Has capacity, no LPA, unable to care for himself

[charlie10]

Sorry to bombard the forum with questions.....being long distance and no practical use, the only thing I can think to do is to try to investigate all possible avenues!

FiL is, at present, in hospital after having his hip mended, pneumonia treated, and some unpleasant after-effects from morphine treated. He has become weaker since he was in hospital in Oct....started using a zimmer in the house then, and also has multiple arterial ulcers. The physio who visited him at home said he would become bedbound very quickly if he didn't make the effort to move (in chair all day/night sleeping and watching tv) So far in hospital he is refusing to mobilise, so we are worried about (amongst other things) whether when he is discharged he will have the mobility level he had beforehand, or whether he will indeed be virtually bedbound.

If he is bedbound, I don't see how he can stay in his home without a much bigger care input (currently carer twice a day for personal care). He is self-funding at the moment, we have been unable to get LPA for him, and we do do not know if he has dementia or not (sometimes think he has, then think we're mistaken ) If he gets super stubborn (as is quite likely) he could refuse to go to a CH and also dispense with carers to his house. What happens then? If we can't do anything without LPA can SS step in and organise him as a vulnerable person? Or is it a case of him having capacity and therefore exercising his human right to make risky decisions?

I've read so much about Mental Capacity.....I understand everything I read, but then I don't understand the sheer 'hit-and-miss-ness' of it!

If anyone has any ideas on how this could go, I'd be really grateful to hear them.....still hoping to get LPA but may not be soon, and hoping that hospital staff may venture an opinion about his mental state, so that at least we know we need to try to get him to his GP.

 

[canary]

Hello @charlie10
This is a difficult situation and could go several ways. I think a lot of depends on what happens in the hospital.
It reminds me a bit of my MIL. She was never formally diagnosed with dementia, but there was no doubt in the minds of people who dealt with her that she had some form of dementia. It all came to a head when she fell and broke her spine. Once she was discharged from hospital she too would not mobalise and did nothing round the house. Her daughter (my sister in law) was her main carer and I was only involved from the sidelines, as it were. Once home my SIL arranged for carers, but it really wasnt enough and she developed pressure sores and a bad UTI, so she ended up back in hospital. In hospital this time the doctors started making comments about her cognitive state, but she was unable to do a scan, so dementia was never officially diagnosed. Once she would have been OK for dischage, though, this time my MIL was not sent home, but placed in a rehab wing of a care home to try and mobalise her. When this failed there was a Best Interest meeting to decide whether it would be in my MILs best interest to go home. At this meeting it was decided that she could not go home as she had become pretty much bed-bound. She was transferred to the dementia wing of the care home and remained there. She passed away there several months later.

Her 3 sons held POA for her, so that was not a problem. My mum, however had refused to give POA and would not accept any carers in her home (it was a nightmare). She ended up in hospital with a TIA (mini stroke) after which she too was placed in a care home for convalescence/rehab. At the end of the 6 weeks period she too had a Best Interest meeting and it was decided that she should remain in the care home, where she lived (and was happy) for three years. The problems was, though, that no-one had POA and she had lost capacity, so I had to apply for Court of Protection Deputyship, which gives similar powers, although it takes longer and is more expensive to apply, and has more oversight from the Office of Public Guardians.

I dont know if my experiences are helpful and perhaps I was lucky, but it did all get sorted out.

 

[charlie10]

thank you for your reply Canary.....I know they 'say nothing worth having in life comes easy' but .......

Apparently the hospital gave him a memory test today, which he passed.....I'm assuming it was just one of the short ones to make sure it was the morphine and not incipient dementia that caused his aggression a couple of days ago. His sons are now wavering about dementia, but I'm still pretty convinced he has it, although his conversations are almost normal and his memory is ok (but it probably would be if it was VaD?) or if not, I think he's had depression for some years and maybe slipping into MCI now. I know it shouldn't matter, we should deal with what's there, but we don't really know what's there as no-one spends more than a few hours a week with him, and we can only phone, so I'm wondering if he's putting on a front for us.....aagh too much reading of old TP threads!!

Trying to dial back the worry until we know something definite, but it's not easy not knowing what's going on. BiL may be stressed with the visiting, he's not really telling my husband much and we don't like to keep ringing him if he's trying to relax. I think if we can't get LPA while FiL is 'softened up' by his hospital stay (he was co-operative for about 2 wks after his last one) we probably won't get Deputyship either, as BiL is not keen on the LPA and probably even less likely to go for the more onerous CoP (he's the one who would have to administer it, maybe with my husband advising and sharing decisions)

I think the big worry is that he retains capacity but is severely physically compromised and his stubborness kicks in over having help....just have to hope that they do a proper assessment before he leaves hospital and he goes along with it.

