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Urgent advice needed please - Carers UK Forum

Urgent advice needed please

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I hope you can help me, I'm at my wits end now. My 86 year old mum was discharged from hospital on Thursday after being in for an infection in her leg after her cat bit her. If you check my other recent post 'I've had enough' there are more details about her health issues which are many. I've been working every day since Friday so I haven't been able to see her but the district nurse goes in daily.
First off she got stuck in the bath on Thursday night. She didn't sit on her electric bath seat for some reason and instead sat in the bath and couldn't get out. Luckily for once she had her pendant alarm on. The responder called me and said she was ok, warm and dry etc but that she had a pressure sore (must be from when she was in hospital) and I called the district nurse to tell her as I know that can be very dangerous if left.
Then on Friday at 4am my mum fell whilst going to the toilet. My autistic brother was staying for a couple of days and called the neighbour who pressed her alarm and the responder came out again.
Tonight, I couldn't get through to my mums phone so I called her neighbour to check on her and she was lying in bed in her own urine. She just wet herself in bed because she was too scared to try and walk to the loo (only a short walk across the hall, she has a Zimmer frame but won't use it). Clearly this cannot go on. The OT before her discharge said she thought my mum did not need a package of care as she seemed bright and able to walk using a frame etc.

I need to know who do I call? What does she need, I.e what packages of care should I be asking for? Who can perform a mental capacity test? Can the doctor prescribe incontinence pants? Is once a day enough to ensure this pressure sore does not become deadly? I just do not know where to turn or where to start. My mum wants and expects her neighbours to sort her out when she wets herself etc and tells them she hasn't heard from me for days (not true) but I didn't even know how bad her incontinence was because she doesn't tell anyone. Please help me, everything is a total shambles.
First ring the hospital, ask to speak to the Chief Executive's office and make a formal complaint about an unsafe discharge. Do the same to the PALS office. Maybe dial 999 and get them to take her back. Did they complete the NHS Continuing Hcealthcare Checklist" as required? Then ring Social Service and ask them to mobilise their Rapid Response Team. Explain that as you work you CANNOT give mum the care she clearly needs. The district nurse should arrange continence products as required. I know it's hard but staying away might be the best way of her getting care.
OK thank you bowlingbun ( you always come to my rescue). My mum doesn't help by pretending she is fine to the professionals but they should have spotted that pressure sore in hospital. The OT thought she seemed ok and she was able to use her frame and the physiotherapist said she was ok on the stair assessment.
So I call social services...not the OT? there are so many different depts I get confused as to who does what.
Fiona, just a suggestion. I think you need to contact the district nurses again tomorrow morning, tell them everything you have told us -that she has fallen, that she has needed responders out twice in the last week, that she is lying in her own urine and expecting neighbours to clean her up.
She obviously needs an urgent OT assessment at home and maybe the DN can bypass and make the social services contact for you, considering that mum sounds as if she should not have come home.
I honestly believe you need to step back from this and as BB says, it will be hard to do. But if she is to get the help she needs with movement, care, incontinence products, she will get these things much faster if there is a professional doing the referrals.
I think you need to tell them that you are unable to attend (work or whatever) and a suitable care package will be put in place. If you refuse to do the care, she will be treated as a vulnerable adult, and the appropriate steps will be taken, while you are on call, it won't happen. This isn't being cruel, this will alert them to how her situation actually is, rather than what she is telling them it is.

I do think you need to take this step, for both your sakes. There is a high chance she will deteriorate and her care needs will rise, no matter what you do - and I've seen the demands put on you. The guilt that comes with such a step can seem overwhelming but it is a good idea to write here when it gets too much.

xx

BB, if I can add something? Just as a cautionary note, in certain boroughs (my old one included), it is not possible for anyone but a professional to make a referral to the Rapid Response Team, hence my suggestion for the DN. Sad situation, but not uncommon I'm afraid.
In my area, the rapid response ream is run by SSD. Their care should have been sorted before discharge, but nevertheless, SSD are primarily responsible for vulnerable adults in the community. My phone call would start saying that there had been a terrible brakdown in communication....she needed care NOW and it was up to them to sort out the bureaucracy so that her needs were met. I'd also start a notebook, listing the date, time, and content of conversations, and made sure I had the full name of everyone I spoke to.
bowlingbun wrote:In my area, the rapid response ream is run by SSD. Their care should have been sorted before discharge, but nevertheless, SSD are primarily responsible for vulnerable adults in the community. My phone call would start saying that there had been a terrible brakdown in communication....she needed care NOW and it was up to them to sort out the bureaucracy so that her needs were met. I'd also start a notebook, listing the date, time, and content of conversations, and made sure I had the full name of everyone I spoke to.
In my old borough, it is run by the local NHS trust, not SSD. They only take professional referrals unfortunately. Hopefully it may not be this way for Fiona and I would still suggest calling the DN too, as they are attending her mother every day.
Hi Fiona
Bowlingbun's idea about keeping a good diary of events is excellent advice. I record all conversations, contact names, phone numbers, promises, advice , appointments etc and it has been very useful. With so many departments involved you will never remember who said what and when weeks down the line.
If your mum will be privately funding any care, then I would also tell District Nurse you want a full CHC assessment immediately she walks through the door and same to every health professional you meet until the ball starts rolling. Dad was turned down once the assessment was completed but got free care for 2 or 3 months while they were processing the request.
Thank you all for your input. The situation was worse than I expected when I got to my mums this morning, she is really quite ill and was in a terrible state and I found her lying in her own excrement severely dehydrated. She is back in hospital in isolation and being taken good care of. They really do not know what is wrong with her as her symptoms seemed like a high temperature indicating infection but her temperature is normal. They are testing bloods tonight.
So sorry, Fiona, to hear that things are worse. However, it may prove to be blessing in disguise. Now is the time to dig your heels in and insist on nursing care. No more failed discharges. I would suggest contacting the hospital social worker to start the inevitable fight and also ask for a full CHC assessment. Good luck, Anne x
Hi Fiona, this is so, so difficult, I know. Can I suggest that when you go to visit mum, you go and see the PALS department (patient liason). Make it clear that you need them to liase with the ward, and all concerned. It's clear that you have been ignored so far.