Advice on social care assessment refusal

[judyri]

Hi

First post for a long time here, but about a different person.

I am next of kin to my 89 year old uncle who lives 4 and a half hours drive away. We've never been close, but as the nearest relative I have power of attorney.. In June he had a stroke and has been an in-patient ever since. The hospital tell me that he had pre-existing small vessel disease of the brain, and that all things considered his prospects of rehab are very limited.

Having been in the stroke rehab unit for 8 weeks, the hospital now want to do a discharge plan, but he's flat refusing to allow a social worker to be appointed. He wants to go home, but I can't see how that would be manageable really. He can't stand without falling over, but he forgets that this is the case. In his mind, he is still capable of doing everything he was before the stroke (he lives alone since his wife died 2 and a half years ago).

Can anyone tell me the implications of refusing to appoint a social worker ? The hospital say there may have to be a best interests meeting but I'm not sure what that entails. He's very volatile and whoever he perceives as being responsible for putting him in residential care (which I'm almost certain is the only option) will become Public Enemy Number One. And I'd very much rather that wasn't me. His solicitor has agreed to visit to chat over options, but I'm really looking for any more advice anyone can give me in what both hospital and solicitor describe as "a very difficult situation" !

Thanks

 

[Shedrech]

hello @judyri
a tricky situation for you to deal with
I agree with the suggestion of a best interests meeting, which is just that, a meeting of those involved to decide what is best for someone who is presenting as not making sensible decisions for themselves so potentially putting themselves at risk - you should be involved, at least having your views taken into account if you cannot be present, but the final decision isn't down to you, so you can tell your uncle that the outcome is what the professionals have decided and you stuck up for him (he doesn't need to know exactly what you said)
I hope all works out

 

[judyri]

hello @judyri
a tricky situation for you to deal with
I agree with the suggestion of a best interests meeting, which is just that, a meeting of those involved to decide what is best for someone who is presenting as not making sensible decisions for themselves so potentially putting themselves at risk - you should be involved, at least having your views taken into account if you cannot be present, but the final decision isn't down to you, so you can tell your uncle that the outcome is what the professionals have decided and you stuck up for him (he doesn't need to know exactly what you said)
I hope all works out

Thank you so much for replying.

Before this, I'd agreed with the family liaison person at the hospital that it wouldn't be necessary for me to do the journey simply to say that I can't see how he could manage at home. I'll be talking to them again early next week to get an update, and will decide then whether it would be more helpful for me to be there in person.

In other circumstances, live-in care could be considered ... but he's a hoarder, and the second bedroom was occupied by his wife before she died, and *nothing* has been moved since ... even down to the laundry basket of clothes that she had worn. He refuses to allow anything to be moved, and absolutely wouldn't allow anyone else to occupy the room.

Another question ... if, as I suspect is the only option, he does have to go into a residential/nursing home (I don't know what level of care he'll require) ... then whose decision is it as to which home he goes into ? He's based in the Vale of Glamorgan in Wales. I have no idea what range of choice there's likely to be. Is this something else that the professionals will decide ?

 

[Louise7]

Another question ... if, as I suspect is the only option, he does have to go into a residential/nursing home (I don't know what level of care he'll require) ... then whose decision is it as to which home he goes into ? He's based in the Vale of Glamorgan in Wales. I have no idea what range of choice there's likely to be. Is this something else that the professionals will decide ?

A CHC assessment should take place before he leaves hospital, which will give an indication of his care needs. Will he be self-funding or reliant on the local authority to pay for his care? If he is not self-funding social services tend to want to keep the person at home if they can, and will provide up to 4 care visits a day. If the best interests decision is that he needs to go into a care home, and he is not self-funding, then social services/local authority will usually find a placement. Be aware though that legally they only need to offer one placement which meets the needs of the individual and is within their budget. Choice can be very limited on that basis, and can delay discharge whilst they wait for a place to become available.

If your Uncle has the funds to pay for his own care then you will be pretty much left to yourself with regards finding a placement. What usually happens is that if a suitable home is found someone from the home will visit your Uncle in hospital to assess him and check that they can meet his needs. It might be worth at least having a look at what type of care home is available in his location but really you will need to see what the outcome of the best interests meeting is, which should also give an indication of whether he needs a residential or nursing home. The situation might be quite tricky though if it is decided that your Uncle has mental capacity to make his own decisions.

