Mum has dementia and refusing help

How are things going, OP?

If the only outcome from the previous assessment was a handrail then it sounds like an occupational therapy assessment not a social work assessment. Even if a social work assessment was completed then it can be done again if things have changed and your dad could also have a carers assessment just for him.

Even if your mum will be self funding her care (does she personally have over £24k in savings in her name or a high income - the house won't be taken be taken into account if your dad still lives in it?) then social services can still be involved if needed - they aren't just there to fund care homes they can assist with the practicalities as well in complex situation like this.

If your mum does go into care then she will be subject to a Deprivation of Liberty order (DoL) which will be applied for by the care home and agreed with the local authority and the court of protection if required. If your mum does require any of the mood calming medications then this will be agreed with the local older adults mental health team and included in the DoL.

When was she last reviewed by the Older Adults Mental Health team and are they aware of the aggression? Most sedating medications such as Lorazepam are only prescribed on an 'as needed' basis and are reviewed regularly, so it would only be given if she was having a particularly agitated day and your dad could/should discuss this with the mental health nurses in much the same way a care home would if she was with them.

Carers are specifically included in the legislation for Safeguarding because it's recognised how vulnerable their caring role leaves them to abuse from the person they care for and how few options they can feel they have to change the situation.

I regularly get involved in these kinds of situations where it no longer becomes manageable and the risks to the people involved if we don't intervene outweigh their right not to have state interference. These things rarely get better if left alone they usually get worse and end in a crisis admission to hospital / care homes/ mental health ward. The earlier professional are aware of the situation to try and help reduce the risks the better.

The current carers will also have a professional duty to report to adult social care if they witness or become aware of aggression towards your dad.

As previously said, it may be possible to provide medication for your mother which will make her more content and amenable. Care homes don't tend to like 'sedation' as such, because it can make the person more like to have falls.

My mother had carers from Home Instead when she was still at home and the manager was absolutely brilliant, whatever issue I called her with she would go the extra mile. So if you have not had a conversation with the manager it is worth doing so, she may well have helpful suggestions.

Re moving to a care home, I would not assume your mother will be distressed by the move. She may be initially, but it may actually work out very well for her. Quite often people who are distressed and anxious at home will settle once in a care home environment. It is easy to think the person is better off in their own home, but that isn't necessarily the case with later stage dementia.

As your parents pay privately for care, you do not need to involve social services. The first step would be to identify a few suitable care homes, and then make an appointment to go in and meet the manager and have a look around. The manager will then want to visit your mother to ensure they can meet her needs (refusal of personal care is a common problem so they will not be phased by that). Visiting care homes and meeting the staff should help to relieve some of your anxiety about the potential issues.

The right sedation for aggressive elderly dementia patients can make their lives much more bearable, OP.
The aggression is due to fear. Sedation calms fears down.

I'm not suggesting turning her into a zombie. But getting her calmer would make her happier and she'd be more cooperative, too.

TheShell
GPs do the SS referral

@unsync what a kind, understanding and gracious post. I f feel bad for jumping on you now
sorry!

@notanaturalmum @whatwouldyoudoifisangoutofkey Apologies I didn't mean for my post to be harsh. I've had one parent die from cancer and the remaining one has vascular dementia. I was trying to say, rather clumsily as it turns out, that sometimes one person's needs can be overlooked when the other person's needs are so acute.

It must be a terrible struggle for your father watching the people he cares for going through everything, whilst also facing his own mortality.

As unpaid carers, it is hard to know what to do for the best sometimes as we are often fighting fires on many fronts. The information and help we need to do so is more often than not spread out or unavailable. Again, apologies @notanaturalmum if my pp upset you, it was not my intention.

Agree with this. It is so difficult but needs to be sorted. Very similar happened with my mum (anger, refusing, screaming blue murder at the doctors, etc). Ultimately you have POA and you need to use it. She needs a Home environment now by the sound of it. We got my mum into one (no, it wasn’t easy to get her there but we insisted) and things improved immensely.

. If you won't put your mother in respite, how about giving him a break instead.
@unsync bit harsh, as you can see from safeguarding social workers post , putting someone into respite is not exactly an easy or straightforward process.
As indeed it shouldn't be .

