Discharge without care package

[whiteroseredrose]

For background FIL has been in hospital in Bristol with a broken hip for 5 weeks. DH brought MIL back to our house in Manchester with him as she has early dementia and couldn't cope alone.

We are selling their house and looking for somewhere near us.

Anyway DH got a phone call from the Estate Agent today. She had been at PIL house today when there was a knock at the door.

There was an ambulance there with FIL. They put him in a chair, in his pyjamas with no frame or walking stick so no help to walk to bed or to the toilet in an empty house. No food in. No care package. Nothing. Just dumped him there.

Fortunately the Estate Agent called DH who has spent the afternoon on the phone.

My question is, who do we complain to about this? It was impossible to speak to anyone on the ward and Drs ignored us.

At the moment I'm so angry I want to go to their MP and local papers.

Thanks.

@Paq sadly this is common, I don't know why, possibly poor communication, poor staff training. I work in the NHS and shake my head/roll my eyes on a daily basis

Most hospitals now operate a system called 'discharge to assess'

the idea behind it is that rather than people sitting waiting in hospital beds for social services / OTs etc that they are discharged home/a care home with a hospital care package and services funded by the NHS.

If they are discharged home and it becomes obvious that the plan is going to fail then the person should be returned to hospital and a different plan made.

in an ideal world the services are there to meet the person when they get home but what often happens is that the ambulance transport gets delayed, or is too early, or the discharge team haven't sorted the paperwork out etc etc and it's all a bit of a mess.

its likely if you ring adult social care that they will tell you it's the hospital discharge teams mess to sort out - it's rare adult social care get involved in the actual mechanics of hospital discharge these days until it's clear the person will be remaining at home.

if the adult safeguarding team investigated every unsafe discharge that is all they would to, unless actual physical harm has come to some one as a result of a poor discharge then it probably won't meet the adult safeguarding threshold and you will be advised to complain via PALS.

the doc linked below explains a bit more about the discharge to assess pathways

www.nhs.uk/nhsengland/keogh-review/documents/quick-guides/quick-guide-discharge-to-access.pdf

I think it's purely that admin staff have been cut leaving clinic staff responsible for completing paperwork and making phone calls they don't have time to do. Because there aren't enough of them either.

so it doesn't get done and everyone assumes someone else is doing it or having those conversations with family/services etc but no one is.

I know this sounds horrendous but we need far more facts here.
Many people return home post hip fracture managing independently although if he had been in for weeks it sounds like he was less able. In that length of time he might have actually rehabilitated on the ward whilst awaiting rehab or a care package.
Hip precautions have been pretty much dropped by most forward thinking trusts as there is little evidence to support them and most patients should just move within their comfort zone.
If he has capacity and said he wanted to go home and told the ward that he would be fine and that he had friends and family who would sort our shopping etc then the ward would have to accept that, unless he was confused.
I think you need to find out way more before complaining about anything.
Imagine if you were in hospital asking too go home and someone said they would not allow it without talking to one of your children first!
I am surprised that your dad has been in hospital for weeks and you seem to not even know what surgery he has had? Have you not been talking to him regularly?
People need to know that there is no magic wand here. There is a huge lack of community carers and patients are getting stranded in hospital for literally months and whilst they are sitting in a bed that they do not need, there are ambulances queueing outside the hospital, treating patients from the ambulance because there are no beds to move them to.
Families need to do all they can to support their own. It is honestly such a rare experience now in hospital, to come across a family where they are willing to provide support on discharge, have a parent live with them for a couple of weeks, offer to stay the first few nights they are home or even offer to get some shopping in. There is a massive expectation that' the state' SHOULD do all this, but this is not possible with the resources available and families need to step up.
My advice is to get the facts.
Was dad at risk? Could he get to the toilet safely? Can he use a phone or computer to order in food? Was he offered a hot meal delivery service but declined? Did he see an OT and have a wash/ dress assessment? It sounds like a community volunteer group was asked to visit asap after discharge and do an emergency shop which is normal. Forgetting to discharge with his walking said it's very poor but once aware it should like they got it delivered quickly.
Once you know which bits were not safe, you know who to target complaint to but please speak to your father first and find out what he told the hospital.

@vdbfamily I appreciate you probably have more knowledge than me but:

• we live in the 7th wealthiest country in the world, the resources should be available.

• an elderly man was discharged to an empty house without his family being notified.

• the family are ill-informed because his doctors and carers will not speak to them.

I find it shocking. I will always find it shocking no matter how common it is.

