How much time? Deciding between care at home or care Home?

[RoxytheRexy]

My mum is in hospital and has been for about a month now. She went in with pneumonia very unwell. We were informed she was palliative and now she has rallied to the point we are thinking about discharge home.

Mum was pretty bad at managing at home before admission to hospital. End stage COPD and cognitive decline/paranoia/anxiety. We had issues with her not opening the door to Meals on Wheels and refusing medication etc.

The hospital say she is fit for discharge. My sister attended a meeting with a Social Worker and an Occupational Therapist where they basically said pick a care home and threw a leaflet at her about paying for care (my mum owns her own home so I would imagine we would be self funding). We feel a little blindsided by all this.

Unfortunately this has come at a really bad time. I’m 4 hours drive away and 38 weeks pregnant. My sister is my childcare for my 3 year old when I go into hospital to have an Elective Section on Monday.

We are stuck. We can’t look for care homes this weekend like the social worker asked. We were hoping to try care at home as that has been suggested previously. How can we buy a little time to make some decisions properly?

Whilst home care is your preference, don't allow her to be discharged until you have everything in place that you need. Once a patient is discharged to the care of others, SS no longer prioritise them. They focus on those that have nowhere to go and no family/friends to care for them. Your DM would be on a list for equipment, referrals, assistance etc, but she wouldn't be anywhere near the top. Get stubborn and refuse to take her until you have everything in order, and that includes your own childcare and post-natal arrangements.

Thank you everyone. Mum has had several cognitive tests and often does pretty well on them. She knows who the PM is and can answer a lot of the other questions. If you were asking her about her neighbour stealing her bins then you would get very different answers!

Whenever Mum is spoken to about discharge she says she wants to go home and that she loves her house.

Me and my sisters have spoken this weekend and my sister really wants to go for care at home first. So I’ve got my list of questions and equipment. Just need to have a baby first!

Cognitive tests aren't the same as a capacity test. Her longterm memory may be OK (knowing who the prime minister is) but her executive function - ability to make decisions - may be poor. A lot of these tests aren't so good at that and you have to be able to analyse which bit of the test she is getting wrong, not just the absolute number. Also saying she can answer a lot of the other questions isn't v reassuring - they are designed so you should be able to answer all of them.

Capacity depends on being able to understand the information about the decision, retain the information you have been given, weigh up the pros and cons and then communicate your decision.

Just saying 'I love my home' wouldn't be evidence of weighing up pros and cons for example - I'd want to see her saying why she can manage, how it would work when a carer isn't there, how she will have medication and so on. Your list of questions wwill be very important as can your mum acknowledge she needs care is she has previously turned carers away? And all the other questions you have.

Like Anna says a capacity assessment is not the same as cognitive tests, someone like her doctor or nurse should carry out a capacity assessment to determine how much information she retains about her condition and her care needs, does she understand what risks are involved. If she lacks capacity then the hospital will have to hold a best interest meeting to plan her future care. It might be a good idea to ask if the occupational therapists have carried out a washing and dressing assessment and t aken her to the kitchen to make a hot drink and a sandwich. Most people when asked would they like to go home or into a carehome will say home. It's what everyone prefers, your mum should be involved in the decision and going to any meetings.