92 year old mum rapid decline

Thank you all so much with helpful advice. Seems many of you have been in the same position. I understand the need for the hospital to make room for other people with urgent medical needs. It’s a catch 21 situation. If she goes home we will only end up back in hospital. I’ve looked at 2 homes now and have a preferred choice. It’s just whether that one can meet her needs. We have POA for finance but not health. She will be self funding for the home if she agrees. I just have to say to her it’s a rehabilitation place until she’s fit enough to go home. She likes it in hospital and is holding her bell close to her in case she needs help. At home she has lifeline but that takes a while to get to me and then I have to drive to her house. It looks like she is only eating less than 300 calories a day at the moment. No sign of the Fortisips we asked for. I like the idea of writing a letter in advance to SS saying a discharge is unsafe.

Michelle825 - Sorry to say this as most contributors seem to want to keep very old people in hospital, but I personally believe that's wrong and as a psychotherapist with lots of experience with bereaved people I know that hospital is never the best place for a person who is medically OK but can't feed themselves, brush their hair, do their own toileting.

People in this position die of neglect, they are not fed because there's no resources available to sit for half an hour and try to coax someone to eat sloppy food, and nobody thinks of combing or washing their hair or massaging their hands. They lie in bed without attention and without being turned, and often this leads to compression sores which can arise very quickly and just as quickly can become ulcerated leading to infection. And of course, pneumonia is rife in such places.

As others have said, social services will arrange for six weeks in a care home on discharge from hospital and during that time a proper care plan can be devised. Your mother might actually like it there so there's a possibility she might be persuaded to stay.

There is another question which you need to contemplate which is if your mother really can't do the things you say, what do you think her life expectancy is? If you can honestly say that it's not more than a few months then is there any way you can keep her at home as a family for that time. Use carers coming in four times a day to do the personal care and lifting, but have a rota among the family so that someone spends one night a week with her (sleeping). I know from experience that many people come for bereavement therapy full of guilt because they feel they deserted their elderly parent at the last hurdle. I know this is a very difficult thing to consider but some people can do it and are pleased that they did when their parent has gone.

Only part of my post was delivered !
hospital and the hospital wanted to send him home .
He wanted to come home .
I found the social worker impossible.
I also didn't like the carers and my father was frightened of them.
Eventually I asked the second lot to go and made my own arrangements using an old friend/neighbour to pop in when I needed to shop .
He wanted tea and chats with her.
I did everything else myself.
Food was a problem.
I made mini meals and left little bowls of treats such as cheese ,chocolate and grapes which he'd pick at .
He craved an enormous variety.
We tried meal supplements but they gave him diarrhoea and stomach cramps.
After some trial and error we were both happy .

M0nica

What a difficult time you have a head of you. Here is a link to an Age UK fact sheet that might help www.ageuk.org.uk/siteassets/documents/factsheets/fs37_hospital_discharge_fcs.pdf

I have been in the situation you have been in. You must stand strong and refuse to let them discharge your mother home. You must insist, that she cannot manage at home and must go into care, at leasttemporarilly. Or you could let them discharge her, wait for something to go wrong and then read them the riot act.

What I did was write a letter in advance (or send an email) listing the things that can go wrong: incontinence, immobility, choking, unable to help herself if she were to get out of bed and fall and send it to social services before she is discharged. Then, when things go wrong you can wave it at them and say 'I told you so,' as you take them through the complaint system. - end of cyncal rant.

Contact PALS at the hospital. I have found them very helpful. Do not let any doctor or nurse browbeat you.

Good advice.
There aren’t the convalescence homes around like there used to be unfortunately, but there are nursing home type hubs that frail elderly patients are often sent to.

At the top of the thread my advice was to refuse as it is an unsafe discharge. I didn’t have time to expand on that but this should help.

www.elder.org/articles/arrange-care/unsafe-discharge-from-hospital-uk/

Hope all goes well.

I'm so sorry to read this .
You have my every sympathy .
I went through it with my father .
He wasn't well enough to be discharged from

I wish I had been more forceful about getting Mum out of hospital. She died of malnutrition and neglect under their "care". Catheter instead of much needed antibiotics to fix the dizziness and not-quite-all-there-ness. Not feeding her properly and actually giving her a banana yoghourt when banana makes her sick. If she did not feel up to eating when they came around early with the menu, they simply did not give her anything for lunch! When I took food in and made her eat, she complained that she was too full, so the fed her laxatives!

