Elderly bedridden mother wants to go home - advice please!!!
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of course the hospital wants her out as quick as possible!Oh, and the assessment was done when she was in hospital a few weeks ago. I don't know who did it exactly. It's now a new social worker who doesn't know her. I felt at the time of the assessment that the hospital was swayed by her desire to go home and their desire to get shot of her.
once her immediate medical emergency has been stabilised... she no longer needs hospital care andd is occipying a bed that someone else may need0 -
Sorry, I wasn't being funny - it's just that people often use the term 'nursing home' when they mean residential that's all.
Right, so did your mother have a DST (Decision Support Tool meeting - determines what nursing needs she has) for her discharge planning? It would have involved someone from continuing health care, family, your mum and social work there. That meeting determines where the funding comes from: health or a mixture of health + social, or just social, depending on her presenting needs. If she positions herself in such a way that her breathing is significantly compromised, that should have been addressed, as that is a serious concern.
I think families are often surprised about how high the thresholds are to be recommended for residential care, and indeed nursing. It is really tough for families.
Thanks for this.
Before she was sent home I did send an email outlining the help she had at home (someone shopping for her for example). And there was a report so that must have been it - yes, it said she had no obvious need for nursing care and I was gobsmacked.
Whens she went into the nursing home it was a private arrangement so I guess the health people weren't really involved. It has been disastrous though.
So - what do you advise please? I have the social worker as my contact and he has told me to ring her local authority to reinstate her care package. I totally agree with you that the breathing thing in particular is a major issue.
I think she has deteriorated since the original assessment, even though it's only a few weeks ago - should I ask for a new one?
But all this is predicated on her accepting that it is risky for her to go home, and she doesn't. Part of me thinks that I should go ahead with the discharge home and then just stick around till she is too unwell to cope (shouldn't take long) and then call an ambulance, as my aunt did. Then it will be the hospital's problem again. I'm sure that sounds terrible but I am at my wits' end..0 -
:heartsmil When you find people who not only tolerate your quirks but celebrate them with glad cries of "Me too!" be sure to cherish them. Because these weirdos are your true family.0
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I would suggest that you get the social worker to visit her, speak to her and do an assessment of her needs if she wants. The problem is that now she isn't under the hospital team, she'll fall into the district, and sometimes it can take a while for an assessment to be done. Hospitals have very tight timelines that social workers have to legally work to.
I'm not surprised they didn't judge her as having nursing needs to be honest, it is very very hard to get. I know it's hard to hear, but being bed ridden and unable to weight bear for example, doesn't mean someone has nursing needs. If the leg ulcers are responding to treatment, and not necrotic, that won't be nursing needs either. Incontinence isn't nursing needs, nor is drinking from a sippy cup. If she doesn't have any night time needs, she wouldn't even qualify for resi care in my area, and incontinence during the night doesn't even qualify as a night time need.0 -
On the plus side (!) she has no signs of dementia and is intelligent. I don't have power of attorney because despite her physical fragility she can make her own decisions and, for example, write cheques.
She can only sign the paperwork giving someone attorney powers while she can make her own decisions. It doesn't have to be used until it's needed but it has to be in place.
If you don't get the POA set up, you could end up having to go to the Court of Protection to be able to make decisions for her which will take much longer and be more expensive.0 -
It's a good question, what she is desperate for. I think she imagines autonomy, having her things around her, familiarity, watching TV and reading as she used to. Quietness. Memories.
This is where her rationality breaks down of course, as it won't be like that any more - but she won't hear it.
Some of those things she should be able to get in a good nursing home. Her own belongings and furniture, watching tv and reading if she is able. Ideally, a degree of autonomy, in practice that's often less likely. However if she can say which areas of autonomy are most important to her that should be up for discussion with the home manager.
My grandmother was similar - partially sighted, COPD, unable to walk unaided, happy enough when the carers were there but calling 999 every time she was alone because she was frightened. I think when people are away from their familiar surroundings and memories they forget just how difficult and how scared they are when they are at home alone, and then the rose tinted specs come out a bit. My grandmother was 60 odd years in the one house, brought up her family, buried her husband. That's an awful lot of letting go and grieving for the life she had lost.
