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.

'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.'

Hi OP, I just wanted to re-iterate this post from earlier in the thread in case you'd missed it. Please look after yourself too.

I am so grateful for you all, no one in RL will want to hear me banging on about my woes, nor do they have the insight into the problems I'm dealing with.

@HappyHammy I think you must be me in a parallel universe! Exactly the same conditions and conditions I'm dealing with. Am so sorry you also went through this but you have no idea how much help you are being.

I've done a quick read through of the CHC initial checklist and only one section doesn't really apply. The rest in my unqualified opinion, she rates as a C or B. Not sure how that translates into a full assessment being instigated.

www.ageuk.org.uk/globalassets/age-uk/documents/factsheets/fs20_nhs_continuing_healthcare_and_nhs-funded_nursing_care_fcs.pdf

*'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.'*

she's not even capable of ringing me now; her eyesight is so poor she can't make out anything on her phone. Pre-lockdown Boots got her sight prescription wrong twice (she had cataract surgery back end of 2019) which she tried to have rectified but then of course everything shut down.
She struggled on but now, probably compounded by her physical state) she can barely see, yet alone use a phone. Can't watch or TV or use her tablet - you can imagine what that is doing for her mental state and played a big part in why she was so miserable in rehab.

I spent hours last week trying to contact Boots opticians to find out about community services as there no way DM can leave the House for a physical eye test and the GP said she couldn't help.
I finally spoke to a branch manager who said there are currently no community services for sight tests, nor any idea when they will reopen. No guidance or protocol for this scenario.
Hilariously he tried to do a basic remote test over the phone with DM but her prescription is so complicated he obviously couldn't be confident in how best to proceed. Not made any easier by DM's inability to coherently convey what was happening when using the glasses.

Yet another huge red flag with safeguarding IMO as her mobility and balance are bad enough anyway. I said as much to the optician and will reiterate as much to SS tomorrow.

Honestly you couldn't make this shit up!

If I recall C is the high risk score for chc then B. A is low risk. Do check. I remember thinking it got confusing being back to front.
Depending on the amount of C and B the links above will tell you what qualify for an assessment

@HappyHammy

If I recall C is the high risk score for chc then B. A is low risk. Do check. I remember thinking it got confusing being back to front. Depending on the amount of C and B the links above will tell you what qualify for an assessment

It's the other way round A is highest level you can score at CHC checklist B is middle And C is low

It only becomes High, Medium Low and No as scoring categories at the next stage if you get a positive checklist to be able to progress

Mostly Cs and a couple Bs is unlikely to meet criteria for positive CHC checklist. But that would be a professional decision by which nurse or social worker completes it .

What did you believe the score was OP out of curiosity ?

Thanks for info. I think i got confused because isnt it written C in the first box then B then A.

[quote HappyHammy]www.ageuk.org.uk/globalassets/age-uk/documents/factsheets/fs78_safeguarding_older_people_from_abuse_fcs.pdf[/quote]
Thankyou for linking an age Concern leaflet in response to my post that It wasn't safeguarding 😄😁 (That tickled me!!)

You might not be aware, that voluntary service booklets like this are written in simple terms, paring down something that is vastly more complex, for the general public. They are no substitute for the legislative acts themselves, HMGov guidance and a good knowledge of case law (how SG & CA works alongside MCA and HRA, and DOLs and what level of seriousness self neglect would need to be at for it to trigger a necessary safeguarding response, as a S.42 Care Act SGC, rather than sit at level of case management, capacity practicable support and client choice and rights)

I appreciate it's an anonymous site HappyHammy so you don't know what anyone's qualifications and day jobs are.
You’ve just not spotted the several professionals giving soft but expert generic advice and support.

There are key differences to the situation you described of your relative and OP’s DM’s current situation, in terms of behaviour, cooperation, capacity, needs and severity of risks.

However I read OP say she’s feels you’re being helpful and she is enjoying talking to you. So even though she’s had better advice and you may end up unintentionally misleading her, I'll leave it there. Any SG will be screened by the LA anyway and they’ll do a CHC checklist if needed.

@HappyHammy

Thanks for info. I think i got confused because isnt it written C in the first box then B then A.

