Deprivation of Liberty dementia patient in Hospital

[Oldsu]

My friends DH is 60 and has early dementia, he is currently in hospital due to dehydration and bed sores and has been doing well, apparently due to his dementia and the fact that he is in a situation where he is scared - IE in hospital and not with his wife he 'apparently' attacked two nurses and drew blood.

They have taken him from the care of his wife and put a DOL on him.

He is NOT violent with her, its the situation he is in that may have caused him to lash out.

My friend is terrified that he will be taken away from her, she can cope with him at home whilst I appreciate that nurses need to be protected, he is a scared vulnerable ill man and surely he cant be penalised for that.

She has a meeting next week, but feel that she needs legal advise to ensure that the fact that its the environment that's has caused the issue not the fact he is dangerous and needs residential care.

What would be the next step for her to ensure her rights as well as his are ensured.

[madamy]

I was under the impression that a DOL was a way of formally being allowed to stop him leaving against his will thus protecting his safety eg the ward doors can be locked, he can be physically prevented from leaving. Nothing to do with his future care. They should have made this very clear. There is also IMCA who provide advocacy for patients who don't have the mental capacity to make decisions.

[SnuffleGruntSnorter]

I'm sorry your friend is having such a difficult time. I think there may be two different issues here.

Firstly it's unfortunately very common for people with dementia to become violent when they're frightened in an unusual situation. The hospital staff will know and understand that, sometimes DOLS has to be put in place to protect both patient and staff. This is not done lightly and is a lengthy process.

The second issue is the bed sores and dehydration and that brought him into hospital. It might be a sign that your friend and her husband need more help to ensure his physical needs are being met, for example helping him to get enough liquid intake and making sure that he is able to move/be moved enough to prevent bed sores. No one would have to live with bed sores if possible - they're painful and an infection risk.

So in these situations there is often a series of meetings involving families, healthcare professionals and social workers to try to work out the best way forwards for everyone. Its not that they want to split up your friend and her husband, they'll be trying to find ways to support them both to look after both their help.

This process is never easy and there's rarely a simple answer to make everyone happy. Dementia is a cruel illness. I hope you can be as supportive to your friend as possible.

[Oldsu]

Sootica my friend is in Yarm so any info on solicitors in that region would be helpful thank you

SnuffleGruntSnorter actually its even worse my friend had been trying for ages to get a GP or nurse out for the bed sores, because he is not mobile and cant get to the surgery, they gave him 5 appoints to go to the surgery and see the nurse, the last appoint was last Friday my friend went on her own and refused to leave until she got a home visit, the GP got him into hospital immediately as soon as he saw him.

I helped her do this as my dad is immobile and has a nurse for his bedsores, so I couldn't see why her surgery refused to get someone out to make an assessment

According to her the Hospital then made a complaint about the GP surgery.
So that's the problem he needed help and didn't get it and it was NOT my friends fault, she tried and tried, so if she is blamed for his state and that used against her for safeguarding reasons then its cruel and a travesty and would need to be fought.

I am trying to help all I can but I am in London, have given her a few links.

[SnuffleGruntSnorter]

This isn't about blame, I'm sorry if my post cane accross that way.

[Oldsu]

that's ok Snufffle it just that she herself is feeling so guilty about it, when I said he went to into hospital on a Friday it was the Friday before last, so has been in over a week she had been given me positive reports ( I live in London so its email and Skype for us) so something has gone wrong in the last couple of days.

[SnuffleGruntSnorter]

Perhaps the most helpful thing would be for your friend to ask to have a sit down conversation with one of the doctors in the hospital team, they can talk about the process and address your friends concerns. In my experience (professional and personal), proper communication between all parties is key, not talk of blame and solicitors.

[Oldsu]

There is meeting next week so hopefully there will be communication BUT she needs to have all the facts and her legal standing is going to be important not just her concerns but her rights as well as his and yes that's what she is going to look at, not to be difficult or obstructive but in reality the possibility of a married couple being separated after 40 years is a lot more important than just a 'concern' its a life changing dreadful possibility (for both of them) and the hospital and doctors would need to acknowledge that and if that means she has taken legal advise IMO the Hospital should accept that.

[Oldsu]

MODS I asked for this to be moved to dementia but am getting lots of advise under legal so can the thread stay where it is please

[Wolpertinger]

The hospital are legally obliged to raise a safeguarding concern if a vulnerable adult is admitted with pressure sores - so it is excellent practice that they have done so. Especially if the surgery was requested to visit 5 times and did not. It really sounds as if the hospital is on your friend's side here.

Equally if he is actively trying to leave the ward or displaying violence and needs to stay there because of his medical needs they are required to have a DOLS order legally to keep him there - so they are again displaying good knowledge of the law on Mental Capacity.

In terms of him future care, they are required to act in his best interests which would require asking his wife what she thinks his wishes would be and seeing what support is availble to meet them. It does sound as if your friend and her DH have not had the community support they need to keep him well and the meeting is about setting up a care package to help meet his needs when he gets home.

