Safe discharge from hospice to home for frail elderly person (EP) living alone

[SeekingPerspective]

I'm so hoping that someone on here can help me understand what might be next for EP (Elderly Person) who was in hospital with multiple organ failure, decided to refuse further treatment, was considered to have capacity to make that decision and was discharged from hospital to a hospice.

They have now rallied a little, still very frail and are now to be considered for discharge from the hospice. I am trying to understand and help ensure they have a 'safe discharge' All they seeem to care about is to 'get home' and do not really seem to have thought through (or be capable of thinking though) the practicalities.

It appears that one option may be that they would be sent home with a care package of four 15min visits each day. Can this be possible for someone who lives alone, is very frail and close to being bed bound? They have made a trip to the loo using a frame and supported by two members of staff. before they were admitted they simply could not bear their own weight and so were bed bound.

They appear to need toiletting which means changing, help with dressing and washing. What about shopping, laundy, bed changing? If anything went wrong in their house? A few years ago one of their radiators sprung a leak and they just ignored it for several days until i visited.

I'm also keen that whatever is decided is sustainable, they have some funds which would cover perhaps the first three months of a nursing or care home so I feel it would be essential for 'adult social services' to be on board for an easy transition. I've had a very distrubed night imagining how this could all go very wrong, I'd be very glad to hear from anyone who understands how these things work.

Yes this is possible and notmal

i am disabled and have disabled friends.

more than 4 visits a day is usually going into care home so SS generally try the four visits a day and wait for it to fail.

They should have an occupational health assessment at the very least? They don’t sound able to care for themself.

They’ve been transferred into hospice care and now want to return home - I would expect a discharge to assess to be carried out. One of the things that’s looked at is their ability to go to the bathroom unaided. They clearly can’t do that at the moment. However, if they have capacity to make the decision to return home, that takes precedence and they can discharge themself. I’m certain the hospice staff will be speaking to your relative and putting as much in place as possible, but the reality is that they will likely deteriorate as soon as they return home sadly.

I’m not sure how discharge from a hospice goes, but if your EP was in hospital you’d want to see an occupational health and physiotherapy assessment. It’s also possible that the EP has medical needs that can’t be met by home visits.

If in hospital, I would be saying things like “we need assurance that this will not be an unsafe discharge to avoid re-admission within a couple of days”. The same principles clearly apply here, but as the EP would end up in the ED, not back in the hospice, this is muddied.

Could you persuade your EP that the hospice needs its bed back, but that they aren’t quite ready for home yet, so need to spend some time in respite care? If self-funding this could be arranged by you/them, directly with a care home. If they are already in multiple organ failure there may be no problem to resolve at the end of the funds.

Yep this sounds normal, unfortunately. From experience with MIL, she had 4 x carers but when they arrived MIL didn't want to get up, or dressed or use the toilet, so obviously the carers would leave her. Then we would get the phone calls that she'd soiled herself, was hungry, was stuck in bed etc. This carries on until some disaster happens, and the merry-go-round starts again.

Yes absolutely it’s possible and likely. The only alternative is if they have their own savings to pay for more assistance or for a place in a residential home

There are no resources, unfortunately, for placing a frail person in a care home, at least in my experience. It might be different in different parts of the UK.

Assuming in England -

If they are still considered to be near the end of their life then they may be eligible for fast track CHC funding to pay for the care at home. The hospice will be able to advise if this is the case.

Otherwise they will be means tested by adult social care for the care - they will usually agree for up to 4 visits a day at home (breakfast, dinner time, tea time and bed time) so potentially 2 x carers 4x a day for up to an hour each visit to help with allt the things you say they need help with.

Depending on needs/funding streams etc either the NHS or Adult social care will arrange an OT assessment for any equipment needed at home.

In my area anyone with palliative care needs would also be eligible for 'hospice at home' support if they were still considered to be end of life but not so unwell they needed to be in the hospice for pain management.

If needs can't be met at home but don't require hospice care for pain/symptom management then residential care could also be an option - again it would depend on who would be funding this as to who would arrange it.

Do you have LPOA for Health and Welfare and/or finances?

I'm just trying to understand what you meant about there being no resources for frail people to go into residential care?

Hopefully I can offer some reassurance that there is as long as the criteria has been met for them to need residential care?

Thank you , it really doesn't sound good, does it?

I do have a registered LPOA , no one has yet asked to see it