Capacity

[Lavender45]

This may be a daft question, but it's concerning me at the moment.

My mum is currently in a secure ward under a section 2. She was detained due to her aggression and it's unpredicatability. Before she was detained it had already been decided that mum lacked capacity when it came to her illness.

Since moving to the secure unit mum had been mostly calm and quiet in front of the staff, just occasionally tearful asking to go home. The nurse I spoke with on Monday said mum masks her illness to an incredible degree and for long periods. She said if she didn't know mum had dementia she's never have guessed.

The consultant allocated to mum in the unit is the same doctor she has at the memory clinic and he has never seemed to take on board anything I have said. He seems to take mum's I'm fine, I cook, clean, shop etc at face value and I've always felt he was dismissive regarding her aggression.

Mum will see this consultant in Friday when he does ward rounds and I fully expect that he will say she is ready for discharge. She's not displaying aggression so he's right, but my concern is over what happens next.

Mum and I jointly own our house so I assume she has every right in the normal way of things to live there, but I don't really believe that mum's aggression has suddenly vanished. I think her calmness is a mask. She cetainly wasn't calm when I saw her on Wednesday, once we were alone she was ranting and sobbing and calling me for everything.

My concern is that we have a consultant who plays down her problems, could he decide that she actually has capacity and can decide for herself that she wants to return home rather than go into residential care.

I know I sound like a nightmare daughter, but I had lived with mum's aggression for months. The most serious incidents involved her trying to strangle me, coming at me with a knife (only a table one as anything sharper was hidden) and on Christmas Eve she came at me with a hammer. I don't want to live under the fear of what the next attack could be any more. As sad as it is I think I would prefer she were in a care home unless I was certain her aggression was under control.

When mum demands to go home she means to her mum and a long demolished property. She was walking off from our actual home several times a day. Being here would not make her happy. I'm really concerned that the consultant could say she's ok to decide where she wants to live and that she could return home when it would put me back in danger and her back to storming off to find her mum and her home.

Can a lack of capacity decision be reversed when it comes to someone having a degenerative illness such as alzheimers?

 

[marionq]

If she is allowed home and her issues ignored you may have to let her go out on her own and have the police pick her up to Make your point. They are obliged to Report to social services who then have to follow it up for her safety.

 

[Lavender45]

Thanks Marionq. I think you are right I would have to let her go out and do as she pleases. The problem with that is she has little road sense and an attitude (which she voices) that things should get out of her way rather than the other way around. I hate the idea that she could cause an accident which could injure herself and others.

I was gutted when I received paperwork yesterday advising me that Dr S was her allocated consultant. I hope he proves me wrong this time. I keep wondering how a geriatric psychiatric consultant to give him his title can be taken in by my mum, but it happens.

 

[Shedrech]

hi Lavender45
I'm hoping that your mum's records make clear why she is in the unit, and that the consultant listens to his staff who have got to know your mum
just in case, can you write out all your concerns and what you want to have happen(pretty much what is in your post) and leave it for the consultant to read - or is it possible for you to be there on Friday and quite deliberately push some of your mum's buttons so he sees her responses - certainly when she talks about 'home' this should be questioned so that the medics understand that 'home' is not where and how she and you now live
see what the reaction is if you say you will refuse to have your mum back with you as you have a right to be safe
you do not sound like a nightmare daughter at all - you sound like a very concerned and caring daughter who is fearful that your mum isn't going to get the support she needs
best wishes

 

[Pickles53]

Someone else on TP suggested that, if someone says they want to go home and the professionals want to accept the statement at face value, the person should also be asked questions to see if they know where home is, who they live with etc. That may well demonstrate that the person has no concept of what 'home'actually is for them in real life.

 

[jugglingmum]

Lavender - I have followed your posts (partly because you are localish to me) and I think you really need to make sure your observations about her attacking you are given to the consultant.

The other observation I have seen on TP is that you cannot be forced to care for her, so therefore you can refuse to have her home.

Please find the strength to make sure these views are made loud and clear to the consultant.

 

[nitram]

Ask to have sight off, and preferably obtain, a copy of the discharge policy, if not forthcoming contact PALS (Patient Advice and Liaison Service). You can find out how to contact them >>>HERE<<<

If a best interests meeting is called make sure that the view 'The nurse I spoke with on Monday said mum masks her illness to an incredible degree and for long periods. She said if she didn't know mum had dementia she's never have guessed.' is recorded. Also make sure that her past violent attacks on you are documented.

