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.

Surely early discharge without supports in place (in order to get acute bed back) mean that such patients will be back in again no doubt when they fall etc. Doesn't make sense to me.

I looked after my mother for a year and it was not a task I would ever do again. She got full time nursing home care in the end and it worked very well. Cost a bomb, but look - who cares since I got my life back and I didn't have to worry about her safety anymore. I could actually sleep!

The thing to remember is that the drs and nurses focus on whether she is medically fit for discharge. The care aspect of the discharge then passes to the discharge team which will include a social worker. You then have a team who is over stretched trying to make arrangements for someone who is, according to drs, medically fit.This doesn't mean that the care aspects and how it's actually going to work have even been considered let alone actually worked out. You need to say unsafe discharge on repeat to the discharge team. They should then look at a re enablement package, either in a rehab unit or at home. If the home environment is so unsuitable then it should be in a unit or a care home who provide re enablement. That's funded for 6 weeks. During those 6 weeks, there should be care assessments etc carried out and a multi disciplinary meeting to decide next steps. It's more difficult if your mum has capacity and there's no power of attorney as they will definitely keep asking her what she wants to do rather than what is realistic. To the poster who asked why do they do it like this? Because adult social care like many other bits of our care system, are on the floor, so everyone runs around patching things over until the inevitable crisis (I had to listen to my mum threaten to run a knife through my dad before anyone would take us seriously) Unfortunately it is a battle. Find out the name of the person on the discharge team, hound them for specific answers and don't back down just because.

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

If your mum still has capacity, she can still allocate you as POA for health matters. This would only become effective once she lost capacity ( if she ever does) so you have time to get this done if you both agree.

You have to be an utter pain in the arse. Their poor discharge planning shouldn’t be your problem or put your mum in danger. We have had to step in and intervene. They were about to ship my mum off to somewhere totally unsuitable and we kicked up a massive fuss then a different consultant reviewed and said she wasn’t actually medically fit for discharge and was still in a month later. There is a huge amount of pressure on beds and quite frankly I’ve seen it happen too often that patients discharged too quickly are then back in a worse state within a few weeks. They need the beds but families have to advocate hard for vulnerable people and be very black and white about what is right for the individual.

I think it is all a bit trickier if self funding - she will be paying for it and if she doesn’t want to, it is hard to see how you or the social workers can force the matter

It can usually be forced (often pretty quickly) by the family doing absolutely nothing and staying away. Cruel as it seems.

It absolutely is the hospital's responsibility to ensure patients are being discharged safely and not to a situation that will see them back in A&E and readmitted in a few days.

Any hint of family support and they'll skip all the safe discharge procedures and assume she can go home with you OP and you'll look after her. Especially if your mum is telling them that. They think that because you visited once a week before, you suddenly have the capacity to provide 24/7 care. You have to make it crystal clear you can't do that, and she either needs a transfer to residential reablement care or care at home. Get a care needs assessment by social care done while in hospital and do not step in, as it's incredibly hard to get it after someone goes home and you can't manage (just been through it!)

All I can say is that if your loved one has capacity and wants to go home, all the powers that be will not give a shiny shit about your abilities, needs or wants.
It's all about what they want and you are left as nothing more than a maid.
Yes, I am bitter....