DoLS - I'm confused!

[Sarasa]

I moved mum to a care home near me about six weeks ago as she was struggling at home. The home have requested a Deprivation of Liberty Safeguarding order and mum was assessed over this last week. From what I can understand they think she is in the right place and no longer has the capacity to live independently. I haven't seen anything in writing yet.
Mum vehemently disagrees, and keeps on wanting to go home. She does know what home she means,though she is a little vague as to where it is and has forgotten that not only was her behaviour putting her at risk, she was bored and lonely there as well. I understood that during the DoLS process someone was supposed to act as mum's advocate. I haven't been asked, and I'm not sure if I'd be the right person anyway as I totally agree that she can't cope on her own anymore. Mum is muttering about getting a solicitor, though I'm not quite sure from where.
Have I got this all wrong, and every thing will be fine, or at a later date will someone say we didn't take mum's views into consideration?

 

[Sirena]

This link doesn't mention an advocate.

https://www.alzheimers.org.uk/get-s...eprivation-liberty-safeguards-dols-assessment

DoLS assessments are carried out by at least two people. They are:

• the best interests assessor
• the mental health assessor.

They are appointed by the local authority (or health board), who must ensure that they have had the appropriate level of training and experience.

Generally, the best interests assessor is a qualified social worker, nurse, occupational therapist or chartered psychologist. They must not be involved in the person’s care or in making any other decisions about it. The mental health assessor must be a doctor who is able to assess whether a person has a ‘mental disorder’ (the term used in law to describe a set of mental health conditions, including dementia) and how a deprivation of liberty will affect their mental health.

 

[nitram]

As you think your mum is in the right place don't worry.

The DoLS assessment decided that she was incapable of making certain decisions and deprived her of liberties.

A major deprivation will be that she now is unable to leave the home - to go home? - unless she is accompanying by an appropriate person.

Without the DoLS the care home staff could not legally prevent her leaving they could only obstruct, a locked door is prevention not obstruction.

The question of having an advocate only applies when there is contention about the decision.

As I said don't worry about legalities.
Worrying about your mum wanting to go home is something else.
Again try not to worry, it's par for dementia, as you implied home in her mind is not a physical place, it's a concept of unachievable former times

 

[northumbrian_k]

It sounds fine to me @Sarasa. Assuming that the DoLS order is authorised this would usually be granted for a year and reviewed thereafter. Your mother will have been assessed as being unable to weigh up the advantages and disadvantages of living where she is against somewhere else and has not got the capacity to make an informed decision about where she lives. So, although she may keep asking to go 'home' she can't because she has been legally deprived of her liberty in her best interests.

There can be a delay to the authorisation process and the paperwork. If you have been asked to act as Relevant Person's Representative (someone to take your mother's part in any subsequent reviews) you will probably get a form to sign and return, together with a copy of all the assessments made. That is what happened twice for my wife, once for respite stays, the second time for residential care in a different place.

But as Nitram says don't worry about the legalities or details, just know that she is safe and in the best place.

 

[Kevinl]

The phrase they use is "Relevant Person's Representative" (RPR). I'm the RPR for my wife but she has no capacity and so isn't able to ask to go home so the fact I agree that she's in the right place for her hasn't stopped me being her RPR.
Once the DoLS is in place I'm not required to do anything other than visit her other than sign a form when it gets renewed each year saying I agree with the assessors review of her condition.
K

 

[Beate]

Don't worry, usually DOLS is a very straightforward process.

 

[Sarasa]

Thank you for your replies. It was the Age Concern leaflet (https://www.ageuk.org.uk/globalasse...s62_deprivation_of_liberty_safeguards_fcs.pdf) that has quite a bit about personal representatives, that made me concerned.
On reflecting on it I can see there is a difference in acting in someone's best interests and acting according to their wishes. I have no doubt mum is best off in a care home, but she has made it clear that she is not happy. As she is still very articulate it is sometimes difficult to remember that what she wants is very different to what she needs.

 

[Toony Oony]

Hi @Sarasa
You're confused? So am I - especially as we are talking same CH, same authority!

