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.

It could be a number of things, dont assume anything until the doctors have done more tests. What are they planning to do, can she have something to calm her down a bit. Poor woman.

I guess they are ruling out physical reasons before dementia. Has the psych been to see her? I feel for the other patients on the ward, it must be distressing for them as well as your poor mum. I really hope they move her to a MH ward soon, you think they would have scanned her brain by now?

Sorry OP - for some reason I thought DM had been diagnosed with vascular dementia already. Par for the course if so.

There are loads of meds to calm her down, but they can't fix the brain damage. Ask to see a psych asap.

Unfortunately there has been no improvement -
DM still very confused and paranoid. She is now dehydrated and refusing all meds. I saw her today and she's a shadow of her former self.
Cannot believe the psych team still haven't seen her, I've been raising merry hell but doesn't seem to make a difference. No updates either from doctors since Friday morning despite several requests.

I am at a loss as to what to do

Oh gosh, that's awful. Not eating, drinking or taking meds will not help. Can you talk to PALS and ask for their help in meeting with the doctors, asking them for a diagnosis and a treatment plan. Maybe the mental health team cant see her without all medical reasons being investigated.

Hi OP, I haven't read the whole thread so apologies if someone has already said this but my GM has vascular dementia. She can have episodes like this when she has a urine infection. It's extreme but as soon as the infection is cleared she goes back to how she was. Obviously she still has dementia but is a lot more stable and capable.

After much cage rattling, DM finally had a brain scan today which came back clear. Her liver scan was also clear
The psychiatric liaison team should now be seeing her this evening which I am praying will provide some answers. The doctor has also given her some meds to calm her down

DH went in to see her today and saw for himself how acutely unwell she has become in the space of literally 10 days. He was utterly shocked at how they have let her refuse meds and food/drink . She is literally a shell of her former self

Glad to hear she has at least been scanned. Hoping the psych team admit her to a MH ward and then the long process of diagnosis will follow! We are 4.5 weeks now since mum was sectioned with no diagnosis or treatment as yet. I do appreciate it all takes time though. At least they will ensure she eats and takes meds, I too am shocked that they have not been more on top of this. However, I guess unless she is sectioned, they cannot force meds etc on her

@flygirl767 I am really hoping they do section her and move her to the MH unit. I don't believe she is being looked after properly and needs a specialist team around her.
I have insisted the psych team ring me as soon as someone has seen her.

Fingers crossed for you and for her. Remembering when it happened to us ... when they found my DM a MH bed it was in a hospital an hour away. Two nurses had to take her there in a taxi at about 8.00pm and I travelled separately. I got to meet her named nurse at 10.00 pm to go through all her likes and dislikes while they observed her. Covid might make it all 10x harder.

You can't feed or water or med someone without their consent. Having said that, the name of the game is to get their consent, as medics well know, with nice food, etc etc.

I don't know how likely it is she's moved the to MH unit - spaces will prob be like gold dust.

Try and find out what's frightening her. Has she always been difficult? It's hard, because sometimes the 'stubborness' (=suicidal idiocy) is a symptom of the madness as well as a cause of it.

@DorsetCamping any news on your mum? I do hope they have managed to move her to a suitable place.

Hi @flygirl767,
Well updates of a sort although still very slow progress.
Finally spoke to a psych liaison nurse from the hospital's MH unit. She'd been to see DM on Tuesday, who although initially engaged in some sort of conversation, very quickly shutdown and refused to talk further. The nurse suspects 'psychotic depression', however whilst she was there she also witnessed Mum have a TIA (unresponsive, altered state of consciousness), which whilst unpleasant was good it was seen).
I suspect DM has had several over the past few months which would account for a lot of her symptoms but have been so small nothing has shown on CT scans.

However they think this is separate to the delerium and suicidal thoughts and so after DM has an MRI scan today, she SHOULD  finally be moved to the MH unit

I had a real rant yesterday, DM has now been on a general ward for a week. She is declining by the day and whilst I appreciate all physical causes have to be discounted, the process has frustratingly slow. She is in utter confused distress and is constantly being bothered by the poor elderly woman in her bay who have dementia. She is getting zero rest and it's an utterly inappropriate environment for someone having a MH crisis.

How is your DM doing @flygirl767 ? Are they getting anywhere with her assessment?

Sorry not sure why all the bold!

This is pretty basic stuff, but have they checked her urine? Elderly people can have psychotic episodes as the result of UTI’s. Also allergic reactions to medications. (Antibiotics? Other new meds?) I’d be asking for a referral to a General Physician who specializes in Geriatric health if you don’t get some very fast answers.

