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capacity or not?

Norfolkgirl

Account Closed
Jul 18, 2012
514
Mental capacity requires someone to be able to understand, use and retain information specific to the subject matter. Basically, I might be able to tell you what I do or do not want in terms of my care but with more complex things like financial issues I may not be able to comprehend and retain that information. For those of you saying that she only needs to understand for a minute or a very short period of time, that is not true and very flaky foundations for any claim that a person had capacity at the time of signing such a document. A person with capacity should be able to make their own decisions about the matter in question, even if that decision seems unwise. This may be seen in cases where someone insists they remain living in their own home even where they may be at risk, let's say of repeated falling as an example, providing they understand the consequences of repeated falls such as long term hospital stays, permanent damage, not being able to get up unassisted and the risks associated with spending lengthy amounts of time on the floor etc.

Social services will assist you with making a judgement in respect of mental capacity in relation to specific matters. They tend to do it better than a lot of doctors in my opinion, but I'm biased ;) I'm a student social worker with a law degree!



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Perhaps if those who are being assessed is FIRST asked, would you be happy to be in pain after a fall, not be able to get up after a fall, not be able to call for help after a fall and then see what they say. And THEN weigh that up with their comprehension of not needing help!
 

Norfolkgirl

Account Closed
Jul 18, 2012
514
Hi Everyone - Just joined today and am at Wits End! Can appreciate Norfolk Girl's situation, as mine appears similar.

My 89 year old mother has been in hospital since the end of April, having broken her hip falling at a respite home, (which I'd rate at 3/10, but that's another story), having been sent into respite with a broken wrist after being in another hospital two weeks, after falling. She was living alone in sheltered flat with carers 4 times a day, since ,my dad died 6 months ago, but no help at night when she is most awake, agitated and likely to fall. The paramedics have been out numerous times this year to pick her up.

We have little written medical evidence of her mental condition, which has deteriorated greatly, but at one stage an assessor wrote "impression of mixed dementia". She is hallucinatory and delusional much of the time and often verbally aggressive as ward staff have seen, but she can also be clear, focussed and lucid in her interactions with professionals when interviewed! She has always been non-compliant and stubborn - she didn't go to a GP for 40 years and has always refused to get reading spectacles, so hasn't read without a magnifying glass for 50 years! Now in hospital she is refusing a scan. That's her character before dementia!

Now we are told she is a bed-blocker and needs to move into a care home full-time, 24 care, asap. We agree this will be best and have found suitable home with vacancy. However, she point blank refuses to go. Insists she wants to go home. I have also brought in a solicitor for the elderly, who explained LPA, which she refused to sign and he says she has capacity to make that decision, however unwise. I have thought about adapting my small house, which will, of course take time, but she refuses to live with me.

She has no idea about finance or care home costs, and has forgotten about her life savings. We know that she does have more than the threshold but have no access to this money. No property to sell, She will not agree to pay for any care, as she thinks everything costs 10p! She also is oblivious of the pressure we are under, telling us "not to bother about her".

We are completely stumped as to how we can help her. Social Services in hospital have not been particularly supportive, but do we insist they take over everything??! They may put her in a home miles away, if they can't find a bed and they were suggesting one with poor standards of CQC inspection. We wouldn't be able to pay it from mum's funds and they won't take over COP because she has capacity! If they send her back to her own home then she will not be safe!

Any thoughts and suggestions welcome. Thanks for reading
Yes absolutely get them to take over everything but stress that they are not to access her finances if it has been alleged your mother has capacity (make sure this is in writing) and they then cannot contradict this - let them have the fun of dealing with your mother and paying for care and I would stand back. If you know what finances your mother has, make a note of any changes. What they are doing is a false economy by letting her go home in anticipation of her falling and/or needing an ambulance ultimately leading to guess what? - bed blocking!

Let us know what happens.
 

MLM

Registered User
Jun 17, 2014
130
Manchester
Norfolkgirl, I'm not sure what part of what I said you disagree with?

