Non mobile Mum being discharged from hospital: what care?

[MiggyInThePiddle]

Can anyone please advise on the various services?

My 88 yo mother is being discharged from hospital after 6 weeks following a broken hip sustained in a fall.

Although the prognosis straight after the op was that she should regain her ability to walk, the physio did not transpire and she is no not able to stand and walk.

The hospital say she is now medically well and they will discharge her - with 4 visits a day from a carer.

She lives with my Dad, 90, who has had a stroke (can walk and talk but wiobbly) and in early stages of vascular dementia. He is not able to care for her.

Her bed can be moved downstairs (she cannot manage stairs) but we do not feel that 4 visits a day will be enough, or safe. She cannot get out of bed without help, my Dad cannot help.

I understand that live-in or overnight care is not provided for dementia (she is in early stage Alzheimer) but we need help a a result of her hip, not her dementia - she was living independently until now.

The hospital say 6 weeks of 3 or 4 visits a day.

Is there a away they could be entitled to more?

They have their house but no savings to speak of.

We cannot sell the house and re-locate them by the time the hispital discharge Mum.

Is there a difference between the support available for medical / health needs as opposed to dementia?

Thank you!

Have you spoken to the OTs and physio’s? And her social worker? You need to ask them not just whether she is medically fit for discharge but whether she is SAFE for discharge. Do they have any step down beds in your area for her to be given time to maybe get back in her feet a little?

For comparisons sake I have a 95yr old relative who has 4 calls a day plus meals on wheels. They are coping just about but live alone so don’t have the added complications that you have with your father also not being fit.

I think you need to be very vocal that you don’t think she is safe and that you want that documented in her notes and that the family won’t cope. Are you getting to the point whereby they should be thinking of full time care?

And they won’t need to sell the house that quickly-social care will at least cover the first 12weeks and will probably ongoing, until they manage to sell the house. You need to speak to the social worker urgently if you are considering this to get the ball rolling, as it can take time to find beds, especially for a couple.

Yes, we are thinking full time care - probably to sell the house and downsize and fund care from that.

But that will take time.

Neither my parents nor us have the £££ to find f/t care in the meantime.

Is it possible to get live in or overnight care from social care? Is it the social worker we should talk to?

They can move into a home whilst waiting to sell the house-the council will probably just put a charge on the house so when it’s sold you pay them back. Another elderly relative is in the same position-in a step down bed awaiting placement. Her local council will fund up to £599.06 a week for a nursing home. If the one she goes to coats more than that then relatives have to just pay the extra not the whole lot. She has 12weeks to stay and make her mind up if it’s the place for her and then if it is she has to sell her house. If not, she can try somewhere else, but she doesn’t have to sell until the 12weeks are up-the council will continue to pay until the house is sold-however long that might be.

Please speak to the social worker attached to the ward and tell them that your mother will not be safe going home, even with carers going in 4x a day and that you are not in agreement for her to go home to an unsafe environment. Tell them that you want a placement for her and your father as they were struggling before this so now it is untenable.

In truth, we don't really want them to go into a home at the moment, and we had been planning to provide live in care for the two of them together in a more manageable downsized home.

Does anyone know if a package of increased care is available instead of costs of residential?

Obviously this would dry up once the house is sold as they then will have cash in the bank.

I say 'sell the house' but they will both have to agree to this - they do both have capacity and Mum is pretty adamant that they do not want to move .
But this is unrealistic, of course.

Truth is you have few options in this situation (I've been a community nurse for 21 years). State will only provide up to 4 calls per day, the rest will need to be self funded. If there is not enough money then there is nothing extra, it falls to relatives I'm afraid. A care home maybe the only round the clock option.

Have she had a continuing health care assessment? If not google it and maybe discuss this with her social worker. There is a massive gap in care provision in the community.

https://www.nhs.uk/conditions/dementia/social-services-and-the-nhs/ hopefully this link works!

