Help. Mum about to be discharged from hospital

[JoJothegerbil]

Mum had a fall on Monday, one of several she has had, but this one resulted in an ambulance trip to A&E. She’s concussed, less confused than she was yesterday and has what they are terming ‘a stable fracture’ in her back. She also has osteoporosis, is a type 2 diabetic and a medicated schizophrenic. She’s been moved to a community hospital today but we have been told that they are keen to discharge her asap.

My brother and I, her NOK, do not feel it is safe for her to go back home. The only loo is upstairs with no way of adding a stairlift, she’s a hoarder so the house in unhygienic and she won’t address the hoard, and she clearly is not bathing or managing her personal hygiene. Up until now, she won’t accept carers.

How do we address this with the hospital? I’ve made my feelings clear with a senior nurse today and she’s noted it down. We have not been given an opportunity to speak to a Dr at all.

I cannot care for her as I am the main bread winner and work full time. I already do a lot; take her shopping, take her to every medical appointment etc but I’m nearly broken. I’m the person that the Lifeline call when she falls so I’m often called out. My brother lives 200 miles away.

We want to be sure that a care package is in place for as soon as she is home. She will need to self fund for a bit as she has around £35k in savings. Up until now she’s been very resistant to care; refusing help with bathing (won’t have a shower), incontinence issues etc but I think we need to force this on her. I’m just so worried she’ll be sent home; she’s very clever at saying ‘she’s fine’ and how she manages well, and I’ll be left to sort her out again. I can’t do it, my job is stressful and I don’t have the headspace. Selfishly maybe, but I also don’t want to be her carer.

Sorry this is long! Looking for any advice at all at how to navigate this.

Needs now outweigh wants. Make it clear to the discharge team you will be stepping right back and doing nothing. And mean it. Cite carer breakdown. No more shopping, no more transporting her about.
What were her plans for coping as she aged?
Youre not the selfish one. The wants of someone at the end of life don’t trump those of others in the prime of theirs. Remember, today is likely the best she will ever be. Think longer term and use this opportunity to extract yourself. It’s not sustainable.

This is useful
https://www.ageuk.org.uk/information-advice/health-wellbeing/health-services/leaving-hospital/

You need to ask speak to occupational therapy and physiotherapy people at the hospital who should be assessing her for discharge. They should liaise with social services if needed or you may need to directly - I'm in Scotland so things can work differently. Make sure you tell them everything, raise your safety concerns and be very clear and firm about what you will and won't do re. care and support.

Ring her local social services adult social care helpdesk and explain that you feel this is an unsafe discharge and that she needs to have a social worker assigned to her as a matter of urgency. You can also speak to the nursing team at the hospital and repeat the unsafe discharge over and over. At best she needs an occupational therapy assessment at home before her return there. However it can be like pushing water uphill with a fork if she's deemed to have capacity.

There should be social worker on the discharge team. Tell them it would be an unsafe discharge as there is noone to supervise her and her home is unsuitable. They might send a ot to assess it and make suggestions for adaptations but that sounds unlikely to work.

Please also remember that hospitals treat the acute illness and your Mums ongoing care is not there responsibility - sounds harsh I know but if you understand their angle it makes navigating the rest more logical.

your Mum as above needs an urgent assessment by a social worker and a short term care package to support her safely at home - what that looks like will be up to her/ you and social services

good luck

Thank you.

Social services have assessed in the past and put up grab rails, sorted a Lifeline out and gave her 10 weeks of decluttering support (it’s not helped as the hoard is back). The house is unsuitable and there is no space for a downstairs loo or bedroom. To complicate matters further it’s in a trust, set up 28 years ago by my Dad before he died aged 56. Mum owns half, and the other half is in trust.

We have POA for finance but not health. Terrible advice from the solicitor who said it wasn’t needed.

I can’t go to the hospital tomorrow as I have an investigative procedure at any hospital myself, but I will tell my brother he needs to keep stressing the ‘unsafe discharge’. The nurse we spoke to today said that they want to discharge them to home asap as patients do better at home than in a hospital setting. Which I’m sure is true if they have support in place.

Does she have capacity to make her own decision about where she wants to live, having carers, does anyone have poa. I'd try and speak to the therapists, would she benefit from inpatient rehab.is the fracture long standing. You need to step right back, tell the nurses there is no help at home, the house is unsafe, don't facilitate her going home, let the staff sort it all out.

