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.

Quick update...all being taken seriously now and a thankfully a place has been reserved at a local nursing home. She is getting increasingly helpless, the carer hasnt helped her get dressed for 3 days and she hasn't had a shower/thorough wash since Friday which I only discovered today

Next hurdle, the home doesn't have a chair big enough and she can't go anywhere without one 🤦‍♀️
OT and Community Matron aren't able source anything so I may have to bite the bullet and rent a bariatric riser/recline at £££

Someone did mention asking about possible budgets in SS pot for helping with cost of chair but not sure whether that's possible.

Its good its being taken seriously. Is she realistically going to sit in an armchair or could she be nursed in bed. Some beds can be positioned like a chair, are they hiring in a bariatric bed for her. Why hasnt she had a proper wash.

Well done OP. Massive well done.

My possibly rather tough post holds a world of sympathy for you - thing is, sometimes you've got to do what keeps you both alive and sane rather than what the elderly person feels like that afternoon.

And on to today's drama.

Arrived at DM's and she's clearly unwell with recurring problems from hospital admission number 2 🤦‍♀️
GP advised to ring for paramedics and after 3 ambulances turn up (first 2 not bariatric fitted) she is taken off to A&E. Christ knows how much that all cost!

SW, Community Matron and myself all in agreement that she is discharged straight to the nursing home. She is absolutely not safe at home and in a real physical and mental mess.
Nursing home won't be ready until Tuesday so we firmly believe best option is for her to stay put until then. All fine and big sigh of relief, until....... very confused phone call from DM, hospital doc wants her to go home with large doses of antibiotics "not safe to be in hospital right now" blah blah.
I told DM nothing is happening, no one has spoken to me and frankly if I switch my phone off they won't be having that conversation.

I've had enough; no one in RL understands, my own family is suffering. I am broken. DB is 3 hours away.

Switch your phone off OP and spend time with your family. This is not for you to shoulder alone, you have done enough. She is safer where she is than at home.

You're right @TwoTribes
It doesn't sit well someone taking up a hospital bed unless absolutely necessary but it's the only option. She CANNOT go home and enough is enough

OP, do you believe what your mother said in that phone call? Because I would have serious doubts about its accuracy. I think she's telling you what she thinks will make you come and get her. Why on earth would doctors say she's not safe to be in hospital? How would that make sense? When all the other staff have agreed the direct move to the nursing home? I take it no doctor actually spoke to you as part of this call?

Oh dear is this still all going on, at last she is back in hospital where she is safe and being discharged straight to a nh sounds a great plan. I doubt anyone has suggested she go home with antibiotics, just step back and don't engage with any more phone calls.

Enough already. Well, enough already years ago. Phone off, have a nice evening. DM is safe and will be even safer in a care home.

I do think one of the factors for care home admission should be 'danger to the health of others'.

Quick update...drum roll.....

DM is in the nursing home!!

A few hiccups over the weekend; no riser/recliner chair big enough (resulting in 4 hour road trip to buy one!) and broken lift in the home BUT she was finally transferred yesterday and apparently all is well!

Huge huge relief, I can finally step back for a while. Although this is respite for approx 6 weeks, if she settled in well I can see it becoming permanent.

Thank you so much for the unending advice and support, it's meant more to me than I can possibly put into words

Oh, well done Dorset. Enjoy your hard-earned break!

Congratulations! Absolutely wonderful news.

Thank goodness @DorsetCamping we had a similar thing with my mum a few years ago. She was discharged home and we’d actually told the discharge team it would fail and she’d be back in 24 hrs and she was, this time with another broken hip!

I would just say though that the capacity thing is tricky. My DM doesn’t have capacity to decide where she lives but is deemed to have capacity to decide if she wants to accept personal care. Effectively this means that she rarely washes but that’s her choice and the care home cannot force her. Just because she has limited capacity for some decisions doesn’t mean total control should be removed and it’s very hard sometimes to remember that.

Well done Dorset!

