity. FIL cannot be forced to have her in his home though.

Hi, I have some comments to make.I speak as a mental health social worker, previously responsible for detaining people under The Mental Health Act and also discharging them.
Your MIL sounds like she has a chronic MH problem which is not. easily treated and she is not compliant with medication. Your FIL is also at risk. Discharging back to home sounds to me, from the information given, a very bad idea. The finance issue is not as you suggest - she should be eligible for S 117 funding for aftercare, funding from both NHS and Local authority.
Sounds like the family are in agreement that she shouldn't return home. There may be a problem in finding a suitable care home, but that doesn't make her home or your home appropriate. Sounds like she's a potential risk to FIL and he has rights too. She can be placed in a care home against her wishes, with a Deprivation of Liberty order (Dols). You could do with legal advice - Age Concern and MIND can advise on suitable solicitors in your area. It's worth spending some money on this, if you can . I know my message sounds hard, but I'm speaking also from personal experience of a Mother with mental health problems, the effects can last a long time. Best wishes.

Yes FIL can most definitely refuse to have MIL in his home. No one can be forced to care for another adult.

Either your DH is there in person or FIL doesn't attend the meeting. Being on a Zoom call when everyone else is in the room will not give your DH the same power as actually being there.

Totally agree with others about capacity - although from what you have said sounds like they have made that judgement already as they have listened to your MIL's wishes to go home. IME the bar for capacity is set very low - if the person can express an opinion they are deemed to have capacity. Yes I know that is not how it was intended to work, but IRL that's how it is interpreted.

If she's under S3 - on no account should she be discharged without a S117 aftercare plan drawn up and ready to roll the second she puts her hand on the front door.

At the end of the day if your MIL has capacity and wishes to return home, there is nothing to stop her. It will be up to your FIL to remove himself as by being there he will appear to be in a caring position. I know its unfair that he should have to remove himself from his home, but if he doesn't it will be very difficult for him to not get drawn into a caring role for your MIL, even if he is becoming frailer.

I know it's hard on hospital staff, but sometimes their focus is purely on 'hospital' and they don't appreciate the 'home'. Many, many years ago I cared for a lady who was over 100. The medics wanted her to go home - she was very frail, incontinent, not mobile. They were insistent her son should care for her. A son who was in his late 70s and himself frail with his own medical problems. They just kept saying her son should look after her, having never met the man. Fortunately the hospital SW sorted out a care home.

Could you move FIL into your home as he can't cope alone ?
A temporary measure but don't tell them that.
They surely would not discharge her to an empty house.

No idea, just bumping it to keep it alive.

Your husband (and ideally you) needs to attend the meeting but your FIL should not, on the basis that he is not well enough. It then needs to be made clear that MIL would be returning to an empty home because your FIL is moving to residential care/moving in with family etc. due to his own health needs. (Doesn't mean he actually has to do this yet)

You'll still be bullied but it immediately changes the circumstances of the discharge if it's to an empty house instead of there being someone else who, no matter their own condition, will automatically be assumed and expected to take on caring duties.

Her capacity is another key issue and needs to be established if you're not clear on that.

You can and should refuse OP. I have a family member who is under section at the moment, and their family members who live with them have refused to have them come home this time due to increasingly violent episodes and family member refusing to take their medication. They are now waiting for a space to become available at a sheltered housing facility for people with mental health conditions.

Unfortunately in our experience, if you continually accept them being discharged home, it becomes increasingly difficult to get them the correct help as the NHS/social services are too happy to wash their hands of you.

But it is also her home and she has a right to live there if she wants and has capacity.

I suggest you or DH read this:

https://www.ombudsman.org.uk/publications/discharge-mental-health-care-making-it-safe-and-patient-centred

I would also suggest DH goes in person to the discharge meeting. It’s easier to read the non verbal body language; and make points more forcefully imo.

Do not underestimate the lengths to which NHS bed management can go - and I bet they are party to the discharge decision; not just the clinicians. They are likely not be health care professionals and have no professional standards, they must adhere to. While they make the decisions, they have no professional responsibility!

DH should make notes asap of what was said in the meeting.

This.

Refuse refuse refuse.

No I can't care for her.
No it's not safe here.
No she can't come home.
No I don't want to discuss a care package.

Just keep saying no and don't budge. They will promise you the world in terms of care and it definitely will not materialise. They may even give you what they've promised for the first few weeks just to get you on board and then they'll take it all away.

My advice is to push back hard. Make it VERY clear that nobody would be able to meet her medical needs or her physical ones. Advise them that she would be unsafe in her home as a result and refuse to accept responsibility for her care. They will then need to find somewhere asap - interim care, whatever.