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Agreeing to moving to a Care Home

Banjomansmate

Registered User
Jan 13, 2019
1,618
Dorset
My friend/partner has Lewy Body Dementia and is currently in hospital after an infection. He has lived alone (with my help) and daily carers but has really needed residential care for a while and after a Best Interest meeting last week it was finally agreed that for his own safety he needs 24 hour care. A CHC meeting with a nurse and Social worker came to the conclusion that he should receive NHS funding, unfortunately he, quite understandably, won’t agree to moving to a Care Home, especially as he has no idea what or where it is likely to be. The Hospital Social worker is doing her best for him but says she has to hear him confirm his willingness to live in care. I cannot tell him what choices/ options there are until funding is agreed and the NHS has offered placements for me to chose from. As I have LPA along with family members I thought we could make decisions in his best interest as long as two medical practitioners said that he no longer has the mental capacity himself but Social Services are saying that if he refuses to move into a care facility then it will have to go to The Court of Protection. I fully understand that he needs to be in a secure unit as he is likely to wander off outside but I am concerned that going to the CoP means he will be sectioned and sent to a mental facility rather than a Care Home.
Have I got this wrong, why do we need a Court order, is that used just to get him out of the hospital? I am hoping to convince him that he is in hospital and cannot return to his flat as there is nobody to look after him but while some of the time he understands what I am saying other days he refuses to listen or let.me talk about it because “People are listening”.

Should I expect an invitation to the next decision meeting about his funding?

C.
 

nae sporran

Volunteer Host
Oct 29, 2014
6,574
Bristol
Welcome to the forum, @Banjomansmate. Sorry the situation your friend / partner is in is beyond my experience. Have you asked the Office of the Public Guardian for guidance, they may be able to advise. I couldn't see anything obviously helpful in the Alz Society factsheets, but hopefully someone can point you in the right direction.
https://www.alzheimers.org.uk/get-support/publications-factsheets is a good resource in any case.
Meanwhile the Dementia Helpline is always available, and they will advise or point you to someone who can :
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
 

Bunpoots

Volunteer Host
Apr 1, 2016
4,087
Nottinghamshire
Hello @Banjomansmate . I’m surprised to read that the hospital social worker is saying this as this was not my experience with my dad after he was taken into hospital last summer.

Dad was sectioned under section 2 of the mental health act so he could be kept in hospital and then moved to assessment bed in a local care home. At no time was it suggested that he would need to move to MH hospital, I think this only happens in extreme circumstances and dad didn’t have any particularly challenging behaviours.

I had health and welfare poa so was consulted throughout the process.
 

Banjomansmate

Registered User
Jan 13, 2019
1,618
Dorset
Thank you both for your replies. I will be going to visit him in hospital tomorrow and try again to get him to agree in front of the social worker that he accepts a move to a care facility. She needs to hear him say this a couple of times to prove he knows what he is agreeing to. Of course the more often the subject is raised then the more anti and belligerent he becomes. Whilst by myself I might be able to quietly talk him round to agreeing, the presence of the social worker to witness it makes it more unlikely. I just have to hope that I can catch him on a good day!

nae sporran, thank you for the links, I have been scouring the internet but haven’t found anything that seemed to match my problem but hope I can chat with the Social worker tomorrow to clear some things up, if I get no joy I may turn to the helpline.

Bunpoots, my friend was sent to the hospital as an emergency admission so he had no choice in that, it is getting him out of the hospital that is the problem! Maybe I am worrying needlessly about his being sent to a mental health facility rather than a Care Home, he does have some minor behaviour problems. Hope your father settled in happily in his new home.

C.
 

canary

Registered User
Feb 25, 2014
11,657
South coast
This is the most ridiculous thing that I have read. The Social Worker doesnt sound like she has very much experience of people with dementia and is interpreting the requirement that patients should be encouraged to have input about their care too literally. Very, very few people with dementia will agree to moving into a care home because they do not understand the reason why they need to. This is why people in dementia homes usually have a Deprivation of Liberty Safeguarding order to make sure that when they are in a care home that they have not agreed to this deprivation of liberty is appropriate.

