Social working ringing tomorrow

[Limetreee]

Hi Mums been in hospital two weeks she’s 92. She was admitted due to feeling unwell, confused and high bp. All her tests have come back clear. I’ve spoken to three Drs and told them all mum is unsafe at home. The social worker has spoken to mum today and told her I’m fed up with caring for her 😡 I’m furious.
I’ve never said that, haven’t even spoken to her yet, she’s ringing me tomorrow.
I would like mum to have 24hr care. But that for us does mean a care home. Mum is totally against it. Does anyone know what might be said or asked tomorrow. I can’t think straight at the moment and don’t want to waste tomorrows call.

I used to be an OP Social Worker - now in management so not frontline.

My first question is: How do you know that the social worker told your mum you were fed up? I suspect this is a case of Chinese Whispers. I would never have said anything like that.

Second question - why do you think your Mum needs 24 hour care? What level of care was she having before she went into hospital? If she was having little or no formal care, then it might be best for her to have an increased care package before looking at residential care.

There's a lot of support and technology which could help your mum to stay independent at home. Ask the social worker what could be put in place. If your mum has capacity to make decisions, and wants to stay in her own home, then that needs to be facilitated.

Is that what your dm said?
Unless you were there that might have been interpretation

They will do an assessment.
Your views considered but they will assess and might not agree with you. Do say you cannot provide care.
Can your dm pay for care?
To give an idea, sw said they would recomnend one visit a day for elderly relative, but she is self funding and gets three . We relatives all agree she needs 3x a day.
Look at care homes locally anyway. Again, will she pay or are you relying onn state funding?

Make a list of all the things that your mum needs care support with: dressing, washing, preparing food, continence, taking medication; falls; getting in and out of bed; mobility around the house; getting anxious/confused. Every single thing you can think of. In what ways is she unsafe? That’s what the social worker needs to know. They’ll probably start with one or more daily care visits to support personal care and meals, unless you have a strong case for 24 hour care.

Hi yes it’s what mum said. I’ve no reason to disbelieve her, she’d seen the SW this morning, we arrived to visit her at 2pm. She has four visits a day from carers. I think that’s the maximum ? Mum lives in a housing association flat and has her rent paid no real savings.

Have the Drs got to the bottom of why she was feeling unwell? Is she not eating / drinking enough? Is she on medication that she isn’t taking correctly? Does she have any diagnosed conditions that she isn’t managing well - diabetes, Parkinson’s, etc?
why do you think she is unsafe at home?

@HeddaGarbled lists all the things you need to think about.

as for your mums reporting of the social workers comment, I’d take it with a big pinch of salt for now. Keep your cool and find out more about what’s going on first.

Can mum be confused?
Or as she decided that as you think she would be better off in a home, he means you're fed up looking after her.

Thank you so much for your replies this is so helpful. I’m an only one, and feel so lonely just now. It’s an absolute minefield.
No there hasn’t been a diagnosis, I’ve only just realised this.They have stopped her angina tablet, as they thought it might be causing her dizzy spells, she’s has a low bp on standing. Although she had two heart attacks last year, stopping the angina tablet seems a bit strange.
I think I need to speak to the Dr or will the SW have her medical records to hand ?
Good idea about not mentioning the comments, I’ll let it go for now.

Has she got an alarm? Pendant?
Do you think she needs more than 4x visits? What does she want? Do you have lpa in place?

So she’s been having dizzy spells Ana feeling unwell and they took her into hospital to explore why? Have they pinned that down? You do need to speak to her Dr to find out more.

Is she being discharged imminently? Is that why the social worker is involved?

if she already has 4 carer visits per day, what do they come to do? Which aspects of personal care does she need help with? Eating, toileting, showering, dressing / undressing, medication?

How much are you currently involved in her care? Do you live nearby?

Sorry for all the questions, just trying to understand what level of care she might need and what’s missing.

Yes she has a pendant alarm, but didn’t think to use it this time, she came downstairs from her flat to a neighbours for help. She’s been having dizzy spells as her bp drops very low on standing, the Dr said they haven’t been able to solve this.
She’s been in hospital over two weeks now and they say she medically optimised for discharge. Although mum said today she doesn’t feel strong enough to go home, she’s in bed all day with the sides up.
The carers don’t do much to be honest, they empty her commode make a cup of tea and have a chat. I do her shopping, sort all bills, bank account and appointments.
She doesn’t get up until 4pm has cereal then a salad later on. She only weighs 6 stone 5 now lost a lot of weight recently, due to her sleeping habits. The carers encourage her to get up at lunch time but she refuses, saying she’s too tired.

mum said today she doesn’t feel strong enough to go home

I wonder if she would be receptive to going to a care home temporarily to “convalesce”. You could discuss that with SW. Ask about a care home temporarily to assess her needs - it was called “discharge to access” when we looked at it for my Mum a couple of years ago.

