Elderly bedridden mother wants to go home - advice please!!!

nightsong

Errata wrote: »

Hydration: elderly people often lose a lot of the sense of being thirsty so they don't drink properly and become dehydrated. Whether in a care home or in their own home, they can't be forced to drink and need hospital admission to sort it out. It gets sorted out and the cycle starts again.
I've read through your posts but can't see anything about a capacity assessment being carried out by a doctor? Has one been done? If it has but not recently then an up to date capacity assessment would be useful.

Thanks for this. Yes, I'm sure you are right about the hydration. She was originally admitted to hospital several weeks ago from home, because of severe dehydation. She says she doesn't feel thirsty.

By capacity, do you mean in a cognitive sense? I have a report that was left in her flat - I assume it's something that was written when she was discharged. It says she "has good cognition and able to make decisions re health needs and discharge plan". Which is pretty clear.

Errata

Cognitive capacity is assessed by a doctor/psychiatrist performing certain clear tests. Anything else is simply someone's 'best guess'.

nightsong

Errata wrote: »

Cognitive capacity is assessed by a doctor/psychiatrist performing certain clear tests. Anything else is simply someone's 'best guess'.

OK, I see, thanks.

I think I read elsewhere on the thread though, that it is illegal to carry out these tests unless there is evidence of cognitive impairment? And I don't think there is, unless an unwillingness to acknowledge the extent of her disabilities counts.

She told me yesterday that her great-nephew is getting married on Wednesday. I know this is the case because my aunt also told me. So there's nothing wrong with her memory, sense of time or understanding of what's going on in the world.

LL30

That's correct - the person conducting the test must have a reasonable belief that the person has an impairment of the mind or brain. Even a diagnosis of dementia isn't enough to provoke a capacity test to be undertaken - there has to be evidence that the impairment is such that it is interfering with the person's ability to make decisions. The actual test itself will only ever relate to a specific decision at a specific time also.

I really admire the way you've handled all this, it's incredibly hard and I think you've done a wonderful job at looking at the bigger picture and been prepared to look at all the facts. I find it's those that have a blinkered approach who struggle the most, not that I'm dismissing how difficult this is for you, it's just that you've been prepared to listen, even if it's been hard to hear.

nightsong

LL30 wrote: »

That's correct - the person conducting the test must have a reasonable belief that the person has an impairment of the mind or brain. Even a diagnosis of dementia isn't enough to provoke a capacity test to be undertaken - there has to be evidence that the impairment is such that it is interfering with the person's ability to make decisions. The actual test itself will only ever relate to a specific decision at a specific time also.

I really admire the way you've handled all this, it's incredibly hard and I think you've done a wonderful job at looking at the bigger picture and been prepared to look at all the facts. I find it's those that have a blinkered approach who struggle the most, not that I'm dismissing how difficult this is for you, it's just that you've been prepared to listen, even if it's been hard to hear.

Thank you for the clarification, and for your kind comments. It is so much easier for me now I've had all the support and useful factual information on here.

margaretclare

nightsong wrote: »

Thanks for this. Yes, I'm sure you are right about the hydration. She was originally admitted to hospital several weeks ago from home, because of severe dehydration. She says she doesn't feel thirsty.

I strongly agree with Errata about hydration. There are a lot of misconceptions about this vital topic. 'Doesn't feel thirsty'. I have understood that by the time we feel thirsty we are already dehydrated. It has also been said that the feeling of thirst diminishes with age.

We need fluid - ordinary water - all the time. The human body is largely made up of water. It is possible to die of dehydration within a much shorter time than of starvation. The body can go without food for much longer than without water.

Dehydration can cause irrational reactions and thinking.

I once had to look after a 90-year-old lady who asked me how she could prevent a recurrent pressure sore. She'd had one following a knee replacement and was awaiting a second replacement. I told her that dehyration was a well-known factor in contributing to pressure sores. 'Stuff and nonsense. It's because nurses are too lazy to rub bottoms with spirit'.

I wondered, if she 'knew' the answer, why she'd bothered to ask me! However, she did say that she'd been taught by her parents never to drink after 7 pm and not to drink with meals.

A lot of older people don't want to drink in the evenings because they don't want to get up to pee in the night. It doesn't work like that. Night-time - 12 hours or so - is much too long to go without taking in any fluid at all.

nightsong

OK, latest update - she has been moved to a ward specialising in "care of the elderly". Every time I ring I am told she is "comfortable" which I'm glad to know but is not exactly informative!

Might the new ward mean anything in particular? Or is it just that her care is no longer for an acute condition?

Also, we are due to go away for a week on Saturday. Part of this is to take our disabled son to his camping holiday for the week and collect him again afterwards, so I intend to go. Obviously the hospital has a mobile number for us and I presume I should tell them we'll be away - do I need to do anything else?

Torry_Quine

nightsong wrote: »

OK, latest update - she has been moved to a ward specialising in "care of the elderly". Every time I ring I am told she is "comfortable" which I'm glad to know but is not exactly informative!

Might the new ward mean anything in particular? Or is it just that her care is no longer for an acute condition?

Also, we are due to go away for a week on Saturday. Part of this is to take our disabled son to his camping holiday for the week and collect him again afterwards, so I intend to go. Obviously the hospital has a mobile number for us and I presume I should tell them we'll be away - do I need to do anything else?

It probably does just mean that she is in a ward which specialises in the care of the elderly.

Other than making sure that they know when you are away and contactable there is nothing more you need to do. Will you be close enough to come back if necessary?

Enjoy your holiday, it sounds like you need it.

nightsong

Torry_Quine wrote: »

It probably does just mean that she is in a ward which specialises in the care of the elderly.

Other than making sure that they know when you are away and contactable there is nothing more you need to do. Will you be close enough to come back if necessary?

Enjoy your holiday, it sounds like you need it.

Thanks. Yes, we can come back if necessary. I am very much looking forward to the break!

margaretclare

What used to be called 'geriatrics'. Care of the elderly sounds a bit nicer.