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.

I was a district nurse for many years and saw the chaos that ensued for families from situations like this. My own DM ended up on BP medication and antidepressants dealing with my GM. I agree with every word knot says.
Think long term. Prioritise your own mental health and step right away. Make social services aware of your decision. Only when a crisis occurs, which it will, will things change.
If she's capable of phoning you, she's capable of phoning social services. Make sure she DM has their number and don't be available.
It's the only way.

Are you planning on picking her up?.

I had a resident ask me for a yellow pages recently, I don’t think they even make them now. Last one I had was a cm thick if that.

Dorset. Yes ring them tonight and ask for the nurse in charge. Ask them is they have a discharge planning meeting tomorrow and will she be seeing a doctor or nurse practitioner before any plan is made. Tell them you are worried about her and do not think its safe to go home unless carers are back in place. Ask for the nurses name just so you know who you spoke to. Ask if they would like you to drop keys and her purse in as they are her property. Good luck.

Honestly I agree with a pp, dont give in to her. Two years ago my father fell and broke his hip? After 10 days once he had started to walk with the walker he tried to discharge him self , I calmly told him and the nurse who rang that of he did so , I wouldn't be taking care of him or coming to get him. He knew I meant it as I had done the same when he tried to discharge himself after a previous stroke. Sometimes you have to be cruel to be kind .
It's clear that she is discharging herself knowing you will relent and assist her. I know it's hard but its time to show her that her actions have consequences.

When I spoke to the nurse in charge earlier this afternoon all she said was that DM must have a negative COVID swab before she'd be allowed to leave, nothing else.

To go home she ideally needs
Covid negative test
Medication
Discharge letter
Careplan review
Falls review
Care agency agrees to look after her
Money or transport home
Key and clothes
Food and heating on
Falls alarm and maybe other equipment
Careline alarm and keysafe

so only about 90% not in place then!

I know it seems horrible but yes, as pp have suggested, don't go and get her!

If she doesn't understand the potentially dangerous situation she's putting herself in then she needs to be reassessed. If she does understand then she's being incredibly self centred and you will be encouraging her to believe you are at her beck and call forever. There is a world of difference between being a loving daughter and being a servant.

It's been made so much harder due to lockdown. Wish I could just eyeball her to get some some sense to go in.

Dorset You sound a lot more empowered to hold your ground tomorrow. Good luck.

The hard thing is and I absolutely agree with all happy has said above, if she is deemed to have capacity they have no legal powers to hold her in hospital, make her take any tests or accept carers. If she has capacity so is making an 'informed choice' absolutely step back- do NOT get sucked in!

Spoken to the nurse in charge. A capacity assessment has been competed which DM passed and they are waiting for the COVID swab results to come back.

DM still adamant that she wants to go home but the care package is not likely to be in place for another day or so. The nurse (a different one to yesterday) is going to try and talk to her again but will tell DM that I will not be going in to pick her up. If she wants I will drop her purse and key over but that's as far as I will enable her.
DM hasn't actually phoned me yet this morning so bracing myself for the fallout!

Good luck

We can't always have what we want, (right now I want a holiday), when I was growing up the line was "I want gets nothing" which is handy now because I repeat it back. She wants to go home but she needs to stay there. You are both adults, what's she going to do if you don't do what she tells you - send you to your room? She can make whatever decisions she wants but you don't have to facilitate them. If she doesn't talk to you for a week then that's just the way it is.

I can empathise with you. My DM is exactly the same, she has been assessed as having the capability to make decisions. Sadly she makes unsafe and even dangerous decisions.

DSis and I are both physically and mentally burnt out. After three hospital admissions in ten days during lockdown the hospital had a right go at DSis. She stood her ground and asked them what exactly are we supposed to do? They had no answers.
We've both withdrawn our support and refused to enable her behaviour. It's hard but necessary.
Good luck and please look after yourself

as a suggestion if/ when DM calls you, youre "looking" for the key /misplaced whatever, cant drop it off today (too busy, sorting her home, shopping blah di blah.....).

Id say DONT drop her key or purse! without those she can`t go anywhere!!

basicaly stall her!

Sadly an unwise decision does not mean someone lacks capacity.

Care alarms are really easy to install and there are multiple options available all doing the same thing, a quick google will sort the. But it does depend on her actually wearing it...

Yes you would go down as the next of kin but you are under no obligation to turn up to help her if she calls for assistance, it would go through their call handlers, and if she's fallen or sounds hurt they will call an ambulance for her. And yes that can be a waste of resources but it's all in a day's work for them and gets her back in front of the NHS for more assessments and oversight.

Don't go and pick her up. I'd be suspicious of her capacity assessment as her 'weighing up information' seems to be my daughter and all the neighbours will do everything for me plus I'll be fine anyway

Well she isn't fine and you and the neighbours aren't doing everything to help her.

Don't go, stick to medical advice. Has she had a proper memory test such as a MOCA or ACE-III?

The hospital will be penalised for a 'failed discharge', where a patient is returned to hospital within a short time of being discharged.

The pressure for beds is so great, that bed managers will try to override and pressure clinical, patient facing staff to get beds ready for the next patients.

Reiterate that you cannot cope, that she needs a physical needs/occupational therapy assessment, a detailed dementia assessment, a proper care package in place and her needs and discharge need to be flagged up with the district nurse team and the GP.

Do not back up any statement relayed to you from your mother.

You cannot physically cope with your mother, her neighbours are just as frail as she is, there is no support in the community and the discharge will be unsafe.

Sorry I haven’t read your previous threads but are you able to have your mother home with you until her care package is in place?

Spoken to DM (with nurse in room). They've told her that IF care can be put in place she can go home tomorrow - of course all she hears is 'tomorrow' 🙄.
However that has at least placated her for 24 hours and I just tuned out when she started ranting about how I have no clue how bad it is in there, how exhausted she is etc etc.
Turns out it's logistically impossible for me to drive her home anyway due to her size and worsening mobility issues. She will need hospital transport.

She can't come to us, we don't have the room. More importantly it would be detrimental to my MH to have her here as things stand.

@StopGo your situation sounds so similar to mine. I have a DB but he lives 3 hours away so can be of very limited practical help. He and I are on the same page though with our approach which helps.
I am physically and emotionally worn out; even before lockdown I was constantly over at DM's sorting every small drama - if I didn't jump it would soon escalate into a full blown medical emergency.
Each time she has been admitted to hospital it is me who deals with the fallout and ensuing shitstorm it creates. All made infinitely more difficult through lockdown, especially being a key worker myself and having DC at home. I am starting to feel resentful at how selfish she has become which is not good for DM or me

My MiL once told my DH that it was his job to look after her.

Keep strong Dorset