How bad does a house need to be to be unsuitable?

[zogandtheflyingdoctors]

My mother is currently in hospital after pneumonia, and was previously quite independent and mobile. However, her house is awful - she's gradually withdrawn into using just one downstairs room, the roof leaks, and there's only one working tap and no shower/bath etc any more.

Hospital are talking about discharging her, but as there are steps between her bedroom and bathroom, and she currently can't walk to the bathroom in the hospital without assistance, I can't see how she will manage at home. I don't think it's fit for habitation anyway, but I don't know what other options there are - I don't have a spare room for her to move into and couldn't provide the level of care she currently needs anyway.

Where do I start? What options are there? Can the hospital just discharge her and leave it to us to pick up the pieces?

Is there a discharge coordinator? Has there been any planning meetings so they know about the house condition?

Raise a Safeguarding concern with social services (google for number) and also ask for an occupational health assessment at hospital. Does she own the house? Be prepared for this to be the start of a fairly major phase of upheaval - how did her home get to be this way?

The discharge team will speak to her and you, plus social services will assess for funding. If she has capacity she can't be kept in hospital against her will though so it better to work it out ASAP

you need to get Adult Social Services involved - they will look at handrails, commodes, etc.

also, tell the hospital discharge people ASAP that her home is not fit for her in her current state of mobility and be ready to refuse discharge if need be. Keep a close watch on what they do at the hospital - my late father was the subject of a surprise discharge because the physio did stairs with him when mum and I weren't around, and he wasn't in a well enough state mentally to tell us that this had been done!

re the shower and bath not working - would it be easy to get them sorted, do you know? How old is your mum, does she have capacity? Has she said anything about what she would like to happen next?

Thanks all. She does own the house, so I realise this makes alternative provision more complicated. She is 82.

We haven't spoken to a discharge coordinator yet - only heard about one today, and planning to phone tomorrow but want to have my ducks in a row first so we don't get pushed into anything that can't work. She has capacity, but also is capable of very deep levels of denial plus "don't want to be a burden"ism.

If she was able to walk and take care of her own toileting etc, she could come and stay with me temporarily but I have a young child and a two bed house (with no downstairs toilet!) so she has to be fit enough to get up stairs. As she has difficulty standing up long enough to move to a chair that's not realistic yet. She really just needs somewhere less intensive where she can recover enough in the short term, but long term I don't know what to do. Ideal would be sheltered accom near one of her children, but we're all outside her local authority. And I don't know yet how she'd feel about that - I broached the idea and she didn't object but not sure how she'd feel when it came down to it.

I'm also afraid to suggest temporary solutions in case we get stuck with something unworkable/unsustainable like her sleeping on our sofa forever with a commode under the dining room table!

I'd ring Adult Social Services before any other steps

I think they give you a case number and you will be able to give that to the hospital and say she's "in the system" so to speak.

It doesn't sound like it's feasible for her to move in with you even temporarily. can you look at homes that provide respite (temporary) care?

Speak to discharge team, they may be able to offer her a bed for 6 weeks in the community. If she wants to be at home eventually ask for an o.t. environment visit. Maybe the downstairs could be turned into a bedroom, she would need a commode and other bits of furniture but o.t. can arrange this. You can look at getting improvement Grant's for the roof, heating, bathroom and toilet. It's on the gov.uk site and also age UK have info. Could she sell up and move into assisted living near you. Ask for a care needs assessment from the hospital and maybe a financial assessment.

My health authority has a special unit for elderly people who don't medically need to be in hospital but aren't fit / able to be discharged to their own home. It may buy you a couple of weeks at least.
That said, an elderly man in my road was recently discharged from hospital back home into a similar sounding situation - a house in total and utter disrepair. He refused all care packages or help from neighbours. At least your mum has you to look out for her.

Do they offer respite or convalescence care? A friend's mum who lived on her own went into convalescence home for several weeks after her operation, until she could manage stairs etc.

Meanwhile you could get Social Services in to put in safety rails and advise on a dsiability bathroom.

Don't offer to have her to stay with you temporarily as this will become a permanent solution. You're quite right in your worries about that!

Discharge team's focus is on making a hospital bed available, but they will pay attention if you state very clearly tat the house is not suitable. You could also try expressing your concern that discharging will result in an early re-admittance to hospital. Make it also clear that you cannot provide support.

In my experience, SS/discharge team are quite content to contemplate someone living in a single room with a commode. And they're used to older people not using a shower or bath, so the absence of those won't worry them. But they will worry about fall hazards, including steps, electrical safety etc.

However, as others have said, if she has capacity, her own wishes will take priority.

You might ask about the desirability of someone recovering from pneumonia to return to a house with damp and mould as a result of a leaking roof and general disrepair.

Thanks all - useful to know that no shower isn't considered as big a problem as the steps, clutter etc.

Called social services today who say they won't do a home assessment until she is at home. Basically - right now, it's all the hospital's responsibility to deal, and liaise with them if necessary. Waiting to hear back from discharge team at the moment.

She's in S Wales btw so some of the rules are a bit different according to this: www.bbc.co.uk/news/health-30902552 Still trying to work it out.

Also trying to work out how we make the house fit for her if it can't be assessed until she's in it! Get her to be carried out of ambulance to front door, phone council then carry her back? Doesn't make sense.

Ironically if they allow her a bit of extra care/help with fixing roof etc now, she may well recover to previous levels of mobility & independence (or close enough to it).