Just seen your post, who owns half the house in the trust.

Been through similar, whatever happens she must get a full care package in place before she returns home. If that doesn't happen, don't pick her up from the hospital.

Don't be persuaded to help out short term or you'll find after a week or so that the promised care package never materialises.

This is no fault of the NHS or Social Work but until we are all prepared to pay enough tax to pay decent carer wages, all the wonderful carers will continue to leave to earn more working in Aldi.

From personal experience, advise that, as others have said it is an unsafe discharge, and your Mum needs a comprehensive care package and until that is established she needs to stay in hospital or transferred to a facility that can do a comprehensive assessment of need. It always helps to say you appreciate they need the bed, BUT sending her home would be unethical and unsafe, and keep repeating yourself. Do not assist in any way or facilitate an unsafe return home. If she has fractured her back, it will likely be agony, and she'll need strong pain meds administered and regularly. Not helpful I know, but talk of "a stable fracture" sounds nothing to see here, but it will be agonising and recovery, with osteoporosis will be slow, if at all.

As the PP above says, wants and needs are entirely different and if the professionals, including social work, get any hint of a supportive, caring family - they will punt her off without a backward glance, or pay lip service by their "maximum" of carers, 10 minutes a pop, 4 times per day - which won't cut it at all. The house being half in trust is a separate concern, and you can ask for a full financial assessment alongside to see what your Mum can realistically afford to contribute to her care.

Resist, at all costs, taking her home and do not bow to pressure. You will help your Mum far better being an advocate for her needs to be met in a comprehensive and thorough way.

It is a horrible path to walk. Best of luck and hope your Mum is OK.

Presume the trust owns it with Mum having a life interest.

She is their responsibility until there is a safe place to discharge her to. That's why there is a huge problem with bed blocking, because it IS their responsibility. It's far from ideal but that is not the OP's fault.

The staff need to work with SS to find her a suitable place or package. Step right back OP because otherwise they will try to put everything on you.

We had similar issues with my in laws and we had to give them an ultimatum, either move from their totally unsuitable house or we would have to step back and let them get on with things themselves. They did listen thank goodness and are now in a much more suitable bungalow just down the road from us.
The difference in their health and stress levels is unbelievable. They are so much happier and so are we!

I hope people are able to persuade your mum to get the help she needs.

I had a similar thing with my very elderly mother when they wanted to disharge her from hospital. We found a care home that was able to take her - initially intended as a short-term stay that extended into a longer stay - as her flat hadn't got suitable grab rails and other adjustments in place, and the hospital wasn't allowed to - or certainly didn't - discharge her to the care home until they were sure it could provide the level of care she needed. Legally, I think there has to be a care plan in place before they can discharge a patient that needs on-going care. The other option we were offered was a convalescent hospital as an interim measure but it seemed rather a lonely kind of place so we pushed to find her a care home. If you or the hospital can find a care home to give her the care she needs while she's recovering and which will give you a breathing space while you assess what needs to happen with her house, that would be ideal. We had to advocate very hard for her to find a care home, we did a lot of research and phone calls ourselves so we could make suggestions to the hospital about what places might come up. Good luck with sorting it out, it's a very tough time to negotiate for all of you.

Does your mum have capacity to choose how she lives? Does she have dementia? What age is she? What does she want to do and what does she want you to do?

if she does have capacity to make (really bad) decisions then all you can do is set your own boundaries and stick to them.

what care does she need? The usual talks that a care will do are:
getting up
getting washed
getting dressed
taking medication
eating
drinking
toileting
getting ready for bed

what care are you providing?

and I’ll be left to sort her out again.
this is where you draw the boundary. Remove your contact details from the landline. Tell social work / discharge team that you will not be providing any care for your mum. Ask them how they expect her to manage all the above, and add to that shopping fur food, cleaning, laundry etc. You get to decide how much you do.

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To answer the questions about the trust; half is mum’s and half is in the trust for the eventual benefit of me and my brother. The trustee is the solicitor and is on the deeds. IF she needs residential care, and I’m not sure we’re at that point quite yet, my understanding is that the half mum owns can be considered for care home fees, probably on a deferred scheme until the inevitable happens.