I haven't seen anyone need a solicitor in these circumstances and have dealt with many people with DOLS orders on wards.

[Oldsu]

Thank you Wolpertinger going to cut and paste your reply so she can read it

[Wolpertinger]

Oldsu has your friend had any help with her DH at home before this admission? If he is not mobile and has pressue sores and is getting dehydrated it sounds like he has early onset dementia but it is now reaching the late stages. If this is the case it would also be helpful for someone to tell your friend this and be realistic about what the future holds for her DH - for example trying to avoid future hospital admissions and focussing on his comfort.

I would suggest that she goes to the meeting with the attitude of 'I very much want to look after him at home and he loves being at home. As you can see he manages best in a familiar environment and has been very distressed in hospital which he has displayed by being aggressive which he does not do at home. But we have not had support in the community from GP, District Nurse, whoever.... I think help such as carers x times a day, would help what do you think?'

As she has got everyone there at the meeting she should also take the opportunity to ask questions about his prognosis (if she feels up to it) and whether this is the time to start focussing on his comfort and preferences ie avoiding coming into hospital and having much much better community support if he hates it so much and deteriorates there. Please ignore this last bit if he is usually a lot better and mobile - I'm extrapolating from your description and may have got completely the wrong end of the stick. However the meeting is a really good opportunity for your friend to ask the medical team questions about everything that is happening and getting dehydrated is a sign he is getting poorlier with his dementia.

[Oldsu]

Hi thank you so much, he has not had much support BTBH my friend has not helped herself, she hated the CPN (and so did her DH) so wont have in the house and one of the neighbours made a complaint about her house being dirty and that she left her DH alone (not true of course) but she had a social worker round to investigate ( he found no concerns BTW) so she has been wary of out side interference.

I told her yesterday that she will now have to accept there will be outsiders coming in and she has accepted that, but she needs to have assurance he will come home to her.

She will have her grown up DCS with her to support her at the meeting.

She is devastated and very scared its the end of her marriage, that's why I wasn't happy that another poster talked about addressing her 'concerns' that is an inappropriate word and belittles and diminishes what she is feeling right now.

TBH if that's the way a 'professional' sees her feelings as just a 'concern' then she needs to have a solicitor, I was actually appalled by the terminology used - seriously appalled, having been married 46 years if someone dismissed my feelings in a situation like that as just a concern I would be furious.

thank you again I will cut and paste your reply to her

[titchy]

Why is she thinking of this in terms of her marriage ending? Regardless of the eventual outcome, her marriage WON'T have ended. Long term he's likely to need to be cared for outside the home. But that doesn't mean the end of the marriage. This doesn't seem logical to me, and I wonder if that's clouding her viewpoint - as if strangers are forcing her to end her marriage when they're not, they're just wanting the same as her - the best care for her dh.

[Wolpertinger]

It sounds like a lot of miscommunication is going on. Please don't worry about the word 'concerns'. It does get used a lot by HCPs but really to mean exactly the same thing as 'worries'. It isn't meant to dismiss or diminish, very much the opposite.

Unfortunately your friend is going to need help to have her DH at home with her and it is good that you have convinced her that she will need to let professionals in the house to help her. If you can remind her of the good experience - Social Worker came round and agreed she was doing the right things - rather than the bad (CPN) so much the better. Besides which everyone is allowed to have personality clashes and not every HCP is great at their jobs. She may have met a bad apple the first time.

The more she can approach the meeting in the spirit that they all want the same thing ie to help her DH the best they can, the more she is going to get out of it. If she has positive ideas for how she could manage better at home for example with help from carers and the district nurses coming to help with pressure sores, or equipment to help his mobility that's also good. If she has a chat with the ward nurses she can get an idea of how much looking after they think he needs and what they think is realistic - would he be in bed all day? able to sit out in a chair? walk to the toilet? etc etc.

The GP issue also sounds like she and the surgery were at cross purposes and miscommunicating. In my mind it happened something like this. He had got more poorly and got a pressure sore and so she booked him to see the nurse. But she doesn't know that the practice nurse only sees patients that can make it to the surgery - the district nurse sees housebound patients. He misses more and more appointments. He gets more and more poorly. His pressure sore gets worse. She gets stressed. The surgery get irritated she is making appointments but don't help her out by asking why he isn't coming. Eventually there is a GP visit and the GP takes one look at him, all becomes clear and her poor DH is sent into hospital for a proper sort out.

I am hopeful that with proper support it will be a lot better after the meeting.

[Oldsu]

thanks Wolpertinger but I still firmly and utterly believe that the word concerns and even worries are totally inappropriate, HCPs may use the word but must be made aware of how it feels to be told that, it really is the wrong terminology and should be changed.

My friend 5 times asked for a HOME visit, 5 times she was told she couldn't have one and to take him to the surgery she tried and tried, the 4th time she managed to get him in the car and then he freaked out and nearly made her lose control of the car so she took him home.