 

[canary]

I think if we can't get LPA while FiL is 'softened up' by his hospital stay (he was co-operative for about 2 wks after his last one) we probably won't get Deputyship either, as BiL is not keen on the LPA and probably even less likely to go for the more onerous CoP (he's the one who would have to administer it, maybe with my husband advising and sharing decisions)

I just thought I would mention that you cant apply for CoP deputyship while they still have capacity, only once it is lost and there is no chance of POA. Heres hoping that you can persuade your FIL to agree to POA - phrase it as something that everyone should do as an insurance policy in case they end up under the proverbial bus, so that family and not strangers will make decisions for them. BTW, if you (like me) are really unable to get POA and someone has got to sort out their finances then it doesnt have to be family that does it. When mum moved to her care home I was told that someone had to deal with her finances and assets (her house and possessions), but if I didnt want to do it it Social Services would apply and the deputy appointed would probably be a solicitor.

 

[charlie10]

yes....I think maybe in the long run a non-family deputy might be best all round.....my husband would do a really good job but we're so far away and money is far too tight to do long haul more than once. A stranger might be better than a family member in denial, which is such a sad thing to say.

"everyone should do as an insurance policy "......hmm that would make him run screaming in the opposite direction....'insurance' is not a word to bring up with my FiL unless you have a few hours to spare This is partly why we're confused....he doesn't do logic (or even discussion), but he denies it in quite a 'normal' rational way Oh well, one day at a time......maybe all will become clearer one day Thank you Canary

 

[canary]

.'insurance' is not a word to bring up with my FiL unless you have a few hours to spare

Call it something else then - think about what he would hate to happen and present it as a way of preventing it.
I know someone who was Catholic and she persuaded her husband to get POA by saying that without it she would have no say and strangers might not arrange Last Rites. He signed!

 

[charlie10]

I can be pretty inventive but spending any money is a no-no in his book......combined with giving someone else (even family) 'power' over him, well..... tried to explain it to him, AND the consequences of not having it, but he just digs his heels in....pulling out my hair one strand at a time!

 

[canary]

Oh dear, that sounds like my mum...........

 

[Rosettastone57]

I can be pretty inventive but spending any money is a no-no in his book......combined with giving someone else (even family) 'power' over him, well..... tried to explain it to him, AND the consequences of not having it, but he just digs his heels in....pulling out my hair one strand at a time!

This is what we did with my mother-in-law to get power of attorney . I'm not saying it's going to work with your relative but it might pave the way and make things easier. My mother-in-law had paranoia and other pre-existing mental health conditions before the dementia diagnosis and she was always suspicious of anything that my husband and I were doing that might take control as it were. She wanted to be seen as normal so what we did is we introduced the idea of power of attorney using a neighbour . We primed the neighbour who had known her for some time and who was going to act as certificate provider. The neighbour made several visits to her,casually dropping in the conversation how she was going to get POA for her family. Eventually, with my husband and I also saying we were getting this as well (which we actually did) ,when the time came to sign the papers, she did. She never wanted to be seen as different to anyone else.

 

[TheBearsMummy]

We used the council and social worker appointed by the hospital after an admittance as the bad guys. She was fearful of being put into a home so I said there was nothing we could do to prevent it if the council or SW decided they wanted her out of her flat as we didn't have any legal authority to say no to them. We also said if she needed money from the bank she had to go out and get it herself as we would be in very serious trouble if we used her bank card without her being present. As she is very determined that "they" are not going to tell her what she can or can't do she happily signed the forms.
It did help that my mum who is a similar age and a good friend to her had already sorted her own POA out and told her that her daughters would be the ones looking after her not the busy bodies

 

[charlie10]

An elderly member of my family occasionally visits him for coffee or lunch out, and if I prime him, he can have a casual chat as 'equals' about things.....sometimes it works, sometimes it doesn't. The main stumbling block at the moment is whether BiL, as the person in country, believes in LPA and is prepared to act. We're across the world, so won't be able to make any informed decisions such as care etc without talking to a lot of people, and time zones and international calls make that very difficult. Also we only know what we've been told.....maybe there's a lot we've not been told, so hopefully it's not as worrying as it seems......we can only hope

But thank you for your suggestions.....everything helps, even just the chance to talk about it and have someone acknowledge our concern

 

[TheBearsMummy]

I wonder if a brief summary of the costs involved might help.
POA fairly easy to set up using on-line forms and a person who knows them can verify and witness. Cost is (I think) less than £200 for each (finance and Heath & welfare).
COP deputy-ship is long winded and will involve solicitors, the court and a lot of paperwork and on going costs in the future.

