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Mental capacity and care choices - battle with social worker!

Discussion in 'I care for a person with dementia' started by Champers, Jun 21, 2019.

  1. Henny

    Henny New member

    Jun 24, 2019
    3
     
  2. Henny

    Henny New member

    Jun 24, 2019
    3
    Social worker, believes mum will ask to go home. We have to gather evidence to prove in court, that mum is at risk now , living alone , being vulnerable . Really don't know how long the process will take. I just hope mum doesn't have an accident or go wandering. Waiting on a door movement monitor to be installed. Should have been in yesterday, but paperwork not done yet. I'm hoping SS will speak to my mums neighbours too, as they witness my mum outside ,all times of the night I live 15 minutes away from her. I have no one else to rely on. It's a heavy burden .
     
  3. canary

    canary Registered User

    Feb 25, 2014
    9,663
    Female
    South coast
    @Henny - ask your neighbours to call the police if they see her outside. It sounds awful to do this, but the police will send a report to SS and this will add weight to you saying that she is not safe at home.
     
  4. Sarasa

    Sarasa Registered User

    Apr 13, 2018
    365
    Oh dear @Champers and @henry. I was worried (still am to a certain extent) that this is what will happen with my mother. I've just moved her to a care home and as she is self-funding didn't get any social workers involved. Mum keeps on making it clear she wants to go home, that she was fine there, and that we are selling her flat without her permission. She wasn't fine, and she did agree to us selling the flat, though she thought that was because she was going to move to a similar place near my brothers.
    I was worried that when the DOLs team came to see her they'd agree she'd have the capacity to make those decisions. From what I can gather, the process isn't completed yet, they agree that she has lost capacity and is in the right place.
    I've already decided that if somehow she did end up going home I'd refuse to do anything to continue to support her and let social services sort out the mess.
    Hope you both get what is best for your respective mothers.
     
  5. Champers

    Champers Registered User

    Jan 3, 2019
    77
    When I had my little chat with the social worker yesterday, I did ask what would have happened if we had just moved MIL straight into residential care from domiciliary care, had she not ended up in hospital, because, presumably SS wouldn’t have been alerted or aware? He told me that they routinely visit care homes too to make sure that residents are happy with their arrangements. I’m not sure if that was a veiled threat to me warning me to not even think about it. I still can’t see how they can make a fair assessment of mental capacity, unless someone is clearly in the later stages of dementia as so many sufferers drift in and out of lucidity.

    Our problem is MIL keeps saying to the SW that she wants to go home, and to us that she wants us to make the decision for her and that she wants us to sort everything out for her.

    I think you are absolutely spot on about refusal to continue support and leaving everything to social services if they take the decision out of your hands. It goes totally against ones instinct to do as much as you can for your loved one, but if SS insist on not listening to families, taking the politically correct route and acting as though they are the unquestionable and omnipotent authority, then they can pick up the pieces and deal with the fallout.


    I’ve probably already mentioned that MIL hasn’t a clue where all her investments are - they’re totally safe - but when she’s asked by the authorities , she’ll say that we deal with that side of things...so when the bills needs paying and they look to us, we’ll just shrug our shoulders and say you’ll have to ask her, you decided she has full capacity. There’s already a big fat one of several thousand pounds sitting on her mantelpiece for last months care awaiting payment, so it will be fascinating how that gets resolved.
     
  6. anxious annie

    anxious annie Registered User

    Jan 2, 2019
    102
    Hi, @Champers and @henry
    Just wanted to say sorry for your troubles, but am not able to offer any advice as I feel I'll shortly be in the same position and unsure of what to do myself! My sister and I are visiting some care homes at the end of this month with the view to putting mums name on a waiting list for a possible move this Winter.
    Mum would be self funding so we thought we wouldn't need to involve SS. We hadn't realised that she would have a Dols visit once she's in the care home and am worried as feel sure mum would say she wanted to go home if she was asked.
    Mum is deteriorating with mobility and personal care (not showering or changing clothes unless we are there), she can't manage any finance, plan or make meals, or go out to shop ( she wouldn't get there or know what to get). She can just about make a sandwich and heat up milk for cereal.
    Mum goes to a day centre and has carers in , but we often have to speak to them as mum feels she needs no help.
    Sometimes I feel mum could "jog along" at home for a while yet, but my sister and I are both getting to "carer breakdown" .
    Having read your thread I don't feel SS would see it this way that we need peace of mind that mum is somewhere she will be looked after 24/7 , with company and be warm and well fed.
     
  7. Louise7

    Louise7 Registered User

    Mar 25, 2016
    991
    You're right that mental capacity can fluctuate, plus someone can be deemed to lack capacity with regards one decision but deemed to have capacity with regards other decisions.

    The Mental Capacity Act states: "A person’s capacity must be assessed specifically in terms of their capacity to make a particular decision at the time it needs to be made".

    So you may find that social services deem that your MIL has capacity to decide where she wants to live but lacks capacity to deal with her financial affairs.

