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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. Banjomansmate

    Banjomansmate Registered User

    Jan 13, 2019
    When I wanted to record The Banjoman agreeing to go into a Care Home from hospital I was told they wouldn’t accept it.
  2. Champers

    Champers Registered User

    Jan 3, 2019
    I’ve not used the recording yet - I’m keeping my powder dry on that one.

    Well, we seemed to have reached a very strange impasse.

    MIL is still in hospital - three weeks ago yesterday - and from what I can see, there’s no actual treatment as such. Her pain relief is being administered, although it’s debatable how effective it is. She’s being left in her bedside chair all day - very much as she was at home too. She had been moved between three wards and stuck in a bed at the end. What is very interesting, and I’ve noted this in case the SW starts the domiciliary care push again, it always takes two physios to get her out of her chair, onto her frame and into a wheelchair. Funny that when she was receiving care at home, it was decided that one carer could more than cope with her physical issues and nothing much has changed since then.

    MIL was wheeled out by the physios into the hospital garden yesterday for 10 minutes fresh air (that’s all) I’m not sure whether it’s NHS Policy, but they both sat within 5 feet of us whilst we were chatting to her. When she did her usual “I want to go home” we gently reminded her about the previous conversation when she agreed that she would try the residential home short term. Immediately, one of the physios said, “It’s up to ****** what she wants to do!” We were gobsmacked - it’s like a dictatorship eavesdropping on us. I thought afterwards that maybe we should have said, “Excuse us, this is a private conversation!” MIL was disappointed when they wanted to return her to the ward and asked if she could stay longer outside and we told them we were happy to wheel her up when she had had enough. They declined and said they had to do it. Again, maybe that’s NHS Policy but it certainly made us feel uncomfortable.

    Finally, as soon as MIL was back in her bedside chair and we started to chat again - nothing contentious, just family news - two nurses came and sat close by randomly shuffling paper. They may well have been perfectly innocuous but I whispered to my husband that I was starting to feel paranoid. He agreed and said it wasn’t only me.

    I don’t want to ask the ward staff what is happening as we have made it clear to the discharge team that if they still insist on domiciliary care, we are having no part of it.

    We really, really don’t want to use the final ace, but apparently, because MIL signed her house over to us both nearly 10 years ago and therefore it’s legally ours, we can refuse to allow her to go back there. If we have to resort to this, I will insist on the SW telling her why.
  3. Sirena

    Sirena Registered User

    Feb 27, 2018
    It certainly isn't NHS policy in our local hospital. When my mother was in hospital after breaking her hip last year, we visited her the day before she was due to be discharged and one of the healthcare assistants said she was about to take my mother out into the garden in a wheelchair, she then promptly got my mother into the chair and handed her straight over to us, gave us directions, and off we went. We double checked it was okay because she was only 9 days post surgery and we were worried we'd mishandle her/the chair!

    I would not mention anything about going home/elsewhere to her, she won't understand/remember what you say. If she says she wants to go home just say something non-committal like "yes of course, no one wants to stay in hospital, you need to be somewhere more comfortable".
  4. nitram

    nitram Registered User

    Apr 6, 2011
    North Manchester

    I think they could have been correct, depending on the design of the wheelchair, for instance it might have been possible for MIL's foot to slip off the footrest and her toes hit the floor, not observing this and carrying on moving forward could lead to injury.

    On a broader aspect, MIL was under their care, if they delegate this care to a lay person they maintain responsibility.

    There may have been an unfortunate occurrence in the (recent) past.
  5. canary

    canary Registered User

    Feb 25, 2014
    South coast
    I think this is an excellent response.
  6. Jaded'n'faded

    Jaded'n'faded Registered User

    Jan 23, 2019
    High Peak
    It's hard to see how moving your MIL from bed to chair and back then ignoring her the rest of the time is in her best interests! Seems that's how it was when she was at home and the same now in hospital.

    In a care home she would benefit from a much richer environment - no question. Varied company, activities, plenty of staff to help move her, and 24/7 care of course. But you know that :)

    I absolutely love the way you are refusing to be walked over by people who don't have a real clue what your MIL is like and what her real needs are. Good for you and long may it continue. I think they will see sense eventually but you really shouldn't have to go through this nonsense.
  7. anxious annie

    anxious annie Registered User

    Jan 2, 2019
    I feel for you having to go through this when all you want is what is best for your MIL. Perhaps you should have quoted back to the physics "It's up to ****** what she wants to do !" when they were for taking her back to the ward and she'd have preferred to stay in the garden! o_O
  8. Champers

    Champers Registered User

    Jan 3, 2019
    #68 Champers, Jul 7, 2019
    Last edited: Jul 7, 2019
    Thanks for your replies - I think we were just being paranoid and overly suspicious. There was no members of staff lurking around at all today so I think I’ve just become super sensitive.

