DOL assessment. What is they say no?

[Pet37]

Hi All

My Dad was diagnosed with Vascular Dementia after an overdoes in August. We have been through a lot since then (as most of us have)

He was held on a section 3 at one hospital, then moved to a care home which he kept trying to escape leading to a number of falls. ne of which put him back into hospital with an additional bleed on the brain. He has two weeks of near catatonia where mum was literally feeding him with a syringe to keep him nourished. Out of the blue he woke up one morning back to normal (well post diagnosis normal) he was talking, eating solids and asking where his car was.

He was moved to a nursing home as the care home was not equipped to look after him anymore. He has been there approx. 3 weeks and the home is lovely, the girls are great and now dad is in his more coherent state the problems have started again.

He is asking when he can come home, he is accusing mum of being out with other men, asking her where she is every night as she doesn't come to bed. We have explained that she doesn't live there, that he needs care that she cannot give etc but as expected by the next day it starts again.

The home manager called to say that he is asking to leave every day so they have to apply for a DOL to keep him locked in. No problem as far as we are concerned. But then Mum spoke to the social working assessing him and she told her that if they do not agree the DOL he could be given leave to go out when he wants or could come home. Post assessment she has said he is borderline so has to be assessed by a doctor.

Panic has set in for my mum because quite frankly she doesn't want him home. She cannot care for him at home, they live on the outskirts of a village on a busy B road, she doesn't drive and they are very isolated. To get to the local shop would take her over an hour and the doctors is a 2 hour round trip. If he walked out the front door he would be five feet from a major road and if the home cannot get a DOL for him, there is no way they can then give it to her so she can lock him in.

He can go days without sleeping more than an hour or so at a time so there is no way she would be able to sleep at night. She is 74 so the stress of looking after him is likely to kill her before him.

Does anyone have any experience in what happens if DOLs are not given? Will they send him home if he asks to go home? What about Mum's best interest? Any advice will be most welcome.

Thank you
Petra x

 

[nitram]

Some points

• Currently a DOLS is not relevant to a domestic situation, this may change in the near future.
• Don't confuse DOLS with 'best interests'. It may be in his best interests to remain in the home although without a DOLS the home can only obstruct him from walking out rather than prevent him. this is the home's problem not your mum's.
• Your mum's wellbeing has to be taken into account.

 

[Pet37]

Thank you for your reply.

I didn't realise that dols was still not a legal requirement at home. I understood that locking him in the house would be illegal (breach of human rights) so I thought she would have to have a legal agreement to do so.

I think because this has been thrown at us so quickly (told Wednesday he was being assessed Thursday and told Friday he was borderline) that I haven't thought more than sheer panic. I will have to see what is being done as far as best interests not just mental capacity.

Thank you again,
Petra.

 

[Witzend]

I do wonder what would happen - in practice - with a resident without a DoL already in place, in a secure care home.

For quite a while there was none in place for my mother in her care home. And although in the early weeks she was often demanding to go home, there's no way they'd ever have let her out - she would very quickly have got lost, and very likely run over. In which case the care home would surely have been condemned for failure in their duty of care to a clearly vulnerable person.
And whatever they might have said (they didn't) there was absolutely no way I was going to take her home - she was only there in the first place because 24/7 care had become an urgent necessity.
But some people (by no means experts) had told me that they could not keep her there against her will, since she had not been officially deemed to lack capacity.

 

[nitram]

For quite a while there was none in place for my mother in her care home. And although in the early weeks she was often demanding to go home, there's no way they'd ever have let her out - she would very quickly have got lost, and very likely run over. In which case the care home would surely have been condemned for failure in their duty of care to a clearly vulnerable person.

This was common practice until 2014 when the supreme effectively court ruled that even if a person lacked capacity they had the same basic right to liberty as a person with capacity, this meant that DOLs had to be applied for.
https://www.scie.org.uk/mca/dols/supreme-court-judgment
Obtaining a DOLs is not trivial and takes time hence the current backlog.

It had an unfortunate side effect that I think has now been remedied.
When a person subject to a DOLs they were considered to have died under state custody and the coroner had to be informed. Although only a formality this meant disturbing delays for relatives especially at weekends and bank holidays when the coroner's office was shut.

 

[Pet37]

Thank you all for your input.

Unfortunately it seems that the people doing the assessment appear to be more focussed on getting him out of the home rather than putting DOLs in place.

Mum had a call yesterday from a doctor who was going to assess dad. They had no idea he has dementia even though we have been told by two hospitals that he has. They didn't know he had been on a section 3 prior to going to a care home. They knew he had been in a care home then went to hospital after a fall with a brain bleed before being moved to the nursing home.

When she visited dad she told him he was there because he had a bleed and asked him how he'd feel if they said he could go home. I am absolutely livid! It is like they have decided he is too healthy to be with them so they are going to send him home. I cannot believe they would say something like that to a man with dementia who takes everything they say as gospel.

I am not sure how we got to this place, he was put in the nursing home because the care home couldn't give him the care he needed. He kept escaping and falling all the time. And while I agree he is currently in a really good place compared to where we were two months ago, I cannot see how they can rule him healthy enough to go home.

I guess it all comes down to the fact that his care is paid for by Social Services and the LHA on Section 117 but surely they don't get to rule him ok to be sent home. Not after we have already been down this route once when he was on the section 3 and the LHA & SS agreed he needed care for his own safety and that it could not be supported at home.

I am at the end of my tether with this, I cannot imagine how my poor Mum is keeping her head above water.

 

[tss502]

Hi, if he has section 117 aftercare funding, they will need to provide appropriate support in line with his needs, and this funding/care should only stop once he is deemed to no longer need it. I would go back to the section 117 assessment - have they done one, and what did it say? Is there a community treatment order in place? Have they suggested discharging him from section 117 aftercare? If not, they remain responsible for his care and for sorting something out. They can't pass this responsibility on to you and your mother, and she can't be forced to take him back home again.

 

[Pet37]

I was always under the impression that the 117 aftercare stays in place until such time as the condition that lead to the section 3 being given is no longer a factor.

As he was put on a section 3 due to the dementia, I cannot see how they can say the condition is no longer a factor. As far as I know there has not been any section 117 assessment since he was discharged form the mental health ward into a care home.

The problem is I have not spoken o anyone directly as Mum is primary carer so she speaks to everyone, but she doesn't really understand half of what they tell her. She is always so tired and frazzled that I am not sure how much she takes in to be fair.

Hopefully there will be a best interest meeting before they tell him he can come home so I can speak to them and argue the case. My Mum feels so guilty that he is in a home that she would probably say he could come home just to keep the peace. The last best interest meeting we had at the mental health ward I didn't hold back from telling them why we did not feel he would be safe at home and they did listen so hopefully I can do it again.

 

[karaokePete]

If you think it would help to speak to the experts on the Helpline the details are

National Dementia Helpline
0300 222 11 22
Our helpline advisers are here for you.
Helpline opening hours:
Monday to Wednesday 9am – 8pm
Thursday and Friday 9am – 5pm
Saturday and Sunday 10am – 4pm

If you prefer to work online just follow this link

https://www.alzheimers.org.uk/get-support/national-dementia-helpline/live-online-advice

 

[Pet37]

Thanks Pete.

I did email the Alzheimer's team to seek advice before posting on here. I got a response on Monday to say they couldn't help and they'd pass my enquiry to the dementia team and they'd come back to me.

I just hoped someone here had first hand experience and may be able to help in the interim.