Has her medication been changed and stabilised?
If so it would be interesting to know if the quoted nurse has reconsidered their view, it all depends on what a 'long period'. Monday is not long ago and that was when the statement was made.

 

[Margi29]

What a terrible dilemma you are in, stuck between a rock and a hard place !!

Surely the hospital staff will have gone over all the instances of your poor mum at her worse on ward ?? ( to the consultant )

It's a nightmare situation for you, to have to stand back and allow your mum to leave the house, and put herself at risk until police sort it.

My main worry is you, god forbid anything could happen, if your mum really seriously hurts you.

Thinking of you x

 

[canary]

On another thread someone was asking whether it would would be a good idea to record a PWD to show them what they were like. It was agreed that it wasnt a good idea to show the PWD the recording, but that it could be useful to show professionals who dont believe it.
Might this be a way to go? Record her when she is aggressive and show the consultant?

 

[Lavender45]

Thanks everyone for your support.

JM, I like Chester much more than I like Liverpool . Whilst I totally agree about refusing to have her home she jointly owns the house with me so legally I'm not sure I can refuse to have her here. I can refuse to care for her and as mean as it feels I'd definately say that.

Mitral I have had a look on line for the discharge procedure thinking that they might be transparent enough to have it available, but it wasn't so I will ask for a copy.

Mum's medication has not changed. For around the first 10 days of mum's stay in the local hospital she was very calm and quiet. The only thing I ever concluded was that it was all unfamiliar and that once she settled the breaks came off her behaviour. The other thing which has been pointed out to me was that in the general hospital ward she was restricted. To be fair the staff did like patients to be in bed or in their chairs, though they let mum wander around accompanied a fair bit. In The secure unit she can roam pretty much at will within the unit, that may have a calming effect.

The consultant is aware of all mum's physical aggression against me and the nursing staff in the local hospital filled in incident reports every time she attacked someone so there is a lot of evidence. Her last assault on anyone was 8 days ago. She's been secure ward 7 of those days. If I were certain the aggression was a thing of the past I would be happy to have her home. Just wish I were sure. It will be intersting to see if the nurse I spoke to stands by what she said. Time will tell I guess. X

 

[Lavender45]

On another thread someone was asking whether it would would be a good idea to record a PWD to show them what they were like. It was agreed that it wasnt a good idea to show the PWD the recording, but that it could be useful to show professionals who dont believe it.
Might this be a way to go? Record her when she is aggressive and show the consultant?

I have some recordings I took before Christmas to be honest as I intended to show them to the consultant if I got the chance, one includes her telling me she'll get a f****** knife and stick it in me as that's how she feels about me. Another is her suggesting I might be poisoning her when I asked her to take her tablets.

Whenever mum has had a memory clinic appointment there has never been an opportunity for me to speak with the consultant alone. I have asked to see him on Friday after ward rounds. I'm waiting for confirmation that he will see me.

 

[Penmon79]

It won't be easy to do but if she threatens you physically you are within your rights to call the police and they will have to make a referral to Social Services. A round the back way of getting this problem recognised!

 

[HillyBilly]

Lavender - most of us here know what you've been through with your Mum so we know how hard things have been.
Do you have POA (H&W) for your Mum? If you do, surely that counts? And won't there need to be a Best Interests meeting?

 

[Lavender45]

Sadly mum wouldn't agree to POA, which doesn't help. I called the police on Christmas Eve and if push comes to shove I will do it again.

Things changed just a little, it seems the day of the ward round is Wednesday afternoon, not Friday mornings. I was told this way too late, but I am invited to the next one. The consultant has made some medication changes. As of this afternoon mum won't be having pregabalin. It was prescribed in an atrmpt to calm mum, but the consultant says its doing nothing apparently, can't say I'd argue there. Mum had been on a prm of Lorazapam, this will now become a daily dose.

The nursing staff keep telling me mum is calm and gets just a bit agitated in the afternoons. If they think she's getting too wound up they have been successful with the prm. If all is working so well and mum is so calm why tweak the meds. Will have to wait and see I guess.

As yet I don't know what will happen about a best interests meeting. The social worker we had was attached to our local hospital. We now need one from the L.A. I'm guessing the meeting will take place once one is appointed. The unit thinks that will be next week. x

 

[MollyD]

Lavender, just adding my support.

Don't know about the UK. But in Ireland, as you live with your mum you can refuse to take her home as you no longer have the resources to meet her needs. Horrible that it should come to your hand being forced like that but it would delay things.

Here we need two consultants' assessments/signatures regarding capacity.

Really hope you get support/back up from the staff who have been caring for you mum regarding this dismissive consultant.

Hug xx