Refusing a Care Assessment - any advice?

Hi @BlueLegume Just wondered how things were going?

@BlueLegume we have shared experiences on other threads, and apart from subtle differences much of your Cockroach Cafe stories sound like our M's read the same handbook.

I posted an update on my Narcisstic Mother thread yesterday which is probably worth reading. I am not going to pretend this gets easier. I thought I was doing really well after posting that original thread. Turns out I am not. We were in exactly the same position as your between September and the week before Christmas.

A few things to note:

Social services can't legally force someone into an assessment. You will need to wait for the crisis.

Agree with your sister now, how you want to handle any crisis and inform your brother. It is perfectly possible for all three of you to have different approaches. Also expect other people's views to change once you are in crisis (including your own). It is amazing how readily people accept the idea of caring, until it becomes a reality.

Expect pushback when you don't provide "perfect daughter" responses. This comes from family and the agencies and the pressure is excoriating.

Your M is going to be very vulnerable and it will be a side you haven't seen before. I am not sure how anyone balances the hurt of the past, with the compassion needed at this time. I am really struggling with this right now.

Crisis can happen very quickly and come out of the blue. I found the family members that should have been prepping for it, avoided the discussions as much as M had historically.

When it comes, it may be awful. Prepare yourself. Your list of "things that will trigger your concern" is good, but we found it really hard to discern what was just normal stuff vs not being well stuff. M is now in a position where everything is being treated as Dementia, but it probably isn't. For her sake I wish there was more nuance as some of her agitation is more likely MH than Dementia. But for me, it also feels like a whole new set of things to have gaslit back at me. "Well she was never like that before" "This behaviour is definitely Dementia (referring to her hoarding tendencies)." It is painful.

And keep posting. You are all keeping me sane right now. We can do the same for you.

Hmm. I think it's very difficult to figure out what's going on here.

My experience of ASW with my other relative is that they had quite a low bar in terms of making a reasonable attempt to contact someone. Is it possible they've come round when she was out or left a voicemail she doesn't know how to access?

Is there an element of "Look! You haven't been doing enough so social services have become involved, you better step up!" here, from her or your brother? Because if there is I'd be suspicious about this letter appearing shortly after you spoke to her.

From bitter experience of having a non-elderly relative with mental health problems, it is nigh on impossible to get the authorities to intervene until there's a crisis, and even then it's hard and quite often not the most helpful intervention. And it sounds like your mum is in a lot better form than my relative was.

I think your best bet is, unfortunately, to drop the rope and let that crisis happen. It's amazing how people can appear to be coping on the surface with even a small amount of propping up.

Are you sure she's definitely not eating? From what you've said your brother seems to have, well, maybe the word isn't "better", but a more enmeshed relationship. Could she be eating food from him but making a drama of not eating with you and your sister to get you back in line?

How did you find out about the referral? Did ASW contact you directly or did your mum and brother tell you?

The mum gave her daughter' a nervous breakdown

She's just pulling your strings.
It's the only control she has anymore.
I know someone like this - always had difficult personality.
Thinks she cut above the rest.
Always knows best.

So keep putting in boundaries
My friend, her daughter gave her a nervous breakdown.

Please don't let that happen to you.

@BlueLegume I’ve ‘followed’ you over from the other thread - Appalling Behaviour - and as you know, we have already compared our frighteningly similar experiences with narcissistic mothers.

I know your mother passed the mental capacity tests 18 months ago, but cognitive issues can creep up quite insidiously and surprisingly quickly. I know with my mother, her behaviour was always irrational, unpredictable and illogical, so when she started slipping into dementia, the signs were dismissed by myself as her usual nonsense. She was also very good at ‘hosting’ - able to just about hold it together for short periods when she needed to impress outsiders.

Alternatively, she may be so manipulative that she is prepared to refuse to eat, wash, dress and take medication knowing that you are a caring daughter with a duty of care, hoping it will force you into compliance and back into her orbit.

Or it could be a combination of both scenarios. My mother used to refuse to comply with her carers until I had been called and had suitably begged, grovelled and pleaded with her to follow the staff’s instructions. I think, even in her dementia, she still genuine enjoyed having that childlike power over me and knowing I was still being drawn into her dramas.

