help-friends parents living in squalor(17 Posts)
posting for a friend who cant cope any more-and I just don't know how to help her. her parents have always liked a drink, her mum has carried on in moderation but her dad has been drinking to excess several years and now has cirrhosis and alcoholic dementia. he has been sectioned for severe self neglect and malnutrition a few months ago but the psychiatrist said this week that he has capacity to choose and social services say they will get someone to do the cleaning, that's about it, but he sends everyone away. The GP arranged for them to visit but says he cant make him go into hospital. the house is filthy and he's incontinent everywhere as he just sits on the sofa as he's so weak and hasn't changed his clothes or washed for weeks. my friend cant face going round any more and her mum just sits saying she cannot cope, is there really nothing else any service can offer? I feel like telling her to call 999 but I know that's stupid. any advice appreciated!
I have read your post a few times
Maybe you should repost your question in AIBU section so that more people can offer you some advice
There must me ways that help can be provided for both of the parents
It is very difficult to get help for people that don't want it-SS can't force a standard of living on people that they deem capable of making their own decision about it.
Do they own their own home? Because if it is a council or HA property it is easier to get help because they may be breaking the terms of their tenancy.
If the house smells and has rodents and is affecting a neighbour they may complain to EH who can use statutory powers to clear out the house, no matter the ownership.
It sounds to me like the underlying issues need addressing in conjunction with the squalor. If they're not addressed the house will revert to squalor pretty quickly.
Your friend needs to get all the info together about her parents potential future options. Are they going to be able to continue to live independently for much longer? If not she needs to get everything researched for the next step.
it is very difficult and soul destroying.
I agree that it is very hard to enforce hygiene on adults who are not interested, and generally in cases of hoarding etc councils only get involved if there is a public health risk eg rodents. However it seems to me both parents fall into the category of "vulnerable adults" and there doesn't seem to be anything in place to safeguard them. The home is clearly not a safe, hygienic place and the only viable alternative, as they can't maintain it/ look after themselves/ let people in to help is for them to go into residential care. Sometimes the move is precipitated by a hospital admission. It's likely that sooner or later one of them will develop something requiring an admission. A plan might be to take photos of the home( looking as ghastly as possible) to have as evidence once they are in hospital. Use these in discussions with hospital social workers/ discharge nurses etc. Your friend needs to decide whether she wants to push to get her parents out of there, no matter their protests, or leave them to it. Either option has its downsides. t's an awful situation for her to be in.
I'm baffled that someone with alcoholic dementia who is sitting his own waste is deemed competent to make his own choices. If I was the DD I think I'd contact Age UK for advice. If her parents were able to care for themselves satisfactorily then this issue wouldn't be arising, but this couple clearly need someone in authority to make some big decisions for them.
Also - I suspect that he may have been sent home, because there aren't any other options and he's now 'bed-blocking' at a very busy time of year for hospitals. This is pretty common - someone reaches crisis and is admitted, then they're sorted out and sent home again. It sounds like he really needs residential care. Has your friend looked into that?
I agree Juneau however as capacity assessors are fond of repeating " people are free to make unwise decisions for themselves". If they are not too cognitively impaired, and understand the consequences of their decisions then people will often be left to go back to very unsatisfactory living conditions. In my experience the bar for capacity tends to be set fairly low. As the Dad has dementia though at some point he won't have capacity anymore and services will have to step in.
thanks for the replies, yes I should have posted it elsewhere, the dad has now been admitted to hospital after falling over and was confused when the ambulance came and he's stayed in mainly because he cant abscond as he cant walk at the moment.the hospital is doing "deprivation of liberty" assessment, not sure what it means but also the landlord had just served an eviction notice due to the disgusting filth.so its not a happy ending but at least things have moved on,not sure what would have happened otherwise
I'd assumed they were home owners, but in this situation it might actually be an advantage to be a tenant as he'll be made homeless and his council will need to treat him as a vulnerable adult and find suitable housing for him after he leaves home. That may well be a care home, which might come as a relief for his family.
The difficulty with people with alcohol problems is that very often after they sober up and have a period of being cared for in hospital their cognitive functions actually improve so that they do then have capacity and the law (mental capacity act) says that they then have to be allowed to make the unwise decision to drink themselves to death.
Even if they are deemed to lack capacity and get placed in a care home against their will the problems don't end there as many people are so determined to drink that they will leave the care home to buy alcohol (very hard for staff to stop them with no legal power) or pressure others to buy it in. I knew one lady so determined that she put an ad in the local paper and managed to employ an unscrupulous person to buy alcohol for her for payment. No care home will look after someone who is regularly drunk and they will give notice to evict. Not many care agencies will offer home care to someone who's regularly drunk either especially as they are often abusive to carers.
It might look as though no-one cares or does anything but the fact is that whilst a person chooses to carry on drinking there's not a lot that can be done. Even sectioning them into hospital isn't much of a solution as they usually just go straight back to square 1 after discharge. There is no legal power to stop them drinking and no practical way to enforce it either. My mental health team look after a number of elderly alcoholics who carry on barely surviving in squalid conditions but all we can do is check up on them and clean them/ the place up if things get too bad and if they even agree to that. They've all been offered support to quit many, many times and they all say that they choose to drink whatever the consequences.
A 'Deprivation of Liberty' assessment is a bit like being sectioned in that others can and do start making decisions for the person concerned, eg like taking them into a care home. So at least they are now in 'the system' now
A DOLS assessment is part of the Mental Capacity Act whereas sectioning is under the Mental Health Act. It's a very complicated unclear bit of law how these overlap (I'm an older people's psychiatrist and I barely understand it).
A DOLS assessment can only take place if the person is deemed to lack capacity to make their own decisions so currently at least that must have been determined to be the case. A DOLS assessment takes place if a person who lacks capacity is having care provided in their best interests that could constitute a deprivation of liberty e.g. They are admitted to hospital or to a care home against their will.
If he continues to lack capacity and it is considered to be in his best interests he might get transferred to a care home against his will. However if he regains capacity he could discharge himself and even if he lacks capacity but continues to object he would have a right to an advocate to help him appeal to the Court of Protection. These cases are increasing in recent years and my mental health trust has been taken to court a couple of times for trying to do what we thought was the right thing. It has made us more reluctant to intervene now.
I have been there with my mother, although not to quite the same extent. She was also an alcoholic and otherwise completely cogent, so had capacity, but was completely happy to live in squalor.
Whataboutbob gives good advice about the photos - that was what convinced the social workers that my mother could not go home. We never had to argue it with her, because she died in hospital, and that's apparently very common in these kinds of cases.
In terms of helping your friend to understand, these kinds of squalor seem to be associated with frontal lobe problems, and frontal lobe damage is often associated with alcoholism. Might be helpful to talk about this with the hospital, because if there is a clear diagnosis, they may be more willing to admit that he does not have capacity.
Thanks for giving us the service provider's perspective mamadoc. Alcoholism can be so nasty, I lost one aunt to it, the effect on my cousins has been profound.
Sorry you have been there chop. I think I remember when you posted. I hope things are easier for you now.
Thanks for remembering bob. Your advice about the photos was so helpful at the time, it really was.
You're very welcome chop, I'm glad i could help a little at a difficult time.
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