Discharge Managers - just need to vent

[TiredofMotorways]

I know they have to be hard-faced cows to do their job properly but ye gods, the combination of aggressive hassling and the complete lack of a formal process we are experiencing with arranging Mum's discharge - aaaargh.

Two weeks ago, a minuted "family meeting" where they told us some bits about Mum's (extensive) needs (nothing we hadn't observed already and said they would need to do an assessment and then they'd report back to us.

Last week Tuesday I talk to therapists as I happened to see them while visiting (so I informally I thought, totally unminuted obviously) who suggested her needs remained high, so I started to look into where nursing homes had spaces but not even decided which daughter to live near.

Wednesday, medics tell us 'another two weeks probably' , so we think good, time to look at a few options and start visiting.

Thursday the discharge manager starts hassling us (by phone) to come in for a meeting. My sister is unwell and I live f*ing 100 miles away.

Monday I make the journey and she starts out with 'if mum goes home xyz' and I say 'how will that work??' (it would be bed bound in nappies with 4 visits per day - for someone newly half-blind and with drastically progressed dementia) She goes off to check (more than once) and its oh yes she needs a nursing home, yet at the same meeting 'you've had two meeting already we need a decision and for you to progress this. We start tonarrow down search.

Rings again Tuesday and then again today "Its fFriday tomorrow we really need to progress this".

Jesus my sister is having cancer followup investigations (which I told her). I live 100 miles away (which she knows). She has my email address, yet persistently phones and texts. So tempted to block her number tbh.

And breathe.

I know she's just doing her job, but the way she combines a saccharine head tilty 'ah bless' when I tell her about my sister's medical appointment then whips out the cudgel.. aaaauuuurrrrrrrrgggghhhh!!!!

I don't mind admitting I went to the bottom of the garden and just had a good cry.

Are they all like this? They just grab you and give you a completely unminuted hassle session? No-one has actually formally told us the assessment has been done or what it revealed. Nothing in writing. Just 'fuck off and sign up to a £2000/week care home in the space of four days'. Grrrr

Forgot to add after being told last weds "another two weeks" on Monday it was "she is ready now". Which we were supposed to have, I don't know, guessed?

You can ask for a teams meetings. It doesn't need to be face to face if travel is difficult or you don't live nearby.

This situation is highly usual unfortunately. Definitely does not need to be so disorganised and then a complete sudden rush to discharge. Likely driven by a shortage of beds for patients with higher medical care needs, but very simple considerations in forward planning and communication would make it so much easier for families to prepare for discharge.

It’s unclear what the full situation is. Will your DM be self funding? If so, then it’s generally up to family to sort out a care home, especially if your DM will be living outside of her usual local authority. If it’s LA funded, then they generally find a suitable home in terms of meeting her immediate needs, within her usual LA. I’m afraid their priority is getting your mum out of hospital as she is bed blocking as soon as medics deem her fit to be discharged, not the needs of her relatives. It’s tough, but the system is broken.

Firstly, sympathy as it's a horrible situation to be in, I've been there.

Secondly, you need to understand that your Mum is bed blocking and needs to be moved asap - that's in days to maybe a week or so, not in weeks or months time. So if you are the one who is choosing the care home, yes, you need to do it right now, not over the next few weeks and months.

Thirdly, you don't have to do it at all. You can hand the responsibility over to Social Services to do on your Mum's behalf. But remember if you do this, then they choose the home, not you, and you might not be in agreement with their choices.

It's a shit situation all round, but you can't expect your Mum to sit in hospital blocking a bed for weeks or months while you decide what to do, you need to make a decision straight away, or opt out and leave it to SS to sort.

I found the last year or so of my Mum's life the worst and most stressful I've ever known. Take care of yourself.

Where is the social worker from the hospital discharge team? It is them who need to do Care Act Assessments first based on hospital asssessments and meeting with you and your mum.

Even if your Mum is self funding you can ask the council to support with finding a suitable care home: https://www.scie.org.uk/care-act-2014/factsheets/care-act-factsheet-1-legal-duties-towards-self-funders/

I'm not being flippant when I say I was traumatised by the discharge nurse when my DM was in hospital in 2019. I asked if she could take herself to the toilet and back and was assured she could. They told DM she was ready to go home even though I had been assured that she would not be discharged until there had been a full assessment. There was no assessment. I refused to take her home without an reablement package so we were granted a few days grace although everything was done in a mad rush because we had been assured that her home situation (a mobile home in our garden) would be assessed.

Even now, seven years on, I can barely think about it without feeling panicky and tearful.

I was told this wasn't a matter for the hospital social worker when i asked at the first meeting.

Honestly the communication has been shite

I know this and am equally keen for mum to move , but it swerved from 2 weeks to four days with no warning. It's just an impossible ask and at the same meeting she told me " asap" she also didn't even know rhe details of mums assessment. It's so crap.