 

[judyri]

If your Uncle has the funds to pay for his own care then you will be pretty much left to yourself with regards finding a placement. What usually happens is that if a suitable home is found someone from the home will visit your Uncle in hospital to assess him and check that they can meet his needs. It might be worth at least having a look at what type of care home is available in his location but really you will need to see what the outcome of the best interests meeting is, which should also give an indication of whether he needs a residential or nursing home. The situation might be quite tricky though if it is decided that your Uncle has mental capacity to make his own decisions.

He's self funding.

The thought of being pretty much left to myself with regards to finding a placement has me absolutely terrified. I'm 200 miles away and find the drive absolutely exhausting (I have health concerns of my own). Seriously considering now relinquishing responsibility for welfare poa in favour of the substitute attorney (a neighbour). I wonder if it would be possible to retain being attorney for finance, at the same time as giving up the welfare one ?

 

[Sirena]

As he is self funding, you can move him to a care home near you.

My mother (self funding) lived a few hours away from me, she had care in her own home for 18 months and when she needed to move to a care home earlier this year I chose one near me. There was no point leaving her in a London care home with no one to visit or check on her (she had a few friends in the area but they were very elderly and unwell, and unlikely to visit her). Care homes near me are also cheaper so that was an added benefit. There were a lot of practicalities to deal with and I too sometimes thought of relinquishing LPA for her, believe me!

I don't know how it would work for you to relinquish health LPA - you would still have to be involved because you're the one handling the money. I don't actually have health LPA for my mother (she never did one), just financial.

 

[judyri]

As he is self funding, you can move him to a care home near you.

My mother (self funding) lived a few hours away from me, she had care in her own home for 18 months and when she needed to move to a care home earlier this year I chose one near me. There was no point leaving her in a London care home with no one to visit or check on her (she had a few friends in the area but they were very elderly and unwell, and unlikely to visit her). Care homes near me are also cheaper so that was an added benefit. There were a lot of practicalities to deal with and I too sometimes thought of relinquishing LPA for her, believe me!

I don't know how it would work for you to relinquish health LPA - you would still have to be involved because you're the one handling the money. I don't actually have health LPA for my mother (she never did one), just financial.

Thanks for replying. I've the reverse situation - he's in south Wales and I'm in Essex, so fees would probably be higher here. He's lived in the same village since 1970, and he's getting regular local visitors to the hospital - former colleagues, neighbours, his cleaner ... none of whom would be willing or able to travel 200 miles to visit. Over the years he and I have had relatively little contact. He came to my mother's funeral in 2010, which was the first time I'd seen him since my father's funeral in 1995. He's never really shown an interest in his great niece and nephew - no birthday cards etc. I had more contact with his wife, and since she died I've tried to keep in touch with him by phone and have visited a few times. Conversation is stilted to say the least, because aside from being uncle and niece there's no common ground. It's so weird. He's been around since before I was born - but there's no real relationship - I don't even think he likes me all that much.

I want to do what I can for the best. Keeping fingers crossed that there's something positive comes out of the hospital next week.

 

[looviloo]

judyri, someone on a different thread kindly posted the following link, to a directory of independent social workers, who work on a fee basis. I'm wondering if this might be useful in your situation? I'm considering contacting one myself because my dad is self-funding and I'm feeling unsupported. Presumably the payment could be taken from your uncle's funds (I've yet to confirm this would be the correct thing to do)?

http://www.baswindependents.co.uk

You could contact a social worker in your uncle's area who would know how the system works there and have knowledge of his local care homes. Perhaps tell your uncle that this isn't actually a social worker but someone you've contacted to help you (love lies).

It sounds like a best interests meeting is the next step, and if you can't be present, perhaps someone from the above directory could represent you/your uncle?

