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Mental capacity assessment

Jaded'n'faded

Registered User
Jan 23, 2019
3,190
0
High Peak
I think the idea of D to A is to 1) get someone out of hospital where their bed is needed and 2) move them to a (hopefully) less busy/fraught setting in order to assess their needs going forwards. This makes good sense as hospitals are not good places for people with dementia and that makes it difficult to assess their needs.

I don't know who finds the D to A placement (presumably the hospital social worker/discharge team) or who funds it (presumably it will be fully funded) or how long it lasts for - I'd guess a few weeks.

So although this is a move forwards, the decision as to where he will go from there has not been made yet. If anyone with an ounce of good sense is involved, they will decide he lacks capacity and must move to full time care.

Fingers crossed for you - it sounds like the OT, etc. are now on board and will support you.
 

canary

Registered User
Feb 25, 2014
18,433
0
South coast
My mum had this, although at the time it was called a reablement scheme.
It a short-term period of assessment (usually aprox 4 - 6 weeks) in a care home so that the persons needs can be assessed. Its paid for by the NHS and the NHS uses beds in a care home that they have a contract with. This means that you dont get much, or any, choice about where they go, but at least its only short-term.

At the end of the assessment there will be a Best Interest meeting where people involved in their care - GP, hospital doctor, Social Worker, manager of the care home, family carer, the PWD (and anybody else connected with their care) - is invited to attend. At this meeting the PWDs needs will be discussed and a decision made about where the PWD will go afterwards. This may be: returning home with a care package, staying at that care home or moving to a different care/nursing home. After mums time of assessment it was unanimously decided that mum could not return home and she actually stayed at that care home.

Do you know which care home you want? Would they be happy to have them back? Use this time now to work out where you want them to go permanently
 

MartinWL

Registered User
Jun 12, 2020
2,029
0
65
London
S
Thank you to everyone who has replied to my recent posts. Things have moved on today and I finally have a glimmer of hope. My daughter contacted the therapist who had spoken to me about my husband. She felt that the therapist really understood the situation and how I am feeling. She said the bungalow was clearly unsuitable for him because of his risk of falls and that he has no understanding of how his condition impacts me. She recognised that I am exhausted and unable to cope with him at home. She explained that whilst there is a procedure to follow regarding trying all appropriate avenues before recommending residential care she feels that every case needs to be looked at individually. She has requested a mental capacity assessment and has made as strong a case as she could to all the other professionals involved that he be referred for discharge to assess in a care home or nursing home. I have since spoken to the ward sister who informed me that the referral had been completed and would be picked up by a hospital social worker. I'm not quite what happens after this but I know the wheels have been set in motion. I have had a conversation with the community social worker who has assured me that she can see on the system that the referral has reached the hospital social worker along with all her records of what has been tried. I have also spoken with a specialist dementia nurse who said this is the best way forward, it is difficult to assess dementia patients properly in a hospital setting, she has promised to chase the referral on Thursday and contact me again to update me.
So I am feeling happier though not counting my chickens yet.
I have asked the ward sister not to tell my husband about all this until it is all arranged as he is still saying he hopes he will be home this week. I've told him they need to get him well and he needs to be able to walk otherwise he can't manage at home.
Fingers crossed things will move on quickly from here.
So glad to hear about the progress. You might try describing the care home as a convalescent home. That's rather old fashioned but still a good concept. It sounds more hopeful than a care home. Most people realise that statistically few people move out of a care home alive, so I can understand why people fear them.
 

yorkie46

Registered User
Jan 28, 2014
400
0
Southampton
Well I knew the confidence yesterday was misplaced. I hadn't heard from anyone today so I phoned at 4pm to see how he is and to ask about visiting. I was told eventually that he had been moved to a different ward. I was annoyed that I hadn't been informed and even more annoyed when I discovered he had been moved last night. Phoned the new ward and was told 'he's doing well. He's medically optimised and he's going home with a care package'. At this point I lost it. I said he's not coming home but the ward sister just kept saying he's had a capacity assessment and he has capacity, he owns his own home and therefore he has the right to live there. I told her I'd been talking to people yesterday about discharge to assess. I asked who had done the capacity assessment and what questions they had asked, she said it was the doctor but couldn't tell me what he'd been asked about. She said he's not confused and just kept repeating that he has capacity and he has the right yo return home. I told her I couldn't manage him at home any more. She said 'you won't have to do anything, the carers will get him out of bed and deal with all his personal care'! I said oh so they're going yo be here all day are they. She said 'no not all day but 4 times' I said so who deals with his needs in between those 4 times then? I'm afraid I didn't handle it very well and put the phone down. I was just so angry. My daughter phoned a bit later and went through all the things she had spoken to the therapist about, she said it sounded like the sister knew nothing about these things. Sge didn't even know he had been admitted from the care home. She also asked that he isn't told yet that he can go home. The ward sister said she couldn't lie to him but my daughter said no don't lie to him just tell him he will be able to come joke when he's fit for discharge. Because I was so angry I didn't ask about his mobility or about visiting. I'm completely deflated again. This is a repeat of last August.
 

