Who decides what care we need

[Daffydill2016]

I will try to keep this brief.
Grand father moved into care home last year with dementia. Social services opened a case, then closed it without giving us any real help. Grandparents have enough money to pay for care and didn't qualify for anything from ss. My aunt was distraught to do this as she felt she had failed him (neither grandparent ever wanted to go into care, but neither was coping at home together).
Grandmother has been admitted to hospital this week following a serious fall and confusion, has an infection which is now being treated. Aunt doesn't want her to go into a care home after the hospital discharge, but my mum and I (who live 50 miles away) think this would be for the best (mum found her following the fall, we don't know how long she had been lying there but probably a few hours). Aunt isn't coping with the stress, but can't see she isn't.
In mine and mums ideal world, we would move both in to the same care home, sell the house and know that they were both being looked after. But my aunt has different ideas. my gran has a Monday to Friday 8-5 carer but she fell at night, so this was no good to her. We can't afford 24 hour care at home for her. Does my aunt have more right to dictate the care arrangements because she is there. Can/will the hospital discharge a patient to this care arrangement or will they want more in place? Also my aunt is known to lie, if she told the hospital more was in place, would they check?
Really what I want to know is, who makes the descion if the patients family can't decide (only 2 siblings)? Does one have the authority to trump the other because they are more local/older/some other reason.
It's a bad enough situaiton without a family battle going on about what to do. Any advice would be greatly received.

[Daffydill2016]

Sorry, should also have added, we have been thinking grandmother should be moved to a care home prior to the hospital admission, she seemed to be declining at the end of last year, but aunt couldn't see it at all. She is quite frail and is waiting for an appointment to come through for a dementia (although mild) assesment.

[Parietal]

I'm not sure of the legal position, but I doubt the hospital will adjudicate between relatives. they will probably want to go for the quickest and simplest discharge they can without many checks.

someone in legal might be able to give advice - I think there is a way to have a legal guardian appointed to look out for grandmother's interests.

but if you can persuade the aunt to agree with your point of view, that would be much better & cheaper than a battle. Is there anything you can do to persuade your aunt, maybe point out that both grandparents want to be together even if not at home? Also, can grandmother express an opinion? her feelings matter too.

[Twittwattwoo2]

If neither daughter have Power of Attorney and your Grandmother is able to make decisions herself then she can decide what she wants to do. The hospital could discharge her home if they are happy that the current care arrangement is adequate.

Has she been allocated a social worker? If so you need to ring them and explain the situation. If she would be self funding then there would not need to be an assessment for residential care but a social worker could provide help and advice in choosing a home.

If your grandmother does want to return home has she got a care alarm and key safe in place? Could an evening carer visit be arranged?

[Daffydill2016]

Hi, thanks for replying. It's good to have shared the problem.
Gran flits between wanting to stay at home and going into care. She worries about who would look after the house if no one lived in it and she won't comprehend selling it.
Both sisters have poa. No social worker as yet. If a care home were needed she would go with her dh. They do miss each other terribly atm.
She won't wear her life line button and wasn't wearing it when she fell. She doesn't understand why it's necessary. There is a key safe but we were met with a lot of resistance about installing it as she doesn't understand its importance and the need for it in an emergency.
You are right that persuading would be easier than a battle....

[florentina1]

As your gran is self funding she can make her own decision about which type of care she needs.

Could you suggest to her that she goes into the home where her OH is for some respite care. She may like it there, if not she can go home and try something else.

the PoA can only be used once she has lost the ability to make decision .LA will only become involved if your Nan is deemed a vulnerable adult. That means a very serious danger to herself or others.

Your next step is to contact the hospital social worker. As an impartial person she is best place to negotiate between your mum and your aunt.

[florentina1]

Also ask for an OT assessment before your Nan is discharged.

[Daffydill2016]

Thank you florentina, I think it does need someone impartial to advise what we should be doing. Moving grandad was had and we made the wrong descion for about a week, he came out of hospital to home and fell again. Family then had to cover the night shifts for a week till my aunt was ready for him to go to the home. There is no option of someone staying with my gran over night now, it's unfeasible for my mum and I to do this again, so need to make the descion now so things are in place.
I will try and get some information about the hospital social worker. I'm guessing the ward sister would havethat information?

[FlossieTurner]

You just phone the hospital and you should be able to go straight through to the social worker. No need to go through the ward.

OTs and Social Workers involved in my mums care were very good. Their priority is your Nan, they will check her skills, physical and mental. They will also talk to your Aunt and help her to see that, in the short term, your Nan needs just a bit of extra care. I think the first six weeks after hospital release is free.

When my mum went into care, she had regular physio to try to help her remobolise. This is much easier to do in a care home, and the staff will help her to do the exercises regularly and in a safe environment.

It might be that your aunt thinks that putting her in a home is equivalent of abandoning her. My mum was much healthier and happier in the home. Someone to supervise her meds and meals. Company of others, plus having her hair done and her nails painted! gave her a new lease of life.

I am so sorry you are going through this.

[Twittwattwoo2]

The ward staff can refer your grandmother to the hospital social work team, they will visit your grandmother on the ward to discuss her care needs and can arrange for an OT assessment, you can request to be present. Your grandmother does not have to be a vulnerable adult to have a social worker allocated. If self funding she does not have to have an assessment for res care but if you are unsure if she will be willing to go into res care a full assessment would be helpful to see what care and support is available.

If the POA is not a lasting poa it might be worth looking into if you think your gm possibly has dementia.

It sounds like a good idea to try and persuade your aunt to agree to your grandmother going into your grandfather's residential home for respite (if they have availability).