Mum had stroke, where do we even start now? She's desperate to go home from Hosp but not well enough

badmemory

What no-one seems to have mentioned is does anyone have a POA for her.  If they have they cannot cut the POA out of the discussions.  She should be able to get free 6 weeks respite care.  Which may or may not improve her situation.

elsien

The OP says she has capacity, so power-of-attorney is not relevant In terms of discharge planning. 

The 6 weeks respite depends on whether they feel there is any rehab potential and whether it’s a health discharge or social care. It’s not automatic that everyone is entitled to it. In my area for someone who will be having the CHC assessment, it has to be done within four weeks of discharge. if no nursing needs assessment is required or this little chance of the person getting back on their feet with six weeks worth of rehab then health won’t fund. 

badmemory

Yes if she has health & welfare & just because someone has capacity does not mean that the poa cannot be used.

elsien

badmemory said:

Yes if she has health & welfare & just because someone has capacity does not mean that the poa cannot be used.

You can only use a health and welfare power-of-attorney when someone has lost capacity. That is the primary difference between it and the financial one. 

And aside from anything else if someone was trying to use any power of attorney to override the wishes of a fully capacitous individual all that individual has to do is simply revoke it. 

Brie

FrankFalcon said:

Hi all

Social services visited the lady 2 weeks ago and agreed with the doctors and told the family "The lady will be discharged when we have found her a suitable respite place".  They haven't said much more than this to us because they told us "We have to have all the meetings with the lady alone so that family members cannot apply any pressure either way by interfering for their own ends".  This we accept. 

QUESTION 1: Does anybody have any similar instances of this or any experience? What are we waiting for? How long? Where will Mum go? Who selects? What if the family disagree with Social Services?

QUESTION 2: Does anybody have any instances of where this has happened? how it would work? Does a person live in Mums house all day everyday? Who pays? How much is it?

So, given that Mum is very distressed and just wants to go home and that her upper body strength is fine.  She could cook for herself etc...

QUESTION 3: Does there exist any machinery/devices that would allow Mum to somehow shuffle/move out of bed to an electric chair to get to the toilet? Does there exist a chair where Mum could do her toilet business and the waste is captured under the chair in a commode to be emptied later?  Of course, then she'd need to get to get back to bed later on?

QUESTION 4: Please, does anybody know of any instances such as this where a person is fully aware of their surroundings, mentally fit but with failing legs (ie...needs help to go to the toilet etc?)

Q1   I understand them needing to talk to your partner's mom alone.  They do need to get the proper understanding of what she wants.  And if she is of sound mind they don't want you/partner pushing her one way or another.  But that's not to say that she is going to make the right decision for herself.  And the last thing you want is to have her home and on day 2 she falls and breaks a hip and goes right back to hospital.  So there's nothing the matter with insisting that mom has an advocate with her for the conversation.  It could be you instead of partner, it could be one of the nurses.  Sometimes Social services have been known to say "you want to go home, don't you?" nodding their head yes and the person agrees and that's all that's done and she goes home.  Which is not right.

What should happen is an OT will assess in hospital as to her needs and then they should visit her home to see if it meets her needs.  Then anything that is missing should be put in place - hand rails, wheelchair, commode, ramp to get her into the house etc.  All that takes money and time and is one of the reasons she may need to be in a care home of some sort for a while.  Some are excellent and some, unfortunately, less so.  We were told by social services that my MiL wouldn't have to pay for the care home but she was then sent a bill so be careful about anything that is said and that mom/you are told.  

We disagreed completely when SS said that MiL could come home (she lived with us) after her second time in hospital.  SS was going to put a care agreement in place which included 2 people coming out 4 times a day to assist her to go to the loo etc.  This was an improvement over their initial suggestion that 1 person 2 times a day would be sufficient.  They also stated that we would need to be on hand 24/7 despite the fact that I was working full time.  We said no. Fortunately the nursing staff at her community hospital agreed that it would be impossible for us to do anything to help MiL (re toilet etc) and that having even 2 people there 4 times a day was insufficient as that amounted to 1 whole hour in 24.  MiL went to a care home instead.

Q2  Whatever is agreed it will be up to your mom to pay for the care (at home or in a care home) if she has more than  about £23k in savings.  Less then that she will pay a lesser amount scaled down until she pays none and SS pays it all.  If she is at home the value of the house won't be taken in to account.  If she is in a care home and no one else lives in the house then they will consider the value of the house as part of her savings.  But you or your partner or any other family member is under no obligation to pay towards her care.  

Q3  Yes I believe such mechanics exist to make someone fairly but assume they are very expensive and so not easily available unless mom can afford them herself.  There is something like a wheelchair that can be used over the toilet or with a removable bowl so she can manage more easily but if she can't support her weight she will need assistance to use these commodes.  And then help to get back in to bed.  I don't think it would be sensible for anyone with this sort of limited mobility should be trying to cook, make a cuppa tea etc.  Certainly not on her own.

