Dad in hospital - what happens next?

[Lizzie K]

Hello everyone. Since I was last on line my father in law has had a fall and has been taken in to hospital. Thankfully physically he was not injured but the medics have decided to do another psychiatric assessment on him whist he is in. He had one three years ago when his dementia was initially diagnosed.

He has had a brain scan and we are awaiting the visit of a psychiatrist and then we are assuming there will be a meeting with us and dad to discuss the situation.

Dad, aged 80 has been at home the last three years and with the aid of carers my hubby and I have cared for him. He has deteriorated badly during the last six months but refuses to go into full time care. He is totally unsafe to be at home alone and we feel that he is now incapable of understanding how ill he is.

When having our initial discussions with the hospital doctor she mentioned that if he refused to go into a nursing home then we would have to look at "other ways" to consider but did not elaborate and we really weren't in the frame of mind at the time to question her.

Has anyone been in this situation? We know that we have no power to do anything and would not want to do anything to "trick" him into going anywhere against his wishes. Friends have told us about the possibility of him being sectioned but one said that "they won't do that because then they will have to pick up the bill"? We don't like the sound of him being sectioned but if it will end up with him beng in a safe environment, giving us some peace of mind then is that an avenue we should explore?

Any advice would be gratefully received. Lizzie K

 

[jenniferpa]

I think the doctor must have been referring to sectioning - I can't think of any other way that he could be put in a place of safety against his will. As to who pays - my understanding is that if after the initial sectioning they still can't "persuade" him to agree to appropriate care, they may do a longer sectioning period and if that doesn't work then, and only then, will they be responsible for the funding. I think most people who are sectioned are sectioned "short-term" and then "agree" to be placed in residential care. I put "agree" in inverted commas, because I think in most situations this is presented as a fait accompli rather than a real informed decision on the part of the sufferer.

Jennifer

P.S. The mind site (mind.org.uk) has a lot of easy to understand info about sectioning.

 

[carolr]

Hi Lizzie

My Dad has been sectioned under section 3 of the act in this situation the state must pick up the tab for all of his ongoing care both medical and social, if any other section of the act is used then the costs are split and means tested. Under section 3 Dad does not make any contribution to his care and his pension is still payable to him. This does however mean that he would have to be placed in an EMI Nursing home rather than a residential care home. There are a limited number of these homes available.

As far as I understand it Dad will be placed in the Nursing Home under section 3 on leave from the assesment unit, only when he has settled and the home are happy that they can cope will the section be lifted, however as he was placed under section 3 his fees will continue to be met by the state.

This is how it has been explained to us, Dad is still in the assesment unit waiting for a bed at our chosen home. I would suggest that you contact Social Services who can send you the leaflets.

This may all go wrong of course and we may end up having to fund Dad but we are assured that this is not the case.

Ask the hospital when they are going to do the assesment because they can section him whithout you being there, once he is under a section 3 its hard to get it lifted.

Hope this helps, good luck

 

[Lizzie K]

Lizzie K

Thanks for advice given. Our main concern at present is to get dad into a safe environment. If he has to have a "temporary section - under S2" (I have been on the Mind website thanks jenniferpa) and he then is able to be unsectioned because he is happy there then all well and good.


Can I ask what an "EMI nursing home is?". Our plan would be to try and get dad into a nursing home close to us which has a dementia unit. We have been to see it and are very pleased with what we saw. If he had to be sectioned under a S2 would he not be able to go there, if we could get him a place? Would he have to go where the social services choose to send him?


We cannot go on with him not being safe. The times recently when we have been contacted by his carers because they have found him on the floor or in other dangerous situations are just too numerous. We are constantly on tenderhooks.

Thanks again and I too will try to support others as well as just ask advice for myself. I am feeling very guilty at present that I am in advice seeking and not support mode to you all. Take care. Lizzie K

 

[carolr]

Hi Lizzie

Sorry for the delay I can only get on line at work as the internet is for my boys at home apparently. An EMI nursing home is a secured unit some are emi residential and some emi nursing, the later has specialist nurses for az and dementia sufferers these homes are the only ones suitable for patients with violent behaviour problems. Under a section the social workers tell you what level of home is acceptable to the patients consultant but the actual choice of which home within this is left with the family. We have 6 available homes in our area but I understand from other members that this is unusual as they seem to be in very short supply.

From what you write I do not think that your parent would require this level of care but speak to the ward staff or better still make an appointment to see the consultant. We have found that the more that we ask the staff the more they make the effort to keep us informed.

My Dad is due to leave the assessment ward next Tuesday, my mum and I had picked a home for Dad and the hospital had arranged for him to go into a new home being opened this week but run by the same people. As we have not visited the new home we have stopped his discharge to give us a chance to see this new one, if we dont like it he will not go there.

Keep us posted.

 

[jenniferpa]

What carolr has posted is my understanding of how the system works as well. It sounds from what you say that the danger is to himself rather than others (i.e. falls etc) which meams he need considerably less intervention that people who are violent or have other challenging behaviours, which means you possibly (depending on your area) have more options for placement. The only thing I will say is that you should not be surprised if it is all dumped back in your lap, despite the doctors comments: it is much much easier from their POV if this is done without the need for sectioning. Some areas are, however, more proactive about this - the only thing I was asked is "she doesn't require nursing does she?" and that was it, although I think that represents a real low point in terms of quality of expected care, and may not be typical.

Jennifer

 

[Nebiroth]

It sounds as though the hospital doctor may have been referring to a section, yes. Usually this is a last resort, and although can be done in an emergency by one doctor, is usually done with two in agreement (normally, one who knows the patient, likely the GP, and a psychiatrist). As I understand it the section is applied for a social worker so they have to agree that sectioning is in the patient's best interests.

The usual reasons for someone being sectioned are because they have a "mental disorder" are a threat to themselves, others or both. Mental disorders might be "severe mental impairment", "psychopathic disorder" or "mental illness"

AFAIK, if you are in hospital under a section, and leave hospital and go into care, then this must be treated as a case of medical need, and thus is paid for by the NHS.

An "EMI" stands for "Elderly Mentally Infirm" and means that the care home is espescially equipped to deal with elderly patients with severe mental impairments. They are usually more secure, and have a higher staff/patient ratio and the staf are trained to deal with for example violent behavior.

Often you will find care homes that have EMI units attached. One home near me, the top floor is designated the EMI part, and is permanently locked (access by PIN codes on the doors) with lockable windows etc.