Palerider

Registered User
Aug 9, 2015
3,135
0
North West
Well I knew the confidence yesterday was misplaced. I hadn't heard from anyone today so I phoned at 4pm to see how he is and to ask about visiting. I was told eventually that he had been moved to a different ward. I was annoyed that I hadn't been informed and even more annoyed when I discovered he had been moved last night. Phoned the new ward and was told 'he's doing well. He's medically optimised and he's going home with a care package'. At this point I lost it. I said he's not coming home but the ward sister just kept saying he's had a capacity assessment and he has capacity, he owns his own home and therefore he has the right to live there. I told her I'd been talking to people yesterday about discharge to assess. I asked who had done the capacity assessment and what questions they had asked, she said it was the doctor but couldn't tell me what he'd been asked about. She said he's not confused and just kept repeating that he has capacity and he has the right yo return home. I told her I couldn't manage him at home any more. She said 'you won't have to do anything, the carers will get him out of bed and deal with all his personal care'! I said oh so they're going yo be here all day are they. She said 'no not all day but 4 times' I said so who deals with his needs in between those 4 times then? I'm afraid I didn't handle it very well and put the phone down. I was just so angry. My daughter phoned a bit later and went through all the things she had spoken to the therapist about, she said it sounded like the sister knew nothing about these things. Sge didn't even know he had been admitted from the care home. She also asked that he isn't told yet that he can go home. The ward sister said she couldn't lie to him but my daughter said no don't lie to him just tell him he will be able to come joke when he's fit for discharge. Because I was so angry I didn't ask about his mobility or about visiting. I'm completely deflated again. This is a repeat of last August.
Mmm you need to put your foot down @yorkie46 make it clear you weren't informed of what happens and to be honest i would call the ward to make the point you weren't informed. You always have to remember healthcare professionals in the UK are paid well for the work they are supposed to do!
 

Sarasa

Volunteer Host
Apr 13, 2018
4,836
0
Nottinghamshire
Oh @yorkie46 I'm so sorry that you are being sent round the houses again with this. It is obvious that there isn't any joined up thinking with your husband's care. I think you need to get hold of PALs and the hospital social worker as well as his community social worker and keep on repeating that you cannot have him home and that discharge to access has been agreed.
Just keep strong and do phone the support line if needed.
Your daughter sounds like a godsend.
 

Violet Jane

Registered User
Aug 23, 2021
848
0
Absolutely awful, and an illustration of how dreadfully family carers are treated. Would you consider getting a solicitor to challenge this? Alternatively, your only option appears to be to withdraw completely by leaving the family home (perhaps to stay with your daughter) and informing SS and the ward that you will not be there when your husband returns. Tell them that there will be no food and so SS will have to buy some. This is the nuclear option but what else can you do? Make sure that you drop off keys at the hospital before you leave so that you can't be accused of barring him from his home.

I hope that SS gets the message. I really feel for you.
 

MartinWL

Registered User
Jun 12, 2020
2,029
0
65
London
Absolutely awful, and an illustration of how dreadfully family carers are treated. Would you consider getting a solicitor to challenge this? Alternatively, your only option appears to be to withdraw completely by leaving the family home (perhaps to stay with your daughter) and informing SS and the ward that you will not be there when your husband returns. Tell them that there will be no food and so SS will have to buy some. This is the nuclear option but what else can you do? Make sure that you drop off keys at the hospital before you leave so that you can't be accused of barring him from his home.

I hope that SS gets the message. I really feel for you.
I was thinking the same as @Violet Jane but I do not see any reason to drop off the keys. As he is so capable let him make his own arrangements to obtain the keys! It is the nuclear option but I agree with others that you are going to have to stand your ground and I would certainly reccommend seeing a solicitor very soon.
 

JHA

Registered User
Aug 7, 2021
631
0
My mom was in a D to A bed last August after a period of delirium and a hospital admission. Initially the hospital wanted to discharge home with a care package but as she lived alone and I had seen her at her worst I protested and it was agreed for her to go to a local care home to be assessed further. Social Services funded the place.

They basically did very little as far as assessments went. At one point the carers said she could not be home alone then a Social Worker visited her twice and deemed her to have the capacity to decide what happened and that she would be ok to return home with carers three times a day. The carers were a waste of time - my mom wanted to get up and go to bed when she wanted and was relatively self sufficient washing/dressing/reheating food etc. Once she realised she would have to pay for them to basically pop in ask if she was ok she got me to stop them and refused to fund any alternatives so it was left to me. I would go over twice a day but then dropped the second visit to a phone call and we muddled along until just before Christmas.