The words to use to the SW are that your friend/partner is a vulnerable person and Social Services have a duty of care to keep him safe; therefore you will hold her personally responsible if he is sent home and something happens to him.
 

Beate

Registered User
May 21, 2014
11,902
London
They already had a best interest meeting, which is exactly for when someone has not got the mental capacity to decide for themselves, so with all due respect, the SW is an idiot. Try telling him that nicely.
 

Bunpoots

Volunteer Host
Apr 1, 2016
4,087
Nottinghamshire
My dad was also an emergency admission after a stroke. Hospital wanted to send him home after one failed discharge I refused to let this happen. Of course dad said he wanted to go home when asked. He obviously had no capacity at this time which was why I agreed to having him sectioned. He couldn’t have coped at home even with carers going in 4 times a day.

He did settle into his carehome, joining in with some of the activities occasionally and even starting to make a friendship. He was only there about 3 months before he died. He was safe and as constant as he could be in his last few weeks.

I agree with what the others have said. It doesn’t sound as though the social worker understands dementia very well at all.
 

Banjomansmate

Registered User
Jan 13, 2019
1,618
Dorset
It isn’t just the one Social worker saying if he doesn’t agree, the chair of the Best interest meeting said it too, (another social worker). Maybe they mean they have to get a Deprivation of Liberty safeguarding order from the CoP? That now makes a little sense to me.
 

Banjomansmate

Registered User
Jan 13, 2019
1,618
Dorset
I checked and found he was in a good mood yesterday so I spent an hour and a half with the Banjoman, explaining all that was happening and why he wasn’t allowed back home by himself. The Social worker was off sick and no others were available to sit in and record his response (hopefully confirmation that he would accept residential care) but they told me a nurse could take a record of it. When I finally got him to understand that he had no choice in the matter and that to accept it was the easiest option all round I went to see his nurse and asked her to come and hear him say it but she refused as it could be said that we coerced him and she would speak to him later. When I phoned the ward this morning she said she only got around to speaking to him this morning and she asked him”Where did he want to go when he left the hospital?” Unsurprisingly he said he wanted to go home! WRONG QUESTION! I was going to let him say that he understood he couldn’t go home and realised he needed to be looked after!
Now I will have to start all over again.
Friends who visited him this evening said he is upset and wants to know what he has done wrong that he is being put away when he doesn’t want to go to a Care home.
 

Louise7

Registered User
Mar 25, 2016
1,789
I have a lot of experience of hospitals, staff incompetence and an appalling lack of dementia awareness so you have my sympathy.

Firstly, has the hospital conducted a mental capacity assessment? If not, request that they do this. If he is deemed to have lost capacity then those with Health & Welfare LPA are the people who are responsible for making decisions in his best interest and the social workers/nursing staff should not be asking him where he wants to go when he leaves hospital.

There is no need for COP involvement if he has lost capacity and there is a H&W LPA in place. Does the hospital have a dementia nurse/team? If so ask to speak to them and explain what is going on. If not, speak to the PALS team. Some are better than others but if you lodge a complaint it should mean that someone else on the ward will look into what's happening. What is the view of the consultant and the ward sister?

When I finally got him to understand that he had no choice in the matter and that to accept it was the easiest option all round
Those with dementia (whether they have capacity or not) will want to go home and will find it difficult to understand why they can't. A better way to approach this is to say something like the doctor has said that he can go home when he gets better and has fully recovered from the infection but he needs some recuperation first. Ask the consultant to help explain the position to your friend/partner as he may accept it better if it is coming from a doctor.

It is not good that you have to 'battle' with the authorities in hospital but stand your ground and request a capacity assessment, which you have a right to be present at (without getting involved in the actual assessment).
 
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Banjomansmate

Registered User
Jan 13, 2019
1,618
Dorset
I have a lot of experience of hospitals, staff incompetence and an appalling lack of dementia awareness so you have my sympathy.

Firstly, has the hospital conducted a mental capacity assessment? If not, request that they do this. If he is deemed to have lost capacity then those with Health & Welfare LPA are the people who are responsible for making decisions in his best interest and the social workers/nursing staff should not be asking him where he wants to go when he leaves hospital.

