District nurses/Mum and where to go

Long winded story but basically my Mum (65yo) has had ulcerated legs for well over a year. Her mobility severely affected and she's incontinant. She also has been diagnosed with hemiparesis (not sure of spelling) by virtue of a brain scan.
Was hospitalised on the IOW for over 3 months, finally discharged home only to then be taken to nursing home as District Nurses concerned for her health and welfare in Dec of that year.

We managed to get her transferred to the mainland in a sheltered housing flat closer to family in March of this year, again her legs were still ulcerated etc. New GP, new DN's and no partner to mentally abuse her. She had carers coming in three times a day to help her with meals and emptying commode etc.

Was hospitalised in bed for almost 7 weeks as was poorly infection etc. On her return to home the DN's made her sign up to a care plan where she agreed that she would be in bed 24/7 for two weeks as her legs were again sliding back wards swelling and lots of exudate. Her legs then got septic which meant another hospital admission (by the same DN) and she's been in hospital for 2 weeks.
In her DN's note folder it says that Mum is not compliant (they have found her out of bed when she should have had her egs elevated) and is making them feel uncomfortable when they visit her, she rolls her eyes when they try and dress her legs, mutters under her breath or becomes verbally aggressive with them. (I know she's in pain from her legs but she has been on morphine based pain killers for almost a year now too).
She complains that the DN who has had to ring to admit her to hospital scrubs her legs like they are doorstops causing her more pain, she also says that the DN is ramming the fact down her throat that her dressings are expensive (3k a month) and her hospital bed has cost them a £1000 to get for her. Mum isn't bothered by this and thinks she has earned the right to treatment from paying in her NI stamps. She also counters her own bed cost more than the hospital bed.

We are now in a situation that my Mum is now medically fit for discharge however the DN's are blocking her discharge saying that my Mum needs nursing home care as she's not compliant and also her incontinence issues where she is not using the commode in hospital but bed pans also mean her care needs are higher than what can be provided in the community. We have a case conference on Tuesday where Dr's, the head DN, the OT lady, myself and my Mum plus her medical advocate are attending.

My Mum is saying that everyone is ganging up on her (even alluded that I was too), she states that the District Nurses are lying and that she was in bed. However I am sceptical as her legs were so much better from her first hospital stay on the main land, they got worse within 2 weeks of her coming home. She is adamant that she was in bed however from the notes in her DN's file it's stated that they have found her out of bed. My Mum is adamant that she is NOT going into a Nursing Home.

Does anyone know what happens in cases like these?
The hospital want to discharge her ASAP, but obviously Mum has to have her care plan in place prior to her leaving hospital. If the DN's are refusing to sign off for her to go home to the sheltered housing flat does she have any choice i.e. she has to go to a nursing home regardless of what she wants?

It's causing me lots of headaches/stress.
Mum just tries her normal coping strategy of either tears or verbally aggressive to get people to back off.
She also thinks I am colluding with the nurses and want her in a nursing home....all I want is what is best for Mum and if she isn't being co-operative with the nursing profession what can I do, her choices/decisions have got her in this situation..but how can I make her see this??
She's promised the DN's she'd do various things and she obviously has thought she knows better with her legs than the nurses etc. So hasn't complied and that's why she's in this situation.

ARRRGHHH

Any ideas thoughts gratefully received.

Sympathies. I have no idea what will happen my mum is still in her own home and stating she can cope and won't accept help unless its us running around behind her.

We get the same she says one thing about the carers that shower her and she won't have them do anymore as they don't do the housework properly are all over the place for times regards to meals etc, so my brother, sister and myself do as much as we can. Totally different story from the carers and knowing mum I can see their point.

She will not use her stick or frame and has taken another fall but she is alright she can manage.

They do get very defensive when they are told somethings ie: the bandages etc., she may of been told they are expensive but not in the tone she is implying.

I put it down to the fact that with my mum she is not coping well and knows it and is now hanging onto her little bit of independence with her fingertips. They say some hurtful things I am not seeing my mum at the moment because of some of the things she has said to me recently and I need some space to heal.

My mum was assesed by SS last year and they said she is lucid so she can stay in her own home she finds everything difficult now and there is going to be a major accident before long. Apparently there is nothing anyone can do. Maybe they are different in your part of the country or she really is at that stage and so she will end up having to go into a home I know my uncle when he took his last fall he is blind too was put into a nursing home no option.


(((Hugs))).

Having friends in the UK who have gone through [and are still going through] very similar situations, the following is what I understand.

You say the case conference will include the doctors, head DN, OT and your Mother's medical advocate, as well as your Mother and yourself. Does your Mother not have a Social Worker as a SW should be included in any decisions.

As far as I know a hospital is responsible for not discharging a patient, even if they are medically fit, if there is not an adequate care package arranged.

There is a problem with the fact that your Mother is not compliant, and comments such as "everyone is ganging up on her", "lying" about her etc could be construed as her being a possible danger to herself. And that could lead to her being temporarily sectioned under the Mental Health Act while her physical and mental health is evaluated.

The one thing you must not do is beat yourself up about the situation.

I think you need one of these...

It depends from trust to trust but deff need the social worker involved, your mum should not be made to stay in bed could there not be a compromise? Out for x amount of time?
I would complain that your mum is constantly made aware of how much care is costing this is not her concern.
As for being sectioned- a mental capacity test would have to be preformed to derermin if your mum has the capacity to make decisions about her care, just because your mum isn't compliant dies not mean she will b deemed to have lack of capacity. People are free to make unwise choices.
Incontinence should not be a problem I have cared for people in their own home who were double incontanant
ATD x

Hmm well went and it was a disaster and I rowed with my mum in the conference

The social worker & Doctor didn't turn up.

All the nurses and OT want Mum to be safe for discharge.
But she refuses to see that and says she 'can do' but she hasn't shown any real attempts to get her self 'doing' in hospital.

She's now threatening to discharge herself...arrrgghh
and she doesn't seem to realise that she needs her care package in place as otherwise she won't be eating or having her commode emptied.

She is refusing to see she needs to stay in bed legs elevated 24/7 until her legs have healed.
Her legs are so much better since she's been back in hospital. I asked her what she wanted amputation of her legs? As all she complained is her legs are painful in bed...but then if she doesn't elevate them they are never going to heal

I came away after the end of the meeting and came home as otherwise I may have said something to Mum that I would have regretted.

Now have a stress headache