Hi can someone advise me with 'Best Interests'?

[bazo]

Hi first post on here so hope someone can give me some advice

Mum has lewy body dementia and is currently immobile with carers coming in 4x a day since the last 4 months. We currently had some issues with the agency given by the council and they complained to social as sister was being rude to staff (coz they didn't know how to use a hoist and some other issues, like carer incompetence! sister didn't mean to be rude.) Having spoken to SS we will continue as normal, however mum and family are concerned they will send mum to CH.

They mentioned best interests of the mental cap act and said will consult family in any decision. Im going through power of attorney for mums welfare to ensure mum stays at home. But they say if mum dont cooperate with the carers when severe dementia sets in then they may have to act. Question is do care agencies refuse to help dress wash change pad on mum if severe dementia sets in? and is the power of attorney useless if they wanna send mum to CH they will disregard it? Only just sent off power of attorney form. Surely if mum has loving familyof me (son) daughter and bro in law then we are happy to keep mum at home? If they do decide to move mum can we refuse or appeal?

Many thanks for reading and any input would be helpful

Bazo

 

[nita]

Hello Bazo,

I think you are in a similar situation to me - have a look at my recent posts. I hope you don't mind my asking but what stage is your Mum in? Is her immobility a sign of her condition worsening?

My Mum is in the middle (I think) stages of AD. She went into respite for several weeks as her mobility was getting worse and we were told she would have to have a hoist. I am not sure whether her mobility problems were partly the result of her dementia as she already had severe osteoarthritis, osteoporosis and chronic pain and it was as if she could no longer struggle to stand on her feet. She can still hold a short conversation with you, understand what you say and respond; she can express her wishes but she sleeps an awful lot and has no short-term memory. She can't follow the TV or read any more.

She came home with 2 carers visiting 4 times a day. I too had trouble with the care agency (do you live in the same place?!!) and it was over hoisting. Mum doesn't like it very much, understandably, and I don't think the carers are all very well trained. The upshot was they refused to hoist her at all and she ended up bedbound. I wasn't rude to them, just a bit panicky. It all seemed to come down to "respecting her wishes" which rather left me high and dry. It has partially been sorted out by the social worker and occupational therapist - it's a long story.

I too have had this question of "best interests" come up. It happened a year ago and I managed to contest it (it didn't come to an official meeting, the issue was reconciled relatively amicably) and now it has come up again. They do have good arguments this time - Mum would be checked and changed regularly in a care home; several different carers could try and get her to comply with getting up/being hoisted, etc. at different times in the day. I can understand their points but still think she would be best off at home where she knows her surroundings and I can cook for her and look after her as I know her best.

You can't get Power of Attorney for a person who lacks capacity - you have to apply to the Court of Protection for deputyship and it is unusual to get this for welfare.

Regarding best interests, from my understanding, Social Services represent the person but family and the person themselves (even if they lack capacity) also have an input in saying where they want to live. The person can also have an advocate. However, it seems to me that SS have the overriding say in what happens as they are responsible for the person's safety and wellbeing and have a statutory duty to ensure this. Nevertheless, if you can put up good arguments as to why the person shouldn't go into care and they agree that enough care is in place at home, you may be able to settle any difference of opinion without it becoming too formal.

I am not sure about your question on care agencies and severe dementia - this seems to be a stumbling block with my mother too as they don't seem to want to take the time to explain things to her in a way she can understand so that she does comply with them. It probably is the case that they have more experience of dealing with dementia in care homes but the majority of the disabled elderly people the care agency staff visit probably have some form of dementia.

The other point I am unsure about is concerning people who are funded by Social Services as I am presuming your mother is, like mine. It seems SS, because they are funding it, have more say over issues of residence than they would if a person was a self-funder. Does anyone know if this is the case? Perhaps people who self-fund don't come to their attention so much because arrangements are made privately and no contact is made with them.

If you google "best interests" and "capacity" and the name of your local council, you will find the document that sets out their policy and will give you a lot of the information you need.

Not much help except I know what you're going through.

Nita

 

[Forestridge]

I'm pretty new to the whole Best Interests thing but I think Nita is right that if someone is self fundung they don't tend to generally come to the attention of SW's and are left to get on with it far more. However if there are problems with an agency then I suspect the agency would involve them, but could be wrong.