There is no need for COP involvement if he has lost capacity and there is a H&W LPA in place. Does the hospital have a dementia nurse/team? If so ask to speak to them and explain what is going on. If not, speak to the PALS team. Some are better than others but if you lodge a complaint it should mean that someone else on the ward will look into what's happening. What is the view of the consultant and the ward sister?



Those with dementia (whether they have capacity or not) will want to go home and will find it difficult to understand why they can't. A better way to approach this is to say something like the doctor has said that he can go home when he gets better and has fully recovered from the infection but he needs some recuperation first. Ask the consultant to help explain the position to your friend/partner as he may accept it better if it is coming from a doctor.

It is not good that you have to 'battle' with the authorities in hospital but stand your ground and request a capacity assessment, which you have a right to be present at (without getting involved in the actual assessment).
Thanks Louise, my understanding of the working of LPAs is as you write, once he has been declared as lacking capacity by two medics then we make decisions for him in his best interest. His GP has stated that he lacks capacity but no other Dr. has said so to my face. He says no Dr. has been to see him or said anything about it to him and while I am sure Drs have seen him I know not what has been said. At the moment I am waiting to hear more about CHC funding for him, the initial assessment took place last week. Unfortunately I cannot get to the hospital again until Sunday but I will make some phone calls.
His hospital Social worker told me she had a patient who agreed to go into residential care but on the day they were due to discharge him he refused to go and they couldn’t make him go, so it seems some hospitals throw out little old ladies in the middle of the night while this one hangs on to them. I suppose I should be grateful he’s in the latter!

C.
 

Louise7

Registered User
Mar 25, 2016
1,789
Where have you got the impression that 2 doctors are required to assess mental capacity? Has the hospital told you that? The first time my Mum was in hospital a mental capacity assessment was carried out by one person. During her most recent hospital stay mental capacity was also decided by one doctor. I have H&W LPA and there was no suggestion that two doctors were required to assess capacity. Mind you, they completely disregarded the LPA anyway! The decision to move your friend/partner into care was made on a best interests basis to prevent him from harm. Do the medical staff and the social workers know that you have LPA? I found that providing them all with a copy focussed their minds a bit!
 

Banjomansmate

Registered User
Jan 13, 2019
1,618
Dorset
I had to take copies of the two LPAs in after he was admitted - the second time in six months, apparently the previous photocopies weren’t in his current admittance file! They know all about them and insisted that all attorneys knew about and were represented at the best interest meeting, including one daughter who had disappeared off to stay with her boyfriend in Europe. They kept her in the link via a phone call. The other one couldn’t even bother to write an e-mail to say she felt her Dad needed to go into residential care! Unfortunately I insisted that his family were included on the LPAs (he only wanted me) as I am only a couple of years younger than him and if anything happened to me they would be null and void. I also felt that his daughters should be the ones to make any decision should it ever get to the stage where equipment needed to be turned off.

I am pretty sure I read that two medical opinions were needed before we could make decisions as to his person due to lack of capacity. He has been happy for me to deal with everything anyway.
 

Sirena

Registered User
Feb 27, 2018
2,137
I had to take copies of the two LPAs in after he was admitted - the second time in six months, apparently the previous photocopies weren’t in his current admittance file! They know all about them and insisted that all attorneys knew about and were represented at the best interest meeting, including one daughter who had disappeared off to stay with her boyfriend in Europe. They kept her in the link via a phone call. The other one couldn’t even bother to write an e-mail to say she felt her Dad needed to go into residential care! Unfortunately I insisted that his family were included on the LPAs (he only wanted me) as I am only a couple of years younger than him and if anything happened to me they would be null and void. I also felt that his daughters should be the ones to make any decision should it ever get to the stage where equipment needed to be turned off.

I am pretty sure I read that two medical opinions were needed before we could make decisions as to his person due to lack of capacity. He has been happy for me to deal with everything anyway.
I know this doesn't help you now, but it's possible to have just one attorney plus a backup should the first attorney be unable to act. My mother named her solicitor as backup attorney, but he has no input unless something happens to me.

