I have an elderly relative who has dementia and is unfortunately in hospital and has had a fall whilst being there and has a fractured hip. He does not have the capacity to make a decision about his treatment. What rights does his family have to protect him from unnecessary operations? Does anyone know the legalities of this situation or experienced something similar, thank you!
Dementia patients consent to hospital treatment
- Thread starter bessiegertrude
- Start date
Power of Attorney
Hello you need to check with the rest of the family to see if there has been a power of attorney put into place. If so this does makes desicions a bit easier if not i am not really sure. My partner had a power of attorney done before they became very ill as the forms states it is a power of attorney hence it gives the named person the rite to say what treatment the person named shall need when they become unable to give consent for anything hope this is of some help. Ko Ko
Hello you need to check with the rest of the family to see if there has been a power of attorney put into place. If so this does makes desicions a bit easier if not i am not really sure. My partner had a power of attorney done before they became very ill as the forms states it is a power of attorney hence it gives the named person the rite to say what treatment the person named shall need when they become unable to give consent for anything hope this is of some help. Ko Ko
I have no experience really except to say treatment hass been declined by me and my husband for prostate cancer, as the side effects were not good from the last lot.
However he is not in hospital, and the plan is for him to remain at home.
If your relative is in pain due to a fall then I would have thought an op would almost have been essential.
Many of us on here vote for pain free and comfort rather than prolonging life.
I would think the nearest next of kin would at least be approached by medical staff.
Jeannette
However he is not in hospital, and the plan is for him to remain at home.
If your relative is in pain due to a fall then I would have thought an op would almost have been essential.
Many of us on here vote for pain free and comfort rather than prolonging life.
I would think the nearest next of kin would at least be approached by medical staff.
Jeannette
Hope the info below might help.
The text below has been taken (cut and pasted) from the following link
http://www.patient.co.uk/doctor/Mental-Capacity-Act.htm
Best interests
Everything that is done for or on behalf of a person who lacks capacity must be in that person's best interests.
The Act provides a checklist of factors that decision-makers must work through in deciding what is in a person's best interests.
A person can put his/her wishes and feelings into a written statement if they so wish, which the person making the determination must consider.
Carers and family members have a right to be consulted.
All decisions must be made in the best interest of that person:
Involve the person who lacks capacity.
Be aware of the person's wishes and feelings.
Consult with others who are involved in the care of the person.
Do not make assumptions based solely on the person's age, appearance, condition or behaviour.
Consider whether the person is likely to regain capacity to make the decision in the future.
The text below has been taken (cut and pasted) from the following link
http://www.patient.co.uk/doctor/Mental-Capacity-Act.htm
Best interests
Everything that is done for or on behalf of a person who lacks capacity must be in that person's best interests.
The Act provides a checklist of factors that decision-makers must work through in deciding what is in a person's best interests.
A person can put his/her wishes and feelings into a written statement if they so wish, which the person making the determination must consider.
Carers and family members have a right to be consulted.
All decisions must be made in the best interest of that person:
Involve the person who lacks capacity.
Be aware of the person's wishes and feelings.
Consult with others who are involved in the care of the person.
Do not make assumptions based solely on the person's age, appearance, condition or behaviour.
Consider whether the person is likely to regain capacity to make the decision in the future.
When my Mam was in hospital needing surgery, her social worker said that myself and my brothers could give consent for surgery (as next of kin). The surgeon was being awkward, saying that he couldn't operate because of the consent issue. The SW went to the hospital and told him we could.
My mother fell and broke her hip in November and I had to agree for her to have the op. To be honest with something like a broken hip it would be inhumane not to have the op done as they would be in terrible pain. Having the op is risky but it does make them more comfortable.
Unfortunately a high percentage of old people do take a downward turn after this sort of thing. My mother went to N/H after 3-4 weeks in hosp - was in RH before but is unable to walk or feed herself now and she was rushed back to hosp on NYears day with pneumonia. Given a couple of days to live by the Consultant on Thursday, woke up on Friday morning and was talking (as best she can) and cuddling me. She is now in a stable condition so we are taking things day by day.
