Elderly mum in hospital. What do we need to know.

Reading this I just realisedhow lucky we were with my mum. It must be a lottery depending on where you live. We had a hospital social worker who came to the team meetings about mum. Occupational therapists who came out and measured every aspect of her flat, deciding that the bedroom was too small and if she came home she would have to have a bed in the living room. They also explained that she could spend 6 weeks in a care home if she wanted to and provided me with a list of those that could supply the nursing care she needed. I didn't like any of them and we were working on a care package for her to return to her flat when she unexpectedly died (she was 95).
Measuring the flat was so complicated and involved working out how carers could function and space for a wheelchair to move about. It really was a job for experts.
As your mum has an ulcer and may need nursing care I believe she should be eligible for a stay in a nursing home fully funded by the NHS. I'm shocked that other hospitals don't provide the help we got.

We (3 siblings) were in this situation when our elderly mother (with dementia) fell and broke her hip. We could not agree on the next step; remaining at home was really impracticable, as, like your mother, she had no downstairs bathroom, but my brother was adamant that she should return there.

She spent some time in the local hospital while we argued, until they insisted we had to come up with a solution, and in the end a meeting was help with us, social services and an independent person who had talked to my mother to try to ascertain what she understood by 'home'. In the end the meeting decided it was best for her to go into a nursing home (which I had already scouted out), as we remained unable to agree (bit like Brexit really!)

She seemed happy in the home, and I feel it was the right route for her at that stage, but it is a very difficult situation, and you have my absolute sympathy.

My mother had enough savings to pay for her care home so we were able to select one we hoped she wouold feel comfortable in, but I suspect that would not have been the case if she had relied on state funding..

Before anything happens your mother should be seen by the hospital social worker who will ask her whether she wants to return home or go into a care/nursing home. The social worker will then coordinate what occupational health and the medical team assess her needs to be. They will then arrange a meeting at the hospital - when this happened for my MIL recently this meeting was attended by myself and my husband, the doctor, occ health, frailty nurse and the social worker. We had a fantastic SW and whilst the doc tried to force MIL into care against her wishes the SW and all the other professionals looked for solutions and agreed a care plan of 4 x 30min and 1 x60min visits each day. MIL was in hospital for 4 months after breaking hip, has dementia, urinary incontinence, COPD and asthma, refused to engage in physio and is now totally dependant on 2 carers to move her from bed (hospital bed provided with air mattress), to commode to chair - all in one room downstairs. In hospital she suffered repeated pressure sores, wasn't eating, had pneumonia and we were told that wherever she was released to she would be dead with 2-3 weeks! She has been home for 3 months and is thriving. Before the fall she was refusing all help, denying the incontinence, not washing or eating properly and generally deteriorating. The first few weeks were difficult with teething problems and we were not sure we had done the right thing in agreeing to support her decision to go home but it is now working and she celebrated her 90th birthday yesterday- I just can't keep up with the food shopping - she's eating like it's going out of fashion!

And time and again the Government keeps kicking the question of elderly care into the long grass. The situation is desperate. Threads and discussions like this should be put under the noses of MPs to get them to do something!

Do not place much dependence in the pre-discharge assessment. When I complained that no house visit had been made as part of the assessment, I was told the assessment is compulsory, but the LA/Hospital decide what the assessment should include and how it should be conducted. In my aunt's case as she lived so far (20 miles) from where Social Services were based, no house visit could be made. They also refused to visit her in hospital because ours is a long thin LA and sick people living at that end of the LA area were sent to a hospital half a mile over the county boundary. This was classed as 'out of area' so no one in that hospital would be visited there.

The assessment was done on the phone between the hospital, who wanted the bed, and the LA who had seen neither the client nor her house nor enquired about her family circumstances. I was not consulted. That is how a woman with dementia, who could not walk nor climb stairs was returned home without notice and without equipment to live with another person, also with dementia in a house with no downstairs bedrom and a very steep narrow staircase. I spent the next week driving to and from my home 20 miles away to care for them. It lasted less than a week. 5 days, 3 GP visits, 2 psychiatric social worker visits and one ambulence call out later they moved into care as emergency admissions.

We had this situation with my mum but it was about 10 years ago now. She was in sheltered accommodation anyway but a care package was put in place and we knew someone was coming in to wash and dress her and a cleaning lady provided for a small sum of money, equipment was provided BUT she wasn't in quite as bad a way as your mum. We asked to see the person in charge of the Ward who seemed to think we wanted to complain but lightened up when we asked exactly what was going on. Good luck and do what is best for you.

Please make sure she has no house keys on her, so that despite what you say, they could take her home anyway. I have heard of this happening, even with no care package or other help in place.

Believe me , if they talk you into taking her home before a care package is in place you are on a hiding to nowhere , it will not happen . 6 weeks free in a care home is what is suggested here to get everything in place

PS Jellybaby, there is no such thing as absolutely adequate care for an old person whose deteriorations cannot be reversed. Please try not to feel guilty. You will do as much as you can and nobody can do more than that.

