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.

This sounds so scary and distressing. Have you approached PALS for some support. They can be useful and very excellent advocates for exhausted family. X

Much sympathy @Pl242 .

We have been through something similar with DM. A fall and a fracture. Talk about discharge after a couple of weeks. No physio but still somehow fit enough to go home with a 'care package'.

What I have worked out through DM's many rotations through the hospital system is that each ward has a 2 week cut off. After 2 weeks they start looking to discharge or move the patient on to another ward. Whether this is appropriate or not for the patient doesn't seem to matter.

Medical care for elderly patients is complicated. They often have multiple conditions which can be affected by a crisis. Hospital silo systems of specialist wards just don't work for people with complex medical needs.

Sadly it's very much based on whether the ward they are on wants to move them on when suddenly they will be 'clinically' fit for discharge. My dad was moved from an orthopedic ward to a nursing home last week, been in hospital 7 weeks, post operative delirium and other problems mean impossible to engage in physio etc, so definitely not the orthopedic wards problem any more. Unfortunately my sibling was led to believe that there was 1 option of nursing home, so that's where he was sent. He's clearly dying, things aren't improving, the delirium continues to increase. Hospital were unable to identify the source of the infection . He has a number of other conditions, very long standing ones. Hospital and discharge team have shown little to no knowledge of these conditions.
Unfortunately adult social care isn't fit for purpose, hospitals want acute beds back ASAP and elderly people are never going to heal in a 2 week time frame. So you then get stuck in the hamster wheel of discharge - inappropriate cate package - fall - hospital - discharge etc etc until they eventually have to go into permanent care.

@Lightuptheroom very much my experience.

DM is now in the nursing wing of a care home.

Each 'go around' of the hamster wheel means that more of 'DM' is gone.

Yes, very much so. My DF has no time for hospitals, always avoids them, unfortunately this time he fractured the top of his femur so in he went. Now, there's nothing behind his eyes at all. He's been physically disabled for many years but was reasonably mentally agile. That's all gone. Hospitals also have a very high expectancy of families navigating a system they've only come into due to a crisis. I know many will understand when i say we treat our animals better. Unfortunately for my dads local authority I used to work for adult social care in that authority for a long time so I'm not afraid to challenge their interpretation of the 'systems'