Unfortunately a high percentage of old people do take a downward turn after this sort of thing. My mother went to N/H after 3-4 weeks in hosp - was in RH before but is unable to walk or feed herself now and she was rushed back to hosp on NYears day with pneumonia. Given a couple of days to live by the Consultant on Thursday, woke up on Friday morning and was talking (as best she can) and cuddling me. She is now in a stable condition so we are taking things day by day.
Been there, done it, bought the t shirt.
The decision maker is the hospital sw if you do not PoA, that person has to power to overrule the family, make a noise and they can appoint IMCAs to decide Best Interests, IMCAs are normally appointed when the person has no-one to speak for them eg family, they were appointed in mum's case as they were drugging mum against our wishes on one occasion. It was a traumatic meeting but we won and got mum out of Hell Hole Hospital.
The last time mum was in the Hell Hole, a consultant tried to frighten me into signing a DNR, I felt nervouse and would not sign as it seemed to be more like a pitch for time share than deciding on life or death of a human being. Mum got injured mysteriously, the hospital told us that "we can do what we like", I was alrmed at things I saw happen both to mum and other patients. A broken arm left unsupported and obviously broken for 24 hours, only taken down to A&E because I made a fuss. The hospital seemed uninterested, I reported them for elder abuse.
Thankfully, the team carrying out the repair to her arm were decent & professional human beings who discussed everything with us. They noted the absence of the DNR form, I told them of my concerns, they accepted that we wished for the best to be done for mum, if she had profound complications then they were to take what they felt was best at the time. As it happened, they decided an operation was too dangerous and just reset the arm, we were told she might lose the use of the arm, thankfully they were wrong.
Before going back to the hospital, aquaint yourself with the Mental Capacity Act, do what you feel is right for the person, don't automatically believe what the hospital tells you - remember where the hip was broken.
Just keep using the term 'best interests', it has a standing in law.
ps If you feel the need to make a complaint about the Decision Maker and that person is a SW, they are mostl likely employed by the county council not nhs.
The decision maker is the hospital sw if you do not PoA, that person has to power to overrule the family, make a noise and they can appoint IMCAs to decide Best Interests, IMCAs are normally appointed when the person has no-one to speak for them eg family, they were appointed in mum's case as they were drugging mum against our wishes on one occasion. It was a traumatic meeting but we won and got mum out of Hell Hole Hospital.
The last time mum was in the Hell Hole, a consultant tried to frighten me into signing a DNR, I felt nervouse and would not sign as it seemed to be more like a pitch for time share than deciding on life or death of a human being. Mum got injured mysteriously, the hospital told us that "we can do what we like", I was alrmed at things I saw happen both to mum and other patients. A broken arm left unsupported and obviously broken for 24 hours, only taken down to A&E because I made a fuss. The hospital seemed uninterested, I reported them for elder abuse.
Thankfully, the team carrying out the repair to her arm were decent & professional human beings who discussed everything with us. They noted the absence of the DNR form, I told them of my concerns, they accepted that we wished for the best to be done for mum, if she had profound complications then they were to take what they felt was best at the time. As it happened, they decided an operation was too dangerous and just reset the arm, we were told she might lose the use of the arm, thankfully they were wrong.
Before going back to the hospital, aquaint yourself with the Mental Capacity Act, do what you feel is right for the person, don't automatically believe what the hospital tells you - remember where the hip was broken.
Just keep using the term 'best interests', it has a standing in law.
ps If you feel the need to make a complaint about the Decision Maker and that person is a SW, they are mostl likely employed by the county council not nhs.
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I remember that when we had unconscious people brought in to casualty needing urgent surgery we would get a hospital administrator to give consent ---admittedly this was in an emergency but they are the ones who are going to make sure the hospital or surgeon isn't sued for doing the wrong thing so should know what they are doing legally.
If you haven't got PoA, might be an idea to tell them the family is in the process of applying to Court of Protection, even if you haven't done this it might stop them in their tracks if there is any talk of taking over your relative and making decisons not in the persons best interests. The process would, of course, be a family discussion first, just don't mention at what stage you are at. 
Thankfully, once we got mum out of the Hell Hole and off the drugs she had 'windows' of reality where PoA consent could be given.
