District nursing - definition of "housebound"

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After my mother spent some time in hospital nearly 4 years ago following a femur fracture she developed an ulcer (on her other leg to the one she fractured) Since then she has been attended by a district nurse at least once per week, sometimes more.

However, their pattern of calls can be rather variable which generally isn't a problem. Sometimes they call on the days I am at home, sometimes when I am at work. Recently they asked for a referral to the vascular clinic to which I will be taking her next Wednesday ( I have now claimed part of my works pension and gone part time) so taking her to this and other appointments no problem as I try to ensure they are arranged for days when I am not working.

As she is due to go to the vascular clinic next Wednesday I thought I would phone the district nursing team to advise that should they call next Wednesday that she might not be in - and she wouldn't be in the following Wednesday as she had another hospital appointment as a final follow up to an issue dating back to last autumn.

This morning when I was at work, I received a call from the District Nursing team to tell me that as she could attend hospital appointments with some assistance that after their home call next week - my mother would be referred to a treatment room service and that I should take her there. Given that I wasn't in a position to have a lengthy conversation about the matter then I accepted what they said. A little later I phoned them back and asked them to call me regarding this issue and a further slightly discussion ensued, but being constrained with work I made no further progress and left it with the DN insisting that the arrangement would be better for myself and my mother.

The DN's further justified their position by stating that as I regularly take my mother out on day, weekend and for several longer trips each year she was not housebound and didn't qualify for their visits. Now I have always notified DNs of when my mother would not be present, and apart from one call when they showed up on a day on which they were not expected - they never appeared to have a completely predictable pattern of calls.

The fact is without my assistance my mother is completely housebound. She can move around the ground floor with a zimmer but has to use a wheelchair to go outside for which I have to put ramps in place and relies on me to take her in the car.

Therefore, what I want to know is it reasonable for the DN's to assume I am there to assist my mother on what could turn out to be very regular visits.

There is going to be one final call next week before the treatment room referral, unfortunately it is going to be on one of my work days.

My mother has suggested that she will refuse to go to the treatment room and I could reinforce that by refusing to take her - not that I really would. But of course if I refused she would be housebound. Should we go for a bit of brinkmanship?

Any ideas on how to proceed with this? It does seem ironic that this has all developed as a consequence of informing the DNs that I am taking my mother to the vascular appointment which they requested in the first place.

John
The NHS definition of housebound says the following

An individual will not be eligible for a home visit if they are able to leave their home environment on their own or with minimal assistance to visit public or social recreational public services (including shopping), and ultimate responsibility to determine whether a patient requires a home visit rests with the assessing clinician.

I suspect the DN did assume you are the carer to you mother, as it does to me. I think many carers just slip into the role without realising.

I suggest you decide if you want to be your mothers carer, as it can get very demanding later on. if you do decide to go ahead, then you must contact the Local Authorities and ask for a Carers Assessment.
John,
I think you will be heading for carer burnout if you have to juggle more appointments and working on top of what you already do for your Mum.

According to the definition that Adonis found, you Mum does qualify for home visits.

The statement,
ultimate responsibility to determine whether a patient requires a home visit rests with the assessing clinician.
could be your way forward. Explain the situation to the Vascular clinician (you work, you struggle to take your Mum to appointments, she can't go out alone etc ) he/ she can then request DN visits continue. If they aren't help, then involve the GP.

Melly1
Adonis_1802 wrote:
Fri Feb 23, 2018 8:53 am
The NHS definition of housebound says the following
I suggest you decide if you want to be your mothers carer, as it can get very demanding later on. if you do decide to go ahead, then you must contact the Local Authorities and ask for a Carers Assessment.
I did decide that I wanted to be my mother's carer and for the past 4 years things have worked out fine until now.

Taking her to the occasional doctor's / hospital appointment is fine.

However, a long running commitment to take her each week to a treatment room (the only highly rated one and the one with long opening hours is several miles away - the fairly nearby (1.5 mile away one is office hours only and only has a two star rating). Basically what was once a 15 - 20 minute district nurse call - could now be an at least once weekly trek and what happens if they want to see her more regularly? This could now tie up a significant amount of time probably in the region of at least two hours.

