Hospital say ready for discharge, family disagree

[Pl242]

Posting for any advice or insight which would be gratefully received.

MIL currently in hospital after a fall resulting in fractured shoulder. Also has dementia, limited mobility (now further curtailed by shoulder injury as can now longer use walker/zimmer), is incontinent and also generally very frail.

After just over a week in hospital they advised she was ready for discharge. They stated she would be fine with a care package of carers coming in four times a day to change her and move her from bed to chair then chair to bed. She would need to be confined to her bedroom at home. They said this would work as she was not attempting to move from chair/bed in hospital.

FIL, her primary carer, expressed that he was not able to cope with her coming home at this point. Prior to fall she was coming to end of 6 week care package following a minor stroke in March. He and other family members disputed the hospital assertion that she wasn’t trying to move from chair/bed in hospital. She has been. Is constantly removing sling as forgets she has a fractured shoulder. Dementia symptoms currently much worse in hospital due to delirium and drowsiness from painkillers. We all think it’s just totally unrealistic for them both to be confined in an upstairs bedroom as we don’t think she can be left alone so in effect FIL would be placed into an almost 24/7 caring role save 4 x 40 mins carer visits per day.

The hospital staff said our only option was to request a social services assessment, which we have. MIL remains in hospital whilst we wait on this. Since this there have been a few other incidents in hospital which have confirmed our view that her being discharged is unrealistic - passing out when physios try to get her to walk, pulled out a cannula overnight leading to blood loss and passing out. Doctors also saying she’s not making much progress, there are other things that have cropped up which they are investigating eg infection. Yet in same breath saying they think she should go home and would be discharged if a social
services assessment hadn’t been requested by the family. None of this makes sense to us.

Grateful for any insight on what we might expect next, tips on how best to manage decisions. FIL torn between wanting to try and bring her home vs going into a care home, but worried that if he says yes to the care at home package he’ll essentially be left alone to cope with a very difficult scenario.

Sorry this is long. Thanks for reading.

There probably isn't much more they can do for her in hospital so want her discharged - does she have a social worker?

If not medically unwell, which is what hospital is for, and it’s dementia and painkiller related, then hospital isn’t the place for her by the sound of it, it’s a social care issue. It sounds as if she really would be better in a dementia care home if FIL and carers can’t look after her.
Infections can be dealt with in care homes, she wouldn’t have a cannula in and could be in a wheelchair if unable to walk.

Sorry - I see you're waiting for this. She needs a social care assessment as this is the gateway to accessing more care. Unless she is a self funder in which case you can go to a residential home anytime you want to

What does FIL want?

normally if SS are funding and the level of need is more than 4 visits a day it would be a care home.

would she/FIL be self funding or does she not have assets and you’re looking for SS/state funding.

if self funding and 4 visits isn’t enough then you can look at either getting in support at home (expensive) or care home. You’d need to organise that.

if you need state funding then SS would need at assess as needing care at that level.

She doesn’t sound medically unwell and therefore doesn’t need the acute bed. However they do need support and your right to push for an assessment. Is there any residential respite care you can use?

Op so what it is , patient medically fit for home, yes dementia on going this will be assessed by social worker, but first port of call is to get her home with care package, community services will support with carers and physiotherapist/ occupational therapy for when home, so first week or so things will be strange with different people coming and going, once shoulder heals pt will be back on her walking frame,
As others post have said, gateway to help and support is the social worker, and they will have heaps of advice to give family,

Thanks for all the responses. Really appreciate them. I understand re medical need/need to release bed etc. But she does have a fractured shoulder which is curtailing mobility and isn’t on road to healing as quickly as it might as her dementia is leading her to forget it’s broken/pull sling off.

We had hoped/ thought (perhaps naively) that there could be some sort of rehabilitation care option until her shoulder is healed and she may be able to use walker again etc and then we could take stock then. But that doesn’t seem to be an option.

Would be self paying for care. They were just at end of 6 week care package funded by ss post stroke when this fall happened and FIL was thinking about what he would need/could pay for. But then this fall happened.

Given she will be self paying I imagine the social service assessment is just really playing for time? As whatever they recommend we will have to fund, or fund extra to their recommendation if FIL feels he needs more support etc? Is that right?

Re what FIL wants, he doesn’t really know. Which is understandable if not that helpful at this point. He’s the type of personality who will put off making decisions and leave things to play out and dictate events.

I think he wants to try bringing her home as thinks if she’s goes into a care home now that’s game over. But he’s very worried about how he will cope. This was true pre fall and now she’s so much worse. So the decision on what next is very difficult.

It sounds to me like she won’t be able to cope at home alone without FIL and just the four visits a day. So - you tell SS that FIL has moved in with you as he’s so stressed/needs looking after himself. MIL will be going home to an empty property. They’ll soon change their tune (gone through similar twice here, do not let SS foist everything onto you/FIL).

ghe advantage if self funding is that you are free to pick any home which has availability.

we contacted the local one on Thursday morning and DF had a room from the Saturday.