I can’t offer much practical help, apart from empathy and support, but I wonder (if possible!) she could somehow be reassessed? If she passes again, it’s tough but maybe she will have to be left until there’s a crisis.

You have my absolute and total sympathy. These individuals suck you emotionally dry and because we’re so programmed to be ‘good daughters’ it’s very, very hard to turn your back on anyone who appears to need our help.
xx

Her capacity will be assessed and if she lacks capacity then decisions will be made for her.

You need to withdraw and not help at all so social services see the true picture.

Ah, sorry to hear, sounds rubbish. Lots of posters going through similar on this board if you take a look at some of the long running threads. All I can really advise is set some reasonable boundaries for yourself of how much care and support you are prepared to provide (whether that's visiting once a week or calling once a day or whatever), communicate to your mother that this is what you are able to do, if she wants or needs more help you are ready to help her get that from social services or privately but if she doesn't want that you won't be able to do it yourself, then stick to it, hard core. Put your phone on do not disturb overnight or if you are unavailable if you need to (you can set it so that calls from your husband or siblings still get through), I know it seems harsh but in a genuine emergency if she can call you she can call an ambulance or whatever. It's helpful but not essential if your siblings can do the same, or at the very least present a united front to your mother that this is what's happening/ not guilt trip you with things like 'oh mum was so upset this morning, she said she'd been trying to call you all night and you weren't picking up'.

I know all this is easier said than done but if you can convince your mum that you really are only able to do so many hours a week and no more, that makes the conversation about outside help a bit easier, because you can approach it as a choice rather than you just refusing, as in 'yes Mum of course I can spend an hour sorting your garden out but that means I won't be able to take you out for coffee as well, which would you rather' or 'of course I don't mind helping you shower but I'll need to leave straight afterwards, if you let a carer help with this we could enjoy spending time together instead, it's up to you though'. Basically work smart within the hours you do have, it's so silly when I hear of elderly relatives of friends or family getting them to do things that could so easily be outsourced like shopping or lifts to places or even cooking, particularly where money is not even an issue - unless you live in the back of beyond taxis, online food shopping and takeaway/food delivery or high quality ready meal deliveries are easily organised, it's such a shame to waste precious family resource on these things.

I do think with these stubborn/manipulative people though it generally does have to get quite a bit worse before it gets better, you have to remember though that this isn't your fault, you've done everything you can with multiple offers of help and support, it was her choice to turn that down so the consequences are hers to live with. I'm not saying abandon her, just that you can easily run yourself into the ground with stress/exhaustion over these things, be strategic and keep yourself well so you can continue to support her the best you can.

Sorry to hear this - who made the referral for your Mum? How old is she - is it suspected/diagnosed dementia you think behind the self-neglect or something else? Do you have a POA for her? Why is she refusing access and does she acknowledge she needs some form of help or not?

Hard to say what next steps would be, essentially if she has legal capacity to make her own decisions she isn't compelled to accept help from the social worker or anyone else, even to the point where she compromises her own health and safety. Everyone is assumed to have capacity until there's evidence to the contrary. This doesn't mean BTW that legally speaking people refusing state help can compel their family members to provide the support instead, although of course emotionally speaking it's very difficult to see your family member going into a decline and refuse to help them at all - although in practical terms sometimes it takes a crisis to get the person (and sometimes the state) to accept the situation. If you think however she has lost capacity to make her own decisions then it's getting the evidence of this you need - would she see her GP? GPs will usually discreetly take into account an account from a family member of what's going on in the background for the person if you email it to them ahead of any appointment, obviously there still needs to be a separate diagnosis process which she would need to cooperate with. If she already has a diagnosis of dementia social services will usually be able to be a bit pushier (or you have more ability to intervene if you have a POA) - this still usually doesn't mean breaking down the front door and carting someone off to residential care forcibly but they will consider what is in her best interests and if there's evidence she's seriously a risk to herself or others this should be taken into account. In practice again I find what tends to happen is it takes a hospital admission as a result of a fall or UTI or other acute event to get any real movement on a truly recalcitrant care refuser though, unless the person changes their mind and accepts at least some level of help?