Hi TC,

I don't know how it is in your area, but where I live there was a definite
protocol that had to be followed before a person could be admitted to a
nursing home.   This, in part, involved a public health nurse who came to
our home and checked my mother in law.   There were other needs as well, in
particular a physical exam which we had to arrange with her doctor, and a
ton of paperwork as well.

Mind you that some time before, we had a complete gerontological work up
done when my mother in law was living in her home a few hours drive away
from here.   We took her to her own doctor who prescribed several tests
including a cat scan and a thyroid test and a psychiatric evaluation.

These three tests led to the conclusion that she was definitely suffering
from dementia.   In particular it was the psychiatric evaluation that showed
exactly how impaired she was, and the cat scan showed her brain was
beginning to shrink in certain key places.    We were then told she
shouldn't live alone anymore but it was at least another six months before
we were able to take her out of the home and care for her ourselves,.....
not due to our negligence, but the fact that we had no legal paperwork in
place and she was not inclined to believe that she needed any kind of care,
this coupled with her neighbors and friends being in complete denial about
just how impaired she had become.

I suggest that you are now running up against a problem because she is in
the hospital from a stroke, and that particular problem is all they are
focusing on.   You may need to contact your local office for the aging, and
find out what can be done to get her admitted to a nursing home.   Work also
from the hospital angle and ask whatever doctor is in charge of her case,
have her tested further to be certain she is able to care for herself.   If
she really is not capable of caring for herself at home anymore, the testing
will reveal it.

Sad to say sometimes you just have to dig your feet in and make some noise
before these things will get attention.   You also need to explain just as
you have explained here, that you are certain she is sufficiently impaired
to be unable to care for herself, and say why.   You may also want to make
some rumblings about holding them legally responsible for releasing her to
her own care, if something bad happens.   That should get their attention!

If she goes home, I am sad to say that unless you have some sort of health
care proxy signed to be able to take care of things yourself, you may have
to wait for some disaster to get any kind of attention to the situation.

Now is the time to act on your concerns while she is already under medical
care.   Don't let them release her till she is tested.   Insist on it.  Talk
to the hospital administrator.  Talk to her doctors.  Talk to everyone and
be adamant.    She needs an evaluation to determine whether she is competent
to care for herself, and it isn't a big deal.   They can do it.

TC, are you in the UK? I ask because your message 'sounds' british to me,
and of course the laws and ways things work are very different between
countries, most of the posters here are US, I am from the UK so can talk
about my experience here which may be of help to you, in summary I think you
are correct in insisting on a proper assessment (of course, once they have
done that they cant just chuck her out and they may even be obligated to
spend some money, hence their reluctance).

I have experienced completely contradictory things here in the UK, at one
end from my father getting fairly poor care, and very little help for my
mother, through to a large number of medical staff and social care people
almost insisting that he was taken into care when we had a 'conference' (we
thought they were going to insist he went home but couldnt have been more
wrong, luckily).

I believe the difference came about because he went into care for a several
week assessment (after my mother insisted it was either that or she would
just leave the house and him to his own devices, which even the social
services knew wasnt safe), where the staff got a proper chance to assess him
and see just how bad his condition was. If your mother is like my father
was, she may appear fine and perfectly normal to anyone that is with them
for 5 or even 10 minutes, someone needs to spend some serious time with
them,and few chats with the social services (who want to show she is OK)
will not show up problems (see my footnote*)  Once this assessment happened
to my father, things started to happen, but it probably occurred a couple of
years after it should have.

So, I think your first focus,as you thought, is on >>demanding<< a proper
evaluation. Putting it in writing is a good starting point, outlining the
sort of things you have said to us, but in more detail, and at the very
outset stating quite plainly that she isnt able to look after herself and
should not be sent home. Sounds like the consultant isnt in this area of
medecine (does he just do strokes?), but I think and agree with you, you
need to be very plain and insist on a proper assessment, try someone else,
maybe via your GP?

I dont know what your personal circumstances are, but flatly and point blank
refusing to care for her would be a stance to consider taking, IME they may
well try and put a lot of the load onto you. If you refuse, they are left
with much less choice. The whole policy is to pass the care onto carers to
keep costs down, you have only got to look at the 'NICE' assesment of
aricept 'not worth the money' to see what I mean.

If the position is that she would be returning to 'home alone' (with your
father in hospital) them I would also consider a solicitors letter, along
the lines of 'she isnt able to care for herself, you havent even evaluated
her for dementia, I will be suing you if she comes to any harm due to your
negligence.' If you can get the name of the social workers involved, put
them in that letter, so people cant hide behind their employer. (social
workers plainly arent able to make a diagnosis of dementia, so you getting a
proper assessment must be your first priority. Point out why your father had
taken over the cooking. She is obviously a serious danger doing things like
that.

As other people have sugegsted here, keeping a detailed diary also helps, so
you can note the exact things she has done and they arent just anecdotal
reports.

*once in a while social workers come to the home where my father is and ask
him questions like 'do you like the food here', and 'how do they look after
you here', its farcical, he cant recall what happened more than 10 seconds
ago (literally). I suppose this fulfils some beauracratic need to check
people are being cared for correctly, without doing it properly such as
spending a whole day at the home watching what is going on instead of 5
minutes filling a form in.

We only started to get the help we needed when we very clearly stated
exactly what we wanted, and refused to take any other alternative. If your
help is needed **in any way at all hwiever minor** to help her get home,
***do not give it***, until at teh very leasyt she has a full assesment. And
i dont see how anyone who doesnt know to switch the gas on can be assessed
as OK, you might want to ask the social security people that,a nd also be
there for any assesment to make sure they arent coaching her, not
necessarily because of malice, just because they dont 'get' dementia.

HTH

Yes absolutely, I'd INSIST that her dementia be taken into
consideration. If the purpose of the assessment is to determine if she
is able to look after herself, they can't NOT look at that. Its not
like she is going home to a hale and hearty husband who can step into
the breech. Its a safety issue - she's not competent to look after
herself. It would be like saying an orphaned toddler is okay to go home
alone just because they can walk.

Just shows you the contrast depending on where you live. When my MIL
was in very early dementia (prior to formal diagnosis), she broke a hip
and had to have surgery here in Toronto. She's been a bit forgetful
prior to the surgery but functioning quite well in terms of managing
her life. Predictably, the anesthesia just threw her for a loop
entirely. The hospital staff was so alarmed by her mental condition
they didn't want to release her - they wanted her to go to a nursing
home, and accused us of being in denial/lying about how she'd been just
prior to the accident.

M

CHANGE DOCTORS.

Hell, yes.  If you don't get the answers you want, then you say
"I want to talk to your supervisor".