"Poor discharge planning from hospital to residential care"

I acknowledge the very difficult times that country is in, and the NHS but am writing here on behalf of my mum as I feel it is important to raise my concerns about the recent experience we have just had.

Mum was recently in WD 8 James Cook University Hospital for 4 days, where she was admitted with a bad urine infection,  resulting in delirium, immobility and  a catheter. She was also diagnosed as covid 19 +ve on admission, but seemingly asymptomatic regarding this. Up until the point of admission mum was mobile with a rollator and not confused.

Throughout the stay it was incredibly difficult to find out what was happening, but on several occasions was advised that she has a very bad pressure sore on her L heel ( Grade 4) that needed review by the tissue viability team on the Tuesday.

Overnight on the Sunday, there appeared to be a change in plan and on contacting the ward mid afternoon on the Monday was advised that mum was going back to the care home. On asking if the home had the correct equipment to support mum was advised yes they did.  On calling the home shortly afterwards and speaking with duty manager, was advised that they had not been told about the change in mums care needs, no mention of catheter, immobility or pressure sore.  The manager rang the ward and when eventually they got through, mum had already left, and the person who answered said we don't discuss patients who are discharged and put the phone down. 

The manager and I discussed our various concerns regarding the situation, they call the District Nurse team, who visited the next day to make a full assessment, advising the discharge letter did not contain any of the above detail regarding mum's care needs or details of pressure sores, catheter or state of mobility. 

 The situation seems very lacking. As a family member i was not advised on the change in plans, and feel the information provided to the care home was totally inadequate, and placing them in a very difficult position. Most of all it seems very unfair to my mum to have been on the receiving end. An irony made worse by the fact that she worked for the NHS for 40 years as nurse herself.