Unsafe hospital discharge? 6 weeks intermediate care?

Hi there,

New to all this…

My 86 year old gran is currently in hospital with a broken pelvis, following a nasty car accident. She has been in for three weeks and was in a lot of pain initially, both from the fracture and some lacerations. They are still treating the latter, but allowing the fracture to heal by itself, with phsyio. She also had tests for a suspected heart attack, but these were inconclusive as far as I can tell. She has only started moving around in the last week and can now walk painfully around the ward with a walking aid.

We assumed she might transfer to an intermediate/rehab centre locally, but yesterday were informed that she may well be discharged home this weekend, if “medically fit”. They said she was “too capable” and wouldn’t qualify for intermediate care, based on answers she gave the physio and OT about her living arrangements, care etc. They are proposing to discharge her without any care support and without having done an assessment of her home. I assume she will get physio visits and possibly wound care, but am not entirely clear on that.

She lives alone in a ground floor flat and was previously very fit and active, doing all her own shopping, cooking, cleaning etc. She also drove until very recently when she decided to give up her own car. She has, however, had two major falls in the last year or so, one which landed her in A&E with a suspected broken nose, and one trying to step up into her shower, leading to a nasty leg wound which took 3 months to heal and has left a large scar. She has also had some problems with her eyesight (two recent cataract operations and slight AMD that makes transitioning from different levels of light more difficult).

For her to go home, we would need to get a trolley, toilet seat, suitable chair, possibly a different bed, a panic button system etc etc. She would also be unable to use her bath or shower safely, or wash her hair, so there are concerns about hygiene. She often has home delivery for her groceries, but uses a step to reach high kitchen cupboards, which obviously now wouldn’t be safe. Previously, she cooked all her own meals, but would now be unable to safely use the oven or hob… All her doorways have lipped thresholds so moving a walker around would be difficult and unsafe. She has tried crutches once, but wasn’t confident on them at all. Her flat has steps to the front and back doors, plus a very high threshold to the latter, which would prevent her from accessing her patio/garden.

So we are very concerned about the plan to discharge her with no support. Neither myself or my aunt live in the same town (although we are both within 30mins drive) and, whilst we are able to help with shopping, a little cooking and cleaning etc, we can’t be there all the time to assist with getting up, dressed, washed etc, or to assist with every meal. My aunt and uncle both work full time in busy jobs and I also work part-time, around looking after my young children. We are also concerned that, having been so active and independent prior to all this, she will be tempted to try and do too much too soon… I’m not clear at all whether there is a “care plan” of any kind on place in terms of what goals she might work towards and when it might be safe to try undertaking various tasks, nor what follow up reviews or physio is planned.

With more time, we may be able to arrange some private care and get all the necessary equipment in place etc, but it feels like they are rushing her home before she (and we) are ready. The ward isn’t full to my knowledge, so no acute bed issues, although I do understand that they don’t want medically fit people staying in hospital longer than necessary. Overall, we were very shocked that no home assessment would be carried out, and that she wouldn’t qualify for any intermediate care at all. We understood that up to 6 weeks intermediate/reablement NHS care should be available, but it sounds like they have “assessed” her based on her answers to their questions alone. As family/potential carers, we weren’t involved in that discussion, only advised afterwards that she is likely to be discharged straight home in the next few days.

Does anyone have any advice? We are obviously going to request a meeting with the doctor, physio, OT etc. Are there any other services that we should be involving? Or any sources of information that might be of help? She is obviously very keen to get home, as anyone would be, but we desperately want to avoid her having to cope alone too soon, and potentially having a fall that lands her back in hospital.

Thanks in advance,

Phone the CEO’s office at the hospital, and complain about plans for an unsafe discharge. She should not be discharged until they are sure she can manage in her OWN home, with all the aids she needs.

Please don’t assume anything. I’d like there to be an OT visit to her home before she does go home and at home reablement package arranged through social services.

