Not allowed to make GP appointment for Mum

[Boredhousewife]

Hi all. I haven't been here for a while but I find I need some advice. I will get right to the issue. Mum is in a care home. She has symptoms of a UTI. Smelly urine, green discharge, extra confusion. The home management staff say that all women get discharge and we are mistaking her saying "ow ow ow" and pulling faces when she wees for signs of pain when it's just her dementia. We weren't convinced nothing is wrong so my sister tried to make a GP appointment. The surgery refused and called the home to ask them if they felt the appointment was necessary. The GP surgery then told my sister they cannot discuss anything about my mother with anyone but the Home. To my knowledge nothing was ever signed giving the home exclusive rights to direct my mother's care, so why can the GP talk to them and only them? Is this usual? The home refuse to take my mother to any appointments, my sister has to take her to dentist etc but how is this going to work if the home wont get the GP in unless it's an emergency, and my sister is now not allowed to make GP appointments for Mum to take her when she needs care for non emergency things? She has made appointments and taken her to them before. What could be going on?! Are dementia patients not allowed GP care for little things unless the care home thinks it's necessary?

 

[cragmaid]

Get tough NOW! (Shouty letters for action not criticism)..Demand that the GP is sent for and do not let them fob you off. Tell the home that unless you hear that the GP is attending within 24 hours you will contact the CQC and the Local Authority and ensure that legal action is taken. Try to ensure that you are there ( if at all possible) when the GP is visiting.
I guess that you don't have health and welfare LPA but even a next of kin should be taken notice of.

In the mean time, if you can, get Mum to drink Cranberry Juice or similar ( even plain water will help to flush her system) it will help.
Good Luck and keep us posted.....Worst case scenario....start looking for a New CH and a new GP.

 

[Boredhousewife]

Thanks for being the voice of sanity. Shouty email has gone to the social worker. This is the second time the home have failed to deal with a UTI. Last time the social worker sent in the safeguarding team. I wondered if that might be why the GP is saying we can't be involved anymore and the home calls all the shots, because we are troublemakers! It just seems so weird that family is suddenly excluded from medical decisions when I have no knowledge of anything legal being passed to give that power solely to the home. Surely if something had been decreed by a court of law, they would have to inform next of kin? To not even be allowed to make an appointment to take mum in to the GP without the ok from the home is weird. Or is it? Has this happened that anyone else knows of?

 

[cragmaid]

In these circumstances....keep on being troublemakers.

 

[canary]

In mums CH her GP comes out to the CH and all of her health records are kept in the CH, which is why the GPs surgery do not like you booking appointments there.

Having said that I do not understand why the CH are not listening to you. If ever I have expressed concern about something (often a UTI) they always take me seriously. All it would take is checking a urine sample.

 

[Boredhousewife]

The home say they checked her urine on Thursday. Thing is, there are 3 women in the same "ward" with very similar names, lots of temporary staff who you never see twice, and they frequently get the 3 patients mixed up. So who knows whose wee got tested? :-/ If it was common practice for the gp to visit in the home, I would have thought they would say so, rather than get all "we can't talk to you only the home"?

 

[cragmaid]

One issue is that you don't know that the GP has been given the true state of play regarding whose legal responsibilty your Mum actually is.

If a urine dip was done on Thursday, then tomorrow is 5 days further down the line, and any infection hidden then will be showing now. Nag them tomorrow.

 

[Sue J]

saying "ow ow ow" and pulling faces when she wees for signs of pain when it's just her dementia.

Dementia patients frequently cannot express pain so when they do you can bet your bottom dollar they are in pain!

Green discharge = infection

Agree with Maureen, be that troublemaker, hope you get some action soon.


Sue

 

[sistermillicent]

I would not for one minute trust a dip stick test to give the definitive answer as to whether there is an infection there.
I would get onto social services and make a huge fuss.
Say the words safeguarding issue as mentioned before here, it should sound alarm bells with them.
Then ask the care home for details of their complaints procedure and raise a formal complaint following the procedure exactly. Keep a copy of all the paperwork. Copy everything to the owners of the care home if it is run by a bigger organisation.