It is very unfortunate that the SW is insisting on your partner being badgered about this, it is very unlikely he will agree, he doesn't understand and as you say he's becoming upset. Even if he agrees once, he may well change his mind five minutes, or five days, later, because he doesn't have the cognitive capacity to make the decision. As it has been established he needs to go to a care home would be far kinder to arrange it behind the scenes for him. I do hope you manage to get this sorted out without too much more distress.
 

Normaleila

Registered User
Jun 4, 2016
731
Hi Banjomansmate
This must be exasperating. I have never heard of 2 doctors being needed to assess mental capacity. I think I'd get angry - let hospital and SW know that you'll be making an official complaint.
My aunt was assessed by an independent (private) social worker I chose, as I have LPA. He assessed that she lacked capacity but could remain safe at home if certain arrangements were made: 3 carers a day, meds given to her by carer, food deliveries arranged by me. This worked for a short time but she didn't cooperate, wouldn't accept food deliveries, and was wandering along and across busy roads. The independent SW then decided she was no longer safe at home and that, as she lacked capacity, we could find her a care home without asking her opinion.
I really can't understand what the hospital are thinking.
 

Banjomansmate

Registered User
Jan 13, 2019
1,618
Dorset
I checked with the ward today and he must have been assessed by the mental health team as having lack of capacity as he has a Deprivation of Liberty order in place, hence he is on a secure ward. His GP has stated that he lacks capacity too. I have also been reading the Code of Practice to the Mental Health Act but that seems to confuse matters a little in my understanding. Most of the time it seems to say that I did exactly what was needed by discussing with him the need and process of him moving to residential care and that as his Attorneys we can make that decision for him but later it seemed to say that as it involves Deprivation of Liberty it might need to go to The Court of Protection!
I think I have been reading too much today!
I cannot actually do anything until I hear from the local NHS Trust about whether or not he does qualify for CHC, when I believe they should give me the option of a couple of residential homes to look at for him. I am hoping that once I can tell him about where he is likely to go then he will accept it anyway.
 

Banjomansmate

Registered User
Jan 13, 2019
1,618
Dorset
Spoke with a Social worker today. If he continues to say he doesn’t want to go into residential care they have to refer him to The CoP due to a Human Rights Court judgement of a few years ago. This could take months! Now I need to convince him that he needs to accept the decision or he will be stuck with hospital food for a long time!
 

canary

Registered User
Feb 25, 2014
11,657
South coast
Try suggesting to him that he can be moved to a much nicer place for convalescing.

His SW is applying the Mental Health Act far too rigorously
 

Baker17

Registered User
Mar 9, 2016
438
Try suggesting to him that he can be moved to a much nicer place for convalescing.

His SW is applying the Mental Health Act far too rigorously
Unfortunately the human rights thing is applied rigorously if the person whether or not they are deemed to have capacity if they are asked where they would rather be and they say x under the human rights act this will be applied, this happened to my OH and he was moved after a long expensive court case and now they are having to be assessed by the chess team called in by the new home due to behaviour which was not present in the previous one, it breaks my heart to see them like this but there’s nothing I can do because you cannot appeal the decision on the grounds of new evidence, the judge at the final hearing said he worked within the law and precedents set in previous cases, the social workers and the advocate appointed for them have been worse than useless and they hadn’t been to see my OH until the chess team were called in, one said it was because it was Christmas another said he had an infection( is she a doctor now) they’d been checked for infection as they have to be before the chess team can be called. Sorry to go on but it makes my blood boil.
 

Banjomansmate

Registered User
Jan 13, 2019
1,618
Dorset
I received a phone call last week from a worker at the County Council’s Mental Capacity Act Team to tell me (finally) that they have a DoL order on him and that as he said to her the previous day that he had a perfectly good flat to go home to, even though she is fully aware that he lacks the capacity to understand why it is unsafe for him to return there, she has requested a independent advocate to go to see him to find out what he wants!
As he is now refusing to eat hospital food I’m not sure what state of mind he will be in or even if he will understand what any meeting is about. If we don’t get him out of there soon he’ll pop off before it gets anywhere near The Court of Protection!
Maybe that is what they want? It would save a lot of hassle and money.