Hospital want discharge and just told DM has Covid

[Lorrymum]

My DM went into hospital on Christmas Eve. She had fallen but fortunately no broken bones. However X-rays showed historic fractures and she also has digestion issues and dementia. She has gone from being fairly mobile to not being able to walk. Today we were told she now has covid.
Hospital are very keen to send her home and we have (sister and I) spoken to various people in hospital all with different opinions. We have now been told she will be home on Saturday. We are not convinced that she is well enough but hospital feel that she will cope if she sleeps downstairs with a commode and carers visiting twice daily. We have to arrange both a commode and for a suitable bed to be installed but haven't a clue who to contact or how this can all be done before Saturday.
Do elderly people still require proper care plan before discharge? This all feels rushed and not properly thought through.

Ask what plans will be put in place in terms of the carers and ask to speak to the hospital social worker to talk everything through with you. Is it reablement that is being offered. Explain that you are concerned that this could potentially be an unsafe discharge. Use those words specifically.

If there is nothing medically wrong with her then the hospital will be very keen to discharge her ASAP to free up the bed.

They'll want the bed.
This sounds cruel but all I would say is for you and your sister to offer to do nothing whatsoever once she's home. If they get wind you'll be inputting any help at all you'll be largely left to it. As an ex district nurse I saw this all the time.
Who will be doing her shopping for example? Her washing? How will they gain entry, has she a key safe?

This sounds as if it’s got potential to be an unsafe discharge. If a hospital style bed and commode are needed then they should be provided.

what are the carers supposed to do in their 2 daily visits? Who will be providing support for your mum to use the commode in between visits, what about meals and drinks?

is there any rehab planned once she’s home?

it sounds as if you need a meeting with the ward team (medic, nurse, physio, occupational therapist and social worker) to make sure that all of your needs can be safely met following discharge. Good luck op!

The hospital discharge team should arrange for her to have community based care or a rehab bed. An OT needs to assess her home and arrange equipment to facilitate her discharge. Make sure you tell them there is no-one available to provide ongoing care within the family. Tbh Saturday seems unlikely.

Where I work normally Occupational therapists will sought that out. You will have to just tell them you won’t be doing that. I wouldn’t worry about the covid, it’s going around and only the really vulnerable are struggling with it.

I think it's tricky. If it were my mother I'd hire the equipment through the British Red Cross and agree to care for her until no later than 6th January to give the care team the opportunity to.put in place an appropriate package taking into account the holiday period. I would explain in writing, I was doing this due to critical incidents and to potentially prevent another elderly person waiting in pain in an ambulance for an hour longer than necessary having possibly already spent a day and night on the floor at home without adequate pain relief.

I would confirm the circumstances were exceptional and I did not consider my mother fit for unassisted discharge with no external, professional support in place. I would wish to speak with the hospital manager prior to discharge and copy the basis on which I was allowing the discharge to my MP and the hospital's CEO.

With a commode and downstairs bed I would consider my mother's home more conducive to recovery than an NHS hospital if I could look after her pending a proper care plan. It would be cleaner, quieter, and less confusing.

Thankfully my mother has a downstairs bedroom at her house and there is also a walk in shower on the ground floor. If nothing else mother and step have planned ahead.

Actually @headstone I'm 62 fully jabbed and have been feeling quite concerned today due to covid. My chest is making dreadful noises, I am wheezing and breathless on exertion and dizzy after a coughing fit. If I am no better tomorrow morning I shall be contacting a private GP for further advice and possibly ab's or anti virals.

I am neither vulnerable nor suffering any chest/heart related conditions.

Have the hospital told you you have to arrange the commode and bed? Usually the hospital discharge team/occupational therapists will sort this out. If they have given you the impression it’s up to you then push right back again. Given her dementia + her lack of mobility there needs to be an assessment of her home and the right kit needs to be sorted out.

During the pandemic something called “discharge to assess” was brought in, where people are discharged with a temporary package and then reassessed once back home for longer term needs. However, this still needs for appropriate care and kit to be arranged before the discharge.

In the meantime, do you know about her finances? Will she be self-funding long term for care?

I work on an elderly rehab ward, and patients requiring a package of care at home cannot be discharged with covid. They need 2 consecutive negative tests on day 5 and 6 after testing positive.

The company providing the carers won't send them to a patient's house if they have covid.