If she cannot stand and walk then refuse the discharge. There must be a convalescence hospital in your area where she will be encouraged to walk/redevelop life skills.
We are in London and had similar when FIL broke his hip. He eventually got home 4 weeks after they wanted to discharge him.
Don't let them walk all over you as they will, to free up the bed.
Insist on a multidisciplinary meeting/review.

I doubt they will get more than 4 visits. She might get an extra night visit but not live in. As others say speak to the social worker and delayed discharge team. Ask for an ot to visit their home to see what adsptstionscsn be made. Also ask your dads gp to arrange an assessment for him as they can no longer look after each other safely and are both st risk.

"If she cannot stand and walk then refuse the discharge. There must be a convalescence hospital in your area where she will be encouraged to walk/redevelop life skills."

She is in such a hospital! Has been there for 4 weeks (or more) following 2 weeks in hospital. They do not get physio every day, the length of time spent immobile in bed is detrimental at a rate greater than the physio is supporting improvement. She is getting weaker, not stronger.

You need to ask to speak to the discharge planner and/or social workers at the hospital. Your mum may be giving them the idea that you may be moving in with them. You have to make it clear that it’s not happening.

We have also been negotiating the minefield that is Social Services/elderly care etc. My advice would be to contact the Dementia UK helpline or Age UK. They are full of advice on just these situations. We found that our rights were very different from what we had been led to believe and that the options were greater. Sadly Mum has gone downhill before we could make the necessary arrangements.

Sorry that you are in this situation. 💐

Thank you all so much for your advice.

boredBored I will look into a Continuing Care assessment.

Thanks for the Age Uk and Dementia UK suggestions, Lonely - sorry you are in the same situation.

The strain on families is so great - we are exhausted after 6 weeks of visiting and taking Dad for visits (a long round trip), while juggling work,and it seems like a f/t job doing the research and pressing for assistance!

Why is it you feel 4 visits would not be sufficient? They will provide food, change pads, toileting etc?
I understand that you think full time care is best as we all want what’s best for our family.

Read this:

www.ageuk.org.uk/information-advice/health-wellbeing/health-services/leaving-hospital/

They may manage with 4 calls a day as in all honesty it sounds like they will both need assistance during those calls, so they are likely to be lengthy-my aunt has two people each morning for 45 mins then a second and third visit for 30 mins (again 2 carers as she need two to transfer) and then 45 mins at night to go to bed (plus meals on wheels delivery so someone else checking in) so with two people to see to, it’s going to take longer than that. Then your only worry is over night. You would have to look into privately funding overnight care though.

But talk to the social worker/OTs etc ASAP

Unfortunately, live-in or overnight care would have to be paid for privately.

The fact you have 4 carers a day agreed sounds like she’s had continuing care assessment/funding approved. Overnight care not provided- I say this just waking up in my dad’s house following my ‘shift’. We’re in a similar mess, currently trying to muddle through with diff relatives doing nights and trying to work out how much of his health is recoverable medically and how much is long term deterioration ...good luck

We refused to have MIL back in similar circumstances, so she went to a reablement centre, the plan being that she would regain her confidence e and be able to walk again. Unfortunately, she has been there a week and now has pneumonia, so we have been warned to 'prepare ourselves', but at least we tried.

How is your mum going to the bathroom?

Sorry if stating the obvious, but have you spoken to Adult Social Services?

NaToth - really sorry to hear that. That has been one of our worries.

Rosa: pads, bed pan thingy, sometimes getting to the toilet with care worker and rota trolley thing.

It looks as if we have pushed for everything possible, and it is going to be 4 visits a day (plus 2 for Dad) , and we are looking for private top-up. We will have to borrow against the house in the longer term.

We are hoping that if the physios don't refer for community physio visits the GP will refer for physio.

Rosa: yes we have been speaking to Adult Care.

Thank you everyone for your input.