Mum has been there 2 years, I agreed to DOLs when she first arrived and innocently thought that was it and it was all sorted.
Mum has always been relatively compliant and the subject has never arisen again. However ..... a few months ago I had a call 'out of the blue' from Social Services about DOLs for Mum. I gave some background info, and they asked for my agreement to be the Relevant Person's Representative. They told me that an assessment would take place and Mum would be asked her opinion about where she lived/if she was happy there etc. My reply was 'Good luck with that' as Mum makes very little sense and lacks the ability to answer most questions.
Fast forward to a couple of weeks ago when I received a parcel of paperwork stating that DoLs had been approved along with transcripts of the assessment by social services and a psychiatrist. Some of the medical info was totally incorrect, but they rightly agreed that Mum was incoherent and had no understanding of her abilities or situation, however it stated that DoLs would be reassessed in 12 months to see if it still applied!

I have heard that there is a huge backlog for DoLs applications locally - not surprising if they do 12 month rechecks on people whose situations have no chance of miraculously improving.

So you may get a call from the SS ......... or you may not for another 2 years! (PS - if you want to know what questions they asked Mum, let me know and I'll PM them to you).

This whole thing left me thinking about what could have happened if Mum's decline had not been so severe, if the assessments were done on a 'bad day' when she hated everybody and everything, when - to a visitor - Mum would have been her old charming self in full hostess mode? She has always complained and lied about the things that I have done for her and bad mouthed me to others, but never to my face. 18 months ago her responses could have been very credible and very different! Just have to hope that they listen to others and have seen it all before I suppose?

Cx

 

[Sirena]

I knew they were supposed to be renewed every 12 months, but that seems really unlikely when you can wait 18 months for the first one to happen. When I spoke to the CH manager recently she said she thought the authorities were regretting instigating this system because it was so difficult and time-consuming to administer.

 

[jugglingmum]

My understanding is that the legally teh DOLS has to be reassessed every 12 months so that will be the 12 month reference.

An acquaintance, who works in a different authority to where I live is the DOLS assessor (SW) for where he works. He said in passing he has never lost one yet although the families have been anxious at times - I queried and he said that sometimes the individual has had an advocate and it has gone to court but he has always secured DOLS where needed, and he clearly listens to the family. From what I read on here not all SW's are as pragmatic, or maybe not all authorities allocate a very senior SW who has many years experience to the job.

 

[Jaded'n'faded]

Thank you for your replies. It was the Age Concern leaflet (https://www.ageuk.org.uk/globalasse...s62_deprivation_of_liberty_safeguards_fcs.pdf) that has quite a bit about personal representatives, that made me concerned.
On reflecting on it I can see there is a difference in acting in someone's best interests and acting according to their wishes. I have no doubt mum is best off in a care home, but she has made it clear that she is not happy. As she is still very articulate it is sometimes difficult to remember that what she wants is very different to what she needs.

That is how it was explained to me by the DoLS woman.

When I first moved mum to the CH it was after a fall where she'd ended up in hospital. Before that, although she was clearly struggling with Alzheimers and had been for a few years, she was living independently, hadn't seen a doctor in more than 10 years and the family was in denial (she's just getting a bit old and dotty'). At first, the problem was that mum wanted to go out shopping (rather than go home) so the CH had to get a DoLS in place. At this point mum could do a brilliant 'hostess mode' and was very articulate. She could keep this up for a while before the cracks started to show. Unfortunately, the SWs ask a lot of leading questions: are you happy here or would you rather be at home/in your own place? That sort of thing, and of course, mum would agree she did want that, though she often thought she was in a hotel or on a cruise....

At first, because I wanted mum to be in the CH and she - apparently - said otherwise, I couldn't be her RPR (Relevant person's representative) and an independent advocate was appointed. I thought it was crazy. The DoLS was granted but only as a temporary measure until mum got a diagnosis. This happened a few months later (mixed AD and VD) and another DoLS assessment was done. I spoke to mum's consultant who was amazed they were even discussing the idea of mum moving elsewhere. As he said, 'she's only going to get worse...' He said if I had any problems with the DoLS team, to refer them to him. They don't have to listen to the consultant's opinion apparently but he said he'd be very surprised if they went against his advice. So that might be a way forward for any of you in this position.

