Beyond furious with hospital discharge

[TonTonMacoute]

MIL has just been sent home from hospital after an operation and a period of recovery. We went over to settle her in, did shopping and so on. We spent a while putting all her meds into the dispenser had a cup of tea then left her, she was totally exhausted and couldn't wait to go up and have a sleep.

Within an hour she rang us to say she had fallen and couldn't get up, luckily we are very close by so DH is over there with her, waiting for an ambulance.

DH had been telling staff at both the hospitals she was in that she lived alone, has Alzheimer's and should not be discharged until an appropriate care package was in place.

They have completely ignored him. We checked her discharge paperwork and it states that they asked her if she wanted help at home and she said no - and they just took her at her word.

They clearly hadn't checked her notes, or it wasn't in her notes, that she lacks proper capacity to make decisions, during her hospital stay they had to put her under a Deprivation of Liberty Order for a time as she was being so difficult when they stopped her anti-psych medication.

DH has been telling them over and over and over again that there was a big risk sending her home they have ignored him and this has happened and I am just fuming about it. It was completely avoidable and now she's headed straight back to hospital again!

That's absolutely shit. Sorry to say this but I would get a formal complaint off to PALS pronto. If there's a copy of the discharge letter around, copy in the doctor who signed it.

Key phrases: unsafe discharge; diagnosis of dementia; mental capacity assessment of ability to decide on discharge destination.

Ah the solid concept of 'capacity'

Sadly your MIL is not the first person who this has happened to and she won't be the last. We were told by Social services that if someone can express an opinion then it has to be respected even if you, they and everyone else on the planet thinks it's totally wrong. Yes- there are exceptions but they are limited and rarely happen. You hear about it all the time - elderly relative is offered home support but declines as a) doesn't want it b) says my son / daughter will help me. Son / daughter lives 300 miles away

Yeah mental capacity assessments are frequently done really badly but they don't have to be. I've seen them done well. Unfortunately if starting from the viewpoint of 'how can I get this patient off my caseload" the capacity assessment is likely to be flawed.

Sadly your MIL is not the first person who this has happened to and she won't be the last.

I know this only too well sadly. When you get to my age half of your friends are going through it all too . I've got to the stage that, when a friend tells me a parent has just died I have to stop myself from saying 'Lucky you, and them!' at least they are spared this terrible treatment. It's truly worrying when you think how many thousands of elderly, and their families are all being treated in this way at the moment.

The ridiculous thing is she can afford to pay for care, instead she is going to be blocking up a hospital bed for goodness knows how long!

Thanks for the replies - just wanted to let off steam really before my head explodes with rage.

That is dreadful but the same happened to my relative, if she has not injured herself then maybe she could be discharged straight to a respite carehome.

It happens all the time Blankets, it's so depressing.

I know, I have seen it from both a professional and personal view, this would be a failed discharge, you could get in touch with PALS to ensure this doesn't happen again, I hope she is ok.

Thanks Blankets.

We waited 6 hours for the ambulance, the paramedics checked her over and she's in one piece, but they insisted on taking her in because she had hit her head and she's on anti-coagulants, so she must have a head scan to make sure there's no internal bleeding.

They seemed surprised that the OT and discharge people hadn't visited her house and had a discussion with us before sending her back, so we could have made sure some basic measures were in place. If she had had a panic button, for example, she wouldn't have had to crawl down the stairs and back up again trying to find the phone .

For the sake of an extra couple of days in the community hospital she is now sitting in an ambulance at A&E for goodness knows how long

OT here in an acute hospital. It does not sound like the best discharge but I am not sure how having carers would have prevented this fall. To be honest, most of the patients we see are widely and frail and at high risk of falls. Most of them are sent home because that is what they want. She could have been discharged to a residential home and still fallen in her room. However, she definitely should have been encouraged to wear a pendant alarm.
She may well have been fully assessed, passed everything, said she did not want help and been deemed to have capacity. In which case we have no choice.
I had to reassess a lady today who has sat in hospital over a week awaiting care to be available. She does not want to wait any longer. Fortunately she had improved a lot but I know her family will be unhappy she was going without the 3 times a day POC. We have to respect the right of a grown adult to make an unwise choice and it is hard for us too

I don’t quite understand, OP- you say you settled her in at home and checked she was ok and felt it ok to leave her.
How would having a care package in place have prevented her falling and being readmitted to hospital?
Did you not anticipate the possibility of her falling and that a pendant alarm would be a good idea as she was going to be left alone? After all you know her better than any medical professional.
I do thoroughly sympathise as I am going through the same with my mum at the moment, 3 daughters taking turns to stay with her currently as we all live at a distance.

Complain to PALS.
Contact SS and ask for an urgent review, telling them that her discharge failed.

Yes,this.

OP .so sorry,it's just awful 😢

Honestly, SS will put it all on you if you don’t put your foot down.

