Who has final say in this situation?

@Oldermum84 but it’s nit being provided “with no issue”

How is it selfish to not want to be put in a care home when care can be provided at home with no issue?

No one is saying the needs of someone at the end of their lives trump anyone else's. They are equally important. But you seem to feel the person at the end of their life shouldn't be listened to? You feel old people aren't important and should'nt have any say in how they receive support?!?

That makes sense.

In Scotland, we have legislation which sets out how people’s choice etc should be safeguarded in the event that they don’t have capacity. For example, their views should always be considered, any action taken should only be when there is a tangible benefit to the person which cannot be achieved without intervention etc. So essentially it’s recognised that the person doesn’t have the capacity to make a balanced decision, but also that they should be included in all decisions where possible. There is also guidance around “bad” decisions, and how people have to be free to make choices that others don’t agree with

This.

I hate these threads bashing SS because they don't do exactly what you want them to. SS often are standing up for the rights of people to make decisions about their own lives.

Yes her life isn't good, but it's not going to improve much in a care home. She'll still be cared for in bed but it won't be her bed and won't be her home. Maybe she feels safe where she is.

Yes it would be easier all round for mil to go into a care home but if she doesn't want to then so be it.

Many people live like this and don't have any family supporting. If the family don't want to provide the support any more then they shouldn't.

TBH there are situations where it is obvious the person lacks capacity for all decisions.

But often even very cognitively impaired people will have capacity to make some decisions for example what they want to eat/drink/wear, what they want on TV and so on.

And in some decisions reality just takes over - if the person lacks capacity to agree to a treatment, if they are going to be kicking and screaming all the way through it, you aren't going to do the treatment.

That’s interesting, thanks for explaining. That must make PoA a tricky thing to manage, if capacity has to be established each time a decision needs made. Obviously I can see the benefit for the individual, but goodness what a big grey area

Quite, @Sunnnybunny72

I’ve promised my dc I’ll never behave like that, and have put a very full welfare and financial POA in place, although I’m only in my fifties, so hopefully won’t be needed for a while, if ever!

Dreadful post. How selfish would you have to be to put your busy adult DC with jobs and families of their own through this indefinitely.
The wants of one person at the end of their life don't trump those of people in the prime of theirs.
Not what I'd want for my children.

No capacity doesn't roll out like that, it's specific to each decision.

And a long term move would generally be seen as a more serious decision than a catheter.

Sorry AnnaMagnani
my post may not have been clear.
Inserting/removal would be a medical process which requires capacity to consent. I would see that capacity to be low and use is a daily event. That if a GP/nurse form a belief that she has not got that level of capacity that rolls out to other decisions and results in a safeguarding concern.

@HobbyHorse30 in England under the Mental Capacity Act is decision specific. There's no certificate to say you lack capacity.

So a decision about care, the decision maker is the social worker if they are funding it. While a decision about medication would be the GP as they are prescribing it.

@AnSolas While a catheter is a medical device, having one in doesn't mean the MIL doesn't have capacity to decide about her care. The catheter is one decision (and quite possibly not even made by the GP but by a District Nurse or Continence Nurse) and social care is a completely different decision.

This.

it’s really hard, but the strain of the care along with all the driving is intolerable. Her poor choices can wreck her life, but not everyone else’s.

I feel for you all, I had this for years with my dad until it all ended very badly, because he just wouldn’t listen

What complete and utter rubbish.

Capacity is unrelated to care needs. A person can require 2:1 full time 24 hour care and still have capacity - one of my colleagues is quadriplegic and has a PA with him or on call 24 hours a day. While he might make the odd terrible decision (in my opinion) by not taking the advice of his technical team 😉, he is perfectly capable of managing a multi million pound project regardless of his physical care needs

AnnaMagnani
In this situation it isn't the GP's capacity assessment that counts.
The capacity assessment has to be by the decision maker and if social services are funding care, the decision maker is the social worker.
It's important for one of the brothers to be there for every meeting with the social worker so they can correct every time MIL starts talking convincingly about things that aren't true.

I would say that catheters are medical devices. If the GP has decided that she lacks medical capacity a social workers assessment would not be in a position override that part if her care?

Capacity is time and decision specific, not a straight yes or no.

I’m a bit confused here about the capacity element (though I’m in Scotland and maybe the law is different). Either your MiL has capacity or she doesn’t. If she doesn’t, the GP will have issued a Certificate of Incapacity, and if no PoA arrangements are sufficiently in place then a guardianship order is needed. If she does have capacity, then what the brothers have PoA for is irrelevant because they have no authority to exercise PoA whilst their mother still has capacity, does that make sense?

In my experience nothing happens until there is “an incident” which generally leads to the elderly person being hospitalised. At this point then it becomes clear to everyone that the elderly person is not safe at home and so sensible decisions can be made.