They could hardly consent to staying/having him stay if they weren't aware he was about to be discharged. And as for not being aware what surgery he has had, if he's anything like my FIL was, he wouldn't ask questions if he didn't understand and quite often told us stuff that was clearly wrong because he'd got the wrong end of the stick/made assumptions so you could talk to him 3 times a day for weeks and still be unclear what treatment he had had. A number of times we made arrangements based on what he told us that turned out to bring inappropriate/inadequate/unnecessary.

I do not disagree necessarily but it is the reality currently.
We assessed a man yesterday on the ward who waited and dressed himself safety and independently. We have him info on bit meal delivery but he said he walks to local supermarket. We did phone his family with consent and they said they would not accept him being discharged without careers in place and they/ he could not afford this. If we accept this, he will wait in hospital, medically fit, for at least a month, to receive care that he can manage without, albeit slowly. That will be a minimum of 30 bed days that could be treating the patients who are pulling up outside our A& Es. Another family yesterday refused mum home as had a bereavement and needed time to sort things. We suggested private respite but they refused to pay. Obviously a sad situation but why should the NHS keep these people boarded in acute hospital beds. Other families do not return our calls because they need a bit of a break. Some children say they won't let their parent home when it is the parents home that they have lived in free all their lives. Others will not let family go into needed care home as they don't want the house sold. Some staff get into trouble for phoning relatives when the patient does not want anything discussed with anyone.
It is really really hard in our hospitals at the moment and whilst there is no excuse for unsafe discharges( unless patient has consent and chooses to go) we have to make tougher choices as to what the risks are as the risk of a patient NOT going home might mean another patient has a 12 hour wait for an ambulance( because they are all waiting outside a&e waiting for a bed to be vacated) and dies at home.
The main issue is not with the NHS currently, it is with the number of patients in hospital beds who do not need medical care, but need some support at home. The basic support often is offered by Age UK/ Red Cross who sure heating is on, food in fridge, sheets on bed etc.
It sounds like these people did arrive and shop and it sounds like careers were arranged for next morning( unless that was result of families subsequent calls)
My suspicion is that if he was in for 5 weeks post hip surgery, he was waiting for a package of care, ( as people not needing care are usually out within a week or so,) which for patients post hip surgery will often just be a morning call to make sure they are up/ washed/ dressed/ breakfasted etc. This means when they are sent home, it will be a volunteer who settles them in as the career will not be there till next morning.
I did once have a patient discharged to an empty home but only because she changed her mind about where she was going,having told us she was staying with her sister, which is where we sent all the equipment etc. She told driver she was going home and was left in house without equipment or support of her sister. She promptly got stuck in her chair that was too low and needed a community admission avoidance team to rescue her!!

@vdbfamily yes I agree that the problem is not in the hospitals, it's in the wider care system.

Hospitals only see the patient as an illness to cure, not the wider context of their families and support systems.

Please don't judge families for not paying for care or taking in care duties themselves. People are already fully committed - jobs, children etc. and can't take on the care needs of a frail elderly person without jeopardising their own lives. If I lost my job because I was caring for a parent I would end up homeless.

People's own illnesses, pressures, financial and MH issues don't go away because someone in their family suddenly needs a carer. They may not be in a position to share all of that information with hospitals.

We have a national health service and a social care service which should be funded from taxes. If the government needs to divert more money into it then they should.

Think its probably better to be sure of the facts before making a fuss on Social media and discussing his confidential medical information with MPs .
Hospitals are not prisons and just because someone is elderly doesn't mean they arent able to make decisions regarding when they want to be discharged or what support they need.

Unless FIL has an ' impairment of the mind or brain' the law says you have to assume they have the capacity to make such decisions (even unwise ones)
He may have been offered and turned down a social care assessment or may have had a social care assment but didnt meet the criteria for support.

again I agree and as an Occupational Therapist, we do look at the whole person and family and are often the ones advocating for a few more days to properly assess and make sure there is robust community support on discharge whether that be a POC or mental health support our a meal delivery service, or a volunteer visitor or attending a day centre etc etc, however we still meet, on a daily basis, patients and family who insist, whatever their financial situation, that they are not prepared to pay for anything and even if they do not meet criteria for free care, will happily inhabit a hospital bed for a month or so to await a few weeks of free care until a SW gets round to the financial assessment that they will no longer undertake in hospitals. This is crippling the system. If people can afford carers or respite after leaving hospital, they / family should arrange and pay for it. If not, they might, the following week, be the person unable to get an ambulance or a bed in A& E.
I do not expect people to give up jobs to care or to be up at night looking after elderly parents and then trying to survive and work a day job etc, but you would be shocked at the level on entitlement we see on a daily basis. I know of 2 patients who spent over a year in hospital with family refusing to divulge their financial information or engage with a discharge plan.
Anyway...I will stop hijacking thread now.
OP, I hope your father is okay and if there were failings once you have spoken to him, go to PALS and request they ask for it to be looked into.

