Discharge from a Hub Bed


I have posted about my Mum before and it has become clear after 4 admissions to hospital this year, that she cannot cope at home.

She is suffering severe depression and anxiety, and I am really concerned that no treatments tried have been effective.

She was moved from a hospital setting, to a care home hub bed nearly two weeks ago. This happened after in patient psychiatric treatment was suggested, but somehow her team decided that community mental health team support in the hub setting would have a similar outcome. In reality this has meant only one visit from a mental health nurse.

The mental health nurse got my Mum out of her room and outside for about 20 minutes.

Other than this, she has sat in her room ruminating and obsessively writing down her worries hundreds of times. There are pages and pages of identical notes. Nobody has challenged this behaviour or really made an effort to engage Mum in other activities, as they say she has capacity and can make her own decisions.

The hub team are keen to discharge Mum. I think this is ridiculous as she is obviously not well.

Where do I stand on requesting that she be given in-patient psychiatric care, which is what we as a family wanted her to try, the two times it was offered before.

I don’t see how the NHS can want to give on her, when not everything has been tried.

The hub team social worker was very honest and said her role is to get people to another setting or placement as quickly as possible. I don’t think this is right for Mum. I understand the pressures, but think the in-patient treatment should be tried before people give up on treatment for her.

Does anyone have experience of navigating this process?

We do eventually want to pursue getting her a care home placement in a specific location, but social services don’t seem keen to help with that.

Does she really have “capacity”?
I would argue this, as she has been admitted and discharged 4 times, and soon a fifth, without any significant improvement!
Do you keep any of her repetitive writing to use as evidence if needed? Do you have Power of Attorney?

Obsessively writing the same things, using the same words, is something taught in schools as a punishment, it’s certainly not the sort of behaviour that people perform in a rational state.

Ask for a mental capacity assessment: the fact is that capacity is always assumed because the law says to do so except when there are concerns. Concerns are not always convenient, though, and it’s important to get it checked before they discharge, because that will change a lot of things. In the meantime, you’d do well to contact the Carers UK Helpline for more advice. 0808 808 7777 - Monday to Friday, 9-6pm.

Thanks for your reply.

People tell me she does have capacity, and today I had a long conversation about what might help her with the community mental health team.

I can take pictures of her notes, that’s a good idea.

POA has been applied for.

The thinking seems to be that if Mum’s social anxiety could be relieved, her mood would improve with ongoing medication. The nurse I spoke to said if environmental stress factors were removed, she’d feel better.

So far, she’s only had one mental health team visit in the hub bed. No talking therapies or anything similar have been tried yet, as the team think she’s not ready to engage.

I asked again today if she could have in patient treatment, and was told the only difference would be how often she is reviewed.

The “thinking” may be correct, but it has to take the vital step between “thinking” and “doing”. It’s not going to happen until THEY arrange it!

Medically there may be little difference between the hub bed and going home as far as they are concerned, but what about you??

Thank you, I feel like she has fluctuating capacity really compromised by her anxiety.

She says she has memory loss, but can remember past events and her life easily when questioned and she does well on memory assessments.

I feel like I want someone professional to intervene and challenge her harmful coping mechanisms, and help her reframe them into a more helpful activity. What’s happening is activity co-ordinators are asking her to join in, she’s saying no, and they are leaving her, because it’s her choice.

I am trying to do this myself, today I am taking in plants and aiming to get her drawing. I want staff to really proactively distract her with activities like this, but so far, it’s all me.

I will call the helpline too.

I asked again if Mum could be an in-patient, as I don’t want her discharged into a permanent care setting yet, when her consultant suggested in-patient care twice, then the offer was recinded, just when she had agreed to go for it.

I know the NHS want her out of the hub bed asap. The social worker was telling me yesterday that it is her job to move Mum on as quickly as possible, and how she has patients waiting on trolleys in corridors for a bed like this.

I don’t want the NHS to discharge Mum until every treatment option has been tried.

It is not your fault if the NHS cannot organise their resources efficiently and effectively.
Mum needs PROPER treatment. “Joining in with activities” really doesn’t sound like it’s going to resolve anything.

I have had an issue ever since major surgery in 2004. 3 gyms, all wanted me to do things that I genuinely could not do.
Proper treatment from a good physiotherapist has transformed my ability to do things within 6-8 weeks.
It turns out that it was a good idea for me to stop the exercises that left me in so much pain I couldn’t sleep. They were so inappropriate they were doing more harm than good and might even have caused extra damage.

