I would really appreciate some advice. When my father's care home applied for a DoLs for him, the personal representative suggested he would be better off being cared for 24/7 in his own home. I have a power of attorney for financial affairs for him and I am not sure this would be in his financial best interests, as it would cost significantly more than the care home and I had been expecting to sell his house soon to pay for his long term care needs. Has anyone experienced a similar situation?
Can I challenge a local authority decision to move my father to 24/7 care at home?
- Thread starter MsWomble
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Hi MsWomble, don't know if you're underground or overground but I hope you're wombling free and thanks for keeping Wimbledon Common litter free.
I'm not quite with the story, he's in a home and they want a DoLS (normal enough), he's self funding so the first 12 weeks will have to be paid for by the LA, then they can continue to pay with a deferred payment against the house you're going to sell, what's the problem?
Care at his home 24/7 is as you say likely to be much more expensive than a care home so why would they prefer to do that, it'll just eat up his money quicker and be a lot harder to manage, what's the point.
As he's self funding what's it got to do with the LA other than it's odd that you have a POA but there is a personal rep which isn't you, is that the LA that appointed the PR for some reason?
Either way if you have a POA for finance what you say goes unless they want to go to the court of protection and take you on in there.
K
I'm not quite with the story, he's in a home and they want a DoLS (normal enough), he's self funding so the first 12 weeks will have to be paid for by the LA, then they can continue to pay with a deferred payment against the house you're going to sell, what's the problem?
Care at his home 24/7 is as you say likely to be much more expensive than a care home so why would they prefer to do that, it'll just eat up his money quicker and be a lot harder to manage, what's the point.
As he's self funding what's it got to do with the LA other than it's odd that you have a POA but there is a personal rep which isn't you, is that the LA that appointed the PR for some reason?
Either way if you have a POA for finance what you say goes unless they want to go to the court of protection and take you on in there.
K
hello MsWomble
a warm welcome from me too (Kevinl's made me smile
)
I seem to remember that another member posted in a similar vein recently - I wonder what is making representatives/SW's question a family's decision, which is rarely taken lightly
certainly challenge the rep - do you know him/her and on what grounds they are suggesting care at home? - maybe the rep is not up to speed on your father's past care - did he have care at home? (it seems that it's becoming some strange 'normal' to insist that 4 care visits a day must be tried before a care home placement)
personally I'd challenge not just on financial grounds but on welfare in your father's best interests, making it clear that he was in no position to remain at home (outline his situation there) and having settled into the home it is certainly not in your father's best interests to be moved back for some period of time until the rep agrees that he's better supported in a care home - for a person with dementia all the changes will increase confusion and wholly unsettle him - and surely the care home manager assessed your father before his moving in, so agrees that he needs to be in the care home and that the home can meet his support needs - (do you have POA for health & welfare? is it too late for this to be obtained?)
best wishes to you and your father
a warm welcome from me too (Kevinl's made me smile
)I seem to remember that another member posted in a similar vein recently - I wonder what is making representatives/SW's question a family's decision, which is rarely taken lightly
certainly challenge the rep - do you know him/her and on what grounds they are suggesting care at home? - maybe the rep is not up to speed on your father's past care - did he have care at home? (it seems that it's becoming some strange 'normal' to insist that 4 care visits a day must be tried before a care home placement)
personally I'd challenge not just on financial grounds but on welfare in your father's best interests, making it clear that he was in no position to remain at home (outline his situation there) and having settled into the home it is certainly not in your father's best interests to be moved back for some period of time until the rep agrees that he's better supported in a care home - for a person with dementia all the changes will increase confusion and wholly unsettle him - and surely the care home manager assessed your father before his moving in, so agrees that he needs to be in the care home and that the home can meet his support needs - (do you have POA for health & welfare? is it too late for this to be obtained?)
best wishes to you and your father
Thanks both for your replies, and glad you liked the username!
I agreed to there being a Personal Representative because I said I may not agree with my father's views. That turned out to be the case as he says he has a house so why can't he live there.
The LA and social worker agree he needs 24/7 care, the only debate is whether that is in his own home or in a care home. I am concerned not only about the cost but also that care at home may raise more organisational issues given I live 2 1/2 hours drive away so can't easily relieve carers for breaks or deal with house-related issues.
Would also really appreciate responses from people who have organised 24/7 care at home.
I agreed to there being a Personal Representative because I said I may not agree with my father's views. That turned out to be the case as he says he has a house so why can't he live there.
The LA and social worker agree he needs 24/7 care, the only debate is whether that is in his own home or in a care home. I am concerned not only about the cost but also that care at home may raise more organisational issues given I live 2 1/2 hours drive away so can't easily relieve carers for breaks or deal with house-related issues.