Fortunately at that point they saw sense (probably because mum talked to the SW about rice pudding for most of an hour and didn't want to discuss anything else ) and mum was granted the full DoLS and I was also made RPR at that point. Phew.

But the whole system is unnecessarily adversarial and it's hard to get your head round at first, especially when they tell you that you're not acting in your PWD's best interests when you know you are.

 

[northumbrian_k]

It seems likely that one's experience of DoLS is dependent upon a number of factors, such as whether one has Power of Attorney, to what extent the person being assessed can sustain the appearance of 'normality', the experience and attitude of the assessors, and the time lag between first application for DoLS and completion of the process. From my limited exposure it isn't always stressful or a bad experience. In fact I would echo what @Beate has said above.

I did not find the process adversarial in any way. This may have been helped by the fact that the staff in the respite unit quickly identified that my wife's talk about "walking home" was a risk that need to be managed, thereby triggering the DoLS process.

In my local authority the delay is nothing like what has been reported in other areas. The first application was made when my wife was in respite in October 2018 and the authorisation was granted by December. When she moved into residential care in mid-May the original authorisation for the respite unit was terminated. A new authorisation was granted for the care home in which she now lives within 5 weeks of her moving in.

The Best Interests Assessors that I dealt with had clearly done a thorough job of assessing my wife's limited abilities and this was borne out by the Medical Assessors' reports. Although if asked my wife would still say that she would rather be at 'home' (whatever she might think of as home), as @Sarasa says, what she thinks she wants is different to what she needs. Hence I have no problem in representing and protecting her interests in my role as Relevant Person's Representative.

I found the written assessments to be helpful, both in terms of confirming my own thoughts about my wife's sadly declining grip on reality and also in the more practical sense that I adopted some of the wording when making a successful claim for higher rate Attendance Allowance.

I hope that this is helpful.

 

[Sarasa]

The person who did the Social Service side of the DoLS phoned today and I've agreed to be my mum's representative. So one more piece falling into place

 

[canary]

And another worry off your mind

 

[Witzend]

My mother had been in her CH for very nearly 8 years before anyone got around to a DoLs assessment! However it would have been immediately obvious to the staff that she was in no fit state to go home - she was already 89 and at least mid-mid stage Alzheimer's. And TBH even if anyone had told us she was entitled to go home (as she was constantly asking to in the first weeks and months) we would not have enabled this by either taking her the 60 miles or,providing house keys, since in our opinion it was out of the question - she needed 24/7 care.
She was very nearly 97 by the time they got round to a DoL assessment, by which time she was incapable of any sort of conversation, let alone making any sense. By the time they got round to informing me that a DoL was in order, I had to tell the (mortified) SW that she'd died 3 weeks previously.

 

[Sirena]

Goodness that is a very late DoLS! I thought my mother had waited a long time but I will now lower my expectations...

 

[MaNaAk]

Eight years! Gosh our occasionally defective council is better than I thought. Anyway Sarasa don't you'll hear soon enough. I was confused first of all but now (sorry I mean 'then' because I can't get used to dad being in the past tense) I realise that it was someone else looking out for dad.

MaNaAk

 

[Sarasa]

Does anyone have any idea when I should get the DOLs paperwork? Th assessment was carried out at the end of June and I agreed to be mum's representative in early July, but since then not a peep. I don't want to chase things up if this is usual, but was wondering if something could have got lost in the post.

 

[Louise7]

I think the time it takes to receive the paperwork varies. Mum had a dols assessment in hospital last year and the paperwork took around 6 weeks to arrive. When she had a subsequent dols assessment in a care home last november it took nearly 6 months to arrive! Both assessments were completed by the same local authority social work team.

 

[theunknown]

I really hope I don't offend anybody, because it's a horrible situation to be in, but we have a legal rule of 'habeus corpus' in this country. My mum was sectioned, not allowed to go back to her home, and is now in a locked unit in a care home. I agreed to the DoL order, but presumably it would have been granted if I hadn't. My mum has never committed a crime in her life but she's locked away, with no personal freedom at all. Making it easier to get a DoL order is a horrifying idea to me.