You are still next of kin even if you don't have power of attorney, I am not sure how that leaves you legally but it must mean something.

 

[stanleypj]

You are still next of kin even if you don't have power of attorney, I am not sure how that leaves you legally but it must mean something.

It does mean something and this has often been stated on TP. There's a quote, I think from NHS guidance on the Mental Health Act, that makes it very clear.

In the longer term, other things you say about the home suggest that you should be looking for a better one.

 

[nitram]

In the MHA the term 'next of kin' is replaced by 'nearest relative'

My understanding is that it relates exclusively to mental health problems and has no legal standing in other cases.

http://www.mind.org.uk/information-support/legal-rights/nearest-relative/#.VbcsAk1Viko

 

[stanleypj]

Thanks nitram - I thought you'd be along with the reference.

So it would presumably apply in this case even though the UTI is not a mental health issue as Boredhousewife's mum's health problem will clearly be exacerbated by the dementia.

 

[nitram]

I think it only applies when the person is under a section, mentally ill not just lacking capacity.

From the link

Nearest relative is a special term used in the Mental Health Act 1983. It gives one member of your family rights and responsibilities if you are:

detained in hospital under sections 2, 3, 4 or 37
under a community treatment order, or
under a guardianship

There's more detail in the linked pdf.

 

[stanleypj]

OK if that's the case I suppose you would have to argue, to the Care Home, that it is good practice to liaise closely with next of kin/nearest relative and take their wishes/feelings into account. The OP could also mention her fears about whether the right resident has been tested and whether the sample has been cultured for sufficient time.

 

[stanleypj]

There's some relevant stuff in this document I think:

http://cqcguidanceaboutcompliance.org.uk/step3.php

 

[nitram]

Done a few searches on NHS and next of kin. All I can get is statements by various hospital groups.

This extract from Portsmouth Hospitals is typical

What is the role of my ‘next of kin’?

The ‘next of kin’ is not simply a contact number. The person you choose must be willing to act on your behalf in case you become unconscious or were unable to communicate due to illness or injury. They must be willing to reflect what they believe would be your wishes in the event of your incapacity or death.

This is the person we would turn to for advice and guidance if you became unable to communicate. In the event of death, it is your ‘next of kin’ who would be consulted about issues such as arranging a hospital post mortem or organ/tissue donation.

Your ‘next of kin’ cannot consent or withhold consent for care on your behalf. However, they will be asked for their views to enable the doctor to make an informed decision as to the best treatment and care for you. So, if you cannot make that decision for yourself, the final decision of care ultimately rests with the doctor in charge of your care.

It is important to remember that the information you give us regarding ‘next of kin’ during your admission is used for hospital purposes only. This information will not be provided to outside agencies and has no legal standing.

 

[sistermillicent]

I was thinking more of kindness, humanity, common sense, practicality, decency, I get sick of everything only mattering in law. But thanks for the information, Stanley and Nitram, that was interesting and would actually have been useful to me last term in my job, had I known it.

 

[nitram]

"I was thinking more of kindness, humanity, common sense, practicality, decency, I get sick of everything only mattering in law"

I agree with all of that, but when up against the patient confidentiality wall there is little choice other than to resort to the law and formal guidance.

 

[stanleypj]

Agree nitram. They will sometimes not even be aware of it what the law and formal guidance say.

 

[Boredhousewife]

thank you everyone

We are in the process of getting the social worker involved, checking with both the GP and a solicitor about the whole issue of who gets to make the health and welfare decisions and whether the home has the right to just take over and exclude us, and why and how that has happened, and the complaints procedure at the home. What a minefield all this is! So many systems that seem deliberately set up to prevent family from "interfering" with the care provided. It seems the current system's aim is to corall the demented, keep them quiet and stop them causing trouble until they die.