Hospital Discharge - how do I insist on help?

[DorsetCamping]

DM (75) is currently in hospital officially with a chest infection (non COVID) but in reality alongside many other problems.
One concurrent condition she does have is severe lymphodema and leg ulcers (diabetes and obesity related). Her feet are also dreadfully cracked and massively painful to walk on. This has been going on for 3 months.
She has been having a (social services) carer come in daily for 30 minutes to strap her legs but that is it. She has been told she needs to keep the weight off of her legs (ie sit down) but needs to get up to prepare meals etc, causing dreadful pain.

The physio has spent 20 mins today to assess mobility and has suggested more grab frames are installed at home but that's it. She also said that because of where DM lives support will be limited

An OT will be seeing her in the morning with a view to discharge. I am petrified they will just let her go home without an adequate plan in place and she will just end up back in hospital. Obviously I can't go the hospital at the moment to discuss a care plan either.

Has anyone else faced a similar situation or has advice on what I should do?

Are you completely banned from the hospital?

Can you ask to speak to the social worker and tell them it’s an unsafe discharge?

Tell them you feel it is a safeguarding issue, keep using that word. Make sure they know you want everything in writing and that you want a named person to sign it. I cannot stress enough how important it is that you get everything in writing.

Ask for a conference call with the discharge team, my hospital has a vulnerable patients team and we were allocated someone from them to help with the discharge, also has he been referred to social services. Before CV, my mum was discharged to a rehab facility who then assessed her/ supported her the get home/ worked out what care she needed. It will also depend on if she would get funding or can afford to pay. Good luck.

Contact Age UK ?

Don't agree to anything if you're unsure (this is assuming you're going to be discussing it with them over the phone/ email of course).
We agreed to my dad being discharged, with help arranged by social services, and then had a real battle to get any decent help at all. Once he was sent home from hospital we were left swinging. I was told by a social worker that other people were more in need, so they had priority.

Definitely not allowed into hospital.
My feeling is that DM will have told them I will go over daily and help her, which whilst I will do what I can, I cannot commit to, especially during this lockdown. I have young children at home.

You've got no chance op tbh. Discharges are really being pushed. Put it In Writing that you will not support and believe her to be at risk. Nothing else you can do.

Yes, agree put it in writing

How far away are you?

One time my dad was threatened with unsafe discharge, we were able to say that mum wasn’t well enough to look after him and both children approximately two hours away with full time jobs.

The care that was being provided was on social services, don’t they have a duty of care to still go?

Unfortunately the new hospital discharge requirements mean that patients must be discharged as soon as they are clinically well enough, before there is a needs assessment or an agreed care plan.

www.gov.uk/government/publications/coronavirus-covid-19-hospital-discharge-service-requirements

The guidance says that people should have a full needs assessment within a couple of days of discharge from hospital.

The Coronavirus Act allows for local authorities to not do full needs assessments if they are overwhelmed because of staff absence and/or increased demand. So far eight local authorities (that we know about) have implemented the emergency measures: Solihull, Warwickshire, Middlesbrough, Staffordshire, Birmingham, Sunderland, Derbyshire and Coventry.

www.disabilitynewsservice.com/coronavirus-concerns-over-councils-rushing-to-free-themselves-from-care-act-duties/

The full guidance is here:

www.gov.uk/government/publications/coronavirus-covid-19-changes-to-the-care-act-2014/care-act-easements-guidance-for-local-authorities

They can't just use the measures as and when, they have to make a proper official decision, keep a record of the decision making process and report it to DHSC. They also have to tell service users and carers that they are implementing the decision.

Assuming your local authority have not implemented the coronavirus measures (if you are not sure then ask) then your mother is entitled to a full needs assessment and you are also entitled to a full carer's needs assessment. You can have these together at the same time if you are both happy to do that.

Good luck OP, it's an incredibly worrying time. Definitely get in touch with AgeUK as well.

Well I say social services but I don't actually know for sure
What I do know is that when DM told the lymphodema clinic that she couldn't do her own leg strapping (her size and arthritis made it impossible) they contacted someone and a carer appeared. apparently it's a trial for 6 weeks but no mention of costs 🤷‍♀️

Yes you can have up to 6 weeks 'intermediate' care on discharge from hospital without facing any costs. It can be provided by NHS or social care.

www.ageuk.org.uk/information-advice/care/arranging-care/homecare/support-after-hospital-discharge/

Ask for her to be referred to district nurses for care of her lymphodema/leg ulcers. She will need to be housebound because of covid so they can assess/ apply compression to improve her legs. I would expect her pain to improve once this is being treated.

Additionally once the intermediate care is approaching stepping down someone will be assessing for future needs and an on going package of care,

Tried week after week to request a district nurse come to the house treat DM's leg ulcers. Not interested, always other priorities. Insisted she attend a clinic which of course has gone out the window since COVID

There is no cost for the interim care but your mum will need to claim attendance allowance and any other entitled benefit based on disability/age or have a grasp of her finances to ensure she can contribute or pay for a long term plan.

If there are no clinics/no way of attending then they have a duty of care to attend. Ask her go to make referral?

Sorry that should be GP

Am so cross with the GP and surgery in general. They have displayed zero concern

Make it very clear you will not be backstop here and massively play down what input you will have. If they get a whiff of family helping out they will discharge her and leave you to it. Be very careful here. You have to put your mental health and DC first.
You also need to have a serious chat with your DM. Her expectations of you are selfish and unrealistic long term.

And as an ex district nurse of 14 years they cannot just not attend to her leg ulcers if she is genuinely housebound. Do not take this on yourself. Put requests in writing to them, the GP and the practice manager.
The service though is on its knees, sadly there are probably very many people like your DM on their caseload which do play second fiddle to palliative cases.

Thank you everyone

@cptartapp DM is genuinely housebound. She has not been out of the house for 8 weeks. Not only is she in constant pain from her legs she also takes Methotrexate for R.A. which puts her in the highly vulnerable COVID category (but hasn't received any 'shielding' letter which yet again makes me cross).

IIRC she received one phonecall from the Community Nurse 2 weeks ago to see how she was getting on but no offer to come out to her.

Methotrexate for RA probably doesn't actually put in her the shielding category. It puts you in the more vulnerable category as far as I've seen. It's irrelevant tbh as her age and frailty already put her in the shielding group.

Whilst I understand your concerns I'm presuming your mother has capacity, therefore she can make her own choices over d/c planning?

What exactly are you expecting the hospital to do? Is it to arrange more carers each day? In which case what tasks are you expecting them to do that your mother cannot do herself or needs help with?
To be honest a hospital is the last place you'd want to be right now. I would be enabling her to be d/c home ASAP as much as possible.