AIBU to think hospital discharge is unsafe for my elderly parents?

[Biggles27]

Mum (83, mild cognitive impairment diagnosis - we believe it’s dementia as she was last test 2 years ago, on waiting list) is in hospital with pneumonia

she’s very weak, eg they’re washing her daily, she can’t shower. If she holds on she can get to the loo

dads on 2 sticks and a wheelchair. He can get upstairs but takes him approx 15 mins, down even longer. History of falls resulting in significant injury. Mum falls too

Mum wets herself then tries to climb the stairs with wet pants and trousers around her ankles and falls - Dad can’t get her up

both are bad at taking prescription drugs

dad isn’t properly on top of her nutrition (Fortisip) -neither were the hospital till today when I insisted she’d die unless they sorted this out - her bmi is below 18 and they left her without any nutrician for 72 hours - I only found out yesterday - I was taking the Fortisip in - turns out they were serving her real food - which she wasn’t eating - no one was checking. Normally you have to leave for meal times but the weekend nurse didn’t throw me out yesterday and the catering lady said oh she never eats her food. I then found all the unused Fortisip

Anyway they’re sending her home tomorrow - she was still on oxygen this morning.

I’ve explained it’s unsafe but they are insisting she’s fit to go home. She sounds plausible but she’s telling absolute lies - she’s believes she’s telling the truth so it’s not lies as such but it’s not the truth

im terrified as it’s unsafe and they are saying it’s not. I’ve said we need carers before she can come home, they’ve said she can cope. I can’t get them to rethink

im not even free to bring her home till 7pm tomorrow - will they just chuck her out? She has no idea where she is or how to get home

Any ideas? I’m beyond desperate

Here’s what ChatGPT says

Be clear with them, there is no one at home to look after her, you won't be transporting her home.

They need to meet with SS (i think) and discuss her care needs and how they can be met - tell them you won't be doing anything, you can't - because if you tell them anything other than that, they will decide you're providing all the care, and send her home.

What to Do If an Unsafe Discharge Occurs
Raise Concerns: Report concerns to hospital staff, the Patient Advice and Liaison Service (PALS), or the ward manager immediately.
File a Complaint: Initiate a formal complaint through the NHS complaints procedure if the safety risk is not immediately addressed.
Safeguarding Referral: Under the Care Act 2014, if the discharge puts a vulnerable adult at risk, agencies have a duty to raise a safeguarding concern.
Contact Social Services: Contact the local authority social services for an urgent care assessment.
Legal and Safety Implications
Unsafe discharges violate guidelines regarding patient dignity, mental capacity assessments, and proper care handover. They are considered a form of neglect and can trigger investigations by the ombudsman.

So does she medically need to be in hospital? Sounds like she needs care in general. Have you looked into private carers or asked your local authority to do a care needs assessment if she might qualify for funding?

I was unaware the mess they are in - I’ve only just found out (ie this week). I took her into hospital last week as Dad called me as Mum had collapsed on the stairs, with underwear and trousers around her ankles and he couldn’t help her. I thought they were coping till I’ve had full access this last week. It’s obvious they’re not

A&E told me she wouldn’t be discharged until an assessment inc social workers had happened. I was quite relaxed. Found out this evening that the plan is to discharge tomorrow! Blindsided me. Apparently as she has capacity she can be discharged!

As a nurse and a DIL of a lady with Dementia,my advice is not too be ‘persuaded ‘that she is safe. Stick to your guns and insist that she has OT intervention,physio referral and say you are not prepared to take responsibility until you are satisfied that she is safe!

She needs an OT assessment. Insist that happens before she is sent home. Make sure you speak to the OT to provide accurate information about her/their home circumstances if you think she won't or can't reliably provide this. It's possible that she may be able to go home if the right support is put in place. An OT assessment will help decide what that might be. The OT can also help get other agencies involved eg social worker

The problem is that if she is ready to be discharged from a health perspective, staying in hospital makes her a bed blocker and prevents someone else with a potential urgent need to be admitted. It's also not fair on the person who has been waiting 24h plus on a stretcher in A&E for a bed to continue to wait.

You need to get in touch with SS immediately and arrange a care package with them. Is there absolutely no way you can get there earlier to help your mum settle?

When my parents were in a similar situation, Mum wasn't sent home till a care package was in place - she had six weeks of four visits a day from carers while it was established how much help they needed. It sounds like you need something like this - stick to your guns and insist you need social services input.

There should be a hospital based social worker I think. Insist they come , and OT. If they try and discharge without that ask for it to be documented that you have told them you feel the discharge is unsafe. Note staff names down.