Also occupational health organise the hospital bed, commode and any other things needed. This wouldn't be done without a home visit first, to assess what's needed, and even before all of that, a discharge planning meeting would have taken place, with family members present to find out what support there is.

Maybe that's just our local trust policy?

If she is medically fit they will rightly be keen to discharge, but that doesn't mean it should be rushed. You need to push back as much as possible and refuse to accept her back home without everything necessary in place.

Even though you will undoubtedly be supportive and present for her make it known that you will not be so they don't discharge her thinking you will be doing everything.

I've seen it too many times where patients like your mum are sent home and there aren't any appropriate facilities delivered yet and no carers booked.

hmmm something is definitely missing in the communication...if she's immobile and they are only arranging twice daily visits....is she being discharged to your home or her own??? if she can't transfer independently and isn't catheterised how is she going to manage toiletting? how is she going to have 3 meals plus drinks a day? it's not your responsibility to arrange equipment. have you or your sister said you are going to responsible for extra care visits to back up the twice daily visits? lots to check out....please contact ward and express your concerns and say that you aren't sure what is happening as different people on ward saying different things.

Good luck with getting an appt with a doctor, or the antivirals, I’m CEV and tested positive Boxing Day, 111 callers phoned me 3 times and I continually had to repeat the information, then an actual doctor called back 24 hours later, after I had managed to contact my specialist nurse team at the hospital for advice. It’s a shambles. Oh and I’m still awaiting the antivirals 4 days later!

I'll be paying @Throwncrumbs. I know I'll get no joy from GP/NHS.

I hope you feel better soon.

Absolutely hold your ground and say that you can't care for her. Or you will end up doing everything. Speak to the discharge coordinator and the OT. I had issues with my friend being discharged during the first lockdown, to a flat with no furniture. And an inadequate care package. I refused avd he was discharged to a care home, where he still is.

TBH I’m not sure we’re getting the full story. If they are sending her home with carers twice a day. She must be able to walk independently and be able to toilet herself as the carers will be in the morning and evening only. So she must be walking??? I’m surprised that you have to source the commode, this should be provided by an OT. You normally have to provide a bed (unless exceptional circumstances) but I don’t think the NHS should provides beds unless absolutely necessary.

Having covid makes the discharge more tricky and it depends on the date she tested positive and if/when she tests negative. With covid sending her home is preferable as rehab hospitals (probably) won’t take her until she test negative (&that could be a while) whereas carers/therapists can go in immediately and aid with care and rehab if she’s home.

In terms of her previous fractures, has fallen before? What have you and your sister done to help?

OP I am sorry, I can't answer your questions re commode and bed

but they tried to discharge mum when she couldn't walk and was dizzy just sitting up in bed. I said "unsafe discharge" but also got genuinely upset because how on earth could I deal with that!

so that bought me an extra two days to get her into respite care.

then we had to wait till the last possible second for a discharge note.

it said "lives with daughter". Could have meant either of us, but it was a deliberate lie to justify moving her out.

contact PALS. Tell the staff you see on the ward that it's unsafe discharge, if you think that.

The company providing the carers won't send them to a patient's house if they have covid. So what happens to someone living on earth their own dependent on carers if they acquire Covid?

FIL was discharged with a 4 visits a day package when he was covid positive.

How was she before the fall? If her acute needs have been met snd she hasn't deteriorated she will be returned to the setting she was in before. Hospitals are not care homes. If you don't think she can cope at home you need to urgently seek a care home place as the acute hospital is not the right place for her (they need the bed)

@Willowswood

Not true, care companies care for covid positive clients all the time. Dsd has had covid 3 times and her carers were amazing (one moved in with her for 6 days)

I'm just saying what happens in my area, so it is true, just area dependent.

Ours is the same, it can take a few weeks to organise . We waited 2 weeks for a bed to be delivered

I can see them being able to put everything in place in a few days op

*can't

OP, given your DM has dementia, she'll be more prone to falls. I'd give serious thought now to a rehab home placement, to get her back into a good physical condition after this fall and hospital stay.

We've been through quite a few discharges this year with elderly relatives, including the first one which was unsafe.

I'd call the ward and ask to speak to the Discharge Clerk. Make it clear that you won't be getting the bed or commode, not will you be arranging carers. Say that you think this may be an "unsafe discharge" and that you want to to have a full multidisciplinary review.

Has your DM got a SW too? If so, I'd be getting on to them to sort out suitable care.