Unsafe discharge from hospital

[PaintYourDreams]

I hope someone can help me with this one please. My MIL was taken into hospital a few weeks ago and it was a nightmare to get her there. She was very unwell but also extremely hostile to any medical intervention and it was very upsetting all round but once she was there and being treated she's accepted it and doing better but still quite a lot wrong with her that will need ongoing treatment.

The problem is that we've been told by a discharge person (not a nurse, I don't think) that at some point they will discharge her by either us collecting her or them taking her home where they will do a two hour 'assessment' to see if she can cope at home. So the assessment will be done once she has already been taken home. MIL will say yes she can manage fine but she was in a terrible mess and not coping at all when she went into hospital and we think that daily carers and a stairlift are the minimum needed. None of this will be in place if they just bring her back and then decide she doesn't need help. Or if they decide that she can't manage, then she's had all the trauma of being taken home and then taken back to hospital.

So I guess my question is whether this is the normal way that an assessment is done or does this mean that they've effectively decided she is discharged back to her house as it is even though we don't think this is safe.

Have had experience with this with MIL, FIL and DM.

You know that list with the 3 most stressful things you can experience -
death of a loved one,
moving house
divorce ?

Well I put Discharge of an elderly frail relative up there too.

The bar for judging someone has capacity is low - can the individual express an opinion - yep they have capacity. Even if the opinion is deluded and complete fantasy - just like Motherofterriers's father.

The only additional thing I would mention is about night time care, or rather the complete lack thereof. My DM has dementia and a night time waker and wanderer. Couldn't get any LA support for this at all.

I can only offer my best wishes to you

He got the fast track when he was nearly dead. My appeal concerned the year or more of care that preceded that. The appeal was successful because of my tenacity and knowledge. How many other people are slipping through this net? - or simply do not know that this funding exists? My OH only got an assessment at all because I knew the system. No-one mentioned it to me.

I truly believe that MotherofTerriers's experiences are not unusual. It is very important that those with some control over this system do not disbelieve this, or improvement will never happen.

Hi, no she was discharged from a ward not A&E
And yes I should have complained but I was stretched doing what I could to support them long distance
In the end I moved mum up here
The quality of care was just appalling

Well there we are - not just me!

Sorry you had this bad experience.

I would put something in writing and ask for a meeting with the discharge team/social worker/OT about specific concerns you have and ask what they have planned to do about them. E.g. cannot get upstairs to bedroom or toilet Cannot prepare food or get a drink Cannot wash themselves. These should have been assessed at the hospital by a physio/OT check that they have. If a hospital bed, recliner chair,commode, perching stool may be required insist these are in place before discharge - as they are keen to discharge they are more likely to be fast tracked. Many years ago I was an OT when assess to discharge was not allowed. It can work but only if you have a swot team ready to supply equipment and care within 24 hours. I have recent experience with a relative's discharge and found I needed to very firm in spelling out what would be needed and they were not to be discharged unless a plan was in place.

My mother was discharged after breaking her hip and spending 10 weeks in a ‘rehab’ centre. The sum total of physio was a printed sheet left in her bed for her to do exercises. She has Alzheimer’s.

She couldn’t stand or walk unaided and as every manoeuvre involved 2 staff members and a rotating trolley I was sure they had mixed her up with another patient when the discharge co-ordinator insisted that she was going across to the toilet independently at night. In the end they phoned and said she was on her way home on hospital transport and was someone there to let her in. I was 3 hours away.

My sister had to rush from work and with a neighbour get her bed brought downstairs. We had to wait 3 days for the care package to arrive, during which my sister and I slept on the living room floor so we could hear her and manhandle her inexpertly on to a commode.

But with both parents we have also had examples of discharge and an enablement package working as it should.

@Justilou1

One of the problems with the concept of capacity, is that legally people are allowed to make decisions for themself over and over again, no matter how stupid or dangerous it is - until someone steps up to say that they DON’T have capacity after all. Your MIL will do everything she can to avoid being moved. (Makes sense.) She will lie to whoever asks. You need to speak to the head nurse now and explain that no neighbours will be doing meals or helping out, and you will NOT be stepping in.

You're right, if someone has capacity, then they can chose to make as many risky of stupid decisions they like. I would always ALWAYS encourage relatives / carers to speak with discharge teams / the teams working with the client to tell them that they person isn't managing/ can't manage / is not being truthful about how things were before they were admitted etc. We cannot force someone to have a care package. We cannot refuse to discharge someone home unless they do not have the capacity to make the decision. Absolutely everyone someone should get POA set up for themselves and their relatives. But POA only kicks in if the person loses capacity. Social services have registers of people who live in the community in really risky situations but for whom they cannot do anything for because the person will not allow them to. It's the realty for more people than you would realise, sadly.

Mother of Terriers' experience is almost identical to mine- except I'm in Suffolk. DF also lived on the South Coast and said I went in to see him every day.
Social worker ignored the POA as she deemed that the test she did meant he had capacity- even though he didn't. Deciding that he was coming to stay with us for Christmas, involving 2 changes of coach when he couldn't stand to go to the loo without help should have given her a clue.

This all sounds so familiar. I was "manhandling" my OH onto a commode too. Sending round a commode ticks a box - but who is there fit to help him use it?

Well it is scary thinking that your loved one might be left at home without the necessary support, and to be honest a few of the responses on this thread haven't helped. But the process did work as it should - the assessment took place (at home), it was quickly ascertained that she couldn't manage at home, and she was then readmitted whilst they rehabilitate further and then assess again over the coming weeks. So thank you very much for the time taken to answer my question about how the new discharge process works - it is much appreciated x

I am very glad that the bed was there for her to return to and hope that the rehab goes well.

@PaintYourDreams

Well it is scary thinking that your loved one might be left at home without the necessary support, and to be honest a few of the responses on this thread haven't helped. But the process did work as it should - the assessment took place (at home), it was quickly ascertained that she couldn't manage at home, and she was then readmitted whilst they rehabilitate further and then assess again over the coming weeks. So thank you very much for the time taken to answer my question about how the new discharge process works - it is much appreciated x

I'm really pleased to hear that the process worked as it should, and hope that your MIL has a positive outcome from rehab.

Great news. I really hope it works for her.

It's good to have an update @PaintYourDreams and am glad a number of us helped you.

I hope your MILs rehab goes well and that things progress positively for her

In my experience a care package was organised for my parent before she left hospital and the carers started as soon as she got home. Unfortunately, they were quick to withdraw once they think they can cope on their own. My parent hated being put to bed at 7pm and then could be left in bed until 11 the next morning, wet and hungry. In desperation she forced herself out of bed and is extremely unsteady and an accident waiting to happen. But she convinced the carers she could cope on her own so they withdrew support after 10 days. Re-ablement after hospital is a short term thing so you need to make your own arrangements for when it stops. We are trying to do that now at short notice and in the meantime my parent is vulnerable.