Mental capacity assessment
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might help
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https://www.mind.org.uk/search-results?q=capacity#stq=capacity&stp=1 .
might lead to something useful.
might lead to something useful.
Yes, I think that's true. They don't have enough background information to ask the right questions!
It's all very well asking if he wants to go home. (Though in my opinion that's the most pointless, useless, unhelpful thing they could possibly ask!) If they ask him, 'What if you go home and you fall, how will your wife be able to get you up? How will she manage by herself if it takes two nurses to move you now? will he be able to give a sensible answer?
And the biggest question, which will never, ever be asked: 'Don't you think you're being unreasonable and unfair on your wife?'
I completely understand that no one wants a situation where old people get bundled off to care homes on the whim of an uncaring relative. But there are already enough safeguarding measures in place to prevent that. This business of 'does he or does he not have capacity?' needs a complete overhaul.
I would cover similar topics but with different wording. You could explain that he needs two people to help him get up and test his understanding by asking what problems would arise if he fell over. The test is of understanding not whether he is sensible. Similarly you could explain the difficulties the wife has in caring for him and then ask him to prove understanding by summarising the impact of his going home on his wife.
He doesn't have to be reasonable fair or nice to anyone but he does have to understand information that is explained to him regarding the decision.
He doesn't have to be reasonable fair or nice to anyone but he does have to understand information that is explained to him regarding the decision.
Mental capacity is always a nightmare, but the problem is how else can someones ability to make appropriate choices be assessed?
I think its a very hit and miss affair depending on who is involved, some teams are excellent at it and others -well....quite poor.
Yes it is very difficult to assess. A person not only has to understand the information that is relevant but also to be able to weigh the pros and cons of alternatives. The assessor should ascertain whether the patient can do that. But these things are hard to measure and test for. It isn't surprising that assessments are not always done well or thoroughly.
The latest installment, I'll try to be brief! This morning I phoned to speak to ward sister, busy would call me back. Officious discharge officer phoned me, 'i'm dealing with it now, he has capacity, he's coming home with carers 4x a day and therapists, social services will monitor' I expressed my concerns but I got the whole legal blurb again. I asked how he would get to toilet between carer visits. Hell manage himself. Can he walk then? Yes! A bit later phone call from ward sister. Consultant talking to him and trying to get him to understand risks of going home but he's adamant. He's told me if he can't go home hell cut his throat! Asked if my daughter and I can go on Monday to talk to him with a member of ward staff and asked me to let her know time. I asked if he can walk, she laughed, oh no, he still needs two nurses!! I've just been told by discharge officer he can get himself to toilet. No that's what he told her but he can't! You can imagine what I thought about that!! After lunch phoned to tell ward sister what time we will go on Monday, unavailable, message left. Officious discharge officer phoned again wanting to know what time we're going. Explained I'd tried to phone ward sister to discuss, well I'm dealing with it now!!! I told her 4.15. oh can't you come earlier? No! Oh well I don't know if I'll be able to get a social worker. I didn't know anything about a social worker being there. Well I'll try but I'll be there!! Oh joy! Can't wait to meet her. So now I'm worried this is turning into some huge multiagency meeting and how that will affect my husband. I then get a call from a therapist wanting to talk about our home, I told her I was going to collect my grandson from school but could speak to her after 4. Oh can't do that, she'll phone tomorrow. I told her I want someone to come to look at the safety issues not just talk about it. So now I've been given blatantly incorrect information, told not to help him which I feel is actively encouraging neglect and told he's threatening to harm himself if he doesn't come home. I'm going to say I think he needs a psychological assessment. The icing on the cake came at 5.10 when I was informed he has fallen again trying to get to the toilet!! So now despite the MRSA they are moving him from the side room to a bed nearer the nurses station so they can keep an eye on him! And tomorrow we'll start all over again.
I think things have reached a point here where you need legal advice and help. Perhaps on Monday your first call might be to a specialist medical negligence solicitor who can get a letter in to hospital management right away threatening action if the patient comes to harm. I wouldn't worry too much about the threats of self harm, unless there is real evidence that he is capable of it. I would be wanting to see the notes of his capacity assessment and scrutinise them, I suspect it may have been inadequate and inaccurate.
I’m afraid that I’m very suspicious of this hospital visit that the hospital is insisting on you making on Monday. I suspect that it will be used to manipulate you into agreeing to have your husband home. You will find it very difficult to tell your husband face-to-face that he can’t come home and when he pleads with you the hospital will be hoping that you will give way.
Do you believe the reported threat of suicide? Do you think that this is something that your husband might have said? Even if he did make this threat that cannot be the determining factor in the decision as to whether or not he should return home.
I don’t trust the integrity of the MCA either when the ward’s experience of your husband’s mobility (absolutely crucial in this case) directly conflicts with the finding of the discharge officer that he is mobile and can get himself to the toilet.
I would consider very carefully whether this hospital visit on Monday will be productive in any way. It might be better to refuse to attend and to tell the hospital that if they are determined to discharge him home against your will you will have no part in this and won’t be speaking to your husband about this as you profoundly disagree with the decision that he should return home as you believe that it is unsafe for both of you.
