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

Yes, but unlikely to be out of area as OP/her Mum want.

@TiredofMotorways I was moving my mother a few hours away from her origal home, to a care home near me, so being able to make the choices myself without SS input made it much more straightforward.

I don't know how far you have got, but I used

https://www.carehome.co.uk/

as a starting point. I then rang a few to talk to the manager and check they could meet her needs, and then arranged to visit.

Thanks everyone, yup been looking at that site @catofglory, it's very useful!

They can discharge to a LA funded care/nursing home for the care and funding assessments to take place, even if they will be self-funding long term, they called it a discharge-to-assess placement. This happened to my DF last year, he had 6 weeks paid for in an LA funded home while they did all the assessments (including CHC which he didn’t get) and this gave us time to find a home in a location of our choice then we took over payments (using his money). Maybe we were lucky but the communication was good and considerate. Dad did have a named social worker who was in touch throughout.

It is an absolute shit show. My osteoporosis riddled mum had “met her baseline” so was ready to go home evidently. Her baseline was able to manage at home, go to loo and make tea and light meals with carers, NOT sit in nappies unable to move between carers which the Discharge Nurse deemed perfectly acceptable.

I give absolutely zero shits about bed blocking and she could equally get an infection from carers. That’s your winning hand OP. Do not yield until they get the right package together. They will only do that if you clearly say “NO” to less than what she is entitled to.

Yes, it bloody well is. It might not be in your case, but it really is for others.

You have my sympathy .
I have experienced something similar when my great aunt needed a care home from a step down place.
There was just me and her daughter in law , her son is dead , we worked full time and did our best to find somewhere asap.
Discharge Social worker was nice as pie until she thought it was acceptable to give us a weekends notice , tried to force us to accept a place with the lowest scores in all categories ( ended up being shut down) until i questioned whether she would be happy putting her loved one in a place like that.
We were given more time and found a good place for her.
Unless you have an endless pot of money elderly in these situations are just a number sadly.

The problems you take about are social not medical so she would be considered ready for discharge

WRT can get infection just as likely from carers - you’re incorrect. In her own home with visitors she’s less likely to get an infection than in an institution full of ill people

From your limited experience.

In many cases it’s not like this - unfortunately once someone is able to be discharged there is unsurprisingly pressure to get them to leave as there will be be acutely ill people needing that bed and medical treatment. Imagine your relative waiting on a trolley needing an acute bed that is currently being occupied by someone who could be discharged - you’d be expecting that person to be discharged asap so your relative (or you) could receive essential medical treatment

Demand completely outweighs capacity atm in every hospital

It is easy to ‘give absolutely zero shits’ about bed blocking until you are the person or relative of the person who is dying in a hospital corridor while waiting for a ward bed because people no longer requiring or receiving medical treatment are in them. Or worse - dying unnecessarily in a hospital corridor without access to the monitoring and treatment that you would have received on a ward. This is happening in my local hospital and when I asked the CEO whether the recently closed wards would be replaced, the answer was categorically ‘no’. There will be no more hospital beds so those in them who are waiting for social care need to be out of them, even if their new functional baseline feels upsetting.

And it is obviously not true to say that there is an equal risk of infection from carers coming into a home as there is from languishing in a hospital full of ill people, visitors and staff. Ridiculous statement that will be met with the incredulity it deserves.

OP - it is very stressful and the communication sounds very frustrating but it sounds as if the correct decision for your mum’s ongoing care has been reached and unfortunately there is a real rush to move people out of hospital.

I agree with this. It’s of course awful for the family but I had an asthma attack years ago and after ICU was ‘released’ to a corridor. Apparently there were so many bed blockers so that was where I ended up. It was grim and upsetting. I was incredibly unwell.

And I too have been seriously ill in a corridor this year, as has my mother twice this year. I still wouldn’t have insisted an elderly person was dispatched for my advantage. My point, if you’d bothered to read it, is the Discharge Nurse solution is to dispatch the elderly from hospital without the effective care and treatment they need and to sit at home in their own shit between carer visits or dispatched to homes where they are exposed to infection. Have you forgotten what happened to the elderly during Covid? I bet that wasn’t ok with you then. It is the same now.

Bit more information re my mum at the time of the conversation with the DN. She still had two broken ribs and a break at T4 for which she required OXY 4 times a day. That’s medicine that apparently you can’t go home with, but the DN was ok with that too.

As another poster said, would you be ok with your mum going home like that? I’d bet you’d put up a fight too.

Eh? So what you are saying is that elderly people with fractures should sit in hospital until they have totally healed and they are back to their pre-hospital mobility, even if that is totally unrealistic? Fractures take months to heal and generally don’t need medical intervention after the initial realignment / setting / pinning / whatever.

But the alternative of home with care is unacceptable as only up to four times a day funded and so yes, without other support they’d wait for assistance between care visits? And care home with 24 hr nurse and carer access is unacceptable as no elderly person should ever go to one due to infection risk (although saying in hospital is ok)??? Tbh I’m not sure what the decisions made in covid have to do with this now either.

And people of all ages and all illnesses are discharged with opioids every day in every hospital from every ward - kid with fractures, mums post c-section, elderly with cancer pain etc etc. Oxycodone can and is given safely at home and in care homes.