Thankfully, once we got mum out of the Hell Hole and off the drugs she had 'windows' of reality where PoA consent could be given.
After two stays in hospital following breaking first one hip then the other within a three week period, Dad ended up doubly incontinent and immobile with his Dementia symptoms rapidly escalated too: as a result he has been in a CH for almost a year now.
Our main fear is an event where he would need to be transferred back to the local hospital, say if he fell or had an illness such as a chest infection. The hospital is awful, truly horrible and in spite of promises that things would change for vulnerable patients we know that it is still as bad, if not worse than it was when he was last in there. Another resident from the CH fell 8 weeks ago, was transferred there and left in pain and with no dignity: his Dementia was completely ignored so he didn't eat or drink for days because the staff thought he was refusing whereas he just didn't know to eat. His wife went in and found him covered in faeces and naked, no covers on him and looking like his bones were going to poke through the skin. When she spoke to a member of staff, the person said she didn't know he had Dementia, they thought he was being awkward.......his wife asked how that could be the case as he had been admitted from a specialist Dementia CH.....the staff member couldn't answer her. This man was then discharged back to the CH, he was in a terrible state and he died later that day.
We have therefore decided, as a family, that in the event that Dad becomes ill we don't want him transferred to the local hospital and we have been advised that we can sign a form instructing the CH to keep him there and care for him there.
As for DNR.....well we have decided that we will sign this because we all know that no way would Dad want to be kept alive, in fact if he had the ability to take his own life we are certain that he would have done so. This kind of existence was his worst nightmare.........we caught him stockpiling painkillers a few years into his diagnosis, he was taking a few at a time and hiding them. He openly told us all, when this was discovered, that when the time came when he could no longer have dignity or self determination, he wanted to know that he had the ability to take his own life. In the end, the illness and the falls meant this course of action was denied to him.
Very hard.....
Our main fear is an event where he would need to be transferred back to the local hospital, say if he fell or had an illness such as a chest infection. The hospital is awful, truly horrible and in spite of promises that things would change for vulnerable patients we know that it is still as bad, if not worse than it was when he was last in there. Another resident from the CH fell 8 weeks ago, was transferred there and left in pain and with no dignity: his Dementia was completely ignored so he didn't eat or drink for days because the staff thought he was refusing whereas he just didn't know to eat. His wife went in and found him covered in faeces and naked, no covers on him and looking like his bones were going to poke through the skin. When she spoke to a member of staff, the person said she didn't know he had Dementia, they thought he was being awkward.......his wife asked how that could be the case as he had been admitted from a specialist Dementia CH.....the staff member couldn't answer her. This man was then discharged back to the CH, he was in a terrible state and he died later that day.
We have therefore decided, as a family, that in the event that Dad becomes ill we don't want him transferred to the local hospital and we have been advised that we can sign a form instructing the CH to keep him there and care for him there.
As for DNR.....well we have decided that we will sign this because we all know that no way would Dad want to be kept alive, in fact if he had the ability to take his own life we are certain that he would have done so. This kind of existence was his worst nightmare.........we caught him stockpiling painkillers a few years into his diagnosis, he was taking a few at a time and hiding them. He openly told us all, when this was discovered, that when the time came when he could no longer have dignity or self determination, he wanted to know that he had the ability to take his own life. In the end, the illness and the falls meant this course of action was denied to him.
Very hard.....
It isn't the cocept of DNR that I have a problem with, it is just I had a feeling that a DNR situation might occur if I signed the form and might not have occured if I didn't sign. I had an uncomfortable feeling which wasn't calmed when I looked around at what was going on. The final straw was when a staff nurse told me not to see what was happening to other patients, I was very uncomfortable about what I saw. There is a time to go and there is a time when the person isn't ready. People getting injured worries me.
The lack of a PoA was used against us, dad and I both felt very cautious about the whole situation. Particulary so as mum had previously had seriously negative experiences which could have killed her if we hadn't intervened.
