MIL coming out of hospital - what do we do ?

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MIL(80) lives 40 miles away in a town "cottage" - lots of levels with a step or 2 between, steep stairs, downstairs toilet, bath etc. It has been adapted for "slight" mobility issues - handrails etc, but that is it. She now has severe spinal pain and has been in hospital for a week. It is getting close to when they will send her home with very strong painkillers as they can find nothing wrong.

We - and DH brother live in multilevel houses without a livingroom/bathroom/bedroom on the same floor - and no way of making it so.

What the heck can we do - she has to use a zimmer now, (which she is learning to use badly with lots of stumbles) she cannot lift her feet at all. We are flummoxed, worried and completely stumped.

It is the immediate situation that worries the heck out of all of us - long term, yes, she can sell the house, move into sheltered accommodation with carers etc - but what happens , what do we do if she has to go home tomorrow?

Can someone go and stay with her for a short time?

Ask the hospital this question. There should be a social worker attached.

I would try to ensure that she is not discharged until she is able to cope and her needs have been assessed. Elderly DF was discharged after an operation and DM had to call an ambulance several hours later as he had sat on the loo, was unable to get off safely and ended up on the floor

She should have an occupational therapy assessment before discharge. However be aware that they may well say to move the bed downstairs and use a commode if she can't get to the loo. Unfortunately bathing (as opposed to strip washing) isn't seen as essential.

A social worker will assess for carers to come in to support her as well. They will make a lot of assumptions about what family will do do make sure you are very clear on what you can and can't do.

In the long term you may have to look at re- housing as you said or occupational therapists at social services could look at adapting her house e.g. a stair lift.

Thank you all... I think it all just seems so impossible. Hopefully we will be able to make sure she does not get discharged without something in place. That worries me most I guess - that she will say she is fine, her boys will take care of her and get herself sent home when there is no-one about to help or to say "don't be daft".

We all work, so it is hard to get the time off again to spend days there when she gets out. It is mainly just the general day-to-day getting about thing that will be impossible - she can't lift her feet, so the step from the living room to the kitchen, and the kitchen to the loo/bathroom will be impossible.

She is still capable of cooking, of seeing to her self - just so limited in mobility in a home that is not fit for that at all that we are seeing nothing but problems stretching out into the future.

We are also in the middle of GCSE exam season for the kids, DH away with work one week out of 2. DH brother (divorced) working shifts in a new job, I don't drive (medical/eyesight reasons), she obviously can't drive any more - and she is 40 miles away. (God, it all sounds pathetic - she is in pain and her life is having to change so much...)

Feels a bit like an "it's all hopeless - pity party" at the moment because nobody seems to want to address the fact that something needs doing and nobody wants to face up to it.

It does sound really difficult. Would she be amenable to finding sheltered accommodation sooner rather than later?

You can refuse to agree to her being discharged and they then have a legal 'duty of care' to ensure things are set up at home to suit her needs, or else alternative accommodation is found - sheltered accommodation etc.

I had to do this with my mum - slightly different circumstances as she had dementia - but they wanted to send her home and my brother and I refused. She stayed in hospital until we found a suitable care home for her - which took quite a while. The council then paid her care home fees until we sold her house, and then paid the council back.

I would meet with the ward staff ASAP and make sure they know a or the layout of the house and that family will not be around despite what she may say. Tell them it will be an unsafe discharge if she goes home without any support. She would be at very high risk of falls.

You could ask if they have any rehab type beds where a physio could look at improving her mobility to manage the steps.

As I said though be prepared that what is acceptable for a safe discharge may not be the ideal. You could move the kettle and microwave etc into the living room so she can be a bit more independent.

In the long term look at adaptations to her house or to her moving - maybe to be closer to you?

You need to get the hospital social worker to do a referral to the community occupational therapist. And then you can touch base with them yourself and suggest showing her the house prior to your MILs discharge. And let her make suggestions based on her viewing. That way the onus is on her to decide what is appropriate safety measures.

If she literally can't walk at all or lift her feet she will need to be discharged with carers coming in 3-4 times a day. Can you speak to her Occupational Therapists at the hospital and find out if they have assessed her?

You may also have to look into getting ramps covering the internal steps. Not pretty, but useful. Dog ramps are widely sold and easy to get, but they need to be wide enough for a person as some are too narrow.