I think you need a proper conversation with your father before you complain.

He may have said he was fine to be discharged. If he has capacity and agreed to the discharge then they will indeed discharge him.

If he knew no one was at home then why did he allow himself to be discharged? Why didn't he call or ask someone to call you? Could it be because he knew you would say no and decided to present it as a fait accompli?

Of course, if he cannot make these decisions it is a completely different story and you should complain to PALS.

This happened to my DF as well. We had met with OH who listed what was needed before he came home (he had a very bad fall, many broken bones) we had nothing in place, couldn't find out when he would be coming out then he suddenly appeared wheeled up to the door in hospital gown and dumped. I complained directly t to the hospital and many months later have just received an apology.. not satisfied with some of the comments ts and I'm considered taking it further

It's rather unfair to blame families refusing to take them on in this situation. Over 20 years ago my mother was given 3 weeks paid compassionate leave from an NHS job to clear an elderly relative's flat (not one of her parents so not a close relative) when they went into a home.

No idea what the current NHS compassionate leave is like but our policy at work is very clear that you may be granted a maximum of a couple of days paid leave to arrange care needs (it specifically states not to provide care yourself) in the event of a short specified list of relatives being ill. But that's it. Anything else would need to use annual leave. Given that a lot of us already need all of our leave for childcare etc that's not going to happen. And given that a lot of us now live 100s of miles from elderly relatives that also makes it impossible.

In the last few weeks I know of an elderly woman having a hip replacement who arranged to go to her daughter's to recuperate for six weeks after. Except the daughter is over 100 miles away and works full time (so can't temporarily stay at the mum's house). So woman discharged within a few days and driven miles away. Not coping well with pain after surgery, journey makes her worse. Can't access GP in new location as she doesn't live there. Condition deteriorates. Daughter ends up driving her all the way back again to access GP and she ends up having to go into respite care. If there was proper convalescent services set up as there used to be then none of this would have happened.

I'd be taking him straight back up to the ward and insist they sort out what they should have done properly in the first place. And I'm an OT! Such poor practice and I'm really sorry this has happened to you and your family.

To all you coping we had 'bed blockers' as they were called in 1980 and here we are still here today. No government has dealt with the problem of an ever increasing aging population, living longer with less family support, no small/cottage hospitals, no convalescent homes. What did they think would happen a huge scandal just building for decades. It is shameful that families are too scared to assist in some cases because they know thatthey could be left abandoned in charge of ill confused family members trying to negotiate care packages with overworked underfunded providers. To learn that hospitals and social workers think it acceptable for volunteers such as the Red Cross to care for newly discharged patients is horrifying

OP: how deaf &/or blind is your FIL?

There was an ambulance there with FIL.

Why didn't FIL ring his family to say what was happening, that he was being discharged to his home?

Is OP saying FIL doesn't have a phone, can't send a text or talk on phone due to stone deafness?

For 6 weeks, I fostered a dog for an 87 yr old man earlier this year getting surgery & rehab. He was a fisherman in working life : I'm just saying not a natural with technology. His wifi was often bad. He still managed to use a phone, keep it charged, see my messages on WhatsApp, keep me & his family informed what was happening with his recovery & location(s).

I have recently had an elderly relative in hospital for a couple of months and the problems for families today are that they often don't have houses with 'spare' rooms for extra people to stay like people used to have back in the 70s, and nowadays all adults in a family work, so there's no-one at home to actually look after the elderly person even if there were enough room for them! I'm surprised though that families can refuse to let an elderly relative be discharged to that elderly person's own home? Or have I misunderstood?

The Red Cross and Age UK do not provide any care but are great for people managing but starting to struggle more. They will and can do stuff that an ambulance home cannot.
We have Age UK Take home and Settle service for patients who can get in and out of a car. The volunteer will make sure all ok at home, house warm, food in fridge sheets on bed etc and will pop out and shop if needed. They then stay in contact for 6 weeks during which time they will sign post to any ongoing needs such as day centres, meal services, counselling, visitors, telecare, help with housework, benefits etc etc. It is not terrifying at all, it is a great service, but in no ways replaces a package of care where absolutely needed. However, were see a lot of patients who do have full capacity, who are adamant they want to manage without carers as they don't want strangers in the house and don't want to wait around for them and don't want to spend their money. We have to respect this and yes... some of those people rely heavily on family to help but often family members are very loathe to say they cannot do it any more.
It is much more complicated than you think when you have a stubborn old eighty or ninety something person in front of you telling you how it is. If they tell us we must not talk to their family we are legally obliged to respect that which is very hard.