"Discharging a vulnerable patient"

My father-in-law is in his eighties and has limited mobility and during the past few months has been increasingly prone to water and chest infections although in the past four years his condition has been generally stable. He lives in a ground floor flat in a sheltered housing complex getting around his flat using a zimmer frame.

When he gets a water infection he loses his balance and becomes very weak, because if this he has a number of falls which became more frequent in Oct / Nov when he seemed to get one infection after another. As he is on Warfarin injuries from falls always look bad. In November he fell during the night and was found the following morning by his carer who arrived at 7:00. An ambulance was called and he was subsequently taken to hospital, examined and discharged. The very same evening he had another fall, taken to A&E and then admitted to a ward where he was treated with antibiotics and rehydrated then discharged, after about 6 days, to be under the care of his GP.

In December we noticed his concentration was deteriorating and people in the housing complex had also noted he was having more falls. In the previous months he had lost a lot of weight - around 3 stones in 4 months. at the end of December we had a call from the life line security people to say the my father-in-law had fallen during the previous evening. when we got to his flat he was very confused, an ambulance had been called and we went with him to the A&E department. It was chaos. After completing the preliminary forms with the nurse we left him in A&E. We did let  the nurse know about his recent medical history and our concern about the weight loss, his weakened state, the repeated water infections and that he lived alone, We asked the nurses to let us know if he was discharged so that we could be at his flat to let him in and make sure he was okay.  I called A&E a few times to check what was happening, I particularly needed to know whether or not he would be sent home that day as we would need to cancell his care package if was going to be in hospital for some time. I also let them know that his granddaughter has stayed with him whilst she was full of cold, in case this had any bearing of possible infection he may have picked up. After a call int he afternoon we cancelled his care package as the hospital were unable to let us know whether he would be discharged.

3 hours later we had a call to say he had been assessed and that he would be discharged. I voiced my concern as his mobility had been very poor when he was taken into A&E earlier that day, he was confused and weak and I doubted he would be able to take care of himself in his flat. However we were told the OT has observed him getting off his hospital trolley, using a zimmer frame to make his way to the toilet, come back and get back on his trolley. I had to leave it at that and asked the hospital to let me know when the discharge process was completed as this would give us time to get to his flat to let him in.

I  only knew he was at his flat when the ambulance crew called me to let me know they were there. Fortunately we live close enough for me to be able to get to the flat quickly and let the ambulance crew in. The crew explained they only had a 15 minute window and that if I had not got there when I did they would had had to just leave him. I was appalled. My doubts re my farther-in-law's fitness to be discharged were further re-enforced when it took both the crew members and I to get him into bed. 

As neither my father-in-law nor the ambulance crew had been given discharge papers I called A&E to find out more about his discharge but was passed around from one person to another.  I did not feel comfortable leaving him on his own during the night so quickly went home and made arrangements to sleep on the sofa so that I would be there if he needed me, which he did regularly through the night to go to the toilet. 

In the middle of the night, needing to go to the toilet for the third time, he was exhausted and close to collapsing. I  had to call the paramedics whose assessment was to return him to hospital, having been discharged just a few hours earlier.

I had repeated told the staff that my father-in-law lived alone, he was weak and confused and had lost weight rapidly. I think that all of these should have been taken into consideration when making decisions about his admittance to hospital or discharge. Had I not made the decision to stay with him that night I'm not sure what would have happened.

We finally received his discharge papers, there was no mention of the water infection or weight loss he had been suffering from in the previous months. I know the NHS is stretched but there was no way he was in a fit state to be sent home to a flat in which he lived alone.