DM about to dangerously discharge

[DorsetCamping]

Apologies for the continuing saga but am at wits end.

To be brief DM (74) has been in hospital 3 times over the last month due to various conditions and the last admission being for 10 days and near deaths door. All pointing to her continuing decline and inability to cope independently.

She reluctantly agreed to go to a rehab unit last week and seemed to be making reasonable progress, no doubt due to be constantly monitored and with the 24/7 care.
Tentative Plans were being discussed for her to go home with an enhanced daily care package.

However, yesterday she had a fall, whereby her walking frame tipped and she banged her head. Thankfully she is ok but naturally it raised deeper concerns about her safety and needs when she goes home.

Onto this morning, she said she is self-discharging and that if I don't go and get her tomorrow she will call a taxi . Said that there is no way she is staying, hates it and is exhausted.
I have spoken to The nursing staff who are adamant that it is not safe for her to go home, especially with yesterday's fall and that her care package needs a new review. More worryingly is that no carers will even be available in the immediate future given COVID and calls on resource.
They have told DM all of this but she it's falling on deaf ears.

I am so cross her with, it's like dealing with a toddler. She has no clue about the worry this is causing or the implications with lockdown. All she keeps saying to the staff is that either I, or her elderly neighbours will help if need be.
I mean, WTF?!
They did ask me about her mental health as she seemed so low today but ultimately it is her decision.

I am so exhausted with her. All she is being asked to do it sit and recover - you'd think she was in a prison cell the way she goes on. I can pretty much guarantee that if she goes home tomorrow she will just end up in hospital again and we'll be back in the same merry go round.

Surely if the home staff know that neither you nor her friends will be coming them they will deal with it and placate her in some way? Lock down and no visitors might be your ally here. Most care staff deal with this Issue every day.
Take advantage of her being looked after safely and relax with your phone turned off if you can.

They've tried to placate her but she won't hear it. This is why I'm worried about her MH as it is absolutely ludicrous to even consider what's she's proposing

Hard though it is, if she's a competent adult then she is allowed to make her own decisions even if they are stupid ones. She is then allowed to deal with the consequences. I know it's hard but she isn't a toddler and you aren't responsible for her decisions or sorting out the mess she will get into. What you can do is to refuse to support her in her poor choices. If she wants to go home she can call a taxi and pay for it. There will be no fresh food in the fridge and you didn't plan on her being back home so you might not be able to get because you have other commitments. Turn your phone off and be otherwise unavailable after making the staff aware that you and the neighbours are not planning on becoming carers.

A relative has had a couple of emergency hospital stays during lockdown and came out with a package of four care visits a day plus district nurse and physiotherapist support. COVID appeared to make no difference to admission, assessment or discharge. Have you been told that there will be no home care?

Stupidly I agreed to go and pick her up. This was before I'd spoken to the nurse and realised severity of the care plan implications from her fall.
I'm not sure she'll ever talk to me again if I tell her I want no part of what she's intending to do.

After her first she had pretty much the same care package that you mention, 4 x daily care as a short term re-enablement plan. However part of the reason she ended back in hospital as wasn't embracing what the carers were there for. She tell them she was feeling well enough to do x y z herself and send them on there way

Apologies for typos!

That must be so frustrating and worrying and infuriating too. What does she think is going to happen when she is at home? Can you bring yourself to let her get on with it by herself until the inevitable happens? She does have a care alarm I assume?

Yes it's all of those @Purplewithred !!

She hasn't had a personal alarm but i'm frantically researching. My understanding though is that I will still be the one who has to sort out the inevitable emergencies if she presses the alarm as I'm next of kin, and so is of limited help

She couldn't get a taxi if she tried - she can't walk anywhere without assistance and I've got her purse!

Dont pick her up if you dont want to. If she wants to self discharge dont get involved. Has she got a Key or money on her. Any clothes, food in the house, heating on, She wont manage at home. She has no help. With the alarm you dont need to be a responder if you dont want to be, the social services can set it up and the company can be responders, we went through this sooooo many times, one time the ambulance took him straight back to hospital as he tripped on the doorstep, maybe the doctor could have a word tomorrow when they see her.

