Care package wasn't enough

My brother thinks more of his job than anything else

He told me he had sorted poa then confessed he hadn't. It was too much

OP, by your own admission your brother has told you he's been struggling, and you've known this for a while. My mum is facing some major health issues but is still able and aware, and I'm still overwhelmed with everything. He's going to work and probably finds that a blessed relief - 8 hours out of 24 where he's not on-call to deal with a shadow of a man who used to be your dad, and the grimness of bodily fluids, the constant grind of food and drink prep, as well as looking after the home, with no partner that you've mentioned to offload on, and likely no social life.

The hospital should not discharge him if your brother cannot support him (he is not obliged to do so either), and support agencies need to step up.

It sounds like this is the 'crisis' I often read of on here, which is the final acknowledgement for the family that they, and their relative can't cope any more.

You are being harsh on your brother.

We didn’t realise just how much mil deteriorated during lockdown. In the end it was making fil ill (he was the one who ended up in hospital. Ambulances were called to mil and in the end fil refused to have her back as she needed more care than he could give, even with care packages.

Your brother has to put his job first.

If he is living there (& it was a genuine arrangement before you knew residential care would be needed, then they can’t sell the house).

We've been in a similar position last year.

My best advice would be to speak to the discharge team in his ward. Ask them what the plans are. If you don't have POA they should still listen to what you have to say.

There is usually a multi-disciplinary meeting before discharge.

If he's not coping with Carers the next step is usually a care-home.

You can speak to his SW (I called MILs very regularly. Find out what they will be suggesting happens to your DF and if it's a home you can say if you'd prefer one near to you or near to your DB, although you may not get either.

We started reading reports and reviews of local care homes when DMIL was still in Hospital so we had a good view of which ones would be suitable and more importantly, which ones wouldn't.

There's probably some paperwork involved, fit instance if he hasn't got it already you will probably have to apply for Attendance Allowance and maybe Pension Credit.

Are you able to go to his home and find details if his bank accounts, savings, NI Number etc?

My mum was in this position with my grandmother. She had dementia and had always refused to sign anything to give poa when she had capacity. In the end it was decided for her after she ended up in hospital with a broken hip. She was fully assessed and the doctors and social worker provided suppirt for my mum to be made deputy. She also had someone from the Office of the Public Guardian advising on what she could do and record keeping. When my Grandma went in to the home she had some funded care and then she built up a debt which was paid off when the deputy had been put in place and had control of the finances. Everyone involved from the NHS, Social Services and the OPG was very supportive and guided my mum through each step. They also took the lead on telling my Grandma she couldn't go home, which had been worrying her family as she'd always been adament she wouldn't go in a care home. Just take everything one step at a time and let the professionals guide you, without letting anyone push you or your brother to have him home if he won't be safe there. It's hard but you will come out the other side and have the relief of knowing you've done the best to keep your dad safe.

Yes, I think you need to stop blaming your brother. You are in for a rough ride now and you need each other so put that aside and just try to work together, guilt and blame don't help anyone. I know it's very, very hard to deal with things like this (I've been there). With regard to the POA, it can be quite difficult to get it all signed - you need independent witnesses etc - so it may have been difficult for your brother to sort this out during lockdown.

I know you feel that your brother is not doing enough but he does need to put boundaries in place for his own sake. Caring can be absolutely brutal and exhausting and the more your brother does, the less help you father will get as social services will see him as coping. He will not be able to sustain a full time job and full time care for someone whose health is sadly only likely to deteriorate.

Hi,
Don't declare/make your Dad homeless if it's your brother's house...it slows the whole process down as the legal paperwork is different. No-one will want to put your dad in the worng place......the hospital team cares too you know.....just good communication and stating facts will be enough and keep re-iterating when you get fed up that it's the third different OT/discharge person/etc it won't be their fault either.

Not sure the house will have to be sold immediately if it is also your brother's current home? In some local authorities at least, they get a valuation and then will wait until the house can be sold to claim "arrears" from the owner (or the owner's estate :( ) for their social care.

Whose house do they live in? That's the biggie. If it's your dads, your brother could find himself needing to find another home sharpish.
You and DB need to make it very clear to the social worker you will take no further part in his care. If they get a sniff of you plugging the gaps they'll be pushing to get him home. If it's your brothers home he can simply refuse to have him back which sounds dreadful but the current situation is not sustainable.
Agree with a pp, the wonders of modern medicine eh. Your poor dad.