    Here's a link to the Mental Capacity Act codes of practice which explains the process:

    https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/497253/Mental-capacity-act-code-of-practice.pdf
     
  8. Sirena

    Sirena Registered User

    Feb 27, 2018
    1,356
    Female
    I'm in a similar position to you, and if I'd read these forums before I moved my mother to a CH I would probably have been paralysed by fear - but I only started reading them after I'd already moved her. She moved to her CH over a year ago and I haven't (yet) had any issues. There is an 18 month waiting list for a DoLs in our area (unless an urgent DoLs is requested because the resident is trying to leave). So she still hasn't had her DoLs as far as I know - I assume they would contact me. She loves it there but no idea if that would be what she said to them, she probably wouldn't understand the question and would say yes to everything.

    I think you just have to do what you think is right, and go from there. Some SWs are a lot more helpful and realistic than others so you can't predict what their views will be.
     
  9. anxious annie

    anxious annie Registered User

    Jan 2, 2019
    102
    Hi Sirena,
    Thanks for your reply. Yes I think we will have to go with what we feel best when the time comes for us to make the decision. I hope there is a wait for Dols in our area too so we would have time for mum to hopefully settle. By then we would have to sell her house too to fund care, so it wouldn't be there to return to. ( probably be in trouble with SS for that too!)
     
  10. Champers

    Champers Registered User

    Jan 3, 2019
    77
    I’m seriously wondering if DoLs applies to MIL now! She’s effectively has no liberty to leave her living room as no effort is made by her care agency to take her out as she is totally dependent on them for all her physical needs.

    Thank you all for drawing my attention to DoLs - I had never heard of it until the last day or so, having seen several posts on this thread referring to it. Having now researched it, it explains - but doesn’t justify - why the SW is desperate to ensure that MIL’s “go home” answer is adhered to - despite it not being in her best interests or the common sense soloution.
     
  11. Champers

    Champers Registered User

    Jan 3, 2019
    77
    So, MIL is still sticking with the, “I want to go home.”

    When we visited in hospital today, she’s now been moved to a cardiac care ward. When we asked her why, she said she had no idea and that it was up to us to ask and that enquires about her health was our responsibility! She is still going on about the fact that she’s in hospital following a fall - completely wrong - and launched into a verbal attack on me for losing her bras when I took home her washing!

    SW then told me that he hadn’t completed her mental capacity assessment as she was physically unwell but clearly, has already made up his mind that she is completely sound, as he told me plans were in place to return her next week to domiciliary care. He said he was glad that we seemed to be coming around to MIL’s way of thinking to which I said we definitely hadn’t, disagreed totally with the decision and the course of action but had to respect MIL’s choice. He then told me the OT would be getting in touch with us to do a home assessment. I replied that the OT and all agencies will need to speak to MIL to arrange everything as we no longer wished to be any part of her care package as the conclusion seemed to be that she was completely compos mentis and was able to make an informed choice tell them what her preferences were.

    It’s difficult, as we have no intention of “punishing” MIL but we have explained to her - and it was so apparent that she didn’t fully understand - that she will be asked to make decisions about her ongoing care and that we can have no influence and that the casual arrangement where my husband ran her bank accounts and investments will have to stop as, because he doesn’t have POA, will be frowned upon by the authorities.
     
  12. Sirena

    Sirena Registered User

    Feb 27, 2018
    1,356
    Female
    My mother was in a rented flat and within a few weeks I handed the keys back to the landlord who then sold it, so my mother definitely won't be going 'home'.

    @Champers I wonder if what you said will focus the SWs mind rather differently - let's hope so. As you say, if he believes your MIL has capacity, she will be able to deal with these things herself. Only of course, she won't.
     
  13. Champers

    Champers Registered User

    Jan 3, 2019
    77
    You’re so right Sirena, sadly, we have to stand back and let everything fail. As MIL’s capacity fluctuates, when she’s having a good moment and she realises she’s got to make her own choices, she’ll have a complete meltdown that we’re not stepping in. For years she’s been quite naughty (maybe a bit mentally lazy?) and would never take responsibility for any decisions - but could be pretty snappy and quick to blame if anything went wrong or not to her approval. Now, when she probably needs our support more than ever, SS have overridden us and put everything squarely in her hands.

    Could be interesting times ahead...
     
  14. 2jays

    2jays Registered User

    Jun 4, 2010
    11,535
    West Midlands
    Don’t forget to mention to social worker that if anything “goes wrong” or your mil comes to harm, you will hold them responsible as it’s obvious to you that mil doesn’t have full capacity
     
  15. northumbrian_k

    northumbrian_k Registered User

    Mar 2, 2017
    653
    Male
    Newcastle
    Has anyone actually asked what your Mother in Law means by 'going home' @Champers? My wife had lived with me in what I consider to be our home for almost 20 years but often asked me when she could 'home'. If asked about this she would specify either her mother's home or the home of her grandmother. As neither of these have been living for more than 30 years this would of course be impossible. A test when applying Deprivation of Liberty Safeguards is whether a person is unable to consider the advantages and disadvantages of living in the current or alternative accommodation and of making a considered decision. If 'going home' is an unclear or vague concept then one would expect experienced social workers to be alert to this possibility.
     