When I do an assessment I don't go into details about risks of falls and capacity to make decisions about issues relating to falls if someone doesn't have a history of falls or a high risk of falls (usually caused by a mobility issue for example) but even then I wouldn't be assessing capacity like how you described as such because capacity or not for the most part falls aren't an immediate reason someone shouldn't live independently. Equipment such as fall pendants, sensors, etc are exhausted first. It would only really become an issue if everything else was exhausted and we were looking at residential care. By which point, if it is on the basis of falls, a person may have been able to live for many years with infrequent falls and the falls the have had may have been minor incidents compared to say a person falling frequently with osteoporosis or someone forgetting how to use equipment to alert someone so spending long amounts of time on the ground. So yes, whilst you are right in how capacity is judged, usually the time which a professional starts systematically assessing capacity like that is when an action needs to be sought which may be invasive/sensitive in some way like suggesting a person enter residential care and leave their home. For things like introducing equipment into someone's life, whilst capacity is still important in order to make a referral to occupational therapy for example, it isn't often such an interrogative process.

We do have a tendency to readily accept capacity when people are making the decisions we agree with, but not so much when taking risks. Many people will take the risk of a fall to remain in their own homes, but there are great devices to support people in taking that risk. Plus risks are a part of what makes life worth living. The most interesting, fulfilling, exciting parts of our lives have usually involved risk.

I'm not saying give up on people and let them harm themselves if it can be prevented. Sometimes a situation reaches crisis point before social workers or anyone else has the right to intervene in a person's life though, and even then they may not have that right. That's a hard thing for us to accept as it is people we care about who we witness being in the centre of that crisis, but ultimately dementia or not, a person may still want to take risks that seem ludicrous but they still may have that capacity. I wouldn't be doing my job if I didn't make sure someone had truly thought through the risks and consequences but likewise I wouldn't be doing my job if I forced my opinion on people for my own peace of mind either.

I feel very connected with people who I work with and I make the time where I can to get to know them as a person. Plus it is usually an emotional reason someone wants to do or not do something, such as pride, fear, stubbornness, whatever, so being clinical can be a barrier. Hence why I think GPs struggle with mental capacity. It is much more humane to spend the time understanding why someone is willing to risk severe injuries and hospitalisation through multiple falls than it is to jump to the conclusion someone doesn't have capacity so you can just override their wishes.

Balancing the interests of carers with their loved ones can be hard, but listening and taking a step away from assessments can help with the trickier issues.
 

LYN T

Registered User
Aug 30, 2012
6,960
Brixham Devon
Perhaps if those who are being assessed is FIRST asked, would you be happy to be in pain after a fall, not be able to get up after a fall, not be able to call for help after a fall and then see what they say. And THEN weigh that up with their comprehension of not needing help!
Hi Norfolkgirl

This sounds a much better approach. Too often (in my opinion) a person can make decisions but have no perception of the consequences.

For instance, when Pete was still deemed to have some capacity to make decisions, he would go walkabout from the house with the dog off the lead. Luckily the neighbours used to bring him back. His right to wander (according to SW's) was more important than the fact he, or the dog, could have come to harm.

Surely this can't be right?

Time and time again I wasn't believed by SW's as to how bad Pete was-he still could manage to put on his 'public face'. SW's should listen to Carers. Their views should be taken into account. I'm fed up with authorities who sit back and wait for a crisis to happen-we read about it all the time on this Forum.

Take care

Lyn T
 

LYN T

Registered User
Aug 30, 2012
6,960
Brixham Devon
I'm not saying give up on people and let them harm themselves if it can be prevented. Sometimes a situation reaches crisis point before social workers or anyone else has the right to intervene in a person's life though, and even then they may not have that right.

.
This statement strikes fear in my heart.

SW's don't have a right to intervene in a person's life when a crisis situation happens?

Please!!! What are they there for?
 

MLM

Registered User
Jun 17, 2014
130
Manchester
No no no, they do! I mean they sometimes can't intervene UNTIL crisis occurs but sometimes crisis occurs WITH capacity and you can't always intervene with that. I can't think of an example but we can make decisions that result in crisis all the time. Gambling is a non-health example. Hitch hiking might have been a good example when it was more popular!
 

MLM

Registered User
Jun 17, 2014
130
Manchester
For example, I might nip to answer my front door and leave the grill unattended. It might catch fire and then crisis would occur (a house fire) but that wouldn't mean my poor judgement meant I lacked capacity or should not live independently.

Do you see what I mean? Dementia doesn't automatically mean a poor decision like that is immediately a cause for concern. As carers it is normal to not want our loved ones to be at risk of harm. That's normal human nature but social workers need to be cautious with jumping to a fast conclusion that someone doesn't have capacity as it can take away so much of a persons liberty.

