Catastrophe - mum has discharged herself

[Hembria]

My dm has been in hospital for about 5 weeks recovering from a lower leg amputation. The hospital discharged her to a nursing home, as they felt she lacked capacity to go home and it wouldn't be safe for her because she gets very confused and incontinent during evenings and nights.
Whist in the nursing home an OT tried to do a capacity assessment on her but said she was too sarcastic for them to complete it but they felt she didn't have capacity and should stay longer term in a home.
Today she discharged herself and the nursing home let her leave even though there is nothing in place for her at home. No toilet she can access, no bed she can access, nor a package of care 😨. The home didn't tell me she had left, i found out because the prosthetic limb service were trying to track her down so phoned me.
She is now sat in her wheelchair, which she is going to have to sleep in, with nowhere to go to the toilet. My dad is very frail, so I'm praying he doesn't try and help her up the stairs.
How the hell does this situation happen? How the hell do I fix it?

I'm lost for words.

First port of call phone your Mum's local adult social care team - Google the town name and adult social care, there will either be an out of hours phone number or a general number and when you call that it will direct you. Explain everything you've said here and that your Dad can't cope with her alone. You are unable to help and so they need to put emergency plans in place. Also make sure they know what the home has done; this is a significant safeguarding issue.

Thank you for responding @NwNmOldFace I will go and have a look for their number now.

Oh dear sorry to hear this. This should not have happened as if she was deemed to lack capacity to make a decision to leave then she should not have been allowed to do so. So that in itself should be followed up and reported to the adult social care team/CQC.

but now she is where she is, I agree you need to either persuade her to go back, at least for a period of time pending further assessment of her capacity and best interests/DOLS, and/or get urgent help from the Adult Social Care team covering her home address. Or if she’s only recently out of hospital back to the team in the hospital that arranged her discharge.

you could also get the GP and district nurses on board and explain the situation.

Bring her to a&e

Does she have a uti ?

There doesn't seem to be anything anyone can do tonight 😕

@Hembria then sadly the only option may be ED, (A&E). Make sure they know the full story of what has happened so they can raise a safeguarding referral too. Wheelchairs are not suitable for her to sleep in overnight, nor really is an armchair tbh without risking severe pressure damage to her bottom and she will also need the loo and appropriate pain relief so if social care are refusing to assist either take her or call 111/999 and explain she's an unsafe discharge

How are you all doing today Hembria? I feel for your dad.

How on earth did she get home, it sounds like the carehome didnt do a capacity assessment and place her on a DOLS. It could have been done in hospital, who authorised her to go to the carehome in the first place if she lacked capacity.

Thanks everyone for your comments and checking in!

Last night was a nightmare of phonecalls with a lot of shoulder shrugging. Adult services told me that they couldn't do anything because she had discharged herself from the care home. 111 said they couldn't do anything and I needed to talk to the gp.

This morning I did get the promise that a district nurse would check on her and she will get a wheelchair toilet today but apparently mum has refused a bed or any other adaptions so she will continue to sleep in a chair and there is nothing else thar can be done until there is a crisis.

Obviously, I will continue to follow this up but if you have any other ideas let me know.

Would requesting an assessment of your dad's needs be a goer?

I would contact her g.p, adult social services and ask the district nurse if she can carry out a capacity assessment. Do social services know she failed a capacity assessment in hospital, do you know how whe was discharged to the carehome, does anyone have poa. If she lacked capacity in hospital then they must have done a best interest meeting and sought cop to discharge her. Have you spoken to the manager of the carehome, they must have arranged her transport, she couldn't have just got herself up dressed, into a wheelchair and out the door.

If they say she does now have capacity and can stay at home would she use a riser recliner chair, some people do sleep in them.
If she has had an amputation then how does she think she is going to get up, use the loo, your dad is too frail and if he tries to help her then they could both end up injuring themselves. Ideally the district nurse will suggest a home needs assessment and persuade her to get help qnd adaptations, if she is worries about the cost then she can get free adaptations to about 3k I think. She can also apply for attendance allowance and your dad can request a carers assessment.
Do you know why she is refusing any help. Do you have power of attorney for her.

Hi @BlanketsBanned the hospital did indeed carry out a best interest decision for her because there is no poa in place. I did explain to social services that she had been deemed to lack capacity in hospital and also from the inconclusive OT assessment that happened on Monday but they said that they couldn't help because she was under the healthcare team and not social care.

The home haven't answered my email - I want their response in writing, but she came back home in an ambulance, so yes someone must have booked it.

Good plan about the district nurses, I'll try and track them down. I've also instructed my dad to tell them he can't cope but I doubt he will admit that to them in reality.

As to my mum, she hasn't really grasped that she can't get upstairs or has has problem.

@PermanentTemporary I'll see if he'll go for it.

Once again thanks everyone, I really appreciate your help with this nightmare.

What healthcare team do social services claim she is under, the nursing home accepted her knowing she lacked capacity so should have arranged an assessment and a emergency DOLS, referred her to her g.p. either a nurse or a gp should have reciewed ner in the carehome for medication, dressings, etc. Was it a nursing or residential home. I imagine the OT wont be too happy she was sent home, you could ring the community team and tell them, maybe they could visit her at home. Some gp practices have elderly care teams, early intervention teams that might help you. If social services wont get involved then ask for the adult safeguarding lead instead. A keysafe might be a good idea and a care/falls alarm. The last thing you need is for her to fall out the wheelchair or off the commode, your dad tries ro get her up and hurts himself. How was the carehome getting paid, you dont want to end up sorring out a massive bill. What a nightmare.

Right, so she's refused a bed or other adaptations - what's the care plan to avoid pressure sores or even to monitor for them? Is your dad supposed to be doing it? Has your mum been able to give any response as to her views on pressure sores and how she feels about dealing with them?

I may say that the thing that caused serious improvement in my mum's situation was my sister writing a HUGE complaint about the first nursing home she went to, copied to Uncle Tom Cobleigh and all. Tbh the manager of the nursing home was OK about it. It sounds like they massively dropped the ball here. Was the GP involved in this plan for her to go home?

Personally I would contact the cqc

Seconding the CQC here, and go to them with all guns blazing.

That's appalling of the home she was in.

Definitely report them to the regulatory body.

That’s terrible. She was assessed as lacking capacity? The care home should put the DOLS in place and started the ball rolling with other services. She shouldn’t have been able to discharge herself. They’ve failed massively.
Have you spoken to them since the discharge?

Capacity can fluctuate, an individual can lack capacity in one setting and at one time but may have capacity at another time. Most care / nursing homes have DOLs (deprivation of liberty) assessments carried out as this enables them to keep the doors locked & legally prevents their residents from leaving. However, an individual who is deemed to have capacity is allowed to make (what may be judged) to be a bad decision. The whole area is extremely complex and never black and white. This sounds like an extremely frustrating, heartbreaking and baffling situation that the OP and her family are in, I hope community agencies are able to offer a solution before an otherwise inevitable crisis leads to A&E

Quick update - the nursing team visited and have said my mum has to return to the nursing home.

What a relief!

will she go though?

Good, lets hope the nurse makes it very clear to the carehome that she cannot look after herself, is the nurse putting in a safeguarding concern. Are they arranging all the transport, is the home the right one or is she going to a new one.

@iCorvidae I really hope so!

@BlanketsBanned it looks like she is going back to the one that she has just left - I guess because that's where her spot bed was arranged for. They can't move her tonight but will arrange transport for her. - I can't thank you enough for all your help with this!

I'll keep you all posted, as I know more

Thank heavens for that. You must be so relieved. But heads still need to roll for letting her go in the first place.