Oh my God, I don't think you are being flippant at all, it's absolutely horrendous isn't it?

Yep, she was practically threatening me with the idea that DM would get an infection if stayed another day. DM didn't help - lying through her teeth that she could do stuff - but from the day she came home for the next two years my life was no longer my own.

Utter bunch of bollocks.

NHS do not do care act assessments, that’s the job of adults social care.

Call up your local authority now, ask to speak to duty and tell them that your elderly parent is being discharged without a Care Act Assessment and you are requesting one as you believe she has social care needs and that there are safeguarding concerns due to advanced dementia and being bed bound.

Everyone is entitled to Care Act assessments and the local authority has a duty to actively identify those with care and support needs.

Every local authority has hospital discharge teams.

Evety single one.

What kind of hospital is your mum being discharged from?

If it’s a mental health ward was she sectioned under section 3 of the mental health act? If she was she will be entitled to s117 after care funding if her needs relate to her mental health (and dementia counts) and this include care home fees being paid for not matter what your mums assets are.

I made a Pals complaint about the discharge manager dealing with my mum. The way she spoke to my elderly parents was appalling and she terrified my mum in hospital. She clearly hadn’t done her job early enough in the process as she suddenly appeared got really pushy, threatening them with having to pay for care if they said no to a transfer somewhere 100 miles away the next morning. Then it became obvious she wasn’t medically fit for discharge and she stayed another 6/8 weeks until ultimately moving to a nursing home under section 117.

My husband had (what he thought was) an informal chat about getting his Mum home after stroke rehab. We had moved house the week before (across the country, to be nearer her). He had talked about getting her house ready (hand rails etc). He arrived the next day to find his Mum sitting outside the hospital with her bags around her. When questioned they claimed they felt he was talking about readying our new house, not hers. It was awful. No care package. No support and so much harder to fight for without the lever of bed blocking. NB Scotland. So might be different.

So much sympathy. OP.

Yes, and where is your mums voice in all of this. She needs to have a capacity assessment. I take it your mum is a self funder but social care can still advise though.

Quite.

She cannot be put in a residential/nursing setting against her will unless an MCA has been completed and if lacking capacity to make a decision a best interests meeting must be held.

Thanks everyone..Yes Mum is a self funder. I am not now in disagreement that she should go to a nursing home - and neither is she insofar as she has the capacity to grasp what it means.

But of course we were reluctant to give up hope she could go home, so really wanted the chance to explore that first. Or if a care home would work vs nursing home.

So for several weeks we were really unclear where we were headed, then suddenly bam, why haven't you organised somewhere yesterday .

So my issue is really with the lack of clear, trustable and written information about what she needs and why, and a legible process on the way to that. How about "we will contact you next week once the assessment is complete" followed by a written version of the assessment when we expected it, rather than ad hoc chats in coridoors? And at least a bit of realism about what two anxious/exhausted/geographically dispersed/unwell/actually quite old ourselves family members can achieve in the space of a couple of days

Ask for a care assessment, done by SW, and a teams meeting.

We had this. Make notes noisily. Point out medically fit = demented, blind, incontinent, bed bound.

Point out DM not safe home alone, and that you and Dsis can’t help. Dsis has got cancer herself, etc.. Repeat.

It’s a who-blinks-first game.

It really isn't like this!

@Supersimkin7 that isn't the issue here though. It has been agreed that OP's mother is going to a nursing home, and she is self funding, so there won't be any arguments of that type.

OP it does sound like the communication has been rubbish, but it is good news you now have a clear plan - nursing home. It will take more than a few days because you have to find somewhere right for her that has a placement available, but at least you know what you're looking for. My mother was self funding and I found her care home within a week, then had to wait another week for things to be sorted out.

You can ask for Social Services input but that may delay things rather than speed things up.

Best wishes, it is not something anyone wants to do but hopefully your mum will be comfortable there.

Can I ask why the family are oblidged to find the care home, why not the discharge team? I appreciate many families will have a preference which is fine. But if the hospital want a rush job are they not responsible for doing it themselves, even for a self funder?

The family aren't obligated to, they can hand it over to Adult Social Care, but then they don't get to choose where she's placed.

Thanks as I thought. And tbh even when she is placed and it turns out it's not great they can then move her at their leisure.

Yes, re choice, as well as overall quality, geographical location is really important to us so journeys are reliably not too long.

So appreciate the warning that social services would impose.

In the end it's not the outcome that has been the issue, it is the contradictions, lack of process, information and advance notice - and as a pp also experienced, discharge manager possibly not doing their job well and taking it out on us, that has been so distressing

Social care will usually give you 3 options and you can choose from them