Wandering is a good example because lots can happen with wandering. Someone who goes out on a regular trip to the shop for example may appear at risk with dementia but things like a GPS system can be a safeguard for if that person decides to do something out of the ordinary that day and get lost. Wandering at the dead of night on the other hand is risky even with a GPS system so you need to deter the person leaving home. Various sensors can be used even if someone lives alone to deter this such as door sensors connected to telecasts devices or prerecorded messages from family saying to not go out, go back to bed. Social workers tend to exhaust these first because it means a lot to people generally to remain at home and have that feeling of independence.
 

MLM

Registered User
Jun 17, 2014
130
Manchester
Don't forget that the mental capacity act also says you have to do the least restrictive thing. It is difficult for a social worker to justify a person going to a care home if they haven't tried these things first. It is difficult to understand but it is done so people can remain in their homes for as long as possible.
 

MLM

Registered User
Jun 17, 2014
130
Manchester
My father in law has Alzheimer's at 55 so I'm not just on this forum for my interest in social work and law. I wouldn't want him to be unsafe either if he was at risk of harm. I just wouldn't want him to lose the independence he has sooner than it is needed either and there is some amazing but simple equipment out there that can keep people at home for so much longer than what their was in the past. It is trial and error to see what works best but that is carefully weighed up. I would be wary of any professional that can quickly jump to the conclusion that someone needs to go into a care home against their wishes due to capacity issues. I've seen doctors do it in hospitals just because it is quicker to arrange a bed at a care home than it is for an OT to go out and assess for equipment and get it all in place. Costs social services £100 a night for a bed in hospital once a doctor has said they are safe to discharge somewhere.
 

AngelFace64

Registered User
Jun 19, 2014
8
P o a

Hi,

My heart goes out to you, my father had Altzimers for over 7 years, before he got really bad my mother and I took him to a solicitor on the advice from the bank as he had been withdrawing large amounts of money. Anyway at the time the bank advised me to see a solicitor for implementing P O A, the solicitor advised us to do one for my mother which at the time, she was hell bent on me not having a say in her affairs, but as the solicitor explained it would only be used if she got to the point she couldn't cope mentally. Thank goodness it was put in place because now she is in a care home because she cannot cope mentally and physically.
I have sort all her financial affairs and money.
I put it down to the solicitors advice, and her GP was great not SS though, they wasn't much help at all. I do hope you get some help soon.
 

AngelFace64

Registered User
Jun 19, 2014
8
Get Help

Hi,

My mothers in a home, self funding this is because I do have P O A and she sold her home some years ago, she doesn't know she pays! But obviously has to because she's above the limit.

My advice would be to get SS involved in a meeting with your mum there, explain, explain and explain they cannot put her into a home unless she is happy and you.
Plus if your mums paying you have the upper hand. Visit homes with her and let her see and tell her its for her benefit and little white lies come into this if needed. We told my mother her Dr thought it better her in there, sometimes when advice comes from another party its taken better.

My mum isn't happy at times but after reading pages on here you realise you not the only one in this situation.

Hope this helps a little..
 

LYN T

Registered User
Aug 30, 2012
6,960
Brixham Devon
No no no, they do! I mean they sometimes can't intervene UNTIL crisis occurs but sometimes crisis occurs WITH capacity and you can't always intervene with that. I can't think of an example but we can make decisions that result in crisis all the time. Gambling is a non-health example. Hitch hiking might have been a good example when it was more popular!
In my experience even when SW was alerted to my Husband making verbal threats and attacking the dog with a stick because he wouldn't learn to read or talk:rolleyes: I still didn't receive help.I had to wait to be attacked before he was sectioned.

By that time Pete had no capacity left.

Glad Pete's consultant gave his SW a right telling off in front of me. She actually told him he had made a wrong decision and he should have listened to me
 

LYN T

Registered User
Aug 30, 2012
6,960
Brixham Devon
For example, I might nip to answer my front door and leave the grill unattended. It might catch fire and then crisis would occur (a house fire) but that wouldn't mean my poor judgement meant I lacked capacity or should not live independently.

Do you see what I mean? Dementia doesn't automatically mean a poor decision like that is immediately a cause for concern. As carers it is normal to not want our loved ones to be at risk of harm. That's normal human nature but social workers need to be cautious with jumping to a fast conclusion that someone doesn't have capacity as it can take away so much of a persons liberty.
I see perfectly well what you mean -I just don't agree with it.