No need to wait for social services.

And who will look after her when she is at home 24/7? Carers only visit for short periods a few times a day and not overnight.

@Omgblueskys thanks for your reply. They had all of this pre latest fall following stroke. But she still fell, broke a bone and back in hospital. So a big question of whether she can be left alone at all and if the answer to that is no (which is what I think/seems likely) then it makes care at home by FIL almost impossible it seems.

Hospital think it’s reasonable to have her confined upstairs in her bedroom with carers in 4 x a day to change her and move from bed to chair and then back into bed at night. They think this is fine as the lay believe she is not trying to move from chair or bed. But she is! And this is only going to get worse as her shoulder heals and she might actually be able to move (at the moment her body won’t cooperate with her will to move, and her dementia leads her mind to forgot she has a broken shoulder and cannot move)!

So it seems to us that with this set up, to keep her safe, FIL also has to stay confined in the bedroom save for the 4 hours max out of 24 when carers are in. I just can’t see how anyone can think this a feasible solution?

@Daisydiary thank you. That seems quite a radical suggestion and one we hadn’t considered. Would SS not then say she needs a care home and you can sell the house to fund it if FIL no longer lives there?

Have you enquired about reablement? It is between hospital and care package at home I believe.

Hi OP, yes, SS would definitely expect the house to be sold if you say FIL is living with you. And they will hassle you about it. I speak from experience! So unless you actually want your FIL to live with you I definitely wouldn’t go down that route.

Occupational therapy should do a home visit prior to discharge. Ask the hospital sw about this. If not safe to go home they should find a rehab placement. Carers don’t do meds so can fil?

@FinallyHere thank you. I think we will end up going down this route but it’s a question of whether we do this now or try to bring her home first. Ironically if she could be in hospital/somewhere else a bit longer, at least until shoulder heals, care at home would have a better chance of working but they seem set on discharging her to FIL in the most difficult circumstances which we think will break her, him or them both. Would love a middle way here but hospital just saying it’s discharge of social services assessment. No other options being put on table.

They can’t force you to sell his half of the house, so to speak! You can also say he’s staying with you temporarily - he just won’t be moving back in just yet. Make sure you have ‘unsafe discharge’ noted somewhere in her medical records if they try to go down this line.

I’m so sorry, it does seem very brutal.

ix be inclined to suggest you arrange ‘respite care’ in a home, so long as you can find one with availability that can cope ‘

respite care seems much more palatable than ‘This is it for ever’

brother advantage of self funding can move anytime (just make you you understand the notice period ? All the best

There certainly used to exist rehab places.

I think they are quite few and far between these days and I suspect are mostly used for patients where SS would otherwise be paying for a care home (ie they are used to try to get patients well enough that at home care is a realistic proposition).

however as you would be self funding a care home there’s no incentive for SS or anyone else to try to get you a place there.

@loobyloo1979 @LIZS thank you. Will look into this further but been told any rehab centres etc would need fully private funded etc. there is talk of specialist equipment and sure OTs would be involved but the sticking point for us is that even with all that, given her physical frailty and cognitive impairment, to keep her safe, FIL would have to be in that upstairs room with her 20/24 hours a day which just doesn’t seem feasible.

A broken shoulder doesn’t need hospital care though, it just needs to heal, and her issues sound mostly down to dementia and confusion, likely increasing due to her being in an unfamiliar setting with constantly changing, unfamiliar faces. Could they pay for several weeks of respite care so she has some continuity?

Is there a rehab unit at another, often smaller hospital she could go to? So not taking up a bed for treatment they will not be offering in her current situation? A geriatric rehab ward with daily physio, OT support could aid her mobility whilst waiting for social care assessments.

There will be nhs funding for rehab. Some units are nhs run, often by subcontractors. They may not be dementia specialist though.

Yes I was about to say this. There should still be available what was called 'reablement care' This is for 6 weeks of after care following a hospital admission to help the person get back to the point of living independently again. It's not charged for or means tested. My mum got this and was transferred to a convalescent home while she recovered. Ask about this as a first step. Maybe Google it and the name of your area to see if there's any information. My mum did actually improve quite a lot during this phase.

Just going by your post it seems to me FIL is unable to care for her at home and she is unable to live at home without help and supervision hence the falls/ serious injuries. Being upstairs in a bedroom is not good for either of them and will make it more likely for future falls because she will try to access kitchen laundry other aspects of her home/ daily life. Next fall will be a hip. Don’t bring her home. Get her placed in a care home or nursing home or rehab facility directly from inpatient in hospital care. The hospital social worker will never be more motivated than right now to free up this bed for more acute care thus securing a placement elsewhere. Once you bring her home she will be your and FIL problem to place elsewhere .