Refusing care

[scarlett176]

Elderly relative has been in hospital for 2.5 months. She initially went in with a stomach issue but that has since been resolved. Prior to going into hospital, she lived alone and appeared to cope fairly well.

She's deteriorated in hospital and is now very weak and confused. She's not been eating / drinking much and is very frail. If she ends up going back home (rather than to care / nursing home), and refuses carers to help her, what happens? The hospital have at times considered her not to have capacity, but on other occasions determine that she does.

I live over an hour away and have young children so am limited in how much I can do. My concern would be that she would go home, be unable to cope, but refuse help from carers. Would the hospital be able to discharge her in this case?

I'm pretty sure there has to be a dishcarge plan before she can go home. When DM was in hospital, they asked my advice if I thought she could cope. At the time she was very frail and confused so she was sent to a care home for free 6 weeks rehabilitation care. She wasn't happy about it but they put a DOL's order in place just for the time she was there. During the 6 weeks, she put on weight, the confusion lifted and she eventually went home with a care package which she accepted. I

I'm not sure what would happen in your relative refused a care package provided but I guess the care company would contact SS who would step in if she was at risk on her own.

If she has capacity, no one can force her to do something she doesn’t want to do. Hospital are under a lot of pressure to discharge.

Hospital has never let my frail MIL home without a care package in place.

As you have mentioned, this will all depend on whether she has capacity currently around understanding her need for support. If she is frail, she will have an OT assessment. The OT will notice if she is confused and if it is obvious she needs support with personal care and she refuses to accept that, that will form part of the capacity assessment. There are some people who very clearly understand the risks of refusing help and choose to do so anyway and have to be allowed to make an unwise decision, however, most elderly frail confused people when you ask them state that they will just manage and that they could do it before so will do it again!
We formally assess that in hospital and demonstrate/ discuss with them how much help they will need and if they are still blindly insisting they will be fine, it is often a sign that they do lack capacity around that. Sometimes someone might say that they know they will struggle and yes they understand they could fall and break a hip or even die, but that is a choice they wish to make and those sorry of conversations usually suggest that they do have capacity. It is difficult but try not to worry. Make sure the ward OT knows what your concerns are.