What I should have done yesterday was be forceful when the initial call was made and just said no and hung up - but I was working and caught on the hop.

John
Melly1 wrote:
Fri Feb 23, 2018 9:12 am
According to the definition that Adonis found, you Mum does qualify for home visits.
The statement,
ultimate responsibility to determine whether a patient requires a home visit rests with the assessing clinician.
could be your way forward. Explain the situation to the Vascular clinician (you work, you struggle to take your Mum to appointments, she can't go out alone etc ) he/ she can then request DN visits continue. If they aren't help, then involve the GP.
Melly1
My mother hasn't seen the vascular clinician yet that is due the day after her last home visit. I was thinking of getting in touch with the GP before that and leaving a written letter with my mother the DN who calles on Tuesday to take back to base.

In that letter I would inform that if they do not continue visits I will not be taking my mother and they had better do something about it otherwise any resulting medical problems will be their responsibility. The devil in me tells me this is the way to proceed.

John
I found myself in that position when I was caring for Dad and the d/ns advised me to never take dad to the drs surgery but to always book home visits and say I couldn't get him in the car or I would loose the home visits. I only ever took him out just after the nurses had been so I knew we had a clear run.
Henrietta wrote:
Fri Feb 23, 2018 9:33 am
I found myself in that position when I was caring for Dad and the d/ns advised me to never take dad to the drs surgery but to always book home visits and say I couldn't get him in the car or I would loose the home visits. I only ever took him out just after the nurses had been so I knew we had a clear run.
Interesting - I never thought there would be a problem taking my mother out as I don't want her stuck in the house all the time. The local DNs have known that I take her out and go off for weekend and longer breaks and it has always been possible to schedule calls around this. I had never been told that taking Mum out would put her home DN visits in jeopardy.

The crazy thing is on this occasion I had called to leave a message to tell them that she might not be in next Wednesday as she was due to go for her vascular referment which the DNs had requested!

John
Agree with Melly, the GP is your closest ally, in all matters concerning your health and welfare, so it is in your interest to keep them up to date. Many a time has my consultant or clinician forgotten to send my GP letters concerning my health, so I now always make a point of asking for the letter to be sent.

It means a little more running around for your organising, but it is worth it in the long run.
Adonis_1802 wrote:
Fri Feb 23, 2018 9:54 am
Agree with Melly, the GP is your closest ally, in all matters concerning your health and welfare, so it is in your interest to keep them up to date. Many a time has my consultant or clinician forgotten to send my GP letters concerning my health, so I now always make a point of asking for the letter to be sent.

It means a little more running around for your organising, but it is worth it in the long run.
Thanks

On Friday afternoon I dropped at letter into the GP's surgery, so hopefully he will get back to me soon.

In the meantime I intend to write a letter to the district nursing service which my mother will hand to the district nurse when the last call is made on Tuesday if the matter is not resolved by the GP by then.

I will state that I feel as though as a result of my good will in taking my mother to hospital appintments and getting her out of the house I am being coerced into taking my mother to the treatment room and in so doing this will add to my burden as a carer and this will impinge into my work commitments and that advantge is being taken of me as I have chosen to go part time to provide additional support for my mother.

The more I reflect on this it is myself who is being coerced and my mother is being used as the pawn which is very unsatisfactory and I perceive as bullying and applying unacceptable pressure on myself as her carer.

I intend telling them that as a consequence I am refusing to take my mother to a any treatment room appointments and as a consequence of this she is now housebound. .

Finally I will refuse to discuss the issue by phone and only deal with written communication on the matter. (no more calling me at work - I will block the DN numbers). I always feel more confident when dealing with correspondence and less likely to be manipulated when dealing with phone calls and stop them calling me at work.

John
Talk to Social Services, arrange for mum to have a Needs Assessment and you, a Carers Assessment. They have a legal duty to support you so you can keep working. Mum's needs will inevitably only increase and increase, sort this out now.