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.

Hmmm this is a very complex discharge. In Scotland to recieve care she would need to be assessed by an OT, physio and social worker. As part of that assessment she would need to have a capacity assessment. There are some people who have capacity (it is a very thorough assessment) yet want to go back to their own house even though they are not capable of keeping themselves clean etc but as they have capacity at the end of the day it is their own decision. If they do not have capacity then a decision would need to be made on their behalf, if that is the case who has power for this. Has their been a power of attorney appointed? If so it could be a distant relative making decisions on their behalf sadly not always in the best interests of the patient. If there has never been a power of attorney put in place an application would need to be made to the courts for guardianship. This can take months and would fall to the next of kin or if there is no one appropriate would be to social work.

I have seen some very poor discharges that haven't been well thought out and 9/10 they end up back in hospital the next night. This is usually when last minute things have been missed (DIstrict nurse referrals, supplies to last until community supply can take over etc) and usually when there's a family member at home. However due to the legalities that surround the situation you have described (capacity assessments and guardianship etc) I have honestly never seen someone in such an unfit state going home.

I'd be very interested to see what input the distant family have had (if they have poa) or what capacity assessments have been done. Do they have a date in place or are they just speaking hypothetically at this point? It's difficult when the hospital can only provide so much information to you and your friend if the family are NOK but I don't think yoy would be unreasonable to raise concerns and have it documented thst you do not think she would be safe at home and that you will not be providing day to day care/assistance with meals etc in case that has been as assumption made.

I echo comments re stating there is no one. If they think you and your friend are doing something they will exaggerate it as if you are doing some care for her and her needs won't be as prioritised. You need to say there is no one. No one can go down as point of contact or next of kin. Then the council should take full responsibility and hopefully put in plans for proper care

I would agree strongly with this - having been involved on both sides of the fence as a health professional in mental health and having a parent with mental illness living a few hours away .I am very supportive of people who wish to remain in their own homes as long as possible(for years elderly people were shipped off to nursing homes at the drop of a hat until the bills started going through the roof) but the home support systems provided by the state often aren't adequate .As you and your friend seem to be thinking that there is no way this situation can be sustained safely in the long term, the best option is to not be involved in the short term as ultimately its the health and social care system that needs to encourage the lady to accept safer long term options....and it appears at the moment they think she has capacity to live alone and it is up to them to offer the appropriate care package/support. The threshold for intervention can be surprisingly high. Sometimes there can be a element of taking advantage of those who try to help out informally because of what a dreadful state the health & social care situation is in. I'm a little perplexed at their inviting a neighbour in for a meeting who isn't NOK or designated as being responsible for care, normally they wouldn't have the right to discuss sensitive clinical details with someone like this, it was hard enough for me to get info that would allow me to work out what was going on as a daughter and NOK!!!

p.s. it may be that the lady will be in the same meeting when your friend is also in there trying to express her concerns...I would strongly advise not to do this as the lady may then feel your friend is speaking out against her wishes....I had endless problems with my parent being very paranoid over what I was saying to staff and it can cause relationship difficulties.

Yes, so all these questions need to be asked/answered at the meeting

Yep - agreed! This resulted in a much better care package for my parent than if she'd been sent home even with carers coming in and out of her home and her being worried all the time. 🌹

Thank you all so much for your help and support with this.
There has been another meeting set for next week to discuss things further.
Keep your fingers crossed for her.

Thank goodness she has you.
I don’t think assisted living will be suffice, she requires a residential care where someone is on hand 24/7.
Be insistent that you can’t provide care OP, because they’ll send her home if they can if you say that. It’ll be a package of care, plus you. Even if you wanted to provide care, it’ll be impossible, we went through this with my aunt. Once they start wandering, putting on appliances, it’s just dangerous.

One of the issues may be that she had never had care previously. Normally social workers will want to try supporting someone at home if the person is saying that it's what they want. It may be that they have a back up plan up their sleeves. It may be that they have carers twice a day but also have a hot meal delivered at lunch. They may have arranged extra support from voluntary services such as Age UK. It may be that community dementia team will be keeping a close eye. I would hope ward OT had been very involved.

Hello, Im afraid I can't do links but suggest you Google the following.
'NHS Hospital discharge and community support guidance" You should find the GOV.UK website which will give you information as to what should be happening for your friend.

She is so fortunate to have you both in her corner 💐

I would keep repeating that you are deeply concerned that this is an unsafe discharge and ask to see the risk assessments done in regard to both her personal care and safeguarding. Say that you don’t feel they are meeting their statutory obligations under the Care Act.

Ask for meetings to be minuted and for a copy. Find out the social worker’s email and send them your own notes from each meeting so there is a paper trail. Ask questions about complaint and escalation routes. Do not say that you will help look after her.

I’m sorry, none of that should be necessary.

Good idea to make it clear at the meeting how little she can do for herself right now (including making decisions about when/what to eat, and how to provide food for herself, toileting, washing & dressing), and that there is absolutely no support for her at home.

I second those who say do not give the impression that you or your friend can 'help' in any way. This will be taken as meaning that one or both of you can and will provide ALL care. Keep shtumm.

After a fall, MIL was bedridden. Once they'd exhausted medical help and decided she should be discharged, she was delighted, because she was looking forward to going home. She told the hospital that her DH would look after her. Luckily, her son had already informed the team that her DH had been dead 6 months. They deemed he did not have capacity to understand her condition and make an informed decision about the level of support she needed. Also luckily, DH had POA, and was able to arrange her move to a suitable care home.

I wish you luck, OP.

*...they deemed SHE did not have capacity ...
<proofreading fail>

Result! She's been moved to a care home in the next village.
I haven't been to see her but am told she's much happier than she was in the hospital although still very confused and she tried to leave in the middle of the night but the doors are (of course) alarmed and a member of staff brought her back.
I'm not sure if this is a permanent move or some kind of assessment period though.

Great update! Well done :)