You will learn amazingly fast about the uses of all the equipment that is available for maximising independence.

This is a similar situation which my 93 yr old mother was in a year ago. MOnica is right, they will put all sorts of pressure on you to get your mother out. She is entitled to a proper assessment, by a social worker, BEFORE she is discharged, and you can insist on this. Also any equipment should be supplied for you after the OT has assessed her home, if she goes home. Believe me, once she is discharged you are very much on your own in my experience.

I am 87 .I live in semi where I have had my bed in the downstairs sitting room since last summer. I cannot envisage your mother managing at home unless she has downstairs toilet at the very least, and better if a shower too. Also, the very large walking frame will probably require furniture being shifted so that she has easy access flow to kitchen and toilet. She may well need a commode besides her bed especially for night. I'd imagine a lot depends upon how mentally adaptable your mother is, and how adaptable her house is. She will need to have loose carpets, steps, etc seen to The OT should advise okay about this if you need advice.

I was not very impressed with the occupational therapists' advice but they are better than no advice at all and can supply some useful equipment.
The physiotherapist in the hospital will assess her ability to move around before she is discharged.

Thank you. We are fairly intelligent youngish pensioners but this has left us floundering. So much we don’t know. We don’t even know what we don’t know!
We’ll try to talk to someone today. And hopefully the promised social worker referral will materialise.

Your last sentence is spot on. Nothing is made easy for you. At the end of the day they just want her off their books with as little money spent as possible.

If you find her discharged from hospital one day without warning and with no living aids (that is what I faced at one point) the place to contact is your local Red Cross.

They will lend you all types of equipment. In my case DH raced to the nearest depot and returned with two walking frames, one for upstairs and one for downstairs and elephant's feet to raise the height of her arm chair so she could get out of it more easily. I think they have commodes as well. The Red Cross do not charge, we just made a donation when we returned the equipment.

In fact I would find out where the Red Cross depot is now, so that should you need it, you are prepared.

Thank you for your replies. When we got to the hospital tonight there was a form from occupational health left on her table asking us to measure her chairs and toilet( upstairs) and bed. She thinks she’s coming home tomorrow when she can’t even stand up.
Why isn’t anything discussed with us? She has been referred to a social worker but we haven’t heard from them yet.
It was a horrible visit tonight. With her saying she’ll sleep on the sofa and use a commode. I was really upset and feel a frail nearly blind 91 year old isn’t being treated kindly.
We broached the possibility of a care home and she wasn’t unhappy with that. She thinks she’d enjoy the company.
It’s flipping hard isn’t it?

You may feel guilty but you must say she can’t come to you or go home with a care package. We had to do this for my mum same age and similar conditions even though she did have a downstairs cloakroom.

After some time she was found respite. You must look after yourself too. A difficult time but be strong.

jellybaby, you should now be very aware that you are going to have a fight on your hands. So please do not let anyone in social services or the hospital bully you into doing anything you are not entirely happy with.

They will use every non-violent method known, threats 'we will just take your mother back home and leave her there.' Emotional blackmail 'We know how much you care for your mother, you know how much happier she will be with you, she will be very upset when we tell her you want to leave her in hospital.' These are just samples of arguments made to me, when I refused to take a family member into my home, which was not suitable and a long way from the hospital.

Age UK have a Fact sheet. The link is: www.ageuk.org.uk/globalassets/age-uk/documents/factsheets/fs37_hospital_discharge_fcs.pdf They will also help and advise you on the phone or by visiting their local office.

You will be put under a lot of pressure to have her home so you need to be strong and resist unless you are really sure you can cope. Toughen up and remember that your own health and well-being come first.

Patients are,or used to be assessed before being discharged from hospital to see if they can boil a kettle for a cup of tea or prepare a meal. If neither can be accomplished they are sent for respite care until they can manage simple tasks.

Speak to the hospital staff and tell them that she won't be able to do very much if anything if she's discharged.

The hospital tried to discharge my friend the week before Christmas with a care package when he had been diagnosed with terminal leukemia. He felt he could not cope at home alone and that his condition would deteriorate resulting in him being back in hospital soon. He stuck to his guns, refused to leave and managed to get allocated 6 weeks respite care in a very nice care home of his choice. He, sadly, died after 3 weeks but, at least, he was well looked after at the end of his life. The care home said that, had he lived longer, they had never known anyone to be kicked out from there so expected him to stay long term

How worrying for you. I think the first thing is to NOTlet her be discharged until social services have organised the care package and are fully aware of both her and your domestic arrangements. I think she will need some equipment for her safety at the very least.

I’m sure someone with more recent experience will. E along soon, but in the meantime I’m sending you ? and a hug because it’s such a difficult thing to sort out.

Forgot to say I’m in Wales. I will feel guilty if I have her with me and don’t manage to care for her adequately and I’ll feel guilty if she has to go into care.

Here elderly people needing care and unable to go home are entitled to care in a nursing home or care home , the social workers will try to convince you to take her home with help coming in , but resist !