What powers do Social Services have to INSIST on changes to care provided at home?

Discussion in 'Welcome and how to use Dementia Talking Point' started by AlsoConfused, Jul 4, 2015.

  1. AlsoConfused

    AlsoConfused Registered User

    Sep 17, 2010
    1,955
    Hi everyone

    Mum (doubly incontinent, mobile, late stages dementia and sometimes needing care at night as well as during the day) is still cared for at home by my Dad (exhausted, blind and having mobility problems). Mum has one half hour of paid care daily to get her up in the mornings but no other paid care.

    Following a monitoring visit by one of the local Social Services team, it's been reported back that the house is a bit grubby (that's being polite - it's unhygienic and smelly). The very good, very helpful GP feels that on balance Mum's care is still acceptable but as a family we need to make changes fairly urgently (possibilities include more paid care; Mum and Dad both moving into assisted, more manageable accommodation; or Mum going into local residential care).

    As a family, we've long felt Dad needs more help and / or to change the way Mum is cared for BUT Dad has determinedly resisted all such suggestions from whatever source they come.

    I think Dad would feel totally defeated by life and age if he were forced into major changes against his will (especially if Mum went into residential care - he wouldn't know what to do with himself and he'd feel dreadfully lonely without Mum's presence). I think Mum would probably enjoy the stimulus of having other people around her and of being looked after by carers who aren't tired and who aren't upset and annoyed by her limitations. On the other hand, Mum wouldn't eat so well and she'd lose whatever comfort she still enjoys in being in her own home.

    I'm seeking your advice please on two issues:-

    (1) What powers have Social Services to insist on various features of Mum's care being changed even if Dad doesn't agree, what's the process they'll follow and how long would that process take before Mum was moved?

    I think it's not an emergency safe-guarding issue, more one of care deteriorating slowly to unacceptable standards. Mum's already been shown not to have capacity.

    (2) What's likely to be worrying Social Services most in this situation and what should we do to resolve their entirely rational worries?

    Apart from the general undesirability of care being provided by an extremely exhausted, disabled carer, supported by whatever family help is possible, I'm assuming Social Services worry a great deal about the unhygienic condition and disease risks.

    Expanding the current care package might deal with this worry. Introducing more care for Mum and for the house would also have the spin-off value of reducing Dad's exhaustion and stress levels (if he could be brought to accept it - which is unlikely); a less exhausted Dad might provide better care for Mum.

    Perhaps introducing a small dishwasher might improve the cleanliness of crockery and cutlery; I'm not sure it'd be used but at least we could try it.

    It's going to be impossible to do much more towards making the house easier for dementia care than it is. We can't do anything about the steep stairs and cramped loos.

    I really would appreciate any advice / information you can give.
     
  2. marionq

    marionq Registered User

    Apr 24, 2013
    5,848
    Female
    Scotland
    Would it be possible for them both to move into assisted care accommodation. I see many elderly couples where both need care so there must be something out there for them.
     
  3. AlsoConfused

    AlsoConfused Registered User

    Sep 17, 2010
    1,955
    There would be a huge number of disadvantages involved in any move they both make - I think the costs to Dad would be less than the costs of losing Mum's presence at home but I'm not 100% sure of that.

    Amongst other problems, Dad's neighbourly "support network" wouldn't be accessible after any move. The neighbours' help and social contact are important - they get Dad to many of his hospital appointments, have retrieved Mum on occasions when she's wandered and offer company.

    If anyone can provide any guide to Social Services thinking and probable actions I'd be grateful. I'd love to know how long we've probably got to try to negotiate a change in the care provided to Mum at home and what happens if we can't do this. I'm hoping to speak to Social Services next week but would prefer to be better informed before the conversation starts.
     
  4. meme

    meme Registered User

    Aug 29, 2011
    1,955
    Female
    London
    You have the upper hand re social services..for now...but I think you would be best staying in control and working with them .. use them to help you with extra carers visits coming in daily..keeping Mum and Dad together and at home and as independent as can be
     
  5. angelface

    angelface Registered User

    Oct 8, 2011
    1,086
    london
    I think you will have to work with SS as well,I suspect if conditions at home get bad enough,they can remove Mum into care.

    I also think your dad's reaction is quite common. Could you start off with a cleaner coming in once a week? Maybe be there for the first few visits to make sure it works well?

    Probabley you would have to be very inventive about reasons for the cleaner, ie you dont have enough time to help,and it upsets you,or whatever.
     
  6. angelface

    angelface Registered User

    Oct 8, 2011
    1,086
    london
    Just another thought here, I had 2 aunts who lived together,one with dementia. They had a lot of support from SS,although the caring aunt did not want any of it.

    One day a crisis occoured,auntie with dementia took a double dose of drugs (we think).she was removed into care the same day,without warning to the caring aunt.