If she hit her head then the dr might suggest a scan. If she cant walk without help and has no money then the staff will make her sign a self discharge letter and may try to persuade her to stay.

I can only hope the staff talk some sense into her overnight.
I feel like such a horrible daughter, damned either way

Can you not be honest with her? Tell her that the plan isn't safe and you love her and couldn't live with yourself if you aided and abetted and something went wrong? Therefore you won't help her go home at the moment. She'll probably tantrum but unless there is a very complex relationship history she'll come round?

You can take the keys and purse in and leave them with the staff with a note for their files saying its an unsafe discharge and you and ndn will not be helping ir arranging a lift home. Is' she in a dorset hospital

I work with patients like this regularly, and I don't mean to be harsh but the most frustrating part is when families say they're really worried about their relatives then support them to make unwise choices and then when they're home we have to pick up the pieces on short notice usually without any safety nets in place.

Have they done a formal capacity assessment?

She couldn't get a taxi if she tried - she can't walk anywhere without assistance and I've got her purse!

Then just say no to picking her up and stay resolute in that. If she’s adamant she can cope alone let her cope alone and see that she can’t.

It’s a cruel to be kind moment

Absolutely agree with posters saying don't facilitate it- I know it will be stressful and unpleasant but it sounds likely her going home and you running around after her would be doubly so. At least in hospital you know she is safe and supervised. for you Dorset

Thank you, I hear everything you are saying.

@oiboi who instigates the capacity assessment? Can the unit do it and can it be done quickly?

To be clear it's not a hospital, it's an NHS funded rehab unit next door to a care home

Does she have a social worker? If not, I'd request one. Does she have mental capacity, is she able to make safe decisions?

I sympathise with you OP, my DM was very compliant and happily listened to advice which made caring for her much easier but MIL wouldn't be told and she was in and out of hospital with dehydration and falls. Sadly it killed her. In hindsight we think MIL had was in early stages of dementia which affected her ability to make safe decisions. Good luck.

Yes. It should be done by the most relevant professional who knows her. They will check she understands the risks she is taking and can weigh them up. They need to make sure she understands that if she goes home with support and means of summoning help she may fall have a very long lie and end up in a situation where she may never return home or even die. If she has capacity and makes the unwise decision then the unit may be able to keep her there until they can put some support in place.

It would help if she understood that you will not support her once she's home, otherwise a lot of patients just expect their family to pick up the slack of their poor choices. Have you a family member living with you who could develop fictitious covid symptoms? Then you'd have to isolate and wouldn't be able to see her for 14 days?!

Does she have a social worker?
Not that I'm aware of, but having had a phonecall last week (pre fall) with social services to discuss her situation, maybe she does? I will ring them tomorrow.

MIL wouldn't be told and she was in and out of and falls. Sadly it killed her. In hindsight we think MIL had was in early stages of dementia which affected her ability to make safe decisions. This sounds spookily similar to DM, dehydration etc- I do wonder about dementia given the unsafe decisions she's making or maybe she's just sheer bloody minded!

Is the rehab unit part of an NHS trust. Is the carehome part of the unit. There will be a discharge co ordinator or a nurse incharge. Just tell them tomorrow you are worried she will not be safe and cannot help. The capacity assessment can be carried out by the dr, a nurse who has had the training, a social worker. It can be done in half an hour. If they say she has capacity then she can make her own decisions but if she lacks then there needs to be a best interest meeting. Do you or anyone have power of attorney. You can ask if shes had a capacity assessment and if not can they do one.

The carers manager may need to agree to take her on again if she keeps falling before she goes home

@HappyHammy yes the unit is NHS
If I ring them at this time in a Sunday will they be able to take a onboard my wishes for a capacity assessment to be undertaken?

Sorry, the thread title gives me images of her exploding. Not helpful, I know.

You've had some good advice, though, and I hope that you, or someone, can dissuade her.