Q4  Yes, sadly there are lots of people in this situation.  Not just the elderly but younger, fitter people who have certain diseases or who have had motorcycle accidents.  Some have become paralympians.   And Superman Christopher Reeves is an extreme example of someone of sound mind but no mobility below the neck.  

Grumpy_chap

elsien said:

Sarahspangles said:

A way forward will be clearer when she’s spent time in a respite home which can focus on rehabilitation and assessment. They will have the sort of aids you’re talking about and will get a feel for the type and number of hours of carer support that will be needed.

I disagree that these short-term places do much in the way of rehabilitation at all. They are short-term beds in ordinary nursing homes, and they’re not going to do any more assessment or rehab than has already been done in hospital

I am sure the success is very variable.

I disagree with your assessment that the short-term rehabilitation does not achieve anything at all.

My father had deteriorated to the point that he could do no more than two steps from the chair and needed assistance to transfer to the bed or commode.
He was offered a short term rehabilitation physiotherapy and the results were really miraculous - he reached a point that he could walk as far as the end of the street.  

Savvy_Sue

Grumpy_chap said:

elsien said:

Sarahspangles said:

A way forward will be clearer when she’s spent time in a respite home which can focus on rehabilitation and assessment. They will have the sort of aids you’re talking about and will get a feel for the type and number of hours of carer support that will be needed.

I disagree that these short-term places do much in the way of rehabilitation at all. They are short-term beds in ordinary nursing homes, and they’re not going to do any more assessment or rehab than has already been done in hospital

I am sure the success is very variable.

I disagree with your assessment that the short-term rehabilitation does not achieve anything at all.

My father had deteriorated to the point that he could do no more than two steps from the chair and needed assistance to transfer to the bed or commode.
He was offered a short term rehabilitation physiotherapy and the results were really miraculous - he reached a point that he could walk as far as the end of the street.  

I agree that short-term rehab options vary wildly. However in this area they seem to be reasonable, as I have known a few people benefit from them and return home. 

However ... she's still going to want to go home, and I think that part of this equation is acknowledging Mum's distress and desire to go home, but looking with her at what would be needed to make that possible / safe. 

And I will say that not all 'going into a home' situations are really awful: I know someone who was diagnosed with a brain tumour nearly 2 years ago, and told they would lose mobility and probably not last more than 6 months. It was not what they wanted, and I was not very happy about how it was arranged. However, they're still with us, AND after an initial rapid loss of mobility (from being parked in bed initially), they've improved from being hoisted by two people, to where they can transfer from bed to wheelchair and back, from wheelchair to car and back, and to walking precariously down the corridor with support. All that is thanks to a physio who comes into the home at least twice a week. 

If they were at home, apart from visiting carers, there would only be occasional visitors, and a huge responsibility on family to ensure all was well. In the home, every time a member of staff passes their room, there's a quick chat - "you OK, do you need anything?" There's far more chit chat going on!

It's not what this person wants, but they can see it's the 'best' situation for them. 

teddysmum

I am in a similar position, but have not had a stroke. However, I lost nearly all my mobility after a 2years  6 months delay for a lumbar stenosis op.I can only walk a couple of metres unsupported and can stand for 5 minutes max. Stairs are walk down with husband ready to catch me and upstairs 'monkey fashion'.

I have lived upstairs for 5 years, as the bathroom is upstairs. From hospital and OT I have a free perching stool, electric bath chair, toilet frame and two walking frames )one dropped off by the OT suppliers after the useless physio fled. I need a bath step, but pre op, when the OT person checked on my bath lift use, I slipped as I had a sudden pain, so they say they can't risk me with one, but I can't use the bath lift by myself, as the strips protecting the bath have to be held, as well as the controller, so My husband is always there to help.  

The lady next door, who has terminal cancer, has been given an NHS wheelchair, but it is heavy, whereas my light one cost £75 from Gumtree and was only used twice, so like new.

I have since, at own expense bought a folding electric wheelchair and though they look easy to use, especially seeing a little boy with
amputated limbs and one adapted arm, racing round in his, found mine difficult to get used to, especially with bad weather keeping me in. I am nearly 76 and having driven a car, find letting go, instead of holding on, in an emergency, very difficult.

When my long awaited kitchen is done, I am also going to buy something that we thought was expensive , which is a Vela chair. This model, 'for elderly people' is marketed by disability sales companies like this one VELA Chair for Seniors/Elderly - Large - Complete Care Shop, but I want a different model that rises up to wall cupboards and can have specially adapted back and seat cushions. VAT free they are under £3000 but there is another brand which works out nearer £2000, but it is hard to tell when the Vela Tango includes extras needed on the the Mercado Medical Real one. You move the chair by using your feet or being pushed, but they do one with added electric drive, but at a cost of £7000. Chairs are strictly made to measure, abroad, so I think the wait is about 6 weeks.

I think a commode would be rather unpleasant if not emptied right away, but think one of these chairs and a normal toilet should work in a bungalow.