Unfortunately a number of people do not survive the incident and that can be very tragic. (Not least as their deaths are often painful, lonely and terrifying.)

There is a balance to be struck and, yes, the idea that my kids could force me out of my home because I’m a bit annoying is awful. But there may be a point where I am unable to risk assess any more and then my kids should be able to do that for me. I would like to stay in my home for as long as possible. But I don’t want to die alone in pain at the bottom of my stairs because I was unable to understand that I was too infirm to climb stairs any more. I like my house. But not that much.

In this situation it isn't the GP's capacity assessment that counts.

The capacity assessment has to be by the decision maker and if social services are funding care, the decision maker is the social worker.

It's important for one of the brothers to be there for every meeting with the social worker so they can correct every time MIL starts talking convincingly about things that aren't true.

If she has convinced the accessor she has capacity they will not force her to go into a home, she would need her rights curtailed through the court of protection, a deprivation of liberty order, to force her into a home. 4 visits a day is the full number of visits generally, and if needs require more then it's time to consider capacity

So this is a very important distinction between the two types of Power of Attorney.

With Financial - a capacitous donor can choose to activate the PoA and give control of their finances over to their Attorney. This is common if someone doesn't feel they have the mental "space" or accuity to take care of their own finances.

With Healthcare - it CANNOT be activated until the donor loses capacity. The decision-making process cannot be removed from the donor while they still have capacity to make decisions.

In this case, as your MIL has capacity, the only way forward is to discuss with her and attempt to calmly influence her into making more sensible decisions for her own health. It may help as she's known to the system to have a social worker present, who can help facilitate the conversation and also act as a lightening rod for any anger. This can really help as a person can release their anger at the "outsider" then listen more constructively to the family.

However if she won't change her mind, all you can do is wait for the crisis.....

Namechangean did you read the first post?
Do you think carer is going to take medical responsibility for someone when they have no medical qualification?

The GP may have concerns about the level of care that she needs. She is bed bound and doing no exercise with failing physical mobility and failing mental capacity.

You are foolish to assume that a GP pratice is unaware of the laws around social care and capacity. Because when it comes to capacity it the GPs opinion which counts.
And GPs or A&E end up dealing with situations created by SS failure.

What a nasty post. Of course people aren’t desperate for their loved ones to go into homes, they’re just worried sick about their loved ones. My mil used to cook things in her oven that shouldn’t be there (kettle once, the fumes were awful!). She would wander, get on buses. Then get lost. Neighbours were always on the phone worried about her. The care home sue went into was wonderful and she had seven happy years there. I don’t think she’d have lasted another two at home.

Ive been caring for my mother for five years. We’re just converting three rooms into a suite for her in the house we’re moving into. She’d prefer to stay at home, but her mobility and balance are dreadful (she has Parkinsonisms). The carers found her under her bed a fortnight ago, she’d fallen and couldn’t get up. My friend found her mother dead after a fall down the stairs, I don’t want to see my mum do similar. And I’m doing all her meals, personal care, shopping and washing. She literally just lies in bed alone all day. Her quality of life at her house has gone. Even with three or four carers a day I’d be worried about her. And quite frankly, I count too. I have practically given up my life for five years. We had carers, but they were poor generally and I still ended up doing everything. So it was easier to just take over.

But please don’t criticise people who are clearly worried and trying to get their parents a safer life, it’s horrible of you. Unlike you, I hope I don’t put other people through the mill when I need some looking after. I’m already looking at my house and planning what I might need in 20 years time (I’m mid 50s).

It’s a good job there are laws like the mental capacity act to protect peoples rights to make decisions for themselves cause it sounds like everyone here is happy to ship their loved ones off to care homes.

It only benefits the family if she goes in to a care home because you’re finding caring for her difficult. She is happy as she is. You can scale back the weekly visits to fortnightly. You don’t have to continue to support her if it’s too much. But unless there’s something you’ve not said I don’t see how she can’t be safe at home: she is in bed. She’s not up and about setting fire to stuff. So what if the oven breaks. You don’t have to take this on and it’s unfair to force someone in to a care home for your comfort.

I would rather live in my own home with some risk rather than be put in a care home and have all of my day to day decisions taken away from me.

Also GPs say everyone should go in to a care home but that’s not their remit, they don’t know the laws that social care work under so their opinion is pretty much irrelevant

@Richtea67

but the brothers do have finance so can administer all her bills, banking and so on - she is unable to do any of this herself.

i was going off the above - that the MIL no longer handles any of her financial affairs. And “the washing machine’s broken mum, I’m going to get a new one delivered” is quite different to seeking a DOL and getting her to agree to move to a care home.

there’s asking, then there’s asking. My FIL generally would be considered to have capacity to decide where he lives, but DH and SIL need to be able to make some unilateral decisions, while keeping him informed of what’s happening around the house and who’s paying for it.