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Mental capacity assessment

yorkie46

Registered User
Jan 28, 2014
399
0
Southampton
My husband is currently in respite care for two weeks. The social worker and her manager are planning to visit to do a mental capacity assessment to determine whether he should be in permanent residential care. He doesn't know about this and I know he doesn't want to go into permanent care but I'm finding caring for him at home myself has become very difficult. We've tried carers but it doesn't work because they are unable to come at the times that suit him. If they are not there when he wants to get up or go to bed then I end up having to do it. Also they are not there in between these times when he needs to go to the toilet, is wet before he gets there and needs changing. If they decide that he doesn't have the capacity to make this decision for himself but he still refuses to accept that he needs to be in care what happens then. I have tried to explain to him that I'm finding it so difficult to give him the care he needs but he says things like 'I will just have to do more myself'. If he could do things himself he would be doing it now. He has very poor mobility and frontal lobe dementia. I dread this turning messy and the decision being put on my shoulders. If this happens I don't think I have the strength to tell him I can't manage him at home. Has anyone been in this position? I know my daughter and my sister feel I have to make this decision but it's so hard.
 

MartinWL

Registered User
Jun 12, 2020
1,985
0
65
London
Your daughter, if also his daughter, should be consulted, but it appears that you cannot cope at home so residential care will be in his best interests and yours. To have mental capacity he needs to understand information given to him in relation to the decision. If he doesn't understand the impact on you, when carefully explained to him, then he does not have capacity to decide for himself. Do point that out, preferably in writing, to the social workers assessing him, before they visit him.
 

Jaded'n'faded

Registered User
Jan 23, 2019
3,103
0
High Peak
I imagine it would be much the same as when I moved my mum to a CH and she wanted to go home.

This is all about keeping someone safe, which can involve forcing them to stay somewhere (i.e. a care home) against their will. To do this it has to be determined that they lack capacity to understand their own care needs.

For a care home (or anywhere else) to keep someone locked in, against their will, a Deprivation of Liberty Safeguarding Order has to be applied for - known as DoLS. This is what happened with my mum. A DoLS social worker came and talked to her to decide if she had capacity to say where she lived. Mum was undiagnosed at the time, which made it all a little harder, but a temporary DoLS was granted for 6 months and later made permanent.

With your husband, the procedure would presumably be much the same.
 

yorkie46

Registered User
Jan 28, 2014
399
0
Southampton
I have now been told that the capacity assessment will be carried out on Friday afternoon. The social worker is also planning to talk to the care home staff about my husband, how much help he has needed, whether they would be able to meet his needs permanently.
Best outcome would be that he is assessed as lacking capacity and he accepts that and that he needs to stay in care permanently. If that is the case is a Best interests meeting necessary ?
If he doesn't accept that he needs to stay in care permanently I understand that there will be a Best interests meeting chaired by the Local authority as they will be paying towards his care. I have been told that my daughter can be involved in this online meeting if she is available (she is a teacher so could be teaching at the time which would make it impossible). If she isn't I'm planning to ask if she can provide a written statement. I understand my husband will not be involved as this would cause unnecessary distress but a written statement will be taken from him. I've also been told that this will be a very uncomfortable meeting because the LA will ask difficult questions about what has been tried and why he can't be cared for at home. This is because there is a financial requirement from them.
Can anyone advise how I can prepare for this meeting? I have no idea what questions I will be asked.
 

canary

Registered User
Feb 25, 2014
18,196
0
South coast
Work out a vague time line of what has happened at home, what has been tried and why it didnt work - and take it with you. Apart from that, stick to your guns that you are unable to care for him yourself. Any hesitancy on your part will be taken as acceptance, so be very clear about it.
 

Shedrech

Volunteer Moderator
Dec 15, 2012
11,947
0
Yorkshire
Hi @yorkie46
Maybe use your posts here as your evidence, they are dated so give the chronology ... either simply cut and paste so they get the unexpurgated details, especially how much your own health and welfare have been affected, or edit a little ... have several copies to give to the other participants
 

Violet Jane

Registered User
Aug 23, 2021
797
0
Yes, you need to be very clear that you are no longer physically and mentally able to care for him. As has been said above, SS will seize on any hesitancy or ambivalence on your part.
 

