Hospital want to send lady home with only twice daily care.

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I'm looking for some advice to bring to a meeting my friend is having on Tuesday with regard to our elderly friend. (We used to work together years ago)

This will be long, I'm sorry in advance. Please stick with me as I don't know what to do for the best here.

The lady has been in hospital for a few weeks now.
Admitted as suffering hallucinations and showing signs of dementia.
She hasn't been able to look after herself for some time as it turns out.

She's been outside wandering around in her pyjamas walking a non existent dog.
(She had a dog but the dog was at home and she went out to walk him without taking said dog)

Unable to look after her pets or house (really in an awful state apparently) they have both been rehomed while she has been in hospital.

Is incontinent (urinary and fecally)

Not feeding herself regularly, When she does eat she has eaten dog food (the type that comes in a roll, we think she may think she's eating pate)

Not drinking any liquids.

Refusing to shower/bath

Very confused/not recognising people she has known for years.

She was in a terrible state the day she was taken to hospital, Found lying in her bed in pee and poo.
Hallucinating very badly and in a very upset state.

She was found to be severely dehydrated and suffering from multiple infections which they have now got on top of.
I am told that the infections were so bad that she would have been dead in a matter of days had she not been found.

Despite recovering from the infections, she is still hallucinating, trying to escape the ward, not recognising people.

The hospital say she is fine to be sent home and that a carer will be provided twice a day.

I think that if this happens it's only a matter of time before something terrible happens as she cannot look after herself/keep herself safe.
The hospital say as she is capable of showering and heating up a can of soup then she is fine to go home.

I really think she should be in a care home as there is no one nearby who can look after her.

Has anyone been through similar or have any advice that my friend can take to this hospital meeting to support them not turfing this lady out to rot at home?

The meeting is with the OT, social worker and doctor.

What is your relationship to the patient ? Have you even met her ? What relationship is your friend to the patient?

I did say we used to work together years ago.
So yes, I've met her.
My friend also used to work with her and lives in the same street.
Did you mean to sound quite so hostile @formulatingAresponse ?

Does she have a social worker assigned to her. I would say it was an unsafe discharge

There is a social worker to be at the meeting, I don't know if this is her own assigned SW.
I'm not sure if there has been one assigned or if it's just general social work department involvement at this stage.

You sound absolutely lovely op.

You sound absolutely right - this lady isn't able to look after herself. Even with a cater 2x a day . So sad . No one cares .

I'd speak to social services and if you can - the nurses at the hospital - they might be able to guide you on what to do .

So sad . Good luck x

Thanks vicar.
I'm worried if the discharge goes ahead that something bad will happen at night.
I think the neighbours will keep an eye out during the day but if she goes wandering in her pyjamas/barefoot again in the winter then it may end badly.
Small village in the Highlands so freezing temperatures and very fast flowing river nearby. Doesn't bear thinking about.

I think your only course of action is to present the facts as you know them, as you’ve written here, to that meeting. Ask how they plan to stop a repeat of events with only two visits per day and no other supervision outside of those visits. How do they plan to stop her wandering into the river etc if it’s taking a ward team and a secure ward to prevent her escape now. Make it very clear that there are no family / friends / neighbours (if that’s the case) that can or would be able to fill in the gaps and provide security, food, companionship, and ensure a decent living environment was maintained. To trot out a well worn phrase - the authorities do have a duty of care towards and safe guarding to your friend. Ask them exactly how they plan to fulfill this.

Thanks @Alphabet1spaghetti2 my friend is attending and I'm emailing in support as she is worried she won't be able to get her points across, She'll print out my email to use as support so I might just copy and paste what I've put above.
I'll use the duty of care and safeguarding lines. Thank you, That's really what I'm looking for are the words that will get action taken.

I'll try and call adult social care and there is a charity called Age Scotland that might be able to advise further.

Do you know if this lady has had a mental capacity test? This is essential and also a cognitive test. This lady urgently needs an assessment of needs by the Social Worker. I’m afraid you may have to demand these as I had to for a family member in a very similar situation.

Mental capacity and cognitive test and assesment of needs by a social worker, I've taken note and will find out tomorrow when my friend visits.
Thanks @BattenburgSlice
What was the outcome for your family member? (Only if you don't mind sharing)

My relative is settled and happy in a care home. They also have dementia. I wish you all well op.

I am sorry to tell you my experience of a similar situation is not hopeful. My colleague passed a mental capacity test and turned away all carers. 10 years later she is still living in squalor eating goodness knows what. She has had several serious accidents, resulting in months in hospital, but she always seems to go on to pass the mental capacity test again, and get discharged with carer visits again, then refuse entry to the carers, and stumble on until the next serious accident. Her house is falling down around her ears - you can see daylight through the ceiling in one place, and there is no electricity. But she somehow always passes the mental capacity test ....

Is she able to recognise when to eat? Can she take herself to toilet/manage incontinence? How will she manage medication?

@2greenroses this is my fear. Sorry to hear about your relative.
@MereDintofPandiculation She isn't able to do any of those things. Regularly soils herself and has lost so much weight that she is almost unrecognisable
I think that the carer will do meds, that's assuming that she only needs them twice per day.

Does she have family? Does your friend have POA for her? If she has family and your friend does not have POA I'm not sure how involved she can be. It sounds like the lady needs full time care.

Poor woman.
In my experience Hospital Social workers are very hard nosed and keen to discharge patients.
Twice daily visits may keep her going but it sounds like she needs a care home.
Is there anyone with power of attorney or a near relative?
At the hospital I would state the facts as known and say you think this is an unsafe discharge.
I would also contact the local authority and report the lady as a highly vulnerable adult - she needs a social worker. They plus her GP will need to be on board to have her needs properly assessed.

No one has POA and her family live far away.
Contacting the local authority is a good shout, Thank you.

Remember to use the phrase unsafe discharge, this was what I was advised when hospital were trying to send my DF home when he was in a similar state to this lady. He also had cancer and died whilst the hospital were still fighting with us that he could cope at home

Yep - unsafe discharge is a key phrase!

Adult social care should be involved. This lady should be in a residential care home. Sometimes you really have to push for these things to happen. Are her family in a different country?
Do they know the extent of her condition?

OT/SS can provide alarms which trigger when a door is opened or movement sensitive mats if she gets up. Could she afford additional care or be eligible for a volunteer befriender scheme? Any family?

Distant family (cousins) are at the opposite end of the UK and yes they are aware, They have visited but I don't think they would be able to take her in or even visit up here much.

Tell your friend to write down he r concerns-
Toileting
Eating/cooking/food prep
Left unsupervised with openable doors/oven/ fire etc
Risk of falling
Bathing/hygiene
Meds
Talk about no family /support

Don't mention people going to check on her etc obviously you will if needed but they will use that to their advantage if they can.

Oh yes and if she is going home she will need an alarm around her neck.
If it's a firm no for care home what about assisted living?

There was mention of an alarm @LIZS but who does the alarm get sent to? There isn't a police station here anymore.