I agree that one of her sons needs to go to the ward and talk to her named nurse about her home and emphasise that none of you are in a position to care for her and that her house is unsafe due to the multiple steps and her inability to pick her feet up. Repeat that you are all concerned that she will be at high risk of fall if discharged as she is.
Then when they start talking about discharge, they need to phone the social worker (she'll have been assigned one) and repeat, especially concentrating on the aspect of her safety.

Options will be a short stay in a rehab unit or community hospital, a short stay in a care home while they assess what she needs - or she refuses these and insists on going home...

Insist that your MIL has an occupational health assessment before she goes home. Say that you have her house keys (and take them from her if she still has them) so that she won't be able to go home without your consent. Start looking into sheltered housing etc at once, and drag your heels over everything until you are sure that MIL will be safe in her own home. Say 'duty of care' a lot while demanding these things.

thank you all - I'm going in to visit with DH today and have made some notes just in case!

As we/everyone have realised we ARE concerned about the high risk of falling and it being unsafe to discharge her, just need to go armed with flameproof drawers I think - DH tends to cave and go along with authority not thinking about the consequences til after they cause problems all round. Better I think, to have things in place NOW, not "go with the flow and sort it later" - which is his (and his brother's) default position.

On my long journey with my parents, the one thing I know is that once they are discharged from hospital, it is much, much, much harder to get any help. Its also much easier to tell a stubborn/proud/scared elderly person who just wants to go home and pretend they can cope that they must accept the help on offer when they are in hospital. I'll now happily put the blame for unpopular things on anyone in authority too, even if that might be a slight exaggeration

Speak to Social Services (don't freak out at this suggestion) about a care package. My late Mum was very proud and rather middle class in a notoriously dysfunctional seaside town. I would have thought social services would have been too busy and too quick to fob us off on our own devices. I was so wrong. They were lovely. So helpful and couldn't have been kinder.

Can you/she afford a stair lift? It helped my Mum so much. Helped her reassert a bit of independence. Gave her back control of her home.

Hospitals are very good at ensuring people are discharged with proper support in place. My blind 94 year old mother was sent home after a fractured hip to her own home where she lives alone but after full assessments, equipment and initially carers. The careers have finished now and she is back to independence albeit with a rollator for when she walks to corner shop.

Can your MIL not go in to respite care until her house has been adapted or sheltered accommodation has been arranged. The hospital can with a referral to ss assist with this. You shouldn't keep your MIL in hospital just because it's gcse time or any other time because if she is medically fit she is suitable to be discharged. I work for the NHS and the amount of medical beds being used for social problems is bad.
Sorry I'm just seeing it from a hospital POV.
You need to speak to social services asap and as a pp stated occupational therapy and if needs be look at a residential home for respite until you are happy . She may be able to get funding for this.
Gov.uk site has information on grants you can apply for to adapt the home.

My Mum went to respite care before going home. It took a bit of sorting out. My top piece of advice is make a note of every phone call and every promise. Don't expect people to call you back even if they say they will. Be polite at all times but determined.
This may be tough for your OH because it is his Mum (or not). You might need to be the one making the calls in that case (or not). Keep your MIL as informed as she wants to be. But this wears down even the toughest of cookies so she might be too fed up for a blow by blow account.

Agree with all of the above. As an ex district nurse I have seen so many times people discharged inappropriately because patients have said they can cope/family will help. Usually because they don't want to pay.
Please be upfront with both the social worker and your MIL about what you are or are not prepared to do. Bear in mind mobility is likely to deteriorate over time too, not improve. Some sort of half way house rehabilitation unit may be best until you can gauge what level she's at.
As an ageing population I really feel we have a duty to prepare for our old age which includes ensuring suitable living accommodation.
Good luck.

Thank you all. Went to visit yesterday and because it was the weekend, nothing has yet been decided about where to go from here on her discharge. Not had a diagnosis yet on the cause and still not got the right "cocktail" of painkillers yet so is in considerable pain alongside a lack of mobility, so may be a little time before the decisions need making.

SHE, however has realised that something has to change, that her house is totally unfit for her future, so has asked us to get it valued so she has an idea of what funds are available for her care. This is such a big step from "I never want to leave my house" that it has surprised us, but it has also indicated the extent of her pain - and the fact that she may be amenable to some form of sheltered accommodation/care facility as a step to get her out of hospital. We were ear-wigging on other patients yesterday - some are being sent to a community hospital facility as their first step, she seemed quite keen on that so hopefully there will be a few options.

So glad your MIL is thinking proactively. This makes SUCH a difference. Good luck to all of you.