If your mum is hitting your dad then adult social care would consider that a safeguarding issue for him as her carer.

Not getting appropriate care for her feet is also neglect even if its being done because you are afraid of the reaction from her and you don't want to upset her.

You are out of your depth and this needs professional help before someone gets hurt.

If you have LPOA for health you can make the decision that she needs to go into 24 hour care but you are going to need professional help to get her there as it may require ambulance/police/a mental health act assessment.

The local authority s.42 safeguarding process for your dad is will most likely to instigate getting all the right people involved to intervene in the current situation. Most local authorities have an online reporting form for safeguarding but if yours doesn't you should be able to ring them tomorrow to discuss it.

Have you just given her access to joggers, t-shirts, ie comfy clothing that can be worn day or night?

It sounds very stressful and it does seem like eventually she will need nursing home care

Sorry OP, I have just read your update. Do you have POA, if so what for? Does she have a social worker (I presume so if she has carers)? Has she ever had a mental capacity assessment?

Get social services involved and request a mental capacity assessment. She isn't able to recognise and address her own needs and welfare and needs an intervention. It's not acceptable to leave her to her own devices when she clearly lacks capacity.

Please think of your father too. It sounds like your mother no longer has capacity and needs specialist dementia care. Your father must be exhausted with all this going on. If you won't put your mother in respite, how about giving him a break instead.

My point is without consent you need to be looking at capacity, consent should also be your main concern. No private podiatrist will see her if she refuses.

@notanaturalmum passing on suggestion to check agencies by looking at
https://www.cqc.org.uk/.
But you may have thought of that already.

I’m so sorry to hear of your ongoing struggles.

This was our situation with my MIL who had advanced dementia but refused any help and a FIL with cancer (unbeknown to us at the time) who was struggling to cope. MIL wouldn’t wash, brush her teeth, wash her hair. And it got to the point that FIL let her sleep in her clothes and sleep in until 3pm every day (as it was easier).

When FIL suddenly died of cancer (he had hidden he was ill) - we were left to deal with MIL. We moved her in with us (as we live quite a distance away and run a business) and very quickly we realised it wasn’t sustainable. MIL refused any help or support which meat my DH (her son) was having to take her to the toilet, shower her - against her will.

After a few weeks (and no sleep or rest bite from the situation) we had no option but to find a care home. We were at breaking point.

We are extremely lucky in that our council (in Surrey) pay for the first month of care. My DH did have POA and although it was against MIL’s wishes he took her into the home for ‘a trial’ he told her. The day she went - there was tears, screaming, refusal but she did have to go in - we just couldn’t cope any longer and she wasn’t getting the care she needed.

Someone gave me some great advice - when the person has no idea of the effect they are having on you, then it is time for them to receive specialist care.

MIL has now been in the care home for 2 years and is absolutely in the best place. It’s a specialist dementia home and she receives fantastic care. The nurses take no prisoners and she is well looked after.

The best place for your mum is a care home. Your poor dad is living his life with a terminal cancer diagnosis looking after her - you will regret that he spent his last months looking after her rather than looking after himself.

Good luck 🤞

@notanaturalmum no experience of corum but they look good on the website.
This
https://lottie.org/home-care/
organistion has been suggested to us by a local London based dementia
specialist.

Yes, I DID THANKS! FFS, i am not suggesting the op make a referral. Never mind!

Have you read the OP?

There's no point making a referral for a patient who won't cooperate. If she won't let her daughter take off her sock, she won't let anyone else take it off.

Your advice only applies to a cooperative patient.

Irrelevant, i am answering the comment saying that podiatry or district nurses will look at it without referral and commenting on the process. Whether the patient will consent or not is not what i am concerned with.

None of that is going to happen because the OP's mother will become aggressive if someone tries to look at her foot.

This is a lady who doesn't wash or put clean clothes on because of her dementia.

She isn't going to cooperate with anyone taking off her sock.

Sorry but working in the healthcare industry i know you won’t get a visit from district nurse or nhs podiatry until there is an after care issue! Probably best getting a home visiting private pod/foothealth professional to deal with issue, if they cant they will then refer to nhs, then care from the above is offered IF it is needed.