Starting on a journey

Registered User
Jul 9, 2019
877
0
How about replacing “ I can’t do it any more” with “ I won’t do it anymore “

We had to take this stance with social services when it all got too much for my sister in law caring for her mother . My daughters are both teachers and found that a distinct advantage when discussing the situation with the social workers. It was all sorted very quickly. Can social services not have the meeting after lessons end or wait til half terms? It is unfair if you attend Unrepresented .
 

Banjomansmate

Registered User
Jan 13, 2019
4,006
0
Dorset
The hospital Social worker actively asked The Banjoman’s relatives about him and what they believed should happen to him, asking for written replies from those who couldn’t be at the best interest meeting, so both his daughters, a sister, (who came to the meeting ) and his sister- in- law in France all had their voices heard. I think your daughter should write her opinion of events.
 

Kapow

Registered User
Nov 17, 2019
152
0
I have now been told that the capacity assessment will be carried out on Friday afternoon. The social worker is also planning to talk to the care home staff about my husband, how much help he has needed, whether they would be able to meet his needs permanently.
Best outcome would be that he is assessed as lacking capacity and he accepts that and that he needs to stay in care permanently. If that is the case is a Best interests meeting necessary ?
If he doesn't accept that he needs to stay in care permanently I understand that there will be a Best interests meeting chaired by the Local authority as they will be paying towards his care. I have been told that my daughter can be involved in this online meeting if she is available (she is a teacher so could be teaching at the time which would make it impossible). If she isn't I'm planning to ask if she can provide a written statement. I understand my husband will not be involved as this would cause unnecessary distress but a written statement will be taken from him. I've also been told that this will be a very uncomfortable meeting because the LA will ask difficult questions about what has been tried and why he can't be cared for at home. This is because there is a financial requirement from them.
Can anyone advise how I can prepare for this meeting? I have no idea what questions I will be asked.
Hi...I was in the same position last June.I was feeling so ill,and knew it was the right time for my husband to go into care.My husband is deaf and the social worker who carried out the capacity test(with my husband behind a plate glass window,due to covid)informed me he did have capacity,and as such,he would be coming home from him being in respite for two weeks.I stuck to my guns...and it got to the stage where I said if my husband comes home then I will leave the home,because if he has capacity then he will be able to look after himself? Social worker goes back again,this time to do another capacity test after I said"You do know he is deaf?"Anyhow,this time she says he does not have capacity,and arranged a Best Interests meeting at the care home,husband not present.There were two care workers present,myself and the social worker,quite informal and relaxed.the social worker asked my view,how my husband being at home had changed,his behaviour,effect on me,etc.,then asked the care workers how they felt my husband was behaving,any toilet accidents and so on.The care workers agreed that they could see my husband was confused,they found him one night in the laundry room,he had tried to find the toilet,etc.,In my experience,you just need to speak from the heart,just tell the truth,the impact it's having on your health...I didn't take any notes in with me or anything because I didn't need them,I had been living it 24 hours a day for over seven years.I honestly wouldn't worry about the meeting,but remember to stress the effect it's having on you,because you are the one that's at the rock face,so to speak.Please let us know how it goes?
 

yorkie46

Registered User
Jan 28, 2014
399
0
Southampton
Thanks for all your advice. The meeting will be on zoom due to Covid. I intend asking if my daughter can make a written statement if she is unable to be involved. I also have to tell the social worker that there is one afternoon I definitely can't attend because I have today finally started bladder treatment I have waited two years for, my condition has been going on much longer than that. I have to have the treatment weekly for a month then it reduces. The specialist nurse I saw today made it clear that stress plays a significant part in my condition.
I read somewhere that a best interests meeting is only to decide the best interests for my husband not for me, is that correct.
The social worker is on my side, she said the difficult questions will be asked by the chair who will be from the local authority. This is because they will be paying towards his care and clearly residential care is more expensive than I am!
 

yorkie46

Registered User
Jan 28, 2014
399
0
Southampton
Is a best interests meeting likely to be called if my husband accepts that he needs to be in residential care or is it only if he is deemed not to have capacity but refuses to accept the decision?
 

thistlejak

Registered User
Jun 6, 2020
227
0
We didn't have a best interest meeting for FIL -he went willingly into his care home after going missing for 10 hours. His SW just said 'we have got somewhere you can go to be looked after for a bit, how do you feel about going?' He said yes, got into her car and went off.
MIL was sectioned and , as we didn't have POA, we had a best interest meeting to determine what happen next for her as she didn't think that there was anything wrong with her.
In answer to your question , if he accepts that he needs care then , in our experience, there won't need to be a best interest meeting.
 

