Hospital pushing for discharge following bleed on brain

[notaflyingmonkey]

DM is nearly 90 and has been in hospital for 6 weeks following a bleed on her brain. She lives alone. Hospital is pushing hard to discharge her - as they see that being about to walk a few metres with a frame and one person supporting means she is good to go home. We have a meeting this afternoon to discuss it. I am resistent to the suggestion, as I really don't see how that can work, and am aware that there is an expectation (from her and in general) that the slack will fall to me to pick up.

Any tips on how to manage the meeting?

You need to know exactly what social care package will be in place in time for her discharge. There will need to be an OT assessment of her home, the risks, and what her capabilities will be in terms of self care / cooking etc..
Make it clear no discharge is happening until all that is sorted. Or are they pushing for a nursing home?

thanks for responding so quickly @missyB1. They are talking about her going back to her home. OT have been this morning ahead of the meeting and done an assessment at home. She suggested mum could get (initially), four carers a day. Which in my mind allows for 1- getting out of bed, and 4 - getting back into bed. And two in between.

In this day and age it sounds reasonable to discharge her at this time, bearing in kind that she is a sitting duck for a life threatening pneumonia and other complications that arise from extended hospital stay. That isnt the problem.

The problem is the arrangements, it sounds like your dm is telling them "my daughter will.." you need to be straight with her and the hospital over what you are not able to do.

If you feel she needs a full care package to survive at home you have to tell her that. Also enquire if she is suitable for a rehab programme either at home or in an intermediate care bed. Be prepared she may not be.

Finally, some people have to go home and fail to realise how much help they actually need which is no comfort to you but it happens time and again. (If only they would see reason at the beginning..) good luck.

Does your DM have capacity? Does she want to go home?

thanks for the responses. DM also has dementia, but since the bleed she is definitely 'altered' mentally, and I don't think has any concept of what being at home will be like for herself. She has become quite childish, and expects to be looked after without effort on her part eg she is now incontinent and reliant on others to change her pads (this is not how she was previously).

I keep saying, and will start the meeting by saying, the answer is not me. I cannot factor into the equation of short, medium or long term care (I work full time, have kids, etc).

If she lacks capacity then a best interests meeting will help. Be clear that you cannot provide care (be wary of agreeing to do interim visits and personal care).

I agree with Florrie that discharge now is appropriate, its where to that's important. Hospital is a dreadful place for frail elderly patients, not just for hospital aquifer infections, but because it is terribly disorientating and confusing for patients with dementia. The constant noise, shift changes, bed changes, other patients, call bells etc are not conducive to recovery of mental faculties.

Would your mother qualify for social care or would she be self funding?

Having had a bleed on the brain I can say for sure that it alters one's abilities and emotions on most levels. Add in the dementia and this does not sound like a good plan. However, what are the options? A home? Four carers a day is, I believe, the max and they'll stay long enough to do the basics but won't be able to stay longer than that.

TBH, unless she could self fund in a nursing home for a bit, then 4 carers a day is as much as you could expect. Being at home as soon as possible is the best thing as it regains self caring skills, encourages mobility and avoids hospital acquired infections.
You have to be absolutely clear with the social workers as to what you can do. IME, they will grump about it, and try and get some guilt in, but stick to a firm line and make sure it is accurately recorded.

thanks for the swift and helpful replies.

so honestly given the extra information - if this were my dm i would be pushing for residential care. I wouldnt be in a position to provide that level of care needed either.

A good residential emi home makes all the difference. The key is finding a good one.

In the meantime you need to state you cannot provide care at home, demand a mental capacity assessment, look into power of attorney for health and ask for social worker assessment, state your concerns about dm at home and higlight if you think there are safety issues, wandering etc.

see what they come up with, ask for a list of residential homes that you can visit, but be aware you wont have long to do this. Ie days. Self funding is anyone with assets over £23500.
If your dm has capacity and refuses residential then go for max care package you csn get, but this may only work out 3 times a day. Once home you might be able to talk dm into a residential home.

Whatever else you do stay firm innwhat you can and cant do!

As CMOT suggests if she has money, there is always the scope to buy your way out of the problem. Some convalescent care to help her back on her feet can make all the difference. And some additional care to re orientate her when she gets home. Perfect use of "rainy day" money.

Does she receive Attendance Allowance. If not she should apply as it helps fund extras that won't be part of a package.