Hi, nurse here!
while I understand that this a very upsetting situation. I’m not sure a package of care could have prevented this. As they would visit for a period of up to an hour and leave, so the fall may have happened regardless.

In terms of the decision of no package of care, even with people with dementia we do capacity assessments. Multiple assessments by different professionals at different periods of the day. This helps to determine whether we ask the patient if they want a package of care, or whether we do a package of care ‘in best interests’ if several people documented conversations where they have assessed the patient to have capacity. It would mean regardless of the Alzheimer’s diagnosis it would still be her choice. This can be really frustrating for family and also for the staff in hospital. When we feel someone would be better suited to some help and the older generation can be quite stubborn fighting for independence, which we have to respect.

I’m sorry this has happened. Just thought I would add the perspective of someone who works on a medical ward who deals with these situations frequently.

Also…. Regardless of your complaint, the fact she has been readmitted within 48 hours of discharge is classed as a failed discharge and her hospital notes will state ‘failed discharge from X ward’ and that ward will be fined for it.

And yet your husband knew there was no appropriate care package in place ….An elderly lady post operation with Alzheimers, known to be a risk , and your husband despite living nearby decided it was Ok to leave her. Why didn’t he stay with her if he was so concerned?

Did she already have a pendant alarm? If not why not. It's an easy thing to put in place.

Yes, I agree Infra it could have happened if other people had taken her home and then left.

However, a package of care is not only about people visiting, it should have included a visit to her home to make sure it was safe, and that any necessary safety equipment and handholds were installed around the place.

In fact she had fallen off the loo, which sticks out into the bathroom and has no support on either side. One of those units that fit round a loo with big handles to hold onto would have prevented this accident and a professional would have spotted it straight away. She should have had a panic button too.

You are also spot on about wanting to hang on to their independence, MIL is as stubborn as a mule and is very difficult to help. That is why we kept telling them that they couldn't assume that we would be able to provide all the help she might need and we needed another pair of eyes on her.

The news of a fine just makes me more depressed somehow, this should be a wake up call not something to be punished.

In fact she had fallen off the loo, which sticks out into the bathroom and has no support on either side. One of those units that fit round a loo with big handles to hold onto would have prevented this accident and a professional would have spotted it straight away

And you spotted it and know what it is she needs. So why not just get it done? You said she has money for care, so just arrange for handles to be fitted and pay for it.

Nurse here, and someone who has dealt with in-laws refusing care at home.
Your MIL has had a failed discharge, hopefully the team will learn of this and they will learn from their mistake, so moving forward it doesn’t happen to someone else.
My in-laws also refused care so we had to get SS involved. They tried to wipe their hands of it, but we dug our heels in and refused to offer care, so they were forced to be involved. Eventually, with a lot of pushing from our end, they did the sensible thing and got a court order to force them into a home, where they are now thriving.
Good luck, but you’ll need balls of steel !

My Mother (end stage 4 Ovarian cancer) was discharged into the care of her 88 year old husband (dementia & on sleeping tablets). They are rural too.
She has been taken back in twice now for collapses as she tries to get out of bed to use a commode. Now bed blocking as she is refusing Hospice so waiting on Hospice at Home care package. Frustrating.
She's also possibly now dying of Cancer as she wasn't scanned till FEB despite becoming ill last Aug due to 'Covid backlog' but that's another story...

Because she was going to bed for a nap! She was grey with exhaustion, we had spent nearly 2 hours with her and she wanted us to go so she could rest. He carried her bag up to her bedroom and offered to help her upstairs, which she refused. He agreed to return in 2 hours to make sure she took her evening medication. What else do you think we should have done?

Even if we'd still been there she would still have fallen off the loo and hit her head!

We had been suggesting a panic button for ages - she wouldn't have it. She is much, much weaker now than before, and if OT had met us and we had visited us and the house before discharging we would almost certainly have got one set up.

Have you ever actually had to deal with this? You can't force people who want to be independent to accept your help and do sensible things, especially when they are demented and paranoid.

package of care ... should have included a visit to her home to make sure it was safe, and that any necessary safety equipment and handholds were installed around the place.

One of those units that fit round a loo with big handles to hold onto would have prevented this accident ... She should have had a panic button too.

When did you realise she needed those things? Since not before her discharge. Sounds like you've learnt a lot very fast. Anyway, It's good that you know all these things & can get them organised before she gets discharged again.

ODFOD!

I made this observation with the benefit of hindsight! I haven't been in her upstairs bathroom for years until last night, I didn't even know she used it as she has a much smaller ensuite.

OT should have visited her home before deciding she was fit to go back, fact. They would have spotted this straight off and yes, we would have happily paid for it.

Yes I looked after my dad with dementia and Alzheimer’s for 5 years so I do know what it is like. I’m sorry your MIL and family are going through this it’s terrible. Unfortunately it will only get worse and your husband need to be proactive and mitigate the risks to your MIL as far as possible. 💐