 

[AliceA]

judyri, someone on a different thread kindly posted the following link, to a directory of independent social workers, who work on a fee basis. I'm wondering if this might be useful in your situation? I'm considering contacting one myself because my dad is self-funding and I'm feeling unsupported. Presumably the payment could be taken from your uncle's funds (I've yet to confirm this would be the correct thing to do)?

http://www.baswindependents.co.uk

You could contact a social worker in your uncle's area who would know how the system works there and have knowledge of his local care homes. Perhaps tell your uncle that this isn't actually a social worker but someone you've contacted to help you (love lies).

It sounds like a best interests meeting is the next step, and if you can't be present, perhaps someone from the above directory could represent you/your uncle?

Many thanks, useful to know about. I had never realised this is an option. Perhaps not personally but for others I know.

 

[judyri]

judyri, someone on a different thread kindly posted the following link, to a directory of independent social workers, who work on a fee basis. I'm wondering if this might be useful in your situation? I'm considering contacting one myself because my dad is self-funding and I'm feeling unsupported. Presumably the payment could be taken from your uncle's funds (I've yet to confirm this would be the correct thing to do)?

http://www.baswindependents.co.uk

You could contact a social worker in your uncle's area who would know how the system works there and have knowledge of his local care homes. Perhaps tell your uncle that this isn't actually a social worker but someone you've contacted to help you (love lies).

It sounds like a best interests meeting is the next step, and if you can't be present, perhaps someone from the above directory could represent you/your uncle?

Yes, thanks I saw that and mentally filed it in the potentially useful drawer. There's only one in South Wales, so that's one less decision ! My mother was self-funding and I agree, you can feel incredibly unsupported - especially if the person you care for is less than co-operative.

 

[Sirena]

Thanks for replying. I've the reverse situation - he's in south Wales and I'm in Essex, so fees would probably be higher here. He's lived in the same village since 1970, and he's getting regular local visitors to the hospital - former colleagues, neighbours, his cleaner ... none of whom would be willing or able to travel 200 miles to visit. Over the years he and I have had relatively little contact. He came to my mother's funeral in 2010, which was the first time I'd seen him since my father's funeral in 1995. He's never really shown an interest in his great niece and nephew - no birthday cards etc. I had more contact with his wife, and since she died I've tried to keep in touch with him by phone and have visited a few times. Conversation is stilted to say the least, because aside from being uncle and niece there's no common ground. It's so weird. He's been around since before I was born - but there's no real relationship - I don't even think he likes me all that much.

I want to do what I can for the best. Keeping fingers crossed that there's something positive comes out of the hospital next week.

I can see why you don't feel it would be appropriate for him to move near you. My situation was a less extreme version - my mother had lived in her flat for nearly 50 years, we had barely seen each other for ten years, and I'm not sure she likes me much. She had a lot of friends around her, but as her dementia advanced the friends started to drop away, some because of their own health issues and others because they didn't want to see what was happening to her. There was only one who continued regular contact.

As you say you have to decide how you can do your best in this situation. Please let us know how it goes.

 

[judyri]

I can see why you don't feel it would be appropriate for him to move near you. My situation was a less extreme version - my mother had lived in her flat for nearly 50 years, we had barely seen each other for ten years, and I'm not sure she likes me much. She had a lot of friends around her, but as her dementia advanced the friends started to drop away, some because of their own health issues and others because they didn't want to see what was happening to her. There was only one who continued regular contact.

As you say you have to decide how you can do your best in this situation. Please let us know how it goes.

I think ultimately wherever they're based, friends will tend to reduce and eventually discontinue visits. After a year in residential care my mother was down to 2 or 3 apart from me and her grandchildren. I take my hat off to the ones who are visiting my uncle regularly - it's a lottery whether he'll be lucid, asleep, ranting about Winston Churchill and anagrams or lying on the bed exposing himself, seemingly oblivious to all around him (I hope. Would be even worse if he was aware that we're all seeing a lot more of him than we'd like to !).

The stroke has affected him in the weirdest way by taking away his *awareness* of his left side. So even though he has the physical strength to weight bear and stand, because his brain doesn't recognise that he's got a left leg, as soon as he tries to do it, he keels over. But then he doesn't remember that this happens, so it gets repeated, which means he pretty much has to be watched all the time otherwise he's on the floor. I can't see how they can possibly decide he's competent to choose to go back to living alone in that state, but I'm just watching this space right now. Will keep posting ...

