MIL in hospital - what happens next?

[timeistight]

MIL is currently in hospital. She’s in a bit of a state, but basically sound. We expect her to be in for about a week.

My question is, what happens when she is ready to be discharged? Every medical professional she has seen in the last two days has offered her an assessment for a care package, which she has flatly refused every time. Can I assume that their professional judgement is that she needs one? I certainly think she does.

As well as the condition they admitted her for, which is physical, she really needs a memory assessment, physio and support to get her mobile again and a suspicious area on her face which may be a basal cell carcinoma looking at.

In your experience, are the hospital likely to pick up on these things, or will we have to drive this?

Also, when she is ready to be discharged, will the hospital contact the NOK (DH), or will we have to ask for a meeting with them?

Thanks.

Unfortunately if she has capacity and she refuses a care package then she cannot be forced to have one.

In regards to the memory issue, in my trust an outpatient appointment at the memory clinic is made I'm not sure if all trusts do this.

She will be assessed by physio and ot (occupational therapist) to see what she needs to return home safely ie commode or adaptations and may do a home assessment etc. Physio will assess her mobility and safety on the stairs and may issues her with a frame or other mobility aids.

In regards to the possible skin issue personally I'd ask for a referral to made. The nursing and medical teams may already be aware of this but sometimes it's get assumed that the gp is aware and sorting this out. So you can ask the nursing team to ask the medics for a referral or you can get mum's gp to do the referral.

For the actual discharge it does vary hugely between wards and trusts. I'll use the way my last ward I worked on would work.

Patient is deemed medically fit and has seen ot and physio who also say fit for discharge. Then the nurse would inform the patient that they were planning discharge and check if they needed transport home (not everyone qualifies for transport) and if they ahd their keys etc. Then we ask if they want nok contacted but if your mum is deemed to have capacity it is upto her if she would want us to contact you. So you could get a phone call from either the ward/discharge team or from your mum hopefully giving you a day or two notice.

But then the nurses have to chase the Dr to wrote the discharge letter and discharge medication which then have to be dispensed by pharmacy which can take a while.

If you manage to persuade her to accept a care package or at least be assessed for one you could be waiting a week or so for the care agency to start (depending on availability) some areas have an interim care support team to allow the patient home with support whilst waiting for the agency to start.
Discharges can be done quickly within a day. I've had patients be medically cleared for discharge at breakfast and we have had them home for tea the same day. I have also had patients medically fit on the 1st of the month and still be sat in th hospital on the 18th due to various issues ie transport availability,awaiting care packages etc.

Sorry that was a bit long. Hope it helps a bit.

That’s brilliant. Thanks. Very much appreciated. This is all so new to DH and me.

In my experience, there would be an OT assessment before discharge, but none of the other things would be picked up or thought about even tbh. Physio after discharge unless its directly to do with what they've been admitted for won't happen.

And I don't usually get notified of discharge - I have make sure that I've got it clearly marked in my parents notes that someone needs to let me know whats going on so I can sort their care. But I'll still find things out 4 hours before they intend to discharge rather than with enough notice to organise things

Everything’s changed now as MIL has made it v clear that she wishes to discharge herself to go home and die and she has reinforced this by being so disruptive that the ward called BIL in last night. All her DC very upset. Whilst I respect her right to do this, I am far from convinced that she has the capacity to make this decision and I know she doesn’t have the ability to manage the process and actually get out. She has no shoes, house keys or money for a start off. Of course I cannot find the discharge policy for our local hospital online, but it looks from other trusts as if there might be a capacity assessment as part of the discharge against medical advice process.

MIL was discharged last Friday. She refused an OT assessment, but DH over-ruled her and this was done yesterday. She will now have some grab rails, which may help a bit. She cannot have a walking aid because she has arthritis in her hands and cannot grip.

She's been back in to A&E today, by ambulance, query heart attack, but has now been discharged. In his dealings with the hospital over the last week, DH has been repeatedly asked if she is 'confused', which she definitely is, but there is no mental health assessment as yet.

It seems that the hospital, like GPs now, will not look at the whole picture.