Sorry to bother you....

Discussion in 'Researchers, students and professionals' started by Liam, Apr 13, 2004.

  1. Liam

    Liam Registered User

    Apr 13, 2004
    ...but i was just wondering if any of you have experience in meeting's with GP's and other professionals. I'm a health and social care student and am writing an assignment on decision making. My case study involves an elderly couple one with dementia (female) and the other the main carer (male), a meeting has been called between the relevent stakeholders regarding whether she should be moved to a care home as she has been locked up by her husband due to her wandering. I am wondering if the female would be asked her views and whether the professionals can demand she is put into care.

    Thankyou for your time
    Regards Liam.
  2. Brucie

    Brucie Registered User

    Jan 31, 2004
    near London
    Firstly, I have no idea what the official position is - I'm sure that someone else will answer for that.

    My expectation is that the situation where a person is put into care, without their own agreement or that of their family, is where they either become a clear danger to themselves, or to others.

    In the situation you describe, particular care needs to be taken regarding the carer husband. Putting his wife into care against his wishes may well have a very bad effect on him.

    It sounds bad to say she had been 'locked up by her husband', but I had to do it, and so have many others. Probably 'it would be better to say 'the doors needed to be secured' otherwise one gets mental images of locking people in a room against their will. In my wife's case, she would try the door, and when it didn't open she would go and do something else. It caused her no distress.

    Thank goodness that part of the story is over for us, however!
  3. Liam

    Liam Registered User

    Apr 13, 2004
    Thanks for your help Brucie, very much appreciated. The case study uses the phrase 'locked up' but i will mention in the assignment your suggestion. As for moving the wife against her husbands will i have decided the best solution would be extra care in the home. Once again thankyou very much Liam.
  4. Ruthie

    Ruthie Registered User

    Jul 9, 2003
    South Coast
    Being locked up depends on the context - being confined in a small space is different from having outside doors locked to prevent wandering into the street.

    If it is necessary to make sure the lady is safe at home by locking doors to prevent wandering, then if she is taken into residential care she will be placed in a "secure" i.e. locked, ward or care home - otherwise she will go wandering from there, unless she has 24hour one-to-one care - highly unlikely, I think!

    Not that this prevented my husband from making a runner from a "secure" NHS hospital dementia unit (he is young and doesn't fulfil the usual "Alzheimers" visual stereotype) - so was able to walk out when the porter took the meal trolley away - he managed to walk about 8 miles on busy rural roads and not get picked up by the police for about 8 hours - at night.

    It would of course be ideal to have 24/7 cover at home by trained professional carers or nurses, but I doubt if many local authorities or NHS trusts would countenance this - it's more cost effective to put people into care homes (especially if the client can pay for the cost themselves!).

    The client should receive an explanation of what is suggested and given every opportunity to express their views if at all possible. I found that the doctors, CPN and Social Worker who dealt with my husband all did this each time he was admitted to hospital in such a way that he agreed reasonably happily.

    Suggest that you may wish to read previous postings about wandering on this site, and the information sheets on the main Alzheimer's Society website are excellent.

    Best wishes with your dissertation

  5. John Bottomley

    John Bottomley Registered User

    Apr 7, 2004
    #5 John Bottomley, Apr 16, 2004
    Last edited: Apr 16, 2004
    Risk management

    1) The lady with dementia must be asked her views. She may not have capacity to make informed decisions, but before that's established it's got to be assumed that she does, and her views sought.

    2) Her capacity needs to be assessed. If she can make valid choices, then whatever she wants to happen should happen.

    3) Her risks need to be assessed. If there are risks (of self neglect, or accidental fire setting, or hostility to others, say) then these need to be addressed. Maybe they can be contained/manageable within the community, may be more speciailised care is needed to meet those needs.

    4) After assessing her risks and her needs, if she's agreeable to the advice that health care professionals offer, then this care plan can be put in to place. If she's not agreeable, and there're no risks, then she does what she wishes.

    5) If there are risks, and these are significant, and she's not got capacity to make informed decisions, then case law shows that health professionals are obliged to act in her best interests (e.g. placing in EMI residential care, if that was what's needed) even if she can't co-operate or consent to this. Clearly, her male carer will have input in to what he feels would suit her best, and may be able to guide on whether a small unit with few people may suit her (as she's always liked a cosy, small, friendly set up) or a huge more anonymous massive care home is better (as she's always been a provate person and like to walk a lot) or whatever.

    6) If there are risks, and these are significant, and she's not got capacity to make informed decisions, and is opposed to care plans, then statutory instruments are considered. This could rarely mean the National Assistance Act, but invariably it's the Mental Health Act 1983 that can be used to admit her for assessment and treatment (treatment being broad, not just medical) and then placement. Her next of kin has input (and rights) if this Act is used.

    As well as considering situations where she's decreasing capacity, and increasing risk, and increasing opposition to support, were there any other issues you needed to consider?

    Edit : oh, as far as work with various professionals goes, yes, it has to happen. A GP will often co-ordinate care. Mental health services will organise hospital care, but also often guide on community care. Social workers will advise on practical and social care. Approved social workers will be needed to consider the balance of the lady's freedom/choices and her needs/risks and decide if the Mental Health Act is used (only approved social workers can make applications to detain people, not medics), and a psychiatrist would need to be involved for a medical recommendation. An occuptaional therapist is often involved in looking at functional level, how to improve or keep this, what help can be put in to place to make things work. A physiotherapist can help with mobility and safety issues. Pharmacists can guide on how to make medication regimens simpler or safer or more effective. Community nurses spend a lot of time supporting carers (including staff in care homes) with advice and ideas. Voluntary organisations including Age Concern or local groups can assist with delivery of advice and direct care (such as respite or sitting or day or holiday care). Any good team will invariably work with a broad ange of folk, to get the best outcomes through using a range of approaches.

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