Thanks for all the advice about stepping back. If I wasn’t local, then how would this be navigated? I think that’s the angle we need to push.

Mum is 83 and has capacity, but doesn’t always make the best decisions. She’s lost the ability to consider consequences and can be very stubborn and unbending if there’s something she doesn’t like or won’t do. Having a shower fitted to use is a classic example even though she cannot get in and out of the bath.

The first step is to request a capacity assessment. You cannot move forward without this, as, if your mother has capacity, she has the right to make poor decisions, including discharging herself from hospital, living in a horde, etc.

So take things one step at a time, first off, get on to the hospital social worker and raise your concerns about capacity. Everything else stems from that one crucial question....

It doesn't matter if yours local or live miles away, you call the Careline company and remove your name, they can be first responders, you tell the discharge team the house is unsafe, you believe this is an unsafe discharge and you are no longer able to help. Like ppl say she needs a formal capacity assessment first, then let the discharge team make decisions either with her consent or in her best interests through the court of protection. If the house is falling into disrepair has the solicitor ever visited if they currently own half. You can also resign as financial poa if you don't wish to continue.

Why do you need to ‘push an angle’? You can just day ‘no, I won’t be providing any care.’

Think about what care you are still willing to provide, if any. Weekly shopping / visit / fridge clear out? Can she cook meals if you give her the ingredients/ ready meals? do you want to stay as the Careline contact? Remember, boundaries are for you - not for anyone else. Boundaries are the limits you set for yourself.

what care does she need? Personal care includes
getting up
getting washed
getting dressed
taking medication
eating
drinking
toileting
getting ready for bed

Will carers be able to do these things, given the state of the house?

The trick is to be involved and in the loop enough to raise the awkward questions about her welfare going forward - without getting sucked into solving the issues yourself.

Social services wanted my DM to be the go - to for my GM. ‘Just’ to do the shopping, occasional laundry, keep an eye etc. My mum said she wasn’t doing it so GM ended up in care. They can’t make you do anything. Make sue she hasn’t a door key on her.

great advice above about refusing discharge. You have to keep on at them thiough and DO NOT presume they know what they're doing or will do what they should be doing. My father in law is in the final days of his life currently from terminal cancer and lives with his wife who has advanced Alzheimer's. Our lives are hell at the moment. He has recently been in hospital for fluid draining off his lungs. They were instructed by family with health and financial POA he must NOT be discharged without speaking to us and care package being reviewed as it isn't sufficient, he has CHC funding.they both currently have 4 carer visits a day of about 45 mins, daily hospice at home visits and daily district nurse visits, it's not enough. The hospital did not do this, they did an illegal discharge and just sent him home in a taxi without letting the palliative team know, the hospital social worker, the care company, the hospice. Nobody even knew he was home till my father in law called us. And now we are back to square one shouting from the rooftops and nobody is listening. It's a crisis waiting to happen. The care company have complained officially to the hospital but that doesn't help us in our current situation. He needs to be in a hospice but refuses to go. Meanwhile my husband is at breaking point and our business is going to ruin with the stress and work involved in them both being at home. Shopping, cleaners, medications, gardeners, banking, medical appointments, constant trips over there when they can't operate the the Ring doorbell, the front door lock, the TV remote, arranging meals on wheels, dealing with the aggression from
my mother in law with Alzheimer's. The list is endless and my advice would be to refuse to do anything at all for her practically and focus on advocating for her with professionals as someone else suggested. I am really sorry you are going through this and I hope you get the professional support you need.

THIS

Currently your DM is deemed of sound mind and can make all decisions regarding her care and discharge. My friend went through exactly this with his parents who were living in filth, both incontinent, couldn’t manage the stairs so weren't getting washed etc. The main way to get help is to contact social services and ask for support where they will do an assessment of needs. What then happens depends on the local authority but at least you have started the process. My friend go a care home place for his DF and supported accommodation for DM.

We are in Scotland and did this for DMIL, she has a superb care package now with carers in 3 time a day with the morning ones are doing the much needed showers/personal hygiene. She wouldn’t be able to stay on her own, in her house without this. The carers also make sure she’s meal planning and having plenty to eat/drink as she forgets to do this.

I hope you get help, its very very stressful.

Absolutely this, OP. Adult Social Care needs to step in on this one. Good luck.

Agree with every single point 👏