Thanks for the reply :slight_smile: Should this be our first course of action?? Had planned to raise our concerns with her hospital team as a first step… but does it need to be taken higher more quickly?

Incidentally, was it realistic to assume that someone would come and assess her home, at the very least, or is this not something that routinely happens before discharge? Should we be contacting social services ourselves to arrange an assessment or anything?

We just assumed that proper home or inpatient intermediate care would be the next step, so she could work up to fully washing and dressing herself, preparing a meal etc etc. We never imagined that she would just be sent straight home with a few bit of portable equipment (zimmer, commode etc). She won’t be able to get up off her sofa safely, so a chair would have to be bought or hired, and I’m not sure if her bed is suitable either. Not to mention the lack of a panic button if she did fall at home… :frowning:

Hospital discharges ?


Being discharged from hospital - NHS

In essence … not by the Book , NO discharge !

Thanks for the reply Rosemary. Do we press the hospital for the OT assessment etc, or do we need to be talking directly with social services about this? :-???

My aunt asked whether a home assessment would be done and they said no. And that gran wouldn’t qualify for any intermediate/reablement care… We’re not clear why she doesn’t qualify, given that she’d be going home alone, having only been able to get out of bed within the last week and start walking on her own with a zimmer a few days ago. I’m also not clear whether she’s able to dress herself - I doubt she’d be able to get socks or slippers on, even if she could manage trousers.

They have based their assessment of her living arrangements and overall health on talking to her alone, but she has a tendency to downplay things. She didn’t tell them about her chest pains when they occurred, forgot to mention that she gets breathless from lung damage due to previous radiotherapy, said she’d had one “slight” fall (not two major ones), and implied that she would have plenty of family around to care for her. Which just isn’t true to the extent that she needs it currently.

My best friend broke her pelvis in a skiing accident, flew home in an air ambulance. She was told it was “stable” but had to hop on one leg for months.
I can’t see how they can possibly think about sending your mum home - unless mum has told them what she USED to do, not what she can do now.

My mum was very frail towards the end, the physio and OT both saw her, and the OT took her home to see if she could manage. I asked to be present for the visit, but they “forgot” to tell me. The OT said mum could get up the steps to her front door, she might have done with the OT standing next to her, but she never EVER went up those steps again by herself.

Has she told the hospital that “someone” will help her at home? My mum would often say things that were not true any more, she just couldn’t admit to herself just how disabled she was. It’s really sad, but you have to look at what your mum now NEEDS not wants.

Definitely make an “immediate formal complaint” to the CEO. I found it worked wonders!!!

The Reablement Care is, I’m fairly certain, part of the 2014 Care Act. Make a coffee, click on Chris’s link, and start reading.

Reablement care ?

NHS on the very same :

Care after illness or hospital discharge (reablement) - NHS

Dovetails in the hospital discharge link.

Thanks for the links Chris :slight_smile: Will definitely take a good look at those.

I’m certain that some form of reablement care should be provided, even if it’s just for the first week or so, to assess how she copes at home and ensure that she can definitely wash and dress herself, safely make a meal and carry it to the dining room, get in and out of bed etc.

Your welcome.

If the NHS followed their own guidelines , threads like this one would not be necessary ?

Chalk up the cost of doing things wrong nationwide and said slade would be gigantic ?

Yes, I think she has probably implied a lot more help at home than we will be able to provide :frowning: I think she’s assuming that this accident is a temporary blip and that she’ll just need a bit of interim support (help with shopping for a bit, living off ready meals, a cleaner), before going back to being fully independent again.