My mom has LBD and hallucinates at times and as a result she went out of her house in the early hours of the morning as she thought there were people in her bedroom. She was returned home by the police who called me and then my battle to get some help started. Her GP referred her to Crisis, Mental Health came out, Social Services rung and said they would be in touch after Xmas. Both the GP and Mental Health said she lacked capacity and could not be left alone. Mental Health suggested 24/7 care or a respite bed in a care home but offered no practical help just kept promising to put a plan in place 'tomorrow'. After 8 days of 'sleeping' on her sofa and taking her back home with me during the day I admitted defeat. I organised a respite bed at a care home that had been recommended when I thought she would remain in care last year. Thankfully she went willingly - I am not sure how I sold it to her as I was near to breaking point. A DOLs was put in place by 'someone' the day after - I only found out by accident two weeks later.

Mom is still in the care home, is extremely unhappy and although I know what I have done is for her own safety I feel like the worlds worst daughter. The care home have been in lockdown since her admittance so I have not seen her for five weeks. I have talked to her on the phone but to say she is disgusted with me is an understatement. It has got to the point that I am terrified to visit or call but I know I need to get my big girl pants on and take that step. I speak to the staff in the care home most days - today they have said she is not eating and is very sleepy which I am guessing is due to a change in medication to help her with behaviour, anxiety and stress.

Heart tells me to just go and fetch her and start sleeping on the sofa again but brain tells me it is not possible as I cannot put my teenage boys though the trauma. In hindsight I should never have allowed SS to basically bully me into giving her the chance to go home as by now she would hopefully have settled somewhere.

Sorry for the essay but if my experience was anything to go by stand your ground with SS as I think their main remit is to get people home regardless.
 

Violet Jane

Registered User
Aug 23, 2021
848
0
For some reason, in @yorkie46's case the social workers have become fixated on property rights which are entirely separate to the issue of capacity. Most people have some sort of property rights, whether as an owner or a tenant and sometimes for other reasons, but that does not mean that they should not go into residential care if that is necessary to meet their needs.

Care visits can be very helpful but they are not always a solution as @yorkie46 has explained. If a person lives alone and has no local support then 3 or 4 care visits a day can help with personal care, medication, meal preparation, washing etc and also provide a check that the PWD has not fallen or got into some sort of difficulty. Conversely, if the PWD lives with a family member there is much less for visiting carers to do as the family member will be supervising the taking of medication, cooking, washing etc. If the PWD is resistant to personal care by paid carers and / or needs changing frequently then visiting carers are not going to be much use.
 

yorkie46

Registered User
Jan 28, 2014
400
0
Southampton
Well it's been another emotionally draining day. My husband has been moved yet again, now into a side room which I eventually found out is because he has MRSA! The original therapist now not involved. My daughter spoke to physio on new ward. She's (my daughter) been brilliant and has spoken to people when I've just been too upset to do it. She tells it like it is! Physio promised to look into what's happening and get back to her but of course she didn't. Meanwhile I had a call from the specialist dementia nurse who was toeing the party line. He's had an MCA, he has capacity, wants to go home, he has a right to do that. She said the ward sister wants me to talk to him on the phone. She said I could have him home but refuse to care for him and leave it to the carers. If he falls just call an ambulance. Doesn't that amount to neglect? These people live in some other planet. My daughter phoned to try to speak to physio again but she had left, the call was taken by the discharge officer. She went through all the issues yet again (why do we have to keep repeating the same things). At the end yet again she was told she would look into it and speak to my husband. Apparently he has refused D2A. My daughter was just explaining this to me on the landline when my mobile rang. It was the ward sister. Nothing to worry about I just need to inform you that your husband has just slipped off the bed when trying to stand up!!!!!! He hasn't hurt himself but I'm waiting for the doctor to see him. I asked how he could come home if he's falling, told her I can't manage him at home and I'd been told if he came home I had to refuse to help him. She said I need to be straight with him and tell him he has to wait for carers and if he falls call ambulance! I said I understood she wants me to speak to him about discharge, she thinks I need to. During the course of this conversation which my daughter was listening in to I discovered that they have now decided to redo the MCA and also do a cognitive assessment. Wonder why?! I also discovered that he is still needing 2 nurses to get him out of bed yet they are happy to send him home to me. The decision my daughter and I have made is to wait to hear back from the discharge officer and for the result of the assessments before I speak to him. I will write down what I want to say to him. My daughter will be with me when I speak to him on speaker phone and will record the conversation on her mobile. I'm going to have to tell him that when he's ready for discharge he can't come home because he can't walk without 2 people and most of the time it will be me or nobody here. I can no longer struggle to help him on my own without rusk of injuring myself.
Watch this space.
 