 

[judyri]

Hi I'm the person who used an independent social worker. I did pay for him from my aunt's account - because it was most definitely for her benefit.

Sorry if this has been covered elsewhere, but can I ask why you decided to go down that route and what it was he did for you ? Did your aunt have to consent to him being appointed ?

 

[judyri]

Phew ! The gods are smiling on me. He's consented today to a social worker. Now waiting for date of best interests meeting, which I will attend if at all possible. Onward and upward. Hopefully.

 

[Kevinl]

I'd hang onto the LPA for H&W if I was you. Where a relationship is clear cut like husband and wife it's debatable if you even need it at all, I think I was asked once if I had one for my wife but no one's ever asked to see it. When my mother lived with me I didn't have an LPA but it was never an issue dealing with the medical side of things as her son, her being a widow and one brother living abroad and the other 150 miles away so just me on the spot the NHS just dealt with me as her next of kin.
The issue you may have is that as a niece without an LPA then that's a bit of a more remote relationship, there could be other closer relatives or other nephews and nieces so having the LPA establishes you as the correct person for them to be dealing with.
K

 

[judyri]

That's a really good service ! My uncle has now consented in hospital to a social worker being appointed so we'll go down that route for now. Thanks so much for the information though - could be very useful in the future.

 

[judyri]

OK. The social worker has been identified and I spoke to her on Monday, at which point she hadn't been to see my uncle, so didn't have a clue how he is. The best interests meeting to decide what happens on discharge is on 3rd Sept (SW is on leave all next week).

I've booked accommodation for a 3 night stay to give me time for the meeting, a visit to his bungalow to have yet another look through papers (apparently there are 2 4-drawer filing cabinets full that I haven't looked through yet) and time to recover from the 200 mile drive. I find motorway driving acutely stressful and tiring, but given the fact that all this is happening in rural South Wales, there's no sensible option but driving. If the decision is that he has to go into residential care of some kind, I guess I'll be going back in relatively short order to visit potential homes. Or maybe I just stay longer and try to do it all in one visit.

Actually, I'm finding the whole business acutely stressful and depressing, which is wreaking havoc with my diabetes and digestion. Overnight, 10 weeks ago, I went from having a distant uncle with occasional phone calls, to becoming heavily involved in everything regarding his finances, property, health, welfare etc. It's scary. The solicitor has told me that when I'm acting as attorney, I can claim back travel and accommodation costs. However, my uncle has already started accusing his cleaner of stealing his money (she hasn't) so I'm terribly reluctant to take anything from his account to cover my own costs, which is an additional vexation because in order to take all this on, I've given up a couple of regular jobs (I'm self employed).

Guess I'm just having a bit of a self-pitying whinge really, and I know all this is very minor compared to the strain many carers experience every day. I just have to grit teeth and get on with it, really.

 

[Shedrech]

hi @judyri
you've a lot to deal with right now so here are some links that may be of use
to the AS site's directory of local services including care homes
https://www.alzheimers.org.uk/find-support-near-you#!/search
to CQC
https://www.cqc.org.uk
to Admiral Nurses
https://www.dementiauk.org/get-support/admiral-nursing/
to the OPG
https://www.gov.uk/government/organisations/office-of-the-public-guardian
many Attorneys take very little by way of expenses - however, yours is a particular situation and it may settle your mind to talk with one of the OPG phoneline operators or e-mail them

 

[judyri]

in email

The issue you may have is that as a niece without an LPA then that's a bit of a more remote relationship, there could be other closer relatives or other nephews and nieces so having the LPA establishes you as the correct person for them to be dealing with.
K

At 200 miles away, I'm closest both in terms of relation and geographically. He is intentionally childless because he wasn't interested in being responsible for anyone else (hah !). I'm the only child of his only sibling. The other 2 nieces on his late wife's side live in Norway and have made it clear they're not even interested in receiving email updates on his condition. My son and daughter both have to work full time, and in any case he's had so little contact with them, he wouldn't recognise them anyway. So conflict with other relatives is the least of my worries !