MartinWL

Registered User
Jun 12, 2020
1,985
0
65
London
If it is important that your daughter should be present, and I can see why it might be, I would insist that the meeting be postponed to a date and time that she could attend. A written statement is one thing but might be brushed aside more easily than a strong personality! I agree with the others that you will have to be very firm. If you cannot cope and provide the necessary care "cannot and will not" must be made abundently clear.
 

Kapow

Registered User
Nov 17, 2019
152
0
Thanks for all your advice. The meeting will be on zoom due to Covid. I intend asking if my daughter can make a written statement if she is unable to be involved. I also have to tell the social worker that there is one afternoon I definitely can't attend because I have today finally started bladder treatment I have waited two years for, my condition has been going on much longer than that. I have to have the treatment weekly for a month then it reduces. The specialist nurse I saw today made it clear that stress plays a significant part in my condition.
I read somewhere that a best interests meeting is only to decide the best interests for my husband not for me, is that correct.
The social worker is on my side, she said the difficult questions will be asked by the chair who will be from the local authority. This is because they will be paying towards his care and clearly residential care is more expensive than I am!
The Best Interest meeting is for your husband,but your well being and the effect that having your husband at home is having on you is also taken into account,and your health problems.Social workers always want the person with dementia to stay in their own home as long as possible,we get that,but it comes to the point where you can no longer cope.At the Best Interest meeting I attended,there was no one from the LA there,and they contribute towards my husbands care(just about!)
 

yorkie46

Registered User
Jan 28, 2014
399
0
Southampton
I guess every area is different in how they deal with these issues. I have been informed by the social worker that if a best interests meeting is needed it will be chaired by someone from the LA . The social worker understands the problems it causes me having sole care of my husband at home. She says the LA will be the ones asking the difficult questions about whether all other avenues have been explored in order to keep him at home. Her, and my, argument will be that we have tried carers but it hasn't worked because they don't come at the times I need them. Even if they did there are all the times in between their visits when he needs toileting and changing. If he is at home with carers I would be paying for a service I didn't receive as I have in the past. And a this to satisfy the people who don't have to do it. The social worker is also going to collect information from the staff at the care home regarding his mobility and how much help he needs. From what I saw on the one visit I made after he had been there 3 days he is needing the help of 2 carers when he walks with his frame. I have also been told by them that it takes 2 carers to get him to his room and to bed in the evening. If that is the case how am I supposed to manage alone in a place that doesn't have the facilities they have to help. I'm hoping that he will accept that he needs to be in care and a meeting isn't needed but I won't know this until after the assessment on Friday afternoon. Always a good time when there's then 2 days with nothing happening!
 

MartinWL

Registered User
Jun 12, 2020
1,985
0
65
London
May I suggest that you try to get a report from the care home yourself, either separately or a copy of what they have sent to the social worker? That will enable you to fight your case better, otherwise inconvenient fact could be brushed aside. The requirement for two carers to perform certain tasks is very important as you don't have two people available at home.

The meeting will focus on his best interests not your best interests. Unfair on you perhaps but that's the purpose of the meeting. So if you can demonstrate that he needs care home care for his best interests and that his needs cannot be met at home you should be home and dry. Do highlight any nighttime needs as no local authority will propose carer visits at 3 in the morning.
 

Shedrech

Volunteer Moderator
Dec 15, 2012
11,947
0
Yorkshire
Hi @yorkie46
At the meeting really emphasise this:

"also have to tell the social worker that there is one afternoon I definitely can't attend because I have today finally started bladder treatment I have waited two years for, my condition has been going on much longer than that. I have to have the treatment weekly for a month then it reduces. The specialist nurse I saw today made it clear that stress plays a significant part in my condition."

as it means that, in the hours between home care visits, you are and will be unable to provide the hands on care and support that your husband now needs due to your own health issues ... so returning him to his home will be putting him at risk of neglect (due to no fault of yours, simply stating the fact) and the LA have the duty of care to ensure his care needs are met satisfactorily which they are right now in residential care so that care must continue in his best (not good enough or better) interests
 

Sarasa

Volunteer Host
Apr 13, 2018
4,743
0
Nottinghamshire
I hope things go as well as they can this afternoon @yorkie46. Maybe print out a bullet point list of all the things you want to get across as to why your husband would no longer be safe at home and you can no longer meet his needs, so you don't forget what you want to say. Just keep repeating as necessary.