    So sometimes there is not a process for removal,action at crisis is what happens. On the other hand,their SW was exceptional in support,sadly they are not all like that.
     
  7. AlsoConfused

    AlsoConfused Registered User

    Sep 17, 2010
    1,955
    Thanks for your replies.

    Us "children" couldn't agree more with the Social Services visitor, both about the unsatisfactory current situation at home and the range of options that might improve it. We'd happily work with them. We've already done our best over the last 2 years to ease the path towards making one or more of these solutions possible.

    The problem is that the key person in the care scenario (Dad) DOESN'T see things the way SS and the "children" do and will fight interfering outsiders and family members all the way if they try to force him. He won't realise he can't win until he's lost the last fight. The options that may eventually be forced on him if he doesn't co-operate could well be those he dislikes most.

    I take the point that a crisis may produce an immediate SS decision to act. I'm also aware SS don't want to ride rough-shod over anyone unless it's absolutely necessary for Mum and Dad's safety. What I don't know is how long we probably have to try to change things round; or what SS's chief concerns in this situation are likely to be.

    I don't want to talk to Mum and Dad's SS until I've got better information about their powers and likely actions. However, I might be able to get answers on these points from the local SS and I'll try to do that next week. Please wish me luck!

    Dad responds best to factual information about the limits of his negotiating options. He's no respecter of persons or of authorities. If Dad doesn't think SS can and will require action then we're left with trying (yet again) to persuade him the advantages of taking that action outweigh all the disadvantages of it. We've largely failed to date; I'm not optimistic about us succeeding in the future.
     
  8. Blogg

    Blogg Registered User

    Jul 24, 2014
    64
    That sounds really tricky. I suppose all you can try and do is try and help your Dad to understand. Would you Dad take the information better from someone else, GP possibly?
     
  9. AlsoConfused

    AlsoConfused Registered User

    Sep 17, 2010
    1,955
    Sadly, no.

    The GP's interpersonal and influencing skills are as good as they get - of all the professionals she has the best chance of getting Dad to listen. Dad's got great respect for her skills and commitment to her patients and he really likes her BUT all of that won't make any difference. Dad will politely ignore her opinions / suggestions (as he does everyone else's) if they don't suit.
     
  10. Not so Rosy

    Not so Rosy Registered User

    Nov 30, 2013
    580
    My Dad was hugely resistant to help as of course he thought there was nothing wrong with the way they were living at home ! He also doesn't respond to authority too well.

    With the help of a great GP, SS and CPN, carers became known as cleaners and they were coming in to help me as much as Mum and Dad. GP and SS sold it as I needed the help more than they did and it would make my life a bit easier and let me relax if I knew the cleaners were coming in each day to help. Dad was told the cleaners would pop up the road for his morning paper or any other bits and bobs each day just in case he didn't fancy going and they would sort out any washing up or loading the washing machine or even change light bulbs.

    Dad accepted the cleaners and the visits went up to four a day. Apart from when Dad started to wander thing went along pretty well.
     
  11. Rageddy Anne

    Rageddy Anne Registered User

    Feb 21, 2013
    5,990
    Cotswolds
    Is he secretly worried about the cost of carers? It might be that he would actually welcome some domestic help if it can be afforded. But if he thinks he can't afford it, that could explain his reluctance.
    Is there any free care through Social Services?
     
  12. AlsoConfused

    AlsoConfused Registered User

    Sep 17, 2010
    1,955
    Thanks Not So Rosy and RaggedyAnne.

    Yes, I think Dad is horrified by the costs of the care Mum already has (which he sees as exorbitantly expensive and a massive unwanted drain on family resources even though he recognises the help is essential and values the helpers' company and input). However, I doubt whether he'll be entitled to any free help (apart from the 2 hours respite / care allowance and the generalised care allowance) as I'm fairly sure Mum and Dad's income and / or savings disqualify them.

    It's at least arguable that the higher rate of care allowance should be paid but Dad doesn't want to ask for it, neither does he want anyone else to investigate the issue for him.

    Unusually, I think Dad would probably resent hiring cleaners more than hiring extra care for Mum. He sees it as his job to manage the house - so it's a tacit admission he's fallen down on his job because he can't see if he has to hire someone else to do it.

    I'm beginning to think there aren't any relatively pain-free solutions; and perhaps it's wasted effort trying for one.
     
  13. AlsoConfused

    AlsoConfused Registered User

    Sep 17, 2010
    1,955
    More mysteries - I spoke to different depts of Mum and Dad's Services for Older Adults and they say they haven't visited Mum and Dad recently. It must be an official visit (not a scam) because the GP spoke of it.

    Anyway - more importantly - us siblings have decided we'll have yet another go at talking to Dad in a forlorn attempt to sort out the problems. We fear ructions and expect failure but ...
     

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