A ward with 28 patients, 1 commode, Cdiff on the ward and cries from all around to use the commode. 4 isolation rooms, 1 toilet with cdiff sufferers re-infecting each other, lack of cleaners to clean toilet. Build up drinks put on table, nurse leaves, drink left, nurse returns, rattles carton, fills in chart that little taken, bins carton, opens another carton, puts on table etc etc. Read some time later that the ward was disbanded, some staff sacked other transferred. Last visit to hospital left me feeling seriously worried, other things happened which frightened the Hell out of me.
If there is that kind of situation, how happy (not) was I being asked to sign a DNR form but at the same time being told 'we can do what we like'.
The lack of a PoA was used against us, dad and I both felt very cautious about the whole situation. Particulary so as mum had previously had seriously negative experiences which could have killed her if we hadn't intervened.
A ward with 28 patients, 1 commode, Cdiff on the ward and cries from all around to use the commode. 4 isolation rooms, 1 toilet with cdiff sufferers re-infecting each other, lack of cleaners to clean toilet. Build up drinks put on table, nurse leaves, drink left, nurse returns, rattles carton, fills in chart that little taken, bins carton, opens another carton, puts on table etc etc. Read some time later that the ward was disbanded, some staff sacked other transferred. Last visit to hospital left me feeling seriously worried, other things happened which frightened the Hell out of me.
If there is that kind of situation, how happy (not) was I being asked to sign a DNR form but at the same time being told 'we can do what we like'.
This idea that 'they' can 'do what they like' seems to be happening more and more. We had a situation like this after Dad's second hip break just before New Year 2012.
He had only broken the other hip about three weeks before and had been in this same hospital for that.
The second time they were ok at first and then it became apparent that the same poor standards we had witnessed the previous time were not just a 'blip', that was the way things were done.
To cut a long story short, when we asked a simple question we were told in no uncertain terms that if we 'continued to interfere' Dad would legally be made into a 'safeguarded adult' and any 'rights' we had as his family would be suspended. The balloon went up over this comment which we later discovered was made because apparently my Mum had asked this person to wash her hands before touching Dad and she had taken offence........!!!
It's shocking the way things are in some hospitals, ours is appalling and if Dad were in there I would be worried sick about having a DNR in place......if he is going to stay in the CH then we feel slightly safer in signing it.
X
He had only broken the other hip about three weeks before and had been in this same hospital for that.
The second time they were ok at first and then it became apparent that the same poor standards we had witnessed the previous time were not just a 'blip', that was the way things were done.
To cut a long story short, when we asked a simple question we were told in no uncertain terms that if we 'continued to interfere' Dad would legally be made into a 'safeguarded adult' and any 'rights' we had as his family would be suspended. The balloon went up over this comment which we later discovered was made because apparently my Mum had asked this person to wash her hands before touching Dad and she had taken offence........!!!
It's shocking the way things are in some hospitals, ours is appalling and if Dad were in there I would be worried sick about having a DNR in place......if he is going to stay in the CH then we feel slightly safer in signing it.
X
Update on my issue raised
Thank you for the replies and input. I am pleased to say on this occasion the hospital made a mistake, or there has been a miracle, he had a 2nd x-ray and there was no more fracture so we were spared having to make a terrible decision. It doesn't excuse them from being incompetent and putting my Uncle through a traumatic time and ourselves. Yet another complaint on the cards. We have now got him into a very nice Nursing home where I hope he will be safe and looked after properly.
Thank you for the replies and input. I am pleased to say on this occasion the hospital made a mistake, or there has been a miracle, he had a 2nd x-ray and there was no more fracture so we were spared having to make a terrible decision. It doesn't excuse them from being incompetent and putting my Uncle through a traumatic time and ourselves. Yet another complaint on the cards. We have now got him into a very nice Nursing home where I hope he will be safe and looked after properly.
On reading this thread I have decided I will never sign a DNR until I'm absolutely certain that Pete has no quality of life left whatsoever. When Pete was previously sectioned last May I was asked about this and he hadn't had a diagnosis then (although it was pretty obvious) I refused to answer the question let alone sign anything.He was only 65. As far as I was (and still am) concerned Pete still has a quality of life worth pursuing.When the time comes I hope I will be strong enough to remember his wishes pre AD-but until then no way!
