Mental capacity

[Namechangearooney]

I have namechanged for this (I feel the need to mention naice ham and cutted up pear but as I have no idea where they originate from, and have only ever seen them used in the context of validating identity, I shall refrain!)

My (78 year old) Step Dad has just been provisionally diagnosed with dementia, he also has a long term degenerative condition and my Mum, to the total detriment of her own health, has been caring for him for the past 10 years, intensively for the past 2 years.

He is currently in hospital (after a nasty fall)and we feel that enough is enough and she cannot and should not cope any more (continence issues, falls, he is becoming abusive verbally and threatening physically) we as a family feel he needs residential care, the nurses and social work team agree and can't believe she has coped for so long.

He is refusing and says he will pay for 24hr carers at home, the thought of this horrifies my Mum, we don't think it will work either as he is a '2 man job' at times, the house belongs to both of them jointly, his mental capacity is questionable (one minute he seems ratiional and lucid the next he is utterly confused and delusional) and he was assessed by the psychiatric team today where from what I can gather he has told them my Mum is trying to fleece him and get rid of him!

I really feel for him as he must be confused and frightened but I'm also worried that they will say he has the capacity to decide to come home and my mum will just be forced back into her caring role - or forced to live with a stranger caring for him 24hrs a day.

I know this is a long rambly post, just looking for a little perspective! Anyone have any ideas?

[stonecircle]

No real advice I'm afraid, but I didn't want to ignore. What an awful awful situation.

Has there been a 'best interests meeting' yet? This should take place before he is is discharged from hospital and is an opportunity for family and the patient (if it is felt they are able to participate) to discuss the best way forward with medical staff, social services etc

I've only ever attended one, for my mother whose care had previously fallen on my sister (I live a couple of hundred miles away and have a family and job so my ability to help is limited). Medical advice was that mum did not have the mental capacity to attend the meeting and take part in the decision-making process. I also made it very clear that my sister's health and wellbeing would suffer further if my mum was returned home with a care package.

Has anyone mentioned a best interests meeting yet? If your step dad is considered to have sufficient mental capacity then I don't believe he could be admitted to a care home without his consent.

[mamadoc]

In order to be judged to lack capacity a person must have

A disease of their mind or brain

AND Be unable to do one or more of the following

Understand
Retain
Weigh up
Communicate

Information relating to the decision

It is decision and time specific ie you could have capacity for some decisions and not others and you could possibly regain capacity eg if treated for an infection.

Just having dementia does not automatically make you incapacitous if it is mild

A person who has capacity has a right to make a unwise decision
A best interests meeting only happens after a person has been determined to lack capacity otherwise they are entitled to make their own decisions.

I am afraid that the fact that your dad is suggesting a possibly workable alternative ie 24 hr carer might mean he has capacity and is making a decision that the rest of the family feel is unwise but it is his right to live in his own home unless he does lack capacity and it is unsafe (not in his best interests).

If he denied that he had any care needs and was very unrealistic that would be a clearer case of incapacity as he would then be failing to understand and weigh up information.

Your mum can refuse to participate in his care but she can't prevent him having home care if that is what he wants and it can meet his needs.

24hr live in care is very expensive and he may not be able to afford it. You can get a live in carer plus extra 'double up' care calls but it costs mega bucks. If he is social services funded they may refuse to fund this level of care. There also needs to be a spare room for the carer to live in and room for equipment eg hoists so a large property is needed.

When arguing the case with medical professionals be sure to make it all about his needs not being met as they are not really able to consider your mums needs or wishes in this.

The medical team can do the capacity assessment but can ask the psychiatrists for a second opinion in difficult cases.

In order for him to go into care against his wishes he needs

1. To be assessed to lack capacity to make this decision
2. For all to agree (family and professionals) that this is in his best interests. The law (mental capacity act) requires that the 'least restrictive option' is chosen so if he can manage with home care that is the first choice

So you see it is not all that easy to move someone into care against their wishes. It might be possible but it might not even if it seems the best thing to everyone else.