A person with Dementia who causes a fire in the house once can do it again with terrible consequences; therefore, I would say that it should be a cause for concern and safeguarding issues should be raised. Of course a person without Dementia would probably not do it again as a hard lesson had been learned.
 

MLM

Registered User
Jun 17, 2014
130
Manchester
I'm not saying let someone keep setting fire to their house! There are ways to prevent problems from happening again though without taking away someone's independence.
 

Pickles53

Registered User
Feb 25, 2014
2,474
Radcliffe on Trent
Don't forget that the mental capacity act also says you have to do the least restrictive thing. It is difficult for a social worker to justify a person going to a care home if they haven't tried these things first. It is difficult to understand but it is done so people can remain in their homes for as long as possible.
I follow what you are saying, but what if the person says all the time that they DON'T want to stay in their home, they are totally fed-up and miserable and that they wish they were 'out of it'? I know that many people aren't determined to stay at home but my mum isn't one of them.
 

Pickles53

Registered User
Feb 25, 2014
2,474
Radcliffe on Trent
I follow what you are saying, but what if the person says all the time that they DON'T want to stay in their home, they are totally fed-up and miserable and that they wish they were 'out of it'? I know that many people aren't determined to stay at home but my mum isn't one of them.
Sorry that should have read 'are' not 'aren't' in previous post.
 

Pickles53

Registered User
Feb 25, 2014
2,474
Radcliffe on Trent
I'm not saying let someone keep setting fire to their house! There are ways to prevent problems from happening again though without taking away someone's independence.
I have heard a lot about various technical solutions but not convinced they are always the answer. If my mum heard a recorded message telling her to go back to bed she would be petrified as she would not understand where it was coming from. The only technical adjustment we've set up so far is an emergency wrist pendant alarm . We do a practice test call every time I visit but she can't remember what to do and detests wearing the alarm button. So the only part of that which might be of use is the automatic falls detector.
 

Pickles53

Registered User
Feb 25, 2014
2,474
Radcliffe on Trent
My father in law has Alzheimer's at 55 so I'm not just on this forum for my interest in social work and law. I wouldn't want him to be unsafe either if he was at risk of harm. I just wouldn't want him to lose the independence he has sooner than it is needed either and there is some amazing but simple equipment out there that can keep people at home for so much longer than what their was in the past. It is trial and error to see what works best but that is carefully weighed up. I would be wary of any professional that can quickly jump to the conclusion that someone needs to go into a care home against their wishes due to capacity issues. I've seen doctors do it in hospitals just because it is quicker to arrange a bed at a care home than it is for an OT to go out and assess for equipment and get it all in place. Costs social services £100 a night for a bed in hospital once a doctor has said they are safe to discharge somewhere.
Maybe it's because my mum isn't in hospital and therefore not costing SS money that there is no sign of the promised OT assessment visit after god knows how many weeks waiting. Call me a cynic, but if she fell and broke her hip I suspect she'd get a lot more attention! I don't want to wait till something dreadful happens.
 

Pickles53

Registered User
Feb 25, 2014
2,474
Radcliffe on Trent
I see perfectly well what you mean -I just don't agree with it.

A person with Dementia who causes a fire in the house once can do it again with terrible consequences; therefore, I would say that it should be a cause for concern and safeguarding issues should be raised. Of course a person without Dementia would probably not do it again as a hard lesson had been learned.
Have to say I'm with you Lyn T. I understand we have to comply with the law of course and why those protections are needed but it's like you have to wait for the train to crash rather than ringing the alarm bell before it happens.
 

MLM

Registered User
Jun 17, 2014
130
Manchester
Yes, there are limitations to technology hence the trial and error I mentioned. There is nearly always going to be a day that comes where everything has been exhausted and we have to accept a person cannot have their wish, if it is their wish, to remain at home.

You may find that the automatic falls detector is no use as well. The problem is with how they detect a fall. Simply lying in bed or reclining with one on can make it think the person has had a fall so they need to be able to know to 1. Take it off when going to bed and 2. Remember to put it back on when getting out of bed. Especially if they set it off accidentally this way and it connects to care on call and they don't respond to the person on the other end speaking to them through the box to check if they are ok or they sleep through it.

It is very very important to see a person in their own home to be able to figure out what will help and what will probably just be a hindrance. I also wouldn't judge capacity off something I have read either or been told. Working with the person and their family directly is so important.