You're in the process of sending off the POA, can I ask who was the certificate provider for your Mum, was it a solicitor or doctor ? I think the problem you have if not and the SW is mentioning the Mental capacity act at this point then they may feel your Mum doesn't have the capacity to make decisions in all areas and I think they could challenge the POA. Capacity does fluctuate and if signed by a solicitor or doctor then I think it would be taken that your Mum understood at the time she signed.

We are in the situation where Mum is deemed to have lost capacity regarding her accommodation , became unwell and went into a CH when the GP came to see her when she became unwell as wasn't drinking properly and had a UTI. We were thinking about her going in but Mum and Brother wanted live in Carers. On the day she became unwell Brother said she should go into CH for a few days whilst we got sorted. CH insisted she was seen by her GP before she came in and he told her she should go and that I would ring him if she refused to get into the car.

This has meant that effectively she was removed from home by her GP under the Mental Capacity Act. We hadn't got the Health and Welfare through and were unable to once her Psychiatrist said she lacked capacity. Mum now has to stay in the CH until a case conference retake takes place and a Best Interests decision is made. She will be represented by a Citizens Adviocate as my Brother and I don't agree what's best for her. He hasn't seen her for over 4 years and wants to try live in care as she sys to him this us what she wants butshe says different things to different people at different times.I feel this would break down quickly given her track record with Carers and that she would be better off in the CH in a self contained flat with the facilities of the CH on hand which will protect her privacy and retain her independence for as long as possible but will be an easier transition to full time care when the time comes. The psychiatrist told her at last appointment she wouldn't be able to stay at home.

Th long and short of it is as we don't have POA she is effectively a ward of SS and neither of us are aloiwed to remove her from the Home. My Brother has been told should he not accept the decision of the panel at the Case Conference then Mum's case will be passed to SS solicitors and it will go to the court if protection. He has said he will accept th decision but as I understand it will consult a solicitor if he isn't happy with the process and been told he is very welcome to bring a solicitor to the case conference.

Our situation is caused by lack of POA and my Brother raising massive red flags about me to the SW when he spoke to her saying my interests are financially motivated and I am 'trying to protect my inheritance' . Clearly the SW had to act to protect my Mum in the circumstances and I would expect no less in the circumstances. Obviously this is absolutely not true in any shape or form but once things like that are put out there measures have to be taken as this woukd be financial abuse on my behalf if it wrre true which it isn't.Our circumstances are very unusual though but an illustration of what can happen with no POA and family disagreement in a self funding case.

I think in your case the POA is very important. Also I would be very careful at this point how the Agency is handled. Speak to them about proceeding as your Mum worsens and have a clear plan in place as how things will work at that point. Speak to the Alzheimer's society in advance and ask if there is someone who could come along to a Best Interests meeting and represent you as family. They gave us the number of a local charity who will assist with things like Attedance Alliwance appeals and I suspect would go to a Best Interests meeting. From my understanding you'll need to show a clear care plan that takes into account her future needs, that you understand this and have provision in place.

 

[bazo]

Best Interets

Thanks you for your comments so far - ironically Nita your situation is currently more or less exactly as mine, and also live in Essex!!

Not sure what stage mum is at, she sleeps a fair amount but likes to be woken all the time as doesn't like the way she 'goes over' but is able to watch tv a few mins at a time, speech slurry however still able to hold conversations.

I have just submitted POA form and hoping that comes back ok, also took advice to complete a witness statement, just a piece of paper with mums signature(mark) signed by 2 witnesses that her wish is not to go to a care home. I will fight tooth and nail for this not to happen. My witness provider is a dementia nurse who visits mum every now and then for the last 2 years and she would get involved should a best interests meeting happens.

Good idea to discuss with the agency going forward about mums care - everyone is different with lewy body dementia and mum is already bed bound, due to probs with the hoist and the agency and the thump they accidently gave her. So don't see the value in dragging mum off somewhere. One question i have now is that if a care home was thrust upon us, is this means tested? Cant remember if i asked that question on original post.

 

[nicoise]

Dear Bazo,

One question i have now is that if a care home was thrust upon us, is this means tested?

As a simple answer, if your mother has assets above £23,250, then she will be required to pay for her care.

If she is above that threshold, then there is no need for a financial assessment by the Local Authority; if below, then an assessment would be carried out.

There are other factors involved here such as location (eg, Scotland, Wales etc) and whether a person qualifies for funding, or has been sectioned and is requiring ongoing care.

This AS Factsheet about paying care home fees gives much more information:

http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=125

 

[nita]

Bazo, I have sent you a private message. nita.