Maybe ask the discharge nurse to arrange INTENSIVE support for mum in the next week in the hub bed and agree what progress has to be made before she is fit for discharge? Not just the length of time she has been in the bed.
Remind the nurse that ultimately mum is HER responsibility, not yours!

Thanks, and I agree, join activities is not treatment

I spoke to the nursing staff at the hub, who confirms Mum needs a nursing bed in a care home due to her mental health difficulties. She can’t communicate about how she’s feeling, or do her self care without prompting. The nurse said the visiting hospital social worker hadn’t spoken to them at all, only to Mum, who can be extremely polite and is expert at making her difficulties.

I think I might complain again through PALS and to the social worker directly.

Good that the nursing staff support your idea. Next time you see the person hell bent on discharge, just tell her it isn’t going to happen. That she needs to talk to the staff PROPERLY, listen to them, and arrange an appropriate nursing home. Mention Continuing Healthcare too!

I am tempted to do it all by email, so I have traceable contact.

I think the social worker will say Mum doesn’t meet a threshold for care. When it comes to CHC people have told me that’s impossible and only for those who are basically dying! Am I right that if she has a nursing need, we might get help funding it?

You shouldn’t allow yourself to be put off applying for CHC by one social worker. The final straw when my brother was awarded it was that he was incapable of looking after his own health, on the contrary, his conduct without help would have been dangerous. Of course, cases vary and councils vary, but without trying you will never know.

Thanks. I have complained via PALS, and also requested this.

My difficulty seems to be that mental health isn’t viewed as a medical need, but I disagree.

Staff should NOT be prejudging the outcome of a Continuing Healthcare Checklist Assessment.
They should go through the procedure, and it should involve you.,
Even if it is negative, it will give a very useful “base line” against which future progress or decline can be measured.
Tell them the more they procrastinate over this, the longer mum will be in their bed, not an appropriate nursing home!

My own mum was also perceived as a “bed blocker” for months, I know what a great strain it puts on relatives.

Thank you, it’s good to know that their negativity is not correct professional practice.

I wrote two very strongly worded, assertive emails this morning, one to the hospital social worker, in which I mentioned my previous complaint to PALS, and saying I would contact them again. Another to PALS.

I got an immediate reply from the social worker, telling me a urgent meeting will be arranged with professionals, to discuss my mother’s needs, and that I will be included.

I still don’t understand why they say mental health is not a medical need? She’s had a complete change of personality and cannot manage daily tasks safely.

I am really concerned that this leaving her to sit will further comprise what little mobility she does have, and her continence, which has been fine until now.

I actually feel like I am in some kind of legal battle over semantics, which is ridiculous.

Hi Alison

I’d start here NHS continuing healthcare - NHS it gives a lot of information and points out that “psychological and emotional needs” is one of the “domains.” That’s mental health.

There is far too much to go into on this forum, but the information above also provides additional links to information and you can dig out what you need. There’s also information about an independent body that can advise you, called Beacon.

Thank you, I have requested the toolkit from.Beacon, which looks really helpful .

I now feel like I might be a bit more informed about how to make sure things are done the right way.

So, there is a proposed urgent meeting of professionals about Mum’s care on Tuesday, next week, that I can attend. Very short notice for me, but I can make it work.

I have asked the social worker to give me:

The purpose of meeting
Details and names of who will attend and their roles and responsibilities in my mother’s care
Details of any checklists, assessments and decision making tools and criteria that have and will be used

I want to read up on legislation and guidance in advance.

Have I missed anything?

I’d say you’re pretty much there. Just make sure you take notes on the day, and take a list of any questions you want answering at the meeting. Check off each one as you get through them (writing down the answers of course). Don’t miss the opportunity to ask those questions!

I’m having the CHC battle at the moment and I can tell you that they can’t do the review while a person is in an acute setting. I don’t know if they would consider the hub as still an acute setting but they won’t consider a review unless someone is stable (as in not deteriorating or likely to improve, not stable in mood). If you look through the Diagnostic Tool checklist and honestly think she meets the criteria then definitely fight for it. If it’s touch and go, maybe choose your battles and save this for another time. Some areas are much worse than others and Hampshire (where I am) is known for very few people actually getting it. I have yet to understand why so few people that meet the initial criteria still don’t get awarded CHC - how does the criteria change or what exactly are they looking for that isn’t on that initial checklist? T’is a mystery!

Mum was a Hampshire resident. No less than 28 (!) different medical issues but still didn’t qualify. I told the assessors he had an exceptionally rare condition, hyperostosis. Assessor had never heard of it. I suggested in that case before making any decision she found out more about it. I even spelled it out to her. Instead she just didn’t mention it on her notes. It’s a painful degenerative condition.