Mum's confusion & hospital dismissing our concerns

[NellyTheCake]

My mum has advanced heart failure but lives at home alone with no carers, is housebound but manages quite well. I live about 5hrs drive from her but she has one other relative nearby who helps out if needed.
Last week she was admitted to hospital because her heart rate was too slow. She phoned her other relative to let her know she was going to hospital and sounded ok, just fed up.

Since then her mental state has gone downhill. When her relative visited her a couple of days after admission, mum thought she was at home. A day later she was in another country!

Mum talked about how she'd been out to the shops with a nice man and lots of other nonsense.
Mum's relative spoke to the ward staff and told them mum was confused. They promised to document it and do an assessment before they sent her home.

Yesterday the hospital called me and said mum was medically fit to go home and had refused carers. I asked about the confusion but the person I spoke to didn't know anything about that.
Today they called again and said mum was medically fit to go home but she needed a bit of physio first. Then they said that mum wanted to speak to me because she didn't think anyone knew she were she was. I told the staff member that someone had been in to see mum 3 times and if mum didn't know this then she was still confused.

I then spoke to mum who told me they had put her in a cupboard and wouldn't let her out. She wanted to call the police because they wouldn't let her go home. She had no recollection of any one visiting her. She told me she had none of her belongings with her.

After speaking to mum, I spoke to the staff member again and they admitted that mum had tried to escape and wanted to call the police. They thought I could talk some sense into her.

Mum's relative has been in to see her this evening. Mum now thinks she's at a train station.
But when this was reported to the staff they just said they would make a note of it. The relative came away with the impression that our concerns are being dismissed and that we are just saying this because we don't want to take any responsibility for mum.

They don't have any explanation for this confusion. They don't seem to have investigated why she's like this. They don't appear to have documented anything about this. Just keep repeating she is medically fit to go home.

We don't know what to do next.

Has anyone got any suggestions?

Reading other people's experiences, hospital delirium could be the problem.

I just have some doubts cos mum's had multiple hospital stays over the last few years. This is her 3rd this year.
She's never been like this before except when she had sepsis (which she doesn't have now)

If only life was so simple

If you have nothing useful to contribute then don't bother saying anything at all

I agree that it sounds like it could be a delirium that can take a few weeks to settle.
just be aware that every hospital has different policies so some of the advice here regarding the discharge process may not be relevant to your mums hospital trust.
i would call tomorrow and ask to speak to a dr. Ask them why they think mum is confused. Ask when her last bloods were taken and if they think it’s a delirium or something else.
it will probably be an occupational therapist rather than a physiotherapist who is seeing mum. They will do an assessment to see what mum needs to enable a safe discharge. You can also ask to speak to them and voice your concerns.
Being medically fit for discharge just means that medically they aren’t doing anything for her that cannot be done in the community. She’s not requiring iv fluids or iv antibiotics for example. However there’s the social side of a discharge and that’s what now needs sorting. Speak to the therapist about what options there are for discharge.

I'm sure you're on this but as soon as she is well, get POA sorted if you haven't already. Good luck.

In our case it was a bleed on the brain and explaining just how different they were from normal meant they looked beyond the UTI originally suggested and scanned then performed emergency surgery which gave us another ten years. I’m sorry if my earlier post was too abrupt and it’s not enormously likely it’s the same thing. I hope your mum feels better soon.

just be aware that every hospital has different policies so some of the advice here regarding the discharge process may not be relevant to your mums hospital trust.
@Beautifulsunflowers not sure if this is the advice you are referring to? Discharge to assess is a national policy.

OP, as PP have commented, the six week rehab service isn’t perfect, but at least it will provide a baseline of current needs.

If your Mum is discharged with support you’ll need to consider things such as access for staff, a key safe is the usual option.

Also, some telecare may help. A pendant alarm and if you are concerned about her going out some door contacts that would alert the telecare base if she went out.

The telecare does need a named contact along with a plan of what to do if she were to leave the house whilst confused.

The telecare can take time to set up. I know some families who have installed a Ring doorbell as an alternative.

If assessed as lacking capacity and decisions to return her home she will need a Deperivation of Liberty in the Community safeguarding order. The process and the order, which is made via Court of Protection, takes months and hopefully your Mum’s confusion will have settled in that time. But the worker can start the process and then monitor.

In the meantime, the worker needs to make reference to this in the support plan after speaking with the local authority’s legal staff regarding any restrictions and actions needed to return her home and actions needed to do this such as any physical touch such as guiding her by the arm away from roads, linking arms whilst walking if the intent is to prevent her from wandering off etc.

Have a look at the Just Checking system which is separate to telecare

https://justchecking.co.uk/

There is no alarm connected but gives an picture of people’s sleep pattern and movements within the home.

You can speak with the assessing worker and request the telecare is in place prior to her returning home.

I know it’s overwhelming, and your Mum may be content back at home to remain indoors. But you don’t know this and it’s better to be informed and suggest solutions.

@NellyTheCake if she has tried to "escape" hospital, they may well have medicated her, for their convenience!!

Seriously! It happened to a relative (although about 10 years ago) and we had no clue until we received the discharge papers

I've had an update
Mum's social worker called. She'd been asked to assess mum for discharge.
Fortunately she's met mum before & said she was shocked at mum's condition.

She's put a stop on any discharge & asked for an urgent review by the Delirium & Dementia team.

Then the ward manager called. They now agree mum doesn't have capacity. They are assessing her mental & physical state. And then will have a meeting to discuss what happens next.

Atm they can't say if mum's delirium is temporary or permanent. Or what is causing it. But the doctor has asked for more tests.

I've had an apology & a promise that there will be a review of what happened. And that they will communicate better in future.

For now I feel more reassured that mum is getting the help she needs.

I’m so pleased. Keep up the pressure though. You’ve done really well to get to this stage. It’s amazing how they do recover.
thank goodness someone who knows her has seen her.
one say my mum was out for coffee. The next she was laid in a hospital bed not knowing what was going on etc.
a few months later she’s out for coffee with her friends.
Try and real a little knowing she’s in safe hands for now and don’t overthink what the future may hold. One day at a time x

Glad to hear the social worker had seen Mum before and agreed with you, and they are reassessing her.
Hope you get some better news soon.
It’s not easy, particularly when you are so far away.

Use the words “unsafe discharge” if she is refusing a care package and she is still presenting as confused. This should trigger further evaluation.

My Mum was suddenly sent home, alone, to an empty house , very clearly confused and not her normal self.
The GP tested her and she did indeed have a UTI, the hospital said they had tested her but she was in a terrible state when left at home. I was so angry and had the whole “lessons will be learned “ response but it was shocking.
So I would insist on a repeat urine test at the very least. Glad her social worker is on the case too. I hope she is better soon OP.