Pester the hospital social workers to get her out into some care (be fussy and check what they offer) or for them to arrange home care of sufficient time (not just 15 minutes to feed her) and then pester her GP to do regular visits. The hospital should be providing Fortijuice and fortisips to build up her strength, but they seem to ration supplies. Holland & Barratt were very good on providing what she could get down

A fall affects everything - the shock to the system causes all sorts. I am "only" 74 and tripped 2 years ago. Never been so poorly since with various aches and pains and so many tests that they tell you are fine, but then you finally get to read the results and they are not. Gradually getting things under control now, but the weight gain from inability to move is going to be difficult to shift.

I have been in this situation. The hospital insisted there was nothing more they could do for Mum and therefore they must free up the bed for patients they could treat. She wasnt well enough to stand and had to have thickener in drinks to help her swallow, but its true there was no more treatment, she just needed nursing care. We paid for private carers four times a day. They did their best but they were always rushed, turned up at random times, never gave her a bath and didnt do meals. She was in pads at night. The slightest sign of a medical issue and they dialled for an ambulance. In retrospect we should have insisted on a care home at the point of discharge, but its very hard to go against someones wishes if they are adamant. In the end Mum got pneumonia three months later and died in hospital. I regret she didnt get proper care at the end, but I know Mum would have said she was happy to have been in her own home up until a few days before she passed away. Its a worrying time and my heart goes out to you

Ask for your mother to be sent to a proper assessment centre so they can determine what it the best way forward. You can refuse to take her to your home but if she has capacity she can insist on going home. The hospital will also do everything they can to insist she has capacity!
My aunt went to an assessment centre and they decided she could come home but the next time she was in hospital they agreed she needed to go into a care home.

As others have said . Stand your ground. I was in your position back in December. Mums 90 had a fall and spent 6 weeks in hospital. The hospital wanted to discharge her as medically she was ok , but physically she was very frail , needed help getting out of bed and walking with a frame . She also got dizzy standing up .
I insisted the physios got to work improving her mobility and I got her out bed and using the frame on my daily visits.
Your mum should have a social worker who works with the discharge coordinator and they should involve you in their assessment. Plus an OT should visit her home .
With my mum , the rehab centre was full , so she had carers 3 x a day at home. 4 months on she’s has them twice a day .
Sadly OP , it sounds like your mum needs to have 24 hour care .
Thinking of you 💐

My aunt was discharged despite the two responsible adults, 2 nieces, one a hospital consultant, the other working for Age UK (me) doing everything within our power to stop them.

She and her DH, with dementia and physically disabled were home for 4 days. doctors or ambulances were called out on each day, and one night the council carer went way beyond the call of duty and stayed 4 hours trying to get her upsairs and into bed.

On the fifth day, as they say. I demanded that the council find me a care home for both - and they did, but my aunt and uncle were self funding.

Agree to most, she'll need a proper care plan to include overnights which I'm not sure social services do. If not it would have to be a private carer (UK). I'm not sure you can mix private and social care together.
If she's having trouble swallowing she'll need soft foods and someone around to ensure she eats. Carers can't hang around to make sure this happens. You have to stress that you cannot do this. It's a lot to take on yourself, we know - been there, and we are retired folk.

I’ve been in a similar situation where the hospital declared Mum fit to go home. We knew she wasn’t so we arranged short-term care in a nursing home. She picked up while there but the fees were extortionate. So she came to live with me but it was extremely hard work even with 3 carers a day. This country really needs to get a grip on the care of the elderly.

Humbertbear

They can’t send her home without a care plan. Demand to speak to the hospital social worker. You will need more than just a hospital bed if she does go home.

Sound advice, but I would recommend you to insist that you need to speak to the consultant in charge of the ward your mother is in.

If your mother cannot get out of bed to go to the toilet or use a commode without help, then she and you are faced with senior nappies overnight. These will be changed by whichever carer gets to her first in the course of the morning or forenoon.

You are right in saying that it sound as if a nursing home is the best possiblity, but I know how hard it will be to persuade your mother of this.

Staying on her own in her home, if she is bed-ridden will be frustrating for her and worrying for you.

Unless she or you are in a position to pay for very superior care, she will be faced with microwave meals served when it fits in with the carers' timetable, not when she wants them, one bath a week (if she is lucky) and you with her dirty washing to deal with - for no-one else will.

Sorry, to be such a moaning Minnie, but this is the reality of staying alone in your own home for as long as you live.

Quite apart from the emotional strain of seeing your mother in this state, you also need to consider if she has a POA, and if not, if any solicitor will still deem her competent to make one, who pays her bills, does her banking if she cannot, and what the rest of the family has to say, if you have brothers or sisters etc. So, a talk with her bank is indicated too.