Can a bed be put into the lounge, when she gets home the crew will take her in, put her to bed, I would say to the OT and discharge team that she does not have access to a toilet and shower so will need a commode, a riser chair if one fits in, a bed, walking aids before she goes home. She might also benefit from carers coming, you need to stress that she is unable to care for herself so needs help, this is why she needs a care needs assessment before she goes home, otherwise she'll just end up back in again. Age UK used to keep lists of trusted workmen, could you get the taps fixed in the kitchen, that way the carers could help her have a wash. Does her insurance cover roof damage.

I haven't called Age UK yet but useful to know they have trusted workmen! That was one big worry - apart from a friend who can no longer help, she's had very bad experiences with cowboys locally so was dreading that bit.

She already had a bed in the lounge. Prob is, the entrance is so cramped that she would literally not be able to get a walker down the hall to get out. So in case of fire, emergency etc she'd be trapped in bed. Given a bit of time, we can arrange to book vans etc and clear stuff out but not if they're trying to get her out right away.

Discharge was quite unspecific. Said she could go to respite but it is a paid for option. I get the impression that getting her off their hands asap is the main goal for them. Perhaps unfair but...

www.ageuk.org.uk/information-advice/care/housing-options/adapting-home/finding-tradesperson/
www.ageuk.org.uk/globalassets/age-cymru/documents/information-guides-and-factsheets/fs6w.pdf

so rules might be different but there is no sense in saying they can only assess when she is at home.

I did get told they would only assess when they got word from the hospital that hospital wanted to discharge dad...could that be what they mean?

hopefully Dint will pop back on as I'm fairly sure she had social services in before her dad was discharged. But essentially I'd tell the hospital discharge team there are safeguarding issues and see if they will hang fire.

is this continuing care a possibility?

www.wales.nhs.uk/continuingnhshealthcare

"so rules might be different but there is no sense in saying they can only assess when she is at home.

I did get told they would only assess when they got word from the hospital that hospital wanted to discharge dad...could that be what they mean?"

I did ask, and she asked her manager and then repeated that they would assess when back at home. She seemed to think it was up to the hospital to do all the running for organising the package. I asked a couple of times "so you might see the house, but only in response to the hospital requesting it?" but that appeared to be something she felt she could not say. It all seems like a big game of "pass the oldie around and if they don't die on you last one holding them when the music stops gets to pay".

Right now it all seems to be on hold as my mother's health has deteriorated again - possibly another fucking secondary infection.

Discussing with siblings whether we blow our meagre savings on getting her out of there to some form of convalescent care or private hospital as soon as she has a "good patch" or whether this will leave us stuck with the hospital refusing to readmit and private hospital unwilling to care for a more seriously ill patient? Can this happen? Plus we could probably only put together 10k between us and that leaves us with no money for house repairs. But it still might be worth it if the choice is leaving her to decay slowly in hospital with each new infection robbing her of a bit more lung capacity and leg muscle.

oh dear, poor mum, hope she gets over this infection soon. Do you have respite care where you are, it's up to 6 weeks funded by the NHS in a community bed, sometimes a community hospital, rehab unit or some hospitals have purchased care home beds. There is also a reablement scheme that allows people to recoup at home with care, you'd have to look at what is available in Wales. Isn't there a cap on care costs in Wales? Hospitals dont refuse to readmit patients if they are unwell. Why are you having to pay for the repairs? how much would need doing, can she afford to pay for any of this herself or apply for grants. If she owns her own home then she could have a financial assessment to see what she would qualify for and how much help she could get. If you feel her house is unsuitable as it is and she will be at risk then tell them she cannot go home until care or some repairs have been done. Does she have mental capacity to make her own decisions around her medical care and where she lives, does anyone have power of attorney? You can't just take someone out of hospital especially when they are unwell and need treatment.

She has and hasn't got capacity: in that when she's very ill she hasn't a clue what's going on and rambles incoherently, but when properly well, she's quite coherent and sharp. I noticed some staff treating her as if she has dementia or diminished mental capacity: no, she's ill. And old.

The discharge guy told me that respite care exists but we'd need to pay, but wouldn't give me any more details about it. He seemed to want to encourage us (her children) to take her home, but none of us could provide anywhere accessible in her current state of health.

I think I need to go back to the council and demand a bit more info on potential help with repairs etc because the council seem to be unwilling to offer information unless repeatedly asked very very specifically. It just seems like really hard work dragging stuff out of people. And horribly time consuming when I have plenty of other stuff we need to do and just want an open, non-cagy conversation about my mother's needs.

I work in adult social care although in England. As your mum owns her home repairs would be her responsibility, additions to make it safe such as rails, etc would be the responsibility of the local authority, but likely provisoned via the hospital team, along with equipment like commodes.
I’d have thought the hospital will have social workers attached to it to assist with discharge planning ie care package.

The hospital OT can do an access visit and advise on what will be needed to make the home safe. If the home is not deemed as suitable with aids and adaptations, then respite may have to be considered and if she has over the threshold in capitol then she would self fund.

The social care lady you spoke to was right in that social care community services won’t necessarily be involved until she was at home as the hospital has responsibility to arrange a safe discharge. They would then pick the case up once she returned home or went to respite.

Hope this helps. They can’t discharge her if you are all not happy.

It might be worth asking for a capacity assessment when she is well, in my experience staff wont do this when someone is acutely unwell.

imo you need to speak to the hospital occupational therapist.

have you talked to PALS at the hospital, they might have some advice.

not an expert by any stretch but have heard in the past that private hospitals sometimes don't like to take these cases and also heard that NHS can be better with infection treatment anyway.