Yes it is

No worries HappyHammy
Good luck to you two setting the world to rights 😀

(Just please don't encourage OP to go in guns blazing when the services are already doing their job as it really isn't a safeguarding (except for the missed call part) at this stage. It might damage OPs credibility with her mum and the services to misunderstand her Mum's rights and where she's up to right now)

Like you say you dont know anyones qualifications or what their day jobs are

I truly appreciate everyone's advice and support - am sorry if it didn't seem that way.

One thing I will ask her SW tomorrow is whether we can get DM back into the rehab unit period of time. Everyone is agreed she discharged herself way to early; She didn't give herself nearly long enough to recover, embrace the therapies offered and get some strength back.
I hate the thought of having to make knee jerk long term decisions when actually what she needs right now is looking after and stabilising. Am thinking that once we know what's recoverable and what's more permanent we can make more concrete plans for long term care.

@HappyHammy

Like you say you dont know anyones qualifications or what their day jobs are

Yes, I know mine and recognise some of the others who posted to help on here, that you maybe didn't realise you said the opposite to. And a few hints from your use of language 'Cause for Concern' and emailing the Safeguarding Lead 😁 so you know exactly why I responded to add a caveat around your rather specific advice.

Look, OP might find this damn fine & helpful guidance from SCIE on the very difficult issue of self neglect and when it becomes a safeguarding concern

"Self-neglect can be a complex and challenging issue for practitioners to address, because of the need to find the right balance between respecting a person's autonomy and fulfilling their duty to protect the adult's health and wellbeing. Both perspectives can be supported by human rights arguments.
The Care Act 2014 statutory guidance includes self-neglect in the categories of abuse or neglect relevant to safeguarding adults with care and support needs. In some circumstances, where there is a serious risk to the health and wellbeing of an individual, it may be appropriate to raise self-neglect as a safeguarding concern. However, interventions on self-neglect are usually more appropriate under the parts of the Care Act dealing with assessment, planning, information and advice, and prevention.
It is vital to establish whether the person has capacity to make decisions about their own wellbeing, and whether or not they are able or willing to care for themselves. An adult who is able to make choices may make decisions that others think of as self-neglect.
If the person does not want any safeguarding action to be taken, it may be reasonable not to intervene further, as long as:
• no-one else is at risk
• their 'vital interests' are not compromised – that is, there is no immediate risk of death or major harm
• all decisions are fully explained and recorded
• other agencies have been informed and involved as necessary.
Risk and capacity assessments are likely to be useful. The legislation makes clear that adult safeguarding responses should be guided by the adult themselves, to achieve the outcomes that they want to achieve.
Carrying out an assessment may be difficult, if the person is reluctant. The Department of Health advises (in statutory guidance on the implementation of the Care Act 2014) that adult social care departments should record all the steps they have taken to complete an assessment of the things that a person wants to achieve and the care and support that they need. Research indicates that intervening successfully depends on practitioners taking time to gain the person's trust and build a relationship, and going at the person’s own pace.
If it is impossible to complete the assessment, or if the person refuses to accept care and support services, you should be able to show that you have tried, and that information and advice have been made available to the person on how to access care and support and how to raise any safeguarding concerns. All your decisions, and the considerations that have led to them, should be recorded in light of the person's wishes and their particular circumstances. You should be able to show that whatever action you have taken is reasonable and proportionate"

The Human Rights Act balance they refer to is usually between Articles 2, 3 verses Articles 5 & 8 - they'll be easy to google, it is important stuff.

Regardless of you and OP having relatives at different stages or exact situations , it's great to have someone else who's had similiar experiences of their relatives ill health and can really understand that frustration from watching a sad, scary and difficult situation unfold. This MN section is so brilliant at finding MNers to give support for that.

OP

One thing I will ask her SW tomorrow is whether we can get DM back into the rehab unit

That's a good question to ask, suspect the bed was quickly filled. We can really feel your exasperation at how Mum didn't appreciate what a rare opportunity she was giving up.

I hate the thought of having to make knee jerk long term decisions when actually what she needs right now is looking after and stabilising.

You could always dIscuss with SW and Mum if a long respite stay (eg 4 weeks) had any realistic value in her situation and during lockdown restrictions.

Might be worth asking the physio from NHS unit if they can email some physio exercises to continue her rehab, if felt to be safe, workable or appropriate.

Also don't forget about 12 week property disregard funding if that might apply - there's eligibility requirements- you can read about it online but go to the LA's adult health and care website to do so, to avoid the well meaning but unhelpful misinformation on the internet.

