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.

I'll ask about assisted living @autienotnaughty is that like a complex of flats with a warden?

I have no experience in this but things I am wondering about:

1. Is it possible at the meeting to suggest an alternate eg care home. Obviously she can stay in hospital forever. Are you able to research other options and present those?

2 if a carer is there twice a day and they don’t feel she is coping, what happens? Is there sone kind of reporting system?

1. Does this lady have the resources to pay for a cleaner and a meal service?

It’s lovely that you are advocating for her. I hope the meeting goes well

There are monitoring companies like the panic button around the neck , to alert a nominated person.

Sounds like she's well past the warden stage and needs 24/7 care.
You need to stress there will be no involvement from neighbours. None. They will use this to their advantage.
Who will be doing her shopping for example if carers are only doing meds? Who does it now? Everyone needs to step right back as only when it's crisis point will anything change.

I think your friend needs to contact the family and ask for their support in getting her into a nursing home

Fall alarms go to a call centre. They then alert nominated people or call emergency services.
Make it very clear that whilst you're helping support her you are not available for any care or emergency contact.

My grandad lived in two. The first was as you described adapted housing with a warden checking on the residents. They all had carers and there was an alarm system that went straight to the carers office .

The second one was better, the carers were on site, the residents had their set visits but could also ring/use alarm in an emergency. There was also a communal lounge/hairdressers/cafe on site and the staff would do bingo, singalongs etc.

My grandad didn't have any savings or property so qualified for full payment by social care. They will try for the cheapest option where possible when they are footing the bill.

Suggest your friend writes to PALS at the hospital, and the safeguarding lead at the local authority outlining her concerns. What you have written here is sufficient.Ask for assurance that a full assessment of welfare and safeguarding issues is completed before she is discharged.

Good luck. Unfortunately social care is broken.

At the meeting the lady should have been invitied to attend, if she is not there ask why not.
Has she had a capacity assessment or been seen by elderly mental health team
What assessments has she had, bathing, cooking, walking, money management
Has the ot done a home visit, is her home safe
If they say she can go home how will she get there, does she have keys, how will the carers get in, do not offer any help with taking her home
Who is paying for the carers, has she agreed to this, hasnthe care agency manager assessed her to make sure they are happy and can meet her needs
Tell them there is no help available from neighbours
Has she had a care needs asessment qnd chc checklist, this may be different in Scotland but check scotland care site
Reitrrate its an unsafe discharge and she sounds like she needs full time care, she wouldnt manage in a warden flat, she needs a carehome

In what capacity is your friend going to the meeting? Do the elderly lady's family know the meeting is going ahead, have they been invited to attend and do they know that someone is going in their place?
Whilst you clearly mean well and it is vital that these points are made, I am not sure your friend is the appropriate person to make them just because the family live a long way away

I don't think she'd be able to afford private care, she rents an association flat currently.

Unfortunately I'm not available to be the responder to the alarm, I live a good distance away and don't drive. My friend has a school age daughter with autism and wouldn't be able to leave her to go looking for her, even if that were possible, where on earth do you start?

For shopping, I know my friend gets her a few bits and I something add to my Tesco delivery for her, take her food We've made, but we've nothing concrete in place for her.

PALS and safeguarding lead, okay will make contact, will try today but I'll assume I won't get anywhere until tomorrow. Thank you.

Spider is right, the family should have been made aware of the meeting qnd inviyed, if they cannot attend can the meeting be done with zoom. The hospital should not divulge confidential info about the lady to your friend so she may only be invited to part of the meeting to say her concerns.

@HappyHamsters none of that has been done. There is no plans (as yet) in place for carers entry, currently the flat is left open as she has lost every set of keys.
I'm not sure if the lady has been invited to attend herself but we will ask that she be there
@spiderontheceiling without wishing to sound unkind to them, Her family are not interested. My friend is going because there is no one else.

Be aware your well meaning intentions are propping up an unsafe situation. I would tell them there is no one to get her food and stop. This could go on for months or longer otherwise.
Cruel to be kind.