@DorsetCamping no, not really. She is refusing to do the Addenbrookes test, they have tried twice but she gets half way through and won't go on. She is getting worse while she is in there, total confusion most of the time. I don't think it is the right place for her but at least she is safe until they can move her to a suitable care home. No idea when that will be though, still no news re social worker.

One thing about the MH unit is although the care is great, medical care all has to be referred back to the main hospital i.e her catheter is still in and they don't seem to be in any hurry to remove it and find out the cause of the urine retention. She has had to be taken to A&E twice due to very low blood pressure which is unsettling. I just want to get moving with a proper diagnosis. The last think I want is for her to be stuck for month on this ward.

I'm glad you are finally getting somewhere, I hope they can move her to the MH ward or unit where at least she will have her own room and some privacy to rest.

She is clear for UTIs and constipation.

This sounds so similar to my DM @flygirl767

I've also been warned that although the MH unit is on the same physical site as the hospital they are very much 2 separate entities, hence why this is all so slow. They won't accept DM until literally every last physical cause has been discounted, which to me sounds untelastic when you're dealing with a elderly person who has long standing health conditions

So my Gran is now no longer alive but this situation is eerily similar. In the December my Gran had a bad fall at home. She was taken into hospital and discharged late at night despite being quite distressed. Over the next few days it became very apparent she was not well, immobile and in a huge amount of pain in her arm where she had fallen. She had a bad break. However in hospital she developed a UTI, was constipated and just generally deteriorated. They moved her to a rehab unit and in there she became increasingly (over a very short space of time) very confused, agitated, low mood. She started pulling at all her buttons, trying to hurt herself with a knife, scissors etc. The GP diagnosed an acute agitated depression. She was transferred to a MH unit where she did improve. They then discharged her back to the rehab unit, but it was too soon and this time she was in a section with patients with acute dementia and she began mimicking the behaviours and began to decline again. Whilst she was there her eldest son passed away very suddenly and that brought about a sharp change back to the sever agitated depression. She was transferred back to the MH hospital, this time she was in a different ward and recieved 3 lots of ECT treatment over the course of a year. It did help and she even endured the death of Papa in this time reasonably well but she was physically very incapable by the time she was stable enough to be discharged, especially as her mental health had stopped her from doing any physio with the broken arm, so it was pretty useless. So she went to a care home with a special unit, nearly 2 years after her initial fall. She had up days and down days but the care home was a safe environment for her. She was well enough for us to take out sometimes and we even hired a carer to take her away for a few days to the location she was originally from. Which when she initially spiralled seemed impossible. She was content when she died which was peaceful. The mental health hospital which was a scary prospect to begin with was so much better for her, and actually a nicer place to visit as well. The care home wasn't a beautiful one but was a homely safe place. Agitated depression can appear like severe dementia, I hope your mum improves though as my Gran did.

Gosh @Merryhobnobs that sounds so similar!
The agitation, confusion and distress. So strange.

DM's MRI is booked for 2.30, but still no firm plan from psych team. I'm hoping the results are back promptly and she can be moved today

My Gran had stopped eating and drinking as well. I think some people had written it off as dementia, especially as she was in so many wards and so many people. But we knew it wasn't that (or certainly not all that). I think the hospital environment can really trigger some elderly people and unfortunately some people can just write it off as 'old people illness'. I can't remember how long it took for Gran to get into the MH hospital, I just know it was a really hard and horrible time, especially for my Mum as both her brothers lived abroad and I lived 3 hours away as well. I think the GP from the rehab unit who coincidentally was a GP from our own practice who had taken care of my Grandparents many times in the past really advocated for us, he knew Gran needed moved. We had a social worker assigned to us as well who I seem to remember understood our perspective. We had to be pretty firm and ask for meetings and state very clearly.

My DM had a social worker assigned whilst she was actually in the rehab unit but I'm not sure what their role is whilst she's in hospital.

Is the SW able to advocate for things to move along in hospital?

The MRI has come back clear so it appears what is going on is purely psychiatric. Still find it hard to believe given some of the symptoms (difficulties swallowing, sudden deterioration in sight, forgetting basic names/events) but guess that's fairly conclusive.

Now trying yet again to get the Psych team to finally take action

They could at least sedate her while she's in the general ward. Awful for the other patients too.

The psychiatrist saw her this evening and is gong to have DM sectioned. There are currently no MH beds available until Sunday so depending on whether they think she is stable until Sunday, may have to move her to an out of area unit.

Feel a bit shocked by the terminology but at least that means she should now start getting the right help.