    Sirena, I think your response to the “I want to go home” reframe is spot on! Thank you so much. We will use that from now on. As with any individual with memory issues, we’re realising there is no point in going over the same old story as MIL has no powers of retention and to try and get her to understand the options available to her in deciding between the care home and home care are totally unproductive.

    It’s very apparent today as well, that the staff are not nursing her as such, but merely monitoring her. Her daily weight is clearly a concern as it’s marked on the whiteboard above her bed but there doesn’t seem to be any target or focus to her treatment - it had crossed my mind that it was heading to end of life care, but surely they would have told us this? There’s been absolutely no mention of when she is likely to be discharged so I’m slightly intrigued as to how long this will go on. As you’ve said Jaded’n’faded, MIL is in exactly the same negative situation she was in when she was at home - just left in an armchair, only this time in the corner of a ward. For all the fuss the SW made about how important it was that her wishes were respected, he’s certainly not concerned about her quality of life at the moment. The residential home has told us they are ready and waiting to accept her, so by him dragging his feet and delying her discharge, he’s prolonging the whole wretched situation.

    The domiciliary outstanding bill has still not been paid, so I wonder what this week will bring?
  9. Champers

    Champers Registered User

    Jan 3, 2019
    Excellent! I’m cross I didn’t think of this myself! :p:D:D
  10. Rosettastone57

    Rosettastone57 Registered User

    Oct 27, 2016
    As others have said, much admiration for such a stance . We're all intrigued as to how it will play out.
  11. Champers

    Champers Registered User

    Jan 3, 2019
    Please may anyone comment on this email we received today. I am SO disgusted and angry. It stinks to me of emotional blackmail!

    “My understanding of the situation is that you currently own the property (since 2012) and that you have agreed for 'T’to stay in the property for the remainder of her life (discussed with you last week).

    However, in conversations with yourself I understand that you would prefer for 'T’ to move into a Care Home for a short trial to see if she would like it and she could either then stay there or return home. You have also mentioned that you have discussed this with 'T' and she agreed to this option during a recent conversation (but she has since forgotten this discussion).

    I have been involved with 'T’from early in her admission and there are growing concerns about 'T’s low mood because of her wish to return home and her continued stay in Hospital is having a negative effect on her wellbeing. I know that you would like 'T' to trial the Residential Home option - however, it's quite apparent that not being at home is having an adverse effect on her, and based on her continued wishes I think moving into a Residential Home would only increase her distress and upset.

    Throughout my involvement her consistent wish has been to return home. 'T’has reiterated this to me and professionals working in the hospital on numerous occasions. Whilst I do accept that 'T' has memory issues, I have assessed her to have mental capacity regarding the decision to return home and she is consistent in this wish. It's important to also mention that even if she lacked mental capacity the recommendation would still be for her to return home. During a meeting with 'T’on the ward (with both of you present) and other professionals 'T' was asked clearly whether she would prefer to move into a Care Home (for a trial) or return home and she clearly expressed a wish to return home.

    I have assessed 'T's care and support needs during her admission and would recommend that she returns home with a reduced package of care - Live in Care (without the two hours carer's break being covered). 'T' is in agreement with this. ********* Care have confirmed that they are able to continue providing 'T’s care (starting this week). I have also explained to 'T' that the cost of the care would be £1150 + a small cost for groceries each week and she is accepting of this.

    The Occupational Therapist would also need to visit the property to look at any equipment provision.
    In discussions with you I understand that there isn't any formal authority to manage T’s finances and I would strongly recommend that you explore the options that would place the informal support you are giving onto a legal footing.

    I am conscious that we have an elderly person in a hospital bed who is becoming increasingly upset at being here and could return home this week.

    I have copied in ************** (Head of Integrated Discharge) as T is now medically fit for discharge and is a delayed transfer of care.

    If it is your decision for T not return to the home could you please reply to this email with your reasons and be kind enough to put it in writing so that it can be shared with 'T' and she will be able to refer back to it on the ward.

    Please also see attached Hospital Assessment.”