I think that you may now need to consult a specialist solicitor or engage an independent social worker. Tell the hospital that you will be challenging the MCA as you believe that it is fundamentally flawed.
Be very careful about being manipulated by the hospital. Their priority is to get your husband off the ward whatever it takes.
I believe - but am not certain - that it is lawful to record telephone conversations eg with the discharge officer if you tell the other person that you are going to do this.
Do you believe the reported threat of suicide? Do you think that this is something that your husband might have said? Even if he did make this threat that cannot be the determining factor in the decision as to whether or not he should return home.
I don’t trust the integrity of the MCA either when the ward’s experience of your husband’s mobility (absolutely crucial in this case) directly conflicts with the finding of the discharge officer that he is mobile and can get himself to the toilet.
I would consider very carefully whether this hospital visit on Monday will be productive in any way. It might be better to refuse to attend and to tell the hospital that if they are determined to discharge him home against your will you will have no part in this and won’t be speaking to your husband about this as you profoundly disagree with the decision that he should return home as you believe that it is unsafe for both of you.
I think that you may now need to consult a specialist solicitor or engage an independent social worker. Tell the hospital that you will be challenging the MCA as you believe that it is fundamentally flawed.
Be very careful about being manipulated by the hospital. Their priority is to get your husband off the ward whatever it takes.
I believe - but am not certain - that it is lawful to record telephone conversations eg with the discharge officer if you tell the other person that you are going to do this.
Hi @yorkie46 , I’m sorry things are still so difficult. I’d phone the support line today to chat through how best to proceed. They open at 10.00.
I can well believe your husband saying he’s commit suicide if you didn’t let him home. My mum threatened to jump out of the window if I did not do what she wanted for instance. Later she told a psychiatrist she never had suicidal thoughts. I think your husband is just trying to tell them how strongly he feels rather than actually seriously considering a drastic plan of action.
I don’t think there is a big conspiracy on as such, the hospital want him elsewhere and going home is the easiest option, specially as social services probably need to see that four visits a day doesn’t work before considering a move to care. The fact that it is to the detriment of both your health and your husbands won’t enter into it.
Stay strong, have you spoken to the dementia nurse at the hospital yet? They hopefully will have more of an understanding of the difference between what your husband wants and what he needs.
I can well believe your husband saying he’s commit suicide if you didn’t let him home. My mum threatened to jump out of the window if I did not do what she wanted for instance. Later she told a psychiatrist she never had suicidal thoughts. I think your husband is just trying to tell them how strongly he feels rather than actually seriously considering a drastic plan of action.
I don’t think there is a big conspiracy on as such, the hospital want him elsewhere and going home is the easiest option, specially as social services probably need to see that four visits a day doesn’t work before considering a move to care. The fact that it is to the detriment of both your health and your husbands won’t enter into it.
Stay strong, have you spoken to the dementia nurse at the hospital yet? They hopefully will have more of an understanding of the difference between what your husband wants and what he needs.
I think it would be a good idea to phone the support line too. Im unsure how effective contacting a solicitor is and how it will change anything quickly enough. Hopefully the people on the support line will be able to advise you.
If you do go to this meeting on Monday take the line with your husband that he needs to go to the care home (call it rehab if you like) until he is better and can walk again. If he says that he can walk remind him (and all of the others present ) that he has fallen at least twice and needs two people to help him. It will take courage, but try and show the rest of the people present that he is unable to understand the reality of his situation and is therefore lacking in capacity to decide to come home.
Keep calm and ask him things like - what will happen if he needs the toilet when the carers arnt there and when he says he will walk, remind him that he cant. Ask him what would happen when he falls and remind him that you would have to call the paramedics. Remember that you are not only talking to him, but to everybody listening too. You need to show everyone that there is a mismatch between what he says and what he can do. If he has a meltdown this would actually be no bad thing as it will show people what you are dealing with.
Make notes of exactly who is there and say that if he is discharged home against your wishes, falls and injures himself then you will hold them personally responsible.
Are you able to bring your daughter with you for moral support?
If you do go to this meeting on Monday take the line with your husband that he needs to go to the care home (call it rehab if you like) until he is better and can walk again. If he says that he can walk remind him (and all of the others present ) that he has fallen at least twice and needs two people to help him. It will take courage, but try and show the rest of the people present that he is unable to understand the reality of his situation and is therefore lacking in capacity to decide to come home.
Keep calm and ask him things like - what will happen if he needs the toilet when the carers arnt there and when he says he will walk, remind him that he cant. Ask him what would happen when he falls and remind him that you would have to call the paramedics. Remember that you are not only talking to him, but to everybody listening too. You need to show everyone that there is a mismatch between what he says and what he can do. If he has a meltdown this would actually be no bad thing as it will show people what you are dealing with.
Make notes of exactly who is there and say that if he is discharged home against your wishes, falls and injures himself then you will hold them personally responsible.