It was only when she told me and I knew my dad had home visits for his pressure sores that she went to the last appointment on her own and kicked up a huge fuss. She honestly knows the difference between the two types of nurses,

She ordered an 'air bed' think that's what she said before the DOL was in place so had been making plans to improve things for him when he comes home.

Yes I agree titchy but she is scared right now and that's how she feels

[Oldsu]

Just been told that she has been to see him and he is sitting in a chair - he is doubly incontinent (wears pull ones) and it was while changing him a nurse got scratched twice, so she has been changing him herself when she can, that's what the trigger was poor man

[Wolpertinger]

I think we are going to have to agree to differ about the words worries and concerns

The issue about the surgery is bad. I think this is evidence where the hospital have your friend's back as they have complained on her behalf - they are clearly as disgusted as she is.

Just to explain further about the DOLS. They won't have got the DOLS yet as it takes bloody ages no way will they have got one in a weekend but they will need to have demonstrated that they have applied for one. The reason for the DOLS is that currently her DH doesn't have capacity to make his own decisions but clearly doesn't want to be in hospital. They have him under continuous supervision and if he tried to leave they would stop him. I suspect your friend would support this as although she does want him home in the long run, currently he is unwell and he needs medical treatment and a proper discharge plan to be able be looked after safely at home.

However as it stands the hospital could be accused of depriving a vulnerable adult of his liberty. They therefore have to apply for a Deprivation of Liberty Safeguards Order or DOLS for short. This means that their decision to stop him going home currently is monitored by the local Safeguarding Authority (I can't remember the proper term) to make sure they have good reason for doing so, is in his best interests and is done for the shortest possible time etc etc.

In practice in hospital it is a bloody tedious paper exercise to please CQC don't quote me on this, Social services are drowning in them and most people are discharged home happily before they are ever properly implemented which is no doubt what will happen to your friend's DH. But if CQC inspected the hospital tomorrow they would be able to wave their piece of paper to say his rights had been protected.

As you can see, absolutely none of this has any bearing on your friend's ability to look after him or wanting to keep him away from her or put him in a nursing home. It's a paper exercise the hospital has to do for legal reasons.

[Oldsu]

Oh thank you so much for the information Wolpertinger I am sure that will put her mind at rest, its a worrying time - I wish I could be there with her

[cecinestpasunepipe]

www.dementiauk.org/how-we-help/admiral-nursing-direct/
My late husband suffered from dementia, amongst other illnesses, and became violent when admitted to hospital with pneumonia, having to be restrained by security. He calmed down if I stayed the night in a chair by his bed, but obviously I could not do that every night.
Anyway, the point of this post is to point your friend in the direction of the Admiral Nurses who are run by Dementia UK, and provide the most amazing support and advocacy for carers.

[Wolpertinger]

Thats OK - if they actually got a DOLS her DH would actually have more legal protection than before. He would have at least 2 detailed assessments to consider whether being in hospital was correct, your friend would be consulted and the DOLS order would be reviewed at regular intervals to check it was still correct.

All they've done so far is follow correct procedure by applying for one.

Cecine makes an excellent point as well, has your friend had support from Dementia UK? She could also talk to the ward about strategies to manage him best while he is in hospital - some hospitals will allow families to stay overnight or do personal care if that calms the person but obviously your friend must be mindful that she doesn't get worn out too.

[Conflictedkate]

A Dols isn't a paper exercise to please CQQ...what an odd concept. It's actually a positive as will protect his rights. He may well be under one already as the hospital can authorise themselves to do this for 7 days as an urgent authorisation so doesn't take ages. The paperwork is standardised and again is not for cqc purposes.

Your friend needs to ensure she's down as the relevant persons representative which takes the role as an advocate in effect.

This does not mean he won't be going home. It simply means the hospital can lawfully keep him there for his care and treatment and his rights will be protected in the meantime. It is also not to be seen as a punishment or something they've done because he scratched nurses. They've probably (and quite appropriately) recognised this behaviour shows he's not that happy with the situation and taken steps to ensure he's protected, given he cannot consent to bring in hospital.

There's no need for solicitors as there nothing to suggest they're going to prevent him from going home.

[Wolpertinger]

Well I was being a bit cynical Every time we've applied for one after the 7 days are up we get an apologetic letter back from Social Services saying they are snowed under and can't meet the legal deadlines and could we kindly carry on as we are please. It's hard not to feel cynical in these circumstances as it hasn't really changed anything we do as we are still all putting the patient and their needs first.

[Oldsu]

Thank you everyone for your help I have passed everything on inc the admiral nurse link which could be a godsend for her

she is not on MN but will tell her how helpful everyone has been

[dunfightin]

Are you able to contact her DCs at all? Any emergency hospital admission when something's gone wrong is incredibly stressful for the family. For the staff it's all normal and they can sometimes fail to explain things fully as it's routine for them. Lots of information gets thrown in and making sense of it all and thinking through the options requires weighing up pros and cons, it's also useful for children to be able to talk things through with someone who is closer to their parents age. My DM's best friend was a fantastic help to chat to over the phone when decisions had to be made for her care. Also Age UK helpline can be fantastic.