MIL in hospital

[NaToth]

MIL (89 mixed dementia 6 years) has finally been admitted to hospital following a fall at home and a night on the floor (again). She has a UTI, kidney problems and is currently on a trauma ward while they look for an injury they are convinced she has. This is the best thing that could have happened as she has been comprehensively neglected by her DC for the last six years and it has brought me and DH to the brink of divorce at times. I'm still not happy frankly. It's been awful.

Last time she was in hospital, two years ago, they called BIL to collect her and discharged her at 7:00pm on a Friday evening in winter, with no follow up.

The family dynamics are complicated in that DSIL takes the main part of looking after MIL, but is completely out of her depth and will not ask for support. I think she thought she was going to do some shopping, cleaning, washing. Instead she is dealing with someone who is virtually immobile, hallucinating a lot of the time, completely disoriented in place and time and incontinent. MIL was bathed in hospital on admission, her first bath in about ten years.

How should we be handling the hospital to ensure that MIL is properly assessed and not discharged until there is something in place that will properly support her, whether at home or elsewhere? DH is severely dyslexic and rather confrontational and his DB is apparently too emotional to get involved.

Thanks.

You need to speak to the ward manager and ask for a meeting with the social worker to tell them your concerns. They will need to carry out a capacity assessment and a care needs assessment once she is stable. You can raise a cause for concern with the social worker and explain that sil cannot manage any more and mil needs professional assessments and care. Does anyone have power of attorney.

Thanks. Yes, SIL and DH have PoA for finances and health and welfare.

Sounds like it is time to go into care
Ask for social worker to help guide you.

May not be time to go into care, but certainly she needs a care package. It sounds like her general health is poor and that if they can sort UTI and kidney problems both her balance and her cognition may improve.

Hospital should have a discharge team - you need to make yourself known to them. Then you need to make it clear she has no support at home, and start using phrases such that you are concerned that without care in place the will be an early readmission to hospitable.

You may also be offered a "reablement" package, either at home or in a care setting - that's a good idea, and is NHS funded, for up to 6 weeks until either it's not needed or until they assess she needs permanent care.

Make sure she doesn't have her house keys with her and that the hospital know that. Then they can't send her home alone in a taxi.

It's good to put things in writing, certainly PoA and contact details, also a statement of her "normal" state of health, is as she was before any short term decline that led her into hospital - the state of health you would hope they would get her back to.

The comment a pp made about keys is a good one.
Refuse to take your mil home until you have seen someone about a care package. We were told to do this by a community nurse when one of my relatives was in hospital. Unfortunately, it's a case of digging your heels in until they offer you what you are entitled to.

Thanks. This is really helpful. We've been to the hospital today. They now have a copy of the PoA and a big flag from me that it will not be safe to discharge her back to her current living arrangements.

The nursing staff mentioned capacity. That's a tricky one. I'm pretty sure that for all normal purposes she does not have capacity, but a professional may differ.

Ask for a referral to the hospital discharge team. If you get chance and you feel it's appropriate have a frank conversation yourself with whichever social worker is allocated about everything you have written above.

Depending on what is available in your area it may be possible for your MIL to have a period of assessment in a 24 hour care environment to establish exactly what her care needs are.

Why have the siblings so far rejected any formal care? Money?

Probably, ultimately. SIL will want to preserve her inheritance, but equally SIL insists she can manage, when she clearly can't, and MIL has, up to now, rejected any form of help and no-one has challenged her. She has had some paid care, but it has never been enough and it's not even clear whether it has actually been happening as she can't tell us and no record has been kept.

Ask for a referral to the hospital discharge team. You need to do this because they are the ones with the power to arrange care or reablement. But always remember their prime target is to free up a hospital bed. So you have to continue to be firm with them about how much or how little you can help, and what needs to be in place for it to be safe for them to come home.

no record has been kept. Carers should be keeping a record of visits - it's used both for paying them and to assess whether the person needs more or less care. Often it's in the form of a file which is left at the person's house. But even if it's electronic, the care provider should be able to provide you with the information.

Just to clarify - I've found the file now, so the carers have been coming in and have recorded their visits. I'm not sure why DH told me it had disappeared.

DH has now been in touch with the Discharge Team (or vice versa). We're now waiting for a date for a meeting with them.

@MereDintofPandiculation and others. So much thanks for your excellent advice. We didn't get to meet the Discharge Co-ordinator. An assessment was done that just seemed to cover mobility, but we were not involved in it, so I am not sure that the hospital has fulfilled its legal obligations.

DH then got a call to say his DM was ready to go home. He said 'No' and said again that we cannot keep her safe. At present, she requires 24 hour care and supervision and it's taking three people to move her, so you can see the difficulty. The end result is that she will go for re-ablement, but in all honesty, we're now looking for a care home.

Interestingly, when DH said that we wouldn't take her home, there was no opposition, so my guess is that they hoped we would just roll over and take her. How worrying is that?

It would be unusual for reablement to be suitable for someone needing three people to move them.

It's more for people who have a chance of living reasonably independently at home.

Well, to be fair, we can't see how it's going to work, but that's what they've offered ...

Reablement will probably have a clause saying that if at any time it's decided that she will need long term care, then the reablement will be terminated - in other words, the free NHS reablement will be turned into means tested care - the reablement team won't simply abandon her.

It's good news - if the reablement team think she needs a care home or a nursing home they'll help you find one. Though you still have to convince SIL.