My heart goes out to you. Been here time and time again with my mum it is soul destroying and heart breaking.
The incidents just keep coming and for us now we have just reached full leg amputation 6 days ago already she is making noises to her out. She is due to go to rehab but I know she will rush that through as quickly as possible so she can get home for a cigarette until the next admission. All carers are dispensed off within a week of arrangement because “her daughter will help” it’s killing me now already had 12 years of if I just can’t cope anymore now it’s become so severe. It never stops does it no matter how bad things get my heart breaks for her but also it’s too much for us to cope with. Stay strong lovely

So many of us in similar positions it’s heartbreaking. I’m learning so much from this thread. I have a phone meeting tomorrow with sw and mum for home care.
Mums agreeing to it at the moment, but we had enablement last year after she broke her hip , all went well for a while,
then one day one of the girls couldn’t access the key safe, mum blew her top and wouldn’t have them again. Expecting worse this time as she’s has memory loss and slight confusion.
It only a matter of time before she falls again, she has low bp which can’t seem to be rectified. If you saw the way she gets on her chair lift 😱 won’t be told though so what can you do .

@Katyy & @Passthebubbly, sorry to hear about your situations. It's so difficult when you're literally dealing with a child in an adult's body

@DorsetCamping I have nothing helpful to add but have read all your posts and am utterly blown away by your love for your mum and the huge effort you have made to keep her safe and well, despite her best efforts otherwise.
I hope you’re taking time for yourself if at all possible. You can’t pour from an empty cup.
You’re doing an incredible job, sorry I can’t help at all!

Thank you for sharing your experience. I have found this a heartwarming thread reading about so many personal stories. We are in a similar position and am gaining so much help from our local community and support groups.

No word back from the SW yet but have just had a hugely helpful phonecall with a Community Matron.
Assuming DM is still at home Wednesday the CM will visit (with me present) and do a full assessment of DM's medical and care needs. Says she then acts as a liaison between the various agencies.

Am so relieved that in principle such an advocate exists (never heard of a CM before) and am hoping that by taking a holistic view she can help set DM on the right path

DorsetCamping. The very best of luck to you and your mum. When you have your mum sorted you need a holiday it is exhausting.

Knew it was to good to be true...
Popped over to see how she was and found her stuck on the loo. Ignoring all instructions not to move without a carer, she had got herself off the sofa and rather use the commode next
To her she went to the bathroom.
Had been stuck there a least an hour and had no strength to push down on the toilet frame to stand up. Nothing I could do to get her standing and so yet again paramedics were called as her legs were getting numb and I was worried about her falling off.

2 hours later they managed to get her upright, very red and bruised backside.

Have spent afternoon dealing with OT, carers and pleading with SW to find her a nursing home ASAP. What should've been a half hour visit has turned into yet another all dayer 🤦‍♀️

Its a good job you visited otherwise she would still be there till the carers or district nurse came. I take it she doesnt use a carelink alarm..what a worry for you.

Horrible OP. Care home, care home, care home.

You're letting the tail wag the dog.

Stop letting your guilt and DM's failing brain put her at risk of sudden death. Stop.

For your DMs sake you must stop engaging with her about why she's not going into care. Repeat that she is going into care. Don't explain why; speak in short, clear sentences. Hang up after 5 minutes.

Long agonised discussions just give DM a sense she is the centre of attention, which is no good, and that she has a point - she doesn't.

Kindness will enable another horrifying accident, and nothing else. Treating DM like an adult could kill her. That's not respect. That's not love.

Control yourself. Stop engaging, stop popping round, tell SS why. Only when DM is in care can you resume the relationship, which ought to be shortly.

OP, a very similar thing happened with my dad. I had to call the paramedics out and I emphasised that I didn't live nearby and that I was worried clout his continuing safety living alone. They were really sympathetic and agreed to admit him to hospital. I was then able to really push social services to move him directly into a care home, which I'd been part way through organising. It did speed things up. If this should happen again - it's quite likely it will - I strongly advise you to take this approach and push for your mum to be admitted and then for her to be kept in hospital until a transfer to a care home is possible. Paramedics see quite a few cases of people like this and they do understand how hard it is.
Can't remember if your mum owns a property or has savings? You will get a grace period, you don't have to hand over money immediately. I also found the finance people in adult social services very helpful once it got to that stage.