@HappyHamsters I think that's exactly right, that she's been invited to voice her concerns.
The family are aware of the meeting and I believe we're offered the option of attending remotely.
This was declined.
I don't think out of unkindness, They don't really know her or are aware of how things have been I suppose.

@cptartapp I know, I think we have to say that we can't be involved in her care, Because as much as we want the best for her, we can't be there all the time.

Your friend needs to be as tough as the people trying to kick her out. She needs to say there is no one, refuse any suggestion that she should be put down as an emergency contact or similar. There is social care out there but it's almost impossible to find.

It's very hard. Thank you for caring about her.

my suggestions are -

ask to see the risk assessment
you/your friend say you are concerned about her being on her own in between the carer visits.
why do they think she’ll be safe on her own in between?

can she go to the toilet herself safely with no help? Is she doing this in hospital now? Can she Get herself something to drink/eat? Could she summon help in an emergency eg by phoning someone or pressing a call bell button? Would she respond appropriately in an emergency like fire or flood? Will she know not to attempt to use the cooker or kettle herself if carers are not there? Can she understand her pets have been rehomed?
is she now lucid rather than still confused?

if that’s all Yes then maybe she will be ok but from what you’ve said, it sounds doubtful.

As far as I know if a care agency was to take her on, and there may well be a wait for this. They would do an assessment and come up with a care plan identifying her needs. From the sounds of it medication, meals, bathing, continence care. A pendant Alarm is also a good shout if there is someone who will take responsibility to answering if it is pressed. A keysafe would likely need to be installed to allow carers access. Depending on how incontinent she is the max 4 visits a day may not be enough and she may need a care home. Food wise companies exist that deliver mi rowave meals that carers would prepare and most agencies will pick up basic shopping eg milk, washing up liquid, bread. The council should be able to provide a cleaner, she really needs an advocate to help get these things in place. It is lovely you care so much.

The lady needs to be involved in the plans if she has capacity, if she doesnt then there should be an advocate acting on her behalf. With no keys then she wont be going home very soon. Is anyone letting the housing association and utility companies know she is in hospital.

@stillvicarinatutu it’s nothing to do with the fact nobody cares. There’s limited resources, staff & funding. It’s literally impossible. Plenty of times, care comes down to the families or the person goes into a care home.

I have experience of working in domiciliary care. This kind of situation is much common than people realise unfortunately. A lot of people only have 2-3 calls a day and end up sitting in their chair alone for the best part of the day before being 'put to bed'. Care is seriously underfunded in the UK and families are mostly expected to pick up the pieces around it. I imagine, and hope, in this case any care company would do an assessment and insist on more than 2 calls a day. Ideally this lady would have a morning, lunchtime, teatime and bedtime call.

I'll be back later to read and answer all the posts, Baby needs fed and I have to make pancakes for the rest of the family coming back from the remembrance parade.

Thank you all so far, it's been a great help starting this thread.

I'm speaking from England so the rules maybe different in Scotland.

1 she needs an assessment of her Mental Capacity. This is an assessment of her cognitive abilities to make decisions for herself. It is situation specific and cand can range from whether she wants porridge or weetabix for breakfast to decisions about housing or money.
2 she needs a Care Act Assessment from social services This is to establish what health and care needs she has . If she is assessed as having a high level of needs, social services are obliged to support her. However I cannot guarantee this Act is law in Scotland

Op we had similar with a 96 year old relative only her problems are just physical. She's been in and out of hospital with falls and infections and being sent home with carers twice a day. It was ridiculous she'd have to lie in a wet bed all night until carers came the next day, she could do nothing for herself and kept asking to go into a home.
Social services fought tooth and nail to keep her in sheltered accommodation and it took a consultant to eventually tell them she wasn't fit to go home again from hospital with carers.
She's in a home now, I think it's about costs so I think you'll have a battle on your hands. Adult social care is who we were dealing with. Good luck!