  16. tryingmybest

    tryingmybest Registered User

    May 22, 2015
    616
    Female
    #36 tryingmybest, Jun 29, 2019
    Last edited: Jun 29, 2019
    Oh @Champers, I'm so sorry to read of your plight. I haven't read your whole thread so aplogies if I've missed anything but I would be inclined to get an urgent private mental capacity test done for your MIL. I am seeing more and more cases of SS acting quite bizarrely and not in the best interests of the person but for their own inflated egos.

    Unfortunately, without a LPA in place, once lack of capacity is confirmed, this case will have to go through the Court of Protection to appoint a Financial Deputy and also to determine where your MIL lives. They will also appoint an Advocate to convey your MILs wishes as if she were still of sound mind and take into account all previous history. It is an expensive route unfortunately. That is what SS meant when they say they will take it to court.

    Although my case with Mum involved rather different cicumstances in that she was being emotionally and financially abused by my sibling, SS and the police refused to initially recognise it was an extreme safe guarding issue. Ultimately, it was resolved with 3 hearings in London at CoP. My Mum was allowed to live with me, a panel Financial Deputy was appointed and a court order issued for limited contact between my Mum and sibiing.

    If I were you, I would firstly get an independent capacity test done and if it's confirmed MIL lacks capacity, get your husband who has previously been dealing with MILs affairs to apply for CoP Financial Deputy with an urgent request to the Judge re Mums place of abode. If he doesn't want to, please find another trusted family member or friend to do this or else SS may apply themselves which you don't want, or a CoP appointed Deputy will be appointed to take over. This is expensive. I would also find an independent Advocate for MIL rather than let the CoP appoint one. SS will then have to complete paperwork to join as a party if it goes to a hearing. If it should go to a hearing all past history with SS will be thoroughly scrutinised in making the decision as to where MIL lives.

    I am surprised that as Mum has a house to sell which would fund her care, that SS are getting so involved. Usually they only do this if the LA are going to be funding. I'm sure once you tell them an independent capacity test has been done and someone is applying for Deputyship, you will be able to get on with finding a nice CH for your MIL and they will back down and hopefully a lengthy court case will not be necessary and you will be able to do everything on your terms and what you feel is best for your MILs future. Please do not let SS take control of all decisions and MILs finances!!

    Good luck.
     
  17. Sirena

    Sirena Registered User

    Feb 27, 2018
    1,356
    Female
    @tryingmybest this sounds like very good advice. Who do you get to do an independent capacity test?
     
  18. Rosettastone57

    Rosettastone57 Registered User

    Oct 27, 2016
    860
    I seem to remember this coming up before and a member saying an independent social worker would be able to do this. Someone will correct me I'm sure
     
  19. Sirena

    Sirena Registered User

    Feb 27, 2018
    1,356
    Female
    @Rosettastone57 Yes I was wondering about that, but thought the poster would have got the independent SW further involved.
     
  20. northumbrian_k

    northumbrian_k Registered User

    Mar 2, 2017
    653
    Male
    Newcastle
    Hi @Champers. My limited experience relates solely to the Deprivation of Liberty Safeguards (DoLS) in a situation where I do have Lasting Power of Attorney for my wife's health and welfare.

    The enclosed summary of the DoLS process may add something to the debate that you are having.

    This link may also be useful:

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

    There are 6 assessments carried out:

    Age assessment – confirms whether the relevant individual is 18 or over.

    No refusals assessment – establishes whether an authorisation would conflict with other existing authority for decision-making for that person, such as an advance decision to refuse treatment under the Mental Capacity Act 2005.

    Mental capacity assessment – establishes whether the relevant individual lacks capacity to decide whether or not they should be accommodated in the relevant hospital or care home to be given care.

    Mental health assessment – determines whether the relevant individual has a mental disorder within the meaning of the Mental Health Act 1983.

    Eligibility assessment – relates specifically to the relevant individual’s status, or potential status, under the Mental Health Act 1983

    Best interests assessment – establishes whether deprivation of liberty is occurring or is going to occur, and if so, whether it is:
    - in the best interests of the relevant individual to be deprived of liberty
    - necessary for them to be deprived of liberty in order to prevent harm to themselves
    - a proportionate response to the likelihood of suffering harm and the seriousness of that harm.

    The Mental Health Assessment is something that a Mental Health Assessor carries out. This 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.

    The Mental Capacity Assessment and Eligibility Assessment may be carried out by the same Mental Health Assessor (using one combined form). Social workers and others who have appropriate training and qualifications eg Best Interests Assessors may also carry out these assessments.

    Social workers have clear guidance on their role as set out at:

    http://www.tcsw.org.uk/social-workers-and-the-mental-capacity-act-2005/

    This starts (rightly) with presumption of capacity but this presumption then needs to be tested and (one would hope) a realistic approach should be adopted which goes beyond saying (merely) that the person wants to go 'home'.

    Hope this helps.
     

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