    One of the main reasons we wanted residential care WAS because of MIL’s low mood - at home! - before she even went into hospital.
  12. Sarasa

    Sarasa Registered User

    Apr 13, 2018
    I can well imagine that your MiL is not happy, but I doubt she'll be happy at home or indeed in a care home. It's a case of what will best meet her needs From what you said the care package wasn't working before, why would a reduced one work?
    The SW seems to admit that your MiL doesn't have the capacity to make financial decisions, hence suggesting that you get things put on a 'legal footing' but has a bit of a blind spot about the 'home' issue. Do you think this might be because you own the home, and the assumption is that you have a hidden agenda to get her out?
  13. Starting on a journey

    Starting on a journey Registered User

    Jul 9, 2019
    You could always have some drastic but perhaps cosmetic damage which means she can't go "home" for a little while...burst pipes, electric re wire, that sort of thing.

    I know it's a bit devious but from the wording of the SW e mail they are not above being devious themselves. I was particularly not impressed by their suggestion that you put in writing why you don't want her to go home, and then infer that this information will be repeated to her every time she asks to go home. Short sighted or what?

    Unfortunately her condition will deteriorate and in a short time it could all be academic as the care agency won't be able to manage.

    I can only assume that the SW has a small caseload and loads of free time.... ridiculous!!
  14. silversea2020

    silversea2020 Registered User

    May 12, 2019
    Im no expert but I think I’d be tempted to respond with something along the lines of that as this social worker has decided ‘it’s in T’s best interests’ to return back home but adding that you STRONGLY disagree with this decision (& give a list of the ‘why nots’) However, there is of course the risk that the LA will apply to be the Deputy & that’s the big risk because then you won’t have any say in anything, financial or health matters - it’s an abysmal letter to be sent. On the other hand, is it worth getting an urgent independent assessment done for mental capacity? It might just bide you time as T is currently in hospital - it’s just a thought.....
  15. silversea2020

    silversea2020 Registered User

    May 12, 2019
    Ignore what I’ve just suggested your post where you say that information you give will be relayed to ‘’T’ - that doesn’t seem right at all ....I am sorry that you are in such a difficult situation
  16. Beate

    Beate Registered User

    May 21, 2014
    "Dear SW

    Thank you very much for your letter in which you expressed your concern about all of our wellbeing.

    I'm afraid I must inform you that the pressure you are putting me under, not least with this latest missive, has had an adverse effect on my health. I have seen my doctor and appear to be suffering from stress and low mood. Hence, to avoid any more negative effects on my wellbeing, I have to regretfully decline your suggestion of returning T to our property for the time being. I am sure you understand that I have to put my health first, and as I legally cannot be forced to look after another person, I suggest you involve T in finding another residence. There is no reason to put anything on a legal footing as according to you T has full capacity and can therefore be involved in the search and also the payment for it.

    Yours sincerely
  17. silversea2020

    silversea2020 Registered User

    May 12, 2019

    This is a brilliant letter @Beate
  18. Louise7

    Louise7 Registered User

    Mar 25, 2016
    I may be wrong but I thought that T lives in her own property so would be returning there (with 24hr care) rather than being discharged to live with Champers?
  19. Beate

    Beate Registered User

    May 21, 2014
    It is still Champers' property though. Maybe a sentence about the proposed care package being inadequate could be added, which would mean Champers being forced to step in. I think the SW needs reminding that Champers has no responsibility but rights of her own regarding her wellbeing, which the SW is trying to ride roughshot over.
  20. Kevinl

    Kevinl Registered User

    Aug 24, 2013
    But is it? It was gifted but unless T pays the going rent for a comparable local property then it's classed as a "gift with reservation of benefits" so on paper with the land registry Champers owns the house but if no rent has been paid then it's a whole different ball game.
    Gifted houses normally allow the gifter of the property to have a beneficial life interest to live in the property, so Champers may well have no legal right to stop them returning anytime T is still alive.
    You'd be well advised to consider very carefully what you put in writing to the as as while it's all been done on the phone or in meetings that's all "he said, she said" no proof of who said what, your position as stated on here that you'd refused to help or co-operate could be quite damning if the ss went for the nuclear option and ask the CoP to appoint a deputy right over your head.
    I had a similar problem with the ss who wanted to send my violent wife home after 6 months of being sectioned against the advice of all the medical professionals at the best interest meeting, I won but I did take one thing away from the experience, ss will do pretty much anything if they may have to fund the cost of care.
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