She can be medically fit for discharge which it sounds like she is but not socially fit for discharge if that makes sense. All the above advice from people is spot on. I had the same with my dad he was medically cleared for discharge and I panicked but spoke to the OT and physio team and they said no way. You have to make sure the two sides of the hospital are talking to each other which they often are not! PALs is a great resource and also your parents GP

Thank you. I’ll pull on my big girl pants and dig my heels in. If she wasn’t so weak and still need a lot of looking after - I’d deal with her needs at home - of course I would. The last place we want her is in hospital!

I had this with my mum on several occasions. I agree with other posters. They will try to force you into taking responsibility for her needs and for a lot of people with work and their own families this is not realistic or sustainable.
Make a big deal of writing the staff members names down that are trying to push this through and when they ask why, say " so that I have a list of accountable people when I put in a complaint to CQC of you not assessing my mother for discharge properly " Say that you want an OT assessment for managing basics like stairs and everyday personal care and an assessment visit to the house to check it's suitability. You also need to get social services involved. If you are lucky, you will get an allocated social worker who will be on your side and knows the right language and trigger phrases to use to get the help you might need.
If it's done properly, your mum needn't become a " bed blocker". In my mum's case, on one occasion discharge resulted in a hospital bed downstairs in her house and daily carers visits for 6 weeks. On another occasion she had 2 weeks in a care home whilst other adaptations were made to her house.
The social worker was brilliant, realising that my dad was not capable of helping with care and that he had needs too although he had not previously been on SS radar and had masked his issues well. The social worker got some extra adaptations done to the home as a result of this and some extra medical help for my dad too. Keep strong, don't let yourself be bullied!

Useful info from Age Concern

www.ageuk.org.uk/information-advice/care/arranging-care/homecare/support-after-hospital-discharge/

My mother has been in hospital twice recently. Both times there has been a full discharge process where physio/OT, SALT and the medical teams have to sign off as fit and agree a care package. In many places in England, there is a 6-week reablement service available for free. I did not agree that my Mum was fit for discharge the first time and practically had a row with the physio who insisted she was fine but they did go through the process. I can’t believe the same process isn’t in place everywhere.

They discharged her first thing this morning. Left her on a chair to phone us after it had happened (around 9am). I was chasing social services at the time. I’d explained we couldn’t pick her up till 6ish. They said you need to get here - I can’t - you have to make arrangements

I’m currently in a medical waiting room which is the only reason I can reply. She was so distressed we managed to find a friend who was able to go get her at 2 as Dad refused to let me fight on. She’s on her own in the house right now as it’s Dads medical appt we’re at - he can’t drive so I’ve had to bring him. Live rurally where we’re not served by taxis and one bus an hour then two changes and he’s in a wheelchair so in no universe can he get there himself

im broken

Report all your concerns to PALs re: unsafe discharge. How awful. Can they afford care?

They can afford a bit of care ie an hour a day but that’s it. We’re not in a position to pay. Got someone coming in tomorrow to assess care needs privately- going to see if social services can help but today I’m done

mum on sofa sobbing her heart out as she feels so ill. Coughing her guts up. Looks like death warmed up and left to cool

she has capacity or your father has capacity and is saying he can cope and is wanting to go home the hospital isn’t in a position to keep her in. It sounds like they need to move into a nursing home, acute hospitals are not for care purposes, if she’s fit for discharge you can find an emergency placement. I know it’s really hard but they will not keep her in hospital longer than necessary. Do you your parents have carers? That’s usually the first step

Do both your parents claim attendance allowance individually ?

It is not means tested

Money can be spent on anything to make their lives easier eg carers, cleaner, transport, health aids

https://www.gov.uk/attendance-allowance

This 100%

This is terrible.
It's only a small part of this awful problem, but could you get a downstairs loo installed in her home and get your dad to keep showing her where it is?

As well as other useful places mentioned here you will find lots of support and suggestions on the alzheimers society forums Dementia Support Forum. There's also a helpline you can ring. Your mum doesn't need a formal diagnosis for this.

Unfortunately what is happening with your family is all too common.

This is so much like what happened with my df in January, he was taken in with an exacerbation of his heart failure, they kept in for six days then discharged him against our advice(we're all health care professionals) as we felt he was not well enough. A week to the today we had to call an ambulance as my stepsister found him semi-conscious and with very low O2 at home.
This time they kept him in for almost six weeks, thoroughly assessed his medical condition and organised ot and social worker involvement, thankfully with adjustments in his medication and a carer going in to help with cleaning and shopping he's better than he's been in 6 months or more