I eventually managed to sell the concept of a home to my Mum by talking about it being nursing led (it’s a nursing home) and somewhere she could go to get better and stronger. Then when/if she was strong enough she could go home. Of course she was not going to get stronger and is never going to get better. Quite the opposite. But emphasising it as temporary and somewhere she could be safe and get the care she needed made it acceptable and not “being put in a home”.

Good luck it’s a really tough time

Daffidale. Thank you for your post, I wasn’t aware that they could go into a nursing home temporarily, it will be worth asking.
She’s had three horrendous falls over the last four years and had long stays in rehabilitation homes. She’s hated every one, but tried really hard to get well, she’s very strong willed. Your right it’s very tough.

Based on experience of working on elderly care ward for years , I'm gathering from what you have said is that occupational therapy and the physical therapy team has been seen your mum? Have you spoken to an occupational therapist about how your mum manages at home? A care profile should of been done by nursing staff to say what help was needed and assistance level.
This is how we do it anyway , with family involvement.
You can request what's know as a best interest meeting. This is where professionals involved in your mums care, social worker, your mum and family sit and give their opinions and try to formulate a plan of discharge. Yet again it's what we do.

If she has capacity then she has a say in where she will be discharged to. Realistically though if she is unable to manage then a care home may be discussed either temporary or longer term and a way forward can be made.

Or extra care kind reablement put in place to tide her over until stronger.

That’s the problem I think, the Dr said last week she didn’t have capacity so he was recommending 24 hour care, this week her confusion has gone, but her memory is really bad.
I’ve not seen an occupational therapist yet. I did see one last time she was in hospital that’s when the carers were arranged. She has everything she needs at home, it’s just that it’s a first floor flat, and because of her dizziness she has fallen down them once and still insists on using them in her stair lift.
A best interest meeting sounds a good idea . Thank you.

Your mum's capacity to make decisions shouldnt be assessed by anyone if she's suffering from confusion that can be resolved. You say she's no longer confused, which is good. If she retains her capacity to make decisions, then her wishes have to be respected, even if you feel she's making unwise or unsafe decisions.

I know it's really hard. My dh is an only child and his 91 year old mother is in and out of hospital. She insists on living in her home, and it's a nightmare for us as she is 6 hours drive away and we both work full time. But we can't make her do anything that she doesn't want to do.

My DM is in a very similar situation but has had a lot of falls and has early stages of vascular dementia. She's just had 10 days in hospital but this time they have discharged her to an Enhanced Assessment Bed in a care home. They said she'll stay there for up to six weeks and a decision will be made as to whether she can carry on living independently. Physios, OTs and a social worker will assess her. Like your mum she's been having 4 carers a day but the dangerous times are when the carers aren't there even with lots of visits from the family.
I feel this has been a good outcome as it will gently get her used to being in a care home if that's the final decision. Could you ask for something similar? Best of luck, I know how traumatic it is for all concerned.

Does she have glaucoma? My MILs glaucoma medication caused low heart rate and blood pressure - she used to pass out - it was several years before the medics put 2 and 2 together and realised the problem.

Hi thank you for all your messages, it’s good to talk. I’ve had an awful night, so many things to think about.
Mum has macular degeneration, doesn’t take medication for it though.
Oblahdeeoblahdoe. Sorry to hear your in the same position, but pleased that you seem to have a good compromise there, that’s the thing I don’t know what’s available.
Hope there’s something out there for my mum, we do live near a big city so fingers crossed. My mum definitely has some sort of dementia with paranoia but as yet it’s undiagnosed. Her brain scan in hospital was normal.
EmmaGrundyForPM. You have a difficult situation too. So sorry I know how awful it is you can never truly relax. Their fiercely independent, always been a good thing but not so much now.

Hi just an update. The SW called, she didn’t seem to any any idea how bad mum was, I had a lot of filling in to do. She only had mums side of the story, which is hardly anything because she can’t remember. I have a best of interest meeting next week at the hospital. Has anyone any idea what happens ?

It’s a meeting where all the various people with a responsibility for / involvement in your mums care come together, give their opinions on the best option for her, going forward. Then a care plan is discussed.

Two things for you to bear in mind:

if you can, speak to the key people in advance so you have a vague idea what they are going to recommend - Dr, social worker, OT, physio etc

be very clear in your own mind as to how much care you are willing to provide. Your mum may have made various statements as to what you are willing / able to do. Also, if you have clear examples of how the at home / 4 care visits a day is not sufficient, be ready with this. Your mum may not have been honest or realistic about how she lives at home.

@rickyrickygrimes has explained it perfectly.

Ricky has explained it very clearly, do you have power of attorney for her health and welfare if the doctors are saying she lacks capacity.

rickyrickygrimes. Thank you so much, some very helpful info. You’ve hit the nail on the head, mum has told the SW I am now retired, so won’t mind helping more, I’m 66 DH 70.
To be fair the SW said this often happens, she did tell mum we need our own lives too.