Yes, longhaul is right about capacity. Nursing home is still accepting DF has capacity over whether to take painkillers, The government guidance is very clear that capacity isn't all-or-nothing, it has to be assessed on a decision by decision basis, from "where do you want to live?" to "would you like a cup of tea?"

Good news for you both.

So so pleased for you and your mum hope she’s very happy there. Can’t help wishing it was my mum we’re just starting on this road, more and more calls for help, just had a call to say she feels dizzy and can I go and take her bp, yesterday could I go because her toaster had broken the day before she had a lot of Pain in her hip. She’s been assessed by adult services we’re waiting for a call to see if she can have carers. I honestly feel like running away, I suffer from anxiety so I’m not much good anyway in these situations, which in turn makes me feel very guilty. But I’ll have to live with that. Good luck to you all.

Congrats @DorsetCamping .

This morning the Matron from the NH rang to say they'd found DM this morning with deep cuts all over her arms.
It appears she'd brought a pair of scissors back from hospital and hidden them somewhere.
I am poleaxed! She has always been prone to low mood and negativity but nothing in this scale.
The GP has been called and I am waiting for a report.

I can't help but think there is some sort of connection with the 'mild seizures' she had durjng the longest hospital stay. The brain scan came back clear but all I can say is that she has been 'changed' since then.
She's like a truculent, obstructive toddler; won't cooperate and confused. She also had a varying hold on reality. Her eyesight has also rapidly deteriorated

I visited the NH this morning and through her window accused me of abandoning her, that she's been weeks (it's actually 2 days), that everyone is unkind and that 'something scratched her arms in the night'
This is all so extreme even for her.

When the nurse spoke to her about the cuts DM
just brushed it off and said her arms were itchy.
However, when I was cleaning her house the other day I found several scraps of paper with notes about how bad her life was, how much pain she was in and even reference to overdose.

Not sure what I'm asking if what I can even do but is it possible that the seizures brought on brain injury causing this behaviour?
Could it be some sort of rapid onset dementia?
Or is it just the culmination of being unwell and tumultuous few months?

Just don't know what to think or do. Am also anxious she will put her place at the NH in jeopardy.

I think the NH will have seen a lot of this type of behaviour. It also shows that she cannot be left on her own so services will have to be involved in her care whatever happens. I would let them know about the notes you found.

I think you should continue to step back and give yourself a break with your phone off. If your dm thinks 2 days is 2 weeks anyway, it really won't make a difference to her.

I do want to step back but it's not so easy when the NH/New GP are asking me for DM's detailed history

How often are they asking you for detailed history? It's ok to tell them you will not be available for 2/3 days. Give them another contact number for emergencies only and make yourself unavailable. You need to put your own oxygen mask on before helping others. Look after yourself.

So sorry Dorset. I can’t say anything helpful, but at least you know now she needs specialist help. Don’t go everyday to see your mum, she won’t be aware of how often your visiting anyway. Be kind to yourself and take care. Xx

Whilst it’s v upsetting to read her notes, far better she is being monitored by a team at the nh and not under your sole care. If she worsens then she will be escalated to somewhere with higher staffing ratios rather than back to you.
My DM left lots of little scattered notes saying how scared she was of people staking out her home and noises. Medication helped her greatly. It’s likely you are still on high alert and wired to her every need. Try to switch off for a few hours if you can.

Well, you really can't look after her yourself now. NH and new GP will have answers next week, don't you worry.

Of course seizures can cause bizarre, usually awful, behaviour - a mate of mine who had a small stroke was vile for months. Old people who have them can be impossible to keep at home.

Switch off (ha ha - easy to say. But try.) DMs behaviour is a medical problem, not a family one - leave decisions up to them.

Dorset This comment addresses something you said on Flygirl’s thread... If your mum’s behaviour was v erratic at the NH now she’s in hospital it would be fair to assume the staff will witness what the NH staff were contending with .... they may make an exception and get an elderly specialist to rake a look.