Would also really appreciate responses from people who have organised 24/7 care at home.
Hi again MsWomble
there are members who have organised full time care at home, so some may respond given time
I'd just like to add that the statement from your dad that
it's easy to just ask 'where do you want to live?' or 'do you want to live at home?' and to take the answer as 'gospel' - however, the person with dementia has mostly lost the capacity to understand what the going home really entails, or even exactly what and where the 'home' is - you will know best how much capacity your dad actually has to weigh up the pros and cons of this decision (and after all, you and he agreed to the care home placement for good reason, I assume)
so follow up is needed to get to grips with what your dad really understands - does he know what/where his house is (and isn't thinking of a previous home or even his childhood home), who will/will not be there with him, what he can/cannot do for himself, that he will have new carers living with him all day every day .....
sometimes it comes down to what is in his best interests ie what he needs, rather than what he wants
sorry - you're probably wrestling with all this already
no easy answers, are there !
there are members who have organised full time care at home, so some may respond given time
I'd just like to add that the statement from your dad that
needs to be interrogated by the representative
it's easy to just ask 'where do you want to live?' or 'do you want to live at home?' and to take the answer as 'gospel' - however, the person with dementia has mostly lost the capacity to understand what the going home really entails, or even exactly what and where the 'home' is - you will know best how much capacity your dad actually has to weigh up the pros and cons of this decision (and after all, you and he agreed to the care home placement for good reason, I assume)
so follow up is needed to get to grips with what your dad really understands - does he know what/where his house is (and isn't thinking of a previous home or even his childhood home), who will/will not be there with him, what he can/cannot do for himself, that he will have new carers living with him all day every day .....
sometimes it comes down to what is in his best interests ie what he needs, rather than what he wants
sorry - you're probably wrestling with all this already
no easy answers, are there !
Is he self-funding or not? If he is, you can organise care yourself and no one can interfere. If he isn't, I strongly suspect that social services would choose the cheaper option, which seems to be the care home. This representative has only made a suggestion after all. I wouldn't worry too much.
Have you had a copy of the report from the DOLS assessment? This should show whether your Father is in the right caring environment, this is what it is all about.
If it says he is, then that's fine and the representative's opinion is just that, an opinion. If your Father still has capacity then it will be a little harder if the DOLS assessment says he could receive the care he needs in his own home.
I have to say care 24/7 in the home is very hard to achieve and it to run smoothly and the distance you are away as you say, will not be easy for you to pick up any of the shortfall plus the extra time needed to organise. Fingers crossed sense prevails and your Father can stay where he is.
If it says he is, then that's fine and the representative's opinion is just that, an opinion. If your Father still has capacity then it will be a little harder if the DOLS assessment says he could receive the care he needs in his own home.
I have to say care 24/7 in the home is very hard to achieve and it to run smoothly and the distance you are away as you say, will not be easy for you to pick up any of the shortfall plus the extra time needed to organise. Fingers crossed sense prevails and your Father can stay where he is.
You mentioned selling the house to pay for his care. Does he actually have income and assets to pay for 24/7 care at home, maintain the home etc. etc.? Because if not, home care simply isn't an option unless the LA are prepared to pay for it (which I can tell you, they won't). Although rates will vary by area, 24/7 home care will always be more expensive (sometimes by a lot, sometimes by a little) than placement in a residential facility. And that's just the direct care costs. As I say - you've got all the other expenses of maintaining a home as well.
Doesn't it, first and foremost, depend on whether or not the Father has capacity to decide where to live?
If he does not have capacity the OP does not say she has PoA for Health and Welfare and also a representative has been appointed for the DoLs so the dispute, that was mentioned, is probably over where he lives.
It may well be in best interests to live in a CH but that decision is not the OP's to make.
The DoLs assessment suggested there should be a review of options, one of which could be to move him to a specialist dementia care home which could meet his needs better. I do not have a POA for Health and welfare, only financial affairs. My father does not have capacity, but after speaking to him the representative suggested he could live at home with 24/7 care paid for with his own funds. The social worker and psychiatric nurse both agreed that this was an option worth trying. The 'dispute' is between his short term health and well being best interest, which may be met by being in his own home, and his longer term financial best interest - it will cost more to have care at home, and once his savings run out, the LA wont pay for him to stay there so he would have to move into a care home anyway. If we were talking several years, this might be a logical decision to make, but at current rates including home maintenance etc it is only a year or so, and I dont think moving twice would be in his health and welfare best interest either.
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So he is self-funding? No social worker can tell you what to do then. Not sure who this representative thinks he is or why he's involved in the first place. He's self-funding, end of. You have LPA, you have to act in his best interests financially. And actually, a care home is probably preferable to living in your own home with carers in and out all the time. At least in a care home he has other people around. I'm really not quite sure what the problem is here.