Are you able to bring your daughter with you for moral support?
I suggest that the benefits of getting a solicitor involved are likely to be that more senior hospital management will focus attention on the case if they are threatened with legal action of any sort. In this case it seems as if @yorkie46 has been talking to quite junior people such as ward sisters etc. If they think there is a whiff of a medical negligence case they will pay attention. In a dispute like this the Court of Protection is the only body that could definitively resolve the conflict as to where the patient should reside. That would take time especially as there is a dispute about whether he has capacity or not. But the involvement of a lawyer might get the NHS Trust to get to grips with this properly.
And so the saga goes on! This morning I phoned the ward to enquire how my husband was and to try to speak to the sister to clarify what is happening on Monday. I wanted to know if she was expecting us to speak to him or is there to be a multidisciplinary meeting. It was a different sister on today who told , guess what,......he's been moved again!!!AND STILL NOBODY TOLD ME. She gave me the number for the new ward. Spoke to a nurse who was looking after him. Apparently he was moved because he needed a side room close to the nurses station so they could keep a closer eye on him! This as a result of the falls. I asked if she knew what they were expecting to happen on Monday. She said the discharge plan is to continue, he is to come home with carers. She asked if I'm happy with that!! I filled her in about the situation and said I'm not happy about it but that doesn't appear to matter. She told me it's recorded that my daughter and I will go to talk to him about his discharge and our concerns about him coming home. She said there would be a multidisciplinary discharge meeting but no indication of when. She will document our conversation and ask the nurse in charge on Monday morning to contact me. I then asked her questions which I thought of during the night. I'm not sure why this didn't dawn on me before. Can he walk at all? No. Can he support his own weight? No, he needs to use special equipment. So he's only moving bed to chair, chair to bed? Yes. So if he comes home he will be confined to one room? Yes. Nobody has actually been clear about this before. In fact the discharge officer actually told me he could get himself to the toilet!! This throws an entirely different light on things. I don't believe his bedroom will be big enough for the equipment and furniture he will need. The therapist who was supposed to phone me today didn't. When I do actually speak to one I'm going to tell them it's vital that someone visits me to look at the space available and layout. Why do I have to think of these things? I was in contact with one of the dementia nurses last week, in fact she was the people who told me I should refuse to do anything for him if he comes home. I don't think she actually saw him. The dementia nurse who knows him will be back from leave on Monday, I've left her an email and text message to ask her to see him and whether she can attend the meeting. I've written down what I want to say to him on Monday, fingers crossed I'll be able to do it. Ive pretty much decided now that it really isn't worth persuing the capacity issue. Whatever I say they will keep telling me it's been done properly and he has capacity. I now feel that's almost irrelevant and his physical problems are the more pressing issue. Log in tomorrow for the next unbelievable installment!!!
I think the cap
I think the capacity issue does matter. If he really does have capacity he is entitled to decide for himself what to do. His decision may be unreasonable unfair and senseless but it will be his decision.
I totally get it. My dad is at home and moves from bed to chair and back again with the help of carers and equipment. Dad has a very small bedroom ( he has a hospital bed) and I and the cleaner had to move the chest of drawers to enable the carer to get the other side.. Dad has “ capacity “ and will not move out of a small bedroom to the dining room to enable the bed to be moved. The other room is twice as big. I have got the OT coming again to reassess him with his equipment ( Sara Stedy and stand aid) carers are saying he is unsafe. If he still refuses the stand aid then he won’t be moving anywhere. He will stay in the bed. His decision.With “ capacity and unwise decisions then he will have to accept them. You need to get the OT to come to your home to assess it. They cannot just send him home. Also you can refuse to do any caring. The GP and Social Services have duty of care. But always seem to rely on family. I hope things improve.( hugs)
Phoned hospital this afternoon and spoke to male nurse in charge. Felt he actually listened and had the information I needed. Seems my husband has been confused today, asking about his mother (not me). Wonder if he's confusing her for me?! Told nurse this is one of his usual confusions and told him about others. He confirmed he's expecting my daughter and I to talk to my husband tomorrow, he's also going to arrange for us to talk to a doctor. He asked who his consultant is in the community, he's never had one! He's going to speak to dementia nurse and therapist tomorrow. Said it looks like OT is planning to visit me to assess home situation. Asked if I have any equipment, No. I'm going to make a list of questions for the doctor. Not expecting to be able to change my husband's mind about coming home but I have to at least explain what will happen if he does.
Hope things go as well as they can today @yorkie46 . Write a list of all the reasons a move to a care home at least for an asst would be in your husband’s best interests. The fact your bungalow has not been assessed, the fact you can’t help him if he falls, the fact your own health needs mean you’d need to leave him for hospital visits etc etc.
I really do question how much capacity to make informed decisions your husband has. If he is asking for his mother the home he wishes to return to may well be his childhood one.
Phone the support line if you want more help or suggestions.
I really do question how much capacity to make informed decisions your husband has. If he is asking for his mother the home he wishes to return to may well be his childhood one.
Phone the support line if you want more help or suggestions.