Hi OP, I agree with other PP about not blaming your brother he was probably (like most) going through an array of emotions and with lockdown on top it would of been a tough time aswel. Have you tried calling adult social services yourself and explained the situation they seem to move things along a little faster that the hospital can. They can access if it’s in your father’s interest to put him into a care home or assisted living with 24hour care. Do you know if he has savings? I think if he has over £16k in savings he will need to pay until it drops below the £16k then he will be entitled to local council care. I’m really sorry you are going through this 💐

Dad may be more confused at the moment if he has got an infection, you said he couldn't wee so he could have been dehydrated or developed a UTI. The ward staff will assess his mental capacity once they feel he is ready, sometimes there is a delay if he is acutely confused. He will have a care diary, the nurses and therapists will assess his mobility, continence, eating and all the help they think he will need. They may keep a 72hr diary, including any behaviour concerns then probably arrange a best interests meeting which you or your brother can attend, dad can too if he is able to discuss the safest option for the future. If he needs 24hr residential care they will Carry out a financial assessment to see what he may need to pay for. It would be worth getting copies of his back statements, savings, pensions, benefits, a house valuation as the sw does this but it takes them forever. Does he own his house, if he goes into a carehome where will your brother live.

During the best interest meeting it may be agreed by everyone that he needs to be in a carehome, the courts dont get too involved in everyone is in agreement and can appoint someone as a deputy to act on his behalf.
The hospital,where at fault just sending him home, you need to make sure that is not allowed to happen again, you can contact PALS and make a complaint that it was an unsafe discharge.
I wouldnt get involved in looking for a carehome yet, wait until he has had the capacity assessment, you and your brother can refuse to take him home. I would let the hospital advise you of the next steps. I dont think your brother effed up, if dad has dementia then it may have been too late for poa anyway.

Stop blaming your brother! He's your dad too! You obviously just left him to it so perhaps put the blame closer to home!

You need to stop blaming your brother who has been doing most of the care up until now. Of course he needs to make sure he keeps his job. But it sounds like your Dad needs to be in residential care. It isnt really feasible he lives with your brother if your brother is out at work all day. Its a pretty poor show that you are the one who does the least and yet are highly critical of the other persons efforts Sadly this is too often the way in these situations.

I understand you have a small child and live far away so can’t be there, but I think you are being harsh on your brother.
He lives with him and sees him everyday, he can’t just quit his job and be his full time carer. Going to work might be his was of managing the situation and helping his own mental health. He doesn’t have the option of going home and relaxing from it.

He didn’t sort POA, but neither did you!

Do you think he, or your brother, may have suggested he had more help at home than in reality? You need to be involved in any meetings and especially an OT assessment. Is there a rehab programme in place? He may seem less lucid on hospital if he has any infections (uti is common), different medication, change of environment. Take him some familiar items and photos so he can take comfort and therapists can talk about it with him.

so sorry you are all going through this.

on the ward the mental capacity assessment will be done for preferred place of care . If (when) your DF is deemed not to have capacity for this decision a "best interests" decision will likely be made in the short term. Currently it is likely he would be listed for a short term bed to further evaluate his needs (short term is health care funded and may be for up to 8 weeks or so) you an your brother would be asked for input during this time. From here social services would get involved with finances and placement (or less likely a large package of care at home).
None of this will happen quickly and unfortunately given the state of health and social care over the whole country currently will be stressful and involve a lot of waiting PLUS possibly some pressure for Dad to go home just through shear desparation in the system.
Living with uncertainty will be very difficult I hope you and your brother can find ways to help and support one another and Dad through this.
It's easy to end up fighting one another because of the stress, and blaming for past problems but you don;t really need more stress from that.

all the best. I'm so sorry it's so hard to see your Dad reduced to this.

Don't panic, this happens all the time, hospitals and social care are used to managing it all.

As I understand it the hospital will be assessing him (joint responsibility with social services) to see what care he needs in the future, and your brother (and possibly you) should be included in those discussions as his carers. With no POA in place don't panic, they will make a 'best interests' decision for him and your brother (as main carer) and you should be consulted as part of that.

Listen out for anything to do with "MDT" (multidisciplinary team = social services, nurses, OT etc) who will all contribute to the decisions as to what happens next. Also listen out for "Discharge coordinator" or latch on to the social worker to keep tabs on what's happening.

The financial situation is a bit more complicated - if it's your father's house and he goes into residential care his home will be taken into account in the financial assessment and will probably have to be sold to pay for his care. Also does your brother have legal access to your father's money, or has it all been done on the nod?

You need to think about what is the best location for your dad to be to make it convenient for all.

Are you close, distance wise, to where your dad is?

You need to think about what home(s) you would consider for him, what location, and how the care would be funded.

Can someone on the dementia ward talk you through everything?

Its awful isnt it. We are all living longer and not in the best of health. In some cases (i.e my DF he is just existing in a care home.) No real quality of life yet we pride ourselves on keeping everyone going.

We do have POA for him thank goodness but he had capacity when it was done. Applying to the courts sadly when someone has lost capacity will take months and cost £££. Does he have money to pay for a care home? My DF was at risk and the GP sent in a urgent care referral but in the end I just couldnt wait and he moved into a care home funded by the sale of his house.

After 6 months some twit from social services called and had got the story all wrong about what had happened. NHS need to hang their heads in shame re this. They all started blaming each other and honestly I just told them to get their processes and policies joined up and put the phone down.

My DF is in a safer place now although it is costing tens of thousands of ££

In a different scenario with my mum, adult social care (through the hospital) were very good at sorting out what she needed.