Again my apologies, but I have been through this when my father reached the stage your mother is at, and I do know how hard it is to suddenly be forced to be "mum" for a parent. but only seeing the care issue and the health problems is only part of what has to be taken into consideration now.

I agree- be firm stand your ground . Clearly she is not fit to return home. Although I do understand why the hospital can not keep her there.
I too am wondering if you has POA?

Yes stand your ground if you don’t feel it’s safe, or you can’t manage. We had all this with my dad.
NHS paid for 6 weeks free in a care home, he ended up back in the hospital before the 6 weeks was up due to dehydration though.
Do you have POA for health?

Thank you all for your kind and helpful suggestions. I’ve been to see her today and they say she is medically fit to be discharged and I’m arguing that she is physically unfit to be discharged Just waiting for the physios to get in touch so that I can discuss it with them. She can’t feed herself and she had a lot of stomach pain today. They did come and give her something for the pain but even swallowing the liquid paracetamol she found difficult. They have literally just phoned me now to say that after her blood test today there is a problem with her gallbladder and they’re going to treat that with antibiotics . It’s such a hard situation to know what to do for the right thing for Mum and for us as a family I will keep you all posted

She should have been allocated a Social worker.

Her home needs to be assessed and made safe before she returns.

She is also entitled to 6 weeks free rehab in residential care.

Speak to Age Concern and get advice.

With my own father, he had sepsis and after a month in hospital they wanted to discharge him as medically fit. He could not walk, sit up, feed himself, or lift his head. He had to go into a care home because he needed professional nursing. Your mother does sound as if she needs to go into a care home to be properly provided for. They will keep an eye on her needs. I had to be very firm with my mother at the time as she wanted to be home and, honestly, I just could not have coped with both of them. The social worker said it would have killed me. But, I could visit the care home as a daughter.

It is understandable that they cannot keep her in a hospital bed for palliative care I slept at my Dads for his last few weeks and the carers did the day times
My best friend is now going to need palliative care at home her family all live away but it’s her choice to die in her own home she is of sound mind, everything will be set up for her to receive day time help but she ll be on her own at night
The NHS cannot fund night care for all the elderly needing it
If family can’t help out, find a care home and tell her it’s rehabilitation before she goes home perhaps if she has hope of going back to her home she will settle better.

Yes I agree with M0nica, also if they discharge her to a rehabilitation unit make sure you visit it and agree to it.
My father was released to a dreadful place a couple of years ago.
There was no rehabilitation, it was an NHS funded pathway 3 bed set up and made him much worse than if he’d stayed hospital.
I wouldn’t have put a stray dog in there and we managed to get him out and into a nursing home of our choice several weeks later.

What a difficult time you have a head of you. Here is a link to an Age UK fact sheet that might help www.ageuk.org.uk/siteassets/documents/factsheets/fs37_hospital_discharge_fcs.pdf

I have been in the situation you have been in. You must stand strong and refuse to let them discharge your mother home. You must insist, that she cannot manage at home and must go into care, at leasttemporarilly. Or you could let them discharge her, wait for something to go wrong and then read them the riot act.

What I did was write a letter in advance (or send an email) listing the things that can go wrong: incontinence, immobility, choking, unable to help herself if she were to get out of bed and fall and send it to social services before she is discharged. Then, when things go wrong you can wave it at them and say 'I told you so,' as you take them through the complaint system. - end of cyncal rant.

Contact PALS at the hospital. I have found them very helpful. Do not let any doctor or nurse browbeat you.

Unfortunately, though it is understandable that she wants to go home, it us not a reasonable option.

It us important that you do not commit to any caring role so that assessments are made on her true need.
From your description ... incontinence, immobility, choking risk, unable to feed herself etc she could be a candidate for NHS Continuing Health Care funding via the NHS which can pay for 24 hour care at home ... my late OH got this (on appeal). Google BeaconCHC for advice.
Carers going in 3 or 4 times a day us insufficient. She will fall and injure herself.
You must stand your ground and insist that she only goes home with 24 hour care.

Thank you for your quick replies. I agree it would not be a safe discharge. I think the rehab centre is full. I don’t thinks she’s anywhere near fit enough. I’m fully aware that she really isn’t going to get better now but just need to make sure she’s well cared for.

Sorry to hear this Michelle
I don’t understand how they can discharge a feeble 92 year old, with carers during the day but no carers at night.
Stand your ground. Hope the issue is sorted. I have no knowledge but I’m sure someone here will be able to advise.