I have no experience of professional 24/7 care at home, but just 1 carer could not do it as you would have to have a waking night carer as well as a day carer, and they would want days off, and it would amount to much more than a care home, as well as having all the costs of running the home, which will probably escalate due to extra heating being needed.
I do have experience of a DoLS assessment for my husband - I am his advocate, as I would not have wanted to appoint a stranger to represent him as they would know nothing about him. I cannot see how a DoLS assessor can take the wish of your father to live at home seriously, as he has already been assessed as lacking capacity. As others have said, home to the dementia sufferer doesn't exist except in their imagination. If you ask him where his home is, and who is there to look after him can he answer that?
The other question should be is he well cared for at the home, and is he happy? Are you are concerned about his welfare there? The DoLS order also enables the home to keep him safe and secure - would he be as secure in his own home? Would 1 carer be able to prevent him leaving the house and getting into danger? Also if aggression or resistance to personal hygiene develops, or mobility problems, 1 carer at a time would not be enough.
Lots to think about - hope you find the best solution for your Dad
If he is self-funding, and well cared for and reasonably happy in the home, I see no reason for disrupting that.
Pete
Many thanks for your post. If its not my decision (as financial power of attorney) whose decision would it be? The social worker mentioned going to Court, is that the Court of Protection? I really dont want to be adversarial about this, but Im surprised that the medical experts can direct me to organise 24/7 care at home - regardless of cost - because it is less restrictive of my father's liberty than being in a care home.
They would (as far as I know) have to go to the CoP, overturn your PoA for finance so they could then access the money (which currently only you have access to) ande then organise the care as they see fit as they now are in financial control.
As for "the medical experts can direct me to organise 24/7 care at home", dubious at best you have control of the moneywise, they have control of his best interests healthwise, they can't "direct" you to do anything without the CoP intervening.
It's obviously a complicated story about why there is a "personal representative" who thinks he'd be better off at home which as said is the more expensive option, you with the PoA for finance want the cheaper option of a full time care home.
The only decision I could support is the one that's best for your dad, if his own home means it costs more but would work and that's what he and his personal rep want then better then go for that, if best for him is full time care home care then do that.
While you do have to consider "longer term financial best interest - it will cost more to have care at home" it's his money and if he'd be better off and happier at home, then it's only money, his money, so why stop him if all the LA and SS think it can be made to work, there's no pockets in a shroud as they say so why not spend it before you go.
K
The problem here, quite rightly in my opinion is the law. The Mental Capacity Act is there to protect and restore power to those vulnerable people who lack capacity.
A DoLs is normally quite a straight forward event, a person goes into care and everyone agrees that is the best place so it is legal for them to be "detained". An advocate for the person is appointed, which is normally a relative, but not in this case as MsWomble does not have PoA for Health and disagrees with her Fathers wishes to go home. An independent advocate is therefore responsible for acting in his best interests and involves all services and family in making a decision. If the advocate decides that a Dols should not be granted or only applies for a certain time alternative care must be arranged.
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I do understand this is difficult for you and I am not in any way trying to be disruptive nor say that a Care Home is not the best place for your Father. I am only trying to explain how I see the way the system works.
Is there a reason you do no have PoA for Health? There are very good reasons why there are two.
As PoA for Finance you have to act in your Fathers best interests with his finances only. You alone cannot decide where the best place is for him to be cared for. Your input should be taken into consideration and also that of the SW and other professionals but if it is decided that he should return home then you have to provide his finances to allow this to happen. If you do not then the state can apply to Court of Protection to have the PoA rescinded and take control. If successful there will be cost to your Father. You can also withdraw yourself if you do not wish to carry on.
The "state" has decided that they do not have the right to detain your Father and restrict his liberty at this time, so if he wants to go home he can.
I'm in a similar situation with my mum. The best interests meeting confirmed the decision that she should remain in the care home following temporary assessment. Now a permanent DoLS is needed and mum's advocate/representative is taking the matter to the COP because mum keeps asking to go home! Based on the decision by social services I terminated the tenancy on her house so she now has no home to go to. She doesn't actually know where 'home' is, everyone including family, the care home staff, and now social services, believe the care home is the best place for her, but the advocate is adamant on taking the matter to the COP. DoLS told me that because I am mum's POA for Finance and for Health & Welfare I could not represent her, hence the advocate. It's absolutely farcical, just when I thought it was all sorted we're now almost back to square one because a woman who has met my mum three times, feels she knows her better than anyone else. I really don't know why I bothered to get the LPAs as the authorities seem to be able to totally disregard them when it suits. The thing is, even if the COP decide that mum should remain in the care home, she will still ask to go home, because that's part of the condition she suffers from and why this advocate can't see that, I don't know!