 

[Bunpoots]

I'm not certain of the costs but I think it's about £85 for each POA and about £800 to get deputyship. And health and welfare is not usually granted for deputyship.

My dad had to apply for deputyship for my mum when she lost capacity after a stroke. It was a bit of a nightmare and a lot of hassle at a time when he could've done without it.

 

[TheBearsMummy]

Sorry, I'm sure Bunpoots is right, I meant to type less than £200 for both

 

[canary]

You dont have to use solicitors for Court of Protection (I didnt), but there is a lot of paper shuffling, people to contact and the forms to fill in are not as easy as POA. It took me about 6 months to go through the process. The Court fees are £400 plus any other costs for getting someone to fill in the form stating that he has lost capacity (this bit is not always easy). You very seldom get Health and Welfare granted and if you apply for it it will cost you another £400 which you wont get refunded if you dont get it. I didnt bother to apply.

There are continued costs in that there is oversight by the Office of Public Guardians (which has an annual fee) and each year a surety bond must be purchased as a sort of insurance policy. How much these are depends entirely on the value of the assets that the deputy is dealing with. The deputy also has to send in an annual financial report stating where the money has gone - right down to the last penny (I kid you not) - and outlining what decisions have had to be made, the justifications for spending large sums and things that you think are likely to be needed in the future.

I did it for 3 years and it is doable, although you can get solicitors to do it for you - remember that they will charge for their time. I had to go for deputyship, but it would have been much easier if mum could have been persuaded to give POA.

 

[Banjomansmate]

What Canary says!
My BIL had to go through that for his Mum so I used the story of the expense of all that, plus the hassle it would be for his daughter to cope with, to convince the Banjoman to agree to doing LPAs. Unfortunately he would only agree to signing them if I was the attorney! Shot myself in the foot there!

I have been asked if I still think they are a good idea and would I agree to it again? to which my answer is always “My life would be a lot harder without them as every official in the world wants to see them before they will listen or talk to you or have any legal or financial dealings with you!” Hospital, Care Home, care firm, Social Services, Banks, DWP, everybody needs to see a copy before they will interact with you.
You need to convince your BIL that even if he (mistakenly) thinks he doesn’t need them yet, they will be really useful in the future so FIL really needs to be encouraged to get them done now “for possible later use”.

 

[charlie10]

thank you everyone for your input....it helps me to know that I'm not over-exaggerating the importance of LPA! Unfortunately BiL is as stubborn as his dad, and insists that he will die in his own home, still able to decide for himself, and he will not go against that whatever we say to him. He can't really accept that he has to be the parent now, and I don't really know what else we can say to him, without really annoying him and being cut off from progress reports.

It makes us feel as if we're not doing the best thing for FiL....feel as if we should be 'bulldozing' this thro, but know it won't happen like that. If it was my brother and my dad, I'd just play the Bossy Big Sister card, but then I'm pretty certain it wouldn't get to this point anyway. Four kids has made me into a bit of a control freak and this is so frustrating......

 

[Spamar]

Presumably you’ve mentioned the possibility of a stroke. One minute fine, next in hospital, maybe unable to talk? Or a car accident, that’s someone else’s fault, of course. No deciding for yourself in those cases!

 

[Sarasa]

@charlie10 , I feel your frustration, I'm someone who likes things properly organised too. It's so tricky when you are so far away, but not a lot you can do until BiL realises when your FiL wants and what he needs are two different things.
My brother and I are at least in the same country but he tends to have a 'go with the flow and it'll all be fine' attitude, while I'm trying to get things done. We manage to work together in my mum's best interests most of the time, but it can be frustrating. At least we have LPA, due to my mum's best friend persuading her it was a good idea. She wouldn't have accepted the idea from her children as any attempts by us to get her to do things are met with'your not my mother' type responses.

 

[charlie10]

thanks Sarasa....I always thought that being organised and thinking ahead would save a lot of panic and frustration....but I hadn't envisaged being stymied by someone else, which is now causing panic and frustration!

Spamar.....yes stroke, under a bus etc etc ....he's actually having his second hospital stay in 5 mths at the moment.....they seem to have the teenage view that it might happen to other people but not to them!