Which, of course, we hope she does! But the worry is that she’ll be thrust into managing alone too soon, and might end up not coping or even having a fall and ending up back in hospital. And then, through merely being a passenger in a car accident (caused by the other driver), she may well end up on a slippery slope of reduced confidence and ability, rather than being properly supported to get back to where she was previously, as near as possible. :frowning:

Yes, I was just saying this to husband last night. How many times do you hear of (particularly older) people being discharged home from hospital too soon, or with insufficient care, only for them to end up right back in hospital?? And quite often from there into a care home prematurely, or in a cycle of falls, hospital visits and worsening outcomes…

So short sighted…

When my Mum had her knees replaced she did get 6 weeks re-ablement care - BUT we had to have a financial assessment from Social Services (SS provide the re-ablement care not the NHS) before hand which resulted in us having to pay for it. In our case it was only needed for getting Mum up and dressed of a morning as I moved in with her temporarily whilst she recuperated from the operation, but as I was working full time back then I needed them to come in so that I could get myself ready for work !

I made sure that I prepared lunch for Mum before I left for work and also left her a flask of coffee, a bottle of water and the biscuit tin to hand ! Some days my sister was able to pop in before I got back from work to make her a cup of tea in the afternoon.

Mum did have a full OT assessment before she left hospital and they did check with me what the situation was at her flat - no stairs, all on one level but they didn’t do a home assessment before her discharge.

I had Reablement Care free after knee replacements in a private hospital - paid for by the insurance company of the other driver who nearly killed me and wrote off my Range Rover.

Writing this has reminded me that if mum’s injury is as a result of a car accident, then ALL her care needs should be met by the other person’s insurance company. Make sure that she makes a claim asap. She should be able to have all the care she needs, private physio, etc. etc. and if, sadly, she doesn’t recover fully, then that should be recoverable too!

In 2017 when mum was discharged from hospital she was discharged under a 'discharge to assess" program through the hospital and LA at no expense. She had doubled up care 4x daily. The LA’s OT and social worker assessed her and qualified her for 6 weeks reablement care, at no cost to mum, even though she had to pay for the LA arranged care package afterwards.

I understood that reablement care was at no charge to patient, not means tested. The LA had a grant from the NHS to pay for it.

Prior to discharge the hospital, LA and family should work out a discharge plan prior to discharge. There’s staff from the LA who work specifically with/in the hospital to coordinate discharges.

If your mum has said someone comes round to look after her and this is incorrect or you don’t want to continue, or start, doing that, then inform the hospital. The family, ie, you, are not obligated to care after discharge.

HI Susie,

I’m finding a lot of conflicting information re care and support following a hospital discharge. Some sources suggest that free care is available for up to 6 weeks, regardless of your financial situation, and others seem to say that it’s means-tested.

"Intermediate Care is an NHS service providing free temporary care for up to six weeks at home or in a residential care home following a stay in hospital…You’ll get Intermediate Care regardless of your income and savings. "
(How to choose a care home for older people - Which?)

“If health and social care staff believe you may need care and support when you leave hospital, they’ll carry out a care needs assessment to decide what help you may need…If you’re found to have eligible care needs, you’ll have a financial assessment to see if you’re eligible for financial support towards to the cost of care.”
(Elderly care after hospital discharge | Age UK)

But I’m not certain whether the above sources are talking about the same type of “care” :-??? If we do have to pay for care, that’s not the end of the world - it’s just so confusing trying to find out what we could/should expect to receive! Especially when they are basically saying that gran doesn’t need any help, paid or otherwise :blink:

Yes, we have already got a claim underway, but I’ve no idea how long these things usually take to process… :unamused:

Tallk to the soiicitor concerned, and explain the severity of mum’s needs. I would be pushing for nursing home rehab care.

Coincidentally, I just stumbled across the “discharge to assess” concept online - will investigate further.

I assumed that something like that WOULD be put in place (i.e. discharge to either rehab care home if necessary, or home with support, but in either case with a clear plan to fully assess her needs, goals, progress and likely longer term needs).

Guess I’m a bit naive! :blush:

Yes, I’ll talk to my aunt and uncle tonight as they are handling the claim. They are definitely not happy for her to come with no or limited support, so we will be pushing for a rehab bed. Or properly assessed, regular in-home care support at the very least.