Palerider

Registered User
Aug 9, 2015
3,135
0
North West
Well it's been another emotionally draining day. My husband has been moved yet again, now into a side room which I eventually found out is because he has MRSA! The original therapist now not involved. My daughter spoke to physio on new ward. She's (my daughter) been brilliant and has spoken to people when I've just been too upset to do it. She tells it like it is! Physio promised to look into what's happening and get back to her but of course she didn't. Meanwhile I had a call from the specialist dementia nurse who was toeing the party line. He's had an MCA, he has capacity, wants to go home, he has a right to do that. She said the ward sister wants me to talk to him on the phone. She said I could have him home but refuse to care for him and leave it to the carers. If he falls just call an ambulance. Doesn't that amount to neglect? These people live in some other planet. My daughter phoned to try to speak to physio again but she had left, the call was taken by the discharge officer. She went through all the issues yet again (why do we have to keep repeating the same things). At the end yet again she was told she would look into it and speak to my husband. Apparently he has refused D2A. My daughter was just explaining this to me on the landline when my mobile rang. It was the ward sister. Nothing to worry about I just need to inform you that your husband has just slipped off the bed when trying to stand up!!!!!! He hasn't hurt himself but I'm waiting for the doctor to see him. I asked how he could come home if he's falling, told her I can't manage him at home and I'd been told if he came home I had to refuse to help him. She said I need to be straight with him and tell him he has to wait for carers and if he falls call ambulance! I said I understood she wants me to speak to him about discharge, she thinks I need to. During the course of this conversation which my daughter was listening in to I discovered that they have now decided to redo the MCA and also do a cognitive assessment. Wonder why?! I also discovered that he is still needing 2 nurses to get him out of bed yet they are happy to send him home to me. The decision my daughter and I have made is to wait to hear back from the discharge officer and for the result of the assessments before I speak to him. I will write down what I want to say to him. My daughter will be with me when I speak to him on speaker phone and will record the conversation on her mobile. I'm going to have to tell him that when he's ready for discharge he can't come home because he can't walk without 2 people and most of the time it will be me or nobody here. I can no longer struggle to help him on my own without rusk of injuring myself.
Watch this space.
I just don't know what to say @yorkie46 -words fail me but this is how it is, huge pressue to get patients out but what happens to them when they leave is an entirely different matter not to mention you have repeatedly said you can't cope anymore. Hopsitals do have to explain re-admission / failed discharge so thats one option if he does come home and it doesn't work out, but I am going to suggest you put your foot down and refuse to have him back home, you do have some say in this and from what I have read you have tried your best to be 'reasonable'. I am sure others who have experienced the same thing or similar things will be able to make some suggestions. But hang in there and your daughter sounds fab.
 

Sarasa

Volunteer Host
Apr 13, 2018
4,836
0
Nottinghamshire
I am so glad you have your daughter helping to fight your corner. I bet your husband is sounding quite credible to people who only see him for a few minutes, hence thinking he has capacity to make decisions about what happens next. Maybe the fall from the bed will make them re-think that.
 

Violet Jane

Registered User
Aug 23, 2021
848
0
I really do question the quality of these mental capacity assessments. Nearly every PWD will say that he wants to go home. Do social workers really probe to see whether the PWD understands what his limitations are, how much support he needs, whether that support can be provided, what the effects on family carer(s) are and what the risks to him returning are?

There is of course another problem: the social worker carrying out the assessment is only interested in the PWD and nobody else.
 

yorkie46

Registered User
Jan 28, 2014
400
0
Southampton
Hello @Violet Jane , the MCA and cognitive assessment is being carried out by a hospital consultant who I'm told is experienced . Of course I haven't spoken to him. I like you am cynical about the validity of the testing and whether my husband is being asked the right questions to find out if he has any understanding about the impact on me and the risks to himself and me of him returning home. Without being a fly on the wall I'm afraid I will never know. I intend phoning the hospital this morning to ask yet again if I can listen in on the phone to the testing but from past experience this won't happen.
 

MartinWL

Registered User
Jun 12, 2020
2,029
0
65
London
I really do question the quality of these mental capacity assessments. Nearly every PWD will say that he wants to go home. Do social workers really probe to see whether the PWD understands what his limitations are, how much support he needs, whether that support can be provided, what the effects on family carer(s) are and what the risks to him returning are?

There is of course another problem: the social worker carrying out the assessment is only interested in the PWD and nobody else.
You are so right @Violet Jane there's good reason from what we have learned about this case to think that mental capacity has not been properly assessed according to law. Assessment of capacity involves testing understanding of relevant information. Hospital staff may not have much understanding themselves of the domestic circumstances of the patient, making it difficult for them to carry out the assessment at all.