If she's so desperate to go home, then all you can do is make damn sure that all the possible care is in place, she's had all the assessments re OT, physio etc, that there's a lifeline in case of emergencies and then let her get on with it. And if it's not sustainable for family to be there then she needs to understand that that is part of the deal before she makes her choice. Then be there to pick up the pieces if neccessary. And try to help her to understand that bouncing back and for between home, hospital and care isn't really sustainable. Because as others have said, staying in hospital long term isn't an option.All shall be well, and all shall be well, and all manner of things shall be well.
Pedant alert - it's could have, not could of.0 -
I totally understand this point of view and realise that it's such a tough choice. That said, I am seeing both my Mum and my Uncle (nan's daughter and son obviously) being slowly eaten away by my Nan who's 86 (I think). She will in no way go into a home or accept that she's too frail to do anything, hell she's wanting to book a holiday in Benidorm. The truth is that she can't even make it up the road to her local Tesco's.My advice is support her in her decisions even if you think they are not for the best. My dad was in hospital earlier this year, desperate to get home and we were preparing the house for him but he died suddenly just days before he would have got home. I so wish we could have given him his wish.
I guess it will come to us all eventually although I'm hoping that I can accept the "I can no longer do this" regime before I become a burden on my family. My Nan doesn't see what she's doing to her son and daughter, indeed she doesn't even believe she's frail despite numerous falls and hospital / doctors visits.
I love her to bits but I hate seeing how much pressure she's adding to my mums and my uncle's life, and she doesn't realise she's doing it. She's totally oblivious to the stress and tension she's causing the family because she is determined to cling on to that independence. I know there's two trains of thought on this but my train (and particularly since I have entered the disabled club) is that I would do anything to avoid putting pressure on others when I begin to struggle.
And yes, I would go into a nursing home if I could not function alone. I know it's not so cut and dried when it's parents and really feel for you on this.0 -
Thank you again everyone. So much useful information and advice as well as empathy.
I do know that we should have done the PoA some time ago. Frankly I just didn't want yet another responsibility - I had PoA for my father, who had dementia and I went through all this with him a few years ago, and I have it for my disabled son. Probably short-sighted to avoid it though.
The best thing is to contact the social worker and express all my concerns I think, as people have uggested. I've realised that my main fear is that her breathing will become obstructed while she is alone and she'll die, so I think I probably need to emphasise this.
I'm awake as usual at 4.30 a.m. and typing this in bed. The stress is beginning to make me ill.
It helps so much to be able to post here and receive kind, thoughtful and well-informed replies. Thank you all.0 -
I wish you luck in your situation. Do write to everybody detailing your worries in black and white.
I am in exactly the same situation, mother wants to return home after a long spell in hospital. She tells lies to all in control. I have told them the truth but they still believe her that she can live independently. I have been living with her for the last two years - it is soul destroying. Professionals seem so gullible - until I become ill and can no longer cope - then I am no use to anyone.
She is so arrogant but this time, I am going to go out when the carers arrive even if I sit in the local coffee shop!!!! I am going to go to the local gym. I have to have time to myself - otherwise I will get so depressed again.
Whilst mother was in hospital, another daughter arranged for her mother to go in to a nursing home. The daughter did not return. The mother was distraught. I suspect neither could cope with the situations - this was hard for the daughter but it worked.0 -
I do know that we should have done the PoA some time ago.
Which she can - if she is mentally 'with it' - revoke at any time.
Neglecting everything mentioned above - there are technical aids which will at least help somewhat with the risks.
These vary from emergency pendants that are worn round the neck, and allow someone to press a button to summon help, to similar devices that are basically 'always on' and detect lack of movement when there should be some.
If she is willing - even setting up a wifi network - and several wireless cams in the house to let you look in and see if she's OK at any time - and call for help if she's not.
Falls are clearly a major risk - but at least in principle, the prospect of having a major problem and that being undiscovered for many hours or days can be mitigated.0
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