What do I do if she won’t go to bed?

@Facecream24, good to hear she has been settled at night.

Re the DoLiC, it doesn’t affect the support that she receives, it’s a protective factor.
As social workers, we have to work within legal directives and if your Mum’s social worker has identified that one needs to be in place then they will apply for one under Best Interest as shown in the Mental Capacity Act.

I know there’s a lot to take in. It sounds as though the social worker is working to promote your Mum’s safety.

So the DoLS order is to legalise what you've just described. You might hear a lot of references to the "Acid Test" or the "Baroness Hale Acid Test". This is the legal definition of a loss of liberty relating to capacity (as opposed to criminality). Basically, a person is considered to be deprived of their liberty if:

1. They are subject to continuous supervision and control and
2. Are not free to leave

If those conditions are met, then a DoLS order (in a care home/hospital) or Court of Protection order (if at home) must be obtained for those arrangements to be legal.

In your mum's case, she's subject to supervision and control from her care team, who are restricting the activities she can do and monitoring her. She's also not free to leave the arrangement, as she does not have capacity to do so.

Therefore, to make the arrangement legal, her Social Worker will have to apply to the Court of Protection for a DoLS order. Otherwise, your mother could be seen to be living in a situation of unlawful imprisonment.

There are some good resources on the SCIE website (google SCIE DOLS) that might help explain it with examples.

Does that help at all?

Really not adding to advise already given just to say, to not be available after 9pm. If you do it once you will do it everytime. Sounds awful saying this. Its your mum and you love her dearly. But they will just say you need to deal with it if they know you can. Sorry to sound like a bitch, know this from personal experience

Hope you don’t mind me answering your last post. There is a Deprivation of Liberty in the Community (DoLiC)

This is applied for, and granted by the Court of Protection, when a person lacks capacity out of respect of their care and support needs when living in the community.

They still need to meet the three stage test-

Is the person under continuous or complete supervision and control by carers/staff?
This can include restrictions on movement, monitoring, or needing permission for day-to-day activities.

Would the person be prevented (physically or through arrangements) from leaving if they tried?

Does the person lack capacity to consent to those arrangements, or are they unable to give real consent?

The continuous supervision can include use of cameras to observe when a person is not physically present.

A DoLiC does not give the police or other people power to return the person. But they can intervene under their general powers — for example, if there’s an immediate risk of harm, or under the Mental Capacity Act s.5 (protection from liability) if acting in the person’s best interests.

If using the kitchen is the main concern then I would simply turn off the kitchen appliances at night obviously with the exception of the fridge. Have a master switch installed if necessary. That way she will not be able to do anything unsafe overnight. I’m a client I had years ago they did this. They had a lockbox fitted over the switch so only those with the code could switch the kitchen power on.

We looked into a live-in carer for an aunt of dh, and TBH it would have worked out more expensive than a reasonable care home, plus you have all the expenses of running a home on top. The aunt (no dementia) would have needed help to some extent at night (needing the loo) which would have meant more than one on shifts.

She did eventually move to a care home.

What makes her more unsafe during the day than at night? Why does the carer need to put her to bed? Does she need physical assistance to get into bed?

I am a self employed carer and have clients who I attend to in the evenings. I don’t put any of them to bed as such. I assist them to get ready for bed but they then sometimes stay up and watch the tv or whatever and take themselves off when they are ready. If she is so high risk during the day that she needs constant supervision then she won’t suddenly be ok to be left completely alone overnight.
If she is at risk of absconding then I would install ring doorbells on all exits with motion detectors turned on after the carers leave to notify you that she has left. I would also get her one of the fall alarms with gps location switched on.
If she is at high risk of falling and that’s why she needs to be in bed then I would set her room up with a tv etc so she has entertainment once she is in bed if she is not asleep. But there will still be a risk of her falling if she needs the bathroom during the night.

Is it an Enduring Power of Attorney you have @Facecream24, thus the lack of Health & Welfare LPoA?

Just to flag to other readers, if you/your parents have an EPA, there is no health provision in it, so you need to do a H&W LPA too now (subject to capacity). The EPA cannot be administered digitally, so you cannot create the code to provide digital access. You will need to have certified copies. Always ask for these back and lodge the original with your solicitor.

@Musicaltheatremum Thanks for the reminder, this was not an option when I had to do this for my mother. But do all institutions accept this method now? My OH registered POA for MIL three years ago and it was patchy, MIL had money various banks and some accepted a code, but some still insisted on seeing a paper copy.

In England you create a code on line. You first create an account for yourself and then you add the poa to this account.
If you type in "using a poa " into Google it will bring up the relevant gov.uk page and this talks you through it.

If the poa is registered then there will be a number and a code(different from above)on the letter that was sent to you. The code may have expired but you can generate a new one through the account you create and they'll send you a new code very quickly.
I used my poa for my father with Barclays and they didn't need the certified copy as everything on it is on the electronic copy which they access with the code you generate for them through the post account. .

It’s difficult. There’s no doubt that people with brain injury/cognitive impairment often do much better in their own homes - they’re not wrong about that. And sitting in hospital because something might go wrong gets shot down fast. I hope she gets into a routine ok.

YY to a prepaid card for her. Huge risks of her being exploited with a debit card of her own.

As said above, if you already have the POA you do now need to enact it. I took mine into my local branch of my mother's bank. I made an appointment to see a member of staff who knew about POAs so it was straightforward and she was very helpful, helped me set up online banking.

They will issue you with a new cheque book/card which will say something like 'POA for (mother)'. They asked if I still wanted her to have her own card too and I said yes.

NEVER let the POA out of your hands. You need to get certified copies made if you need to send it anywhere.

I know what you mean about it feeling 'wrong', I did not want to delve into my mother's finances, but that is what the POA is for. I did it for a long time so got used to it.

Do you have a Finance PoA already in place and signed off?

Assuming yes, the way it (should) works is you send off a copy and evidence of the loss of capacity (the Social Worker should have done a formal report confirming this) to the bank. They will then cancel all cards, etc and re-issue them to you, as well as providing you with online banking access. You can then make arrangements as you see necessary - you shouldn't really give your mum a card with free access to the account if she's not capable of making decisions about the money, it puts her at risk. If she needs a card, you can look at a prepayment card, which you'd load up with a certain amount. This gives her access to funds while reducing the risk.

A capacity assessment is decision specific. So a person can lack capacity regarding care and support needs and risk, but have capacity regarding finances.
If there is no POA for finances already in loaded and your Mum lacks capacity re finances, a POA cannot be granted. It would need to be a court appointed financial deputy ship.
This process is lengthy and expensive.

It’s not clear from your post if the bank
account had already need frozen. If it hasn’t, then can you support her with her finances?

I'm sorry to hear about your mum.

I suspect this 'care package' will fall apart pretty quickly. It is unsustainable as she is not safe to be left alone, and yet the plan includes her being left alone for a considerable part of the day.

Do not offer any support for this care package, if it doesn't work without your input, it doesn't work full stop. So if you do get a phone call, say you are unable to help. They will have to reassess the situation which will probably mean moving her to residential care.

Obviously the care package has a time on it (9pm) as the worker has to go home! But the care package says they need to make sure she’s in bed before they leave - she’s stubborn and grumpy with the situation as it is - what if she just refuses to go to bed?

If the carer is good, they won't be able to go home until the objectives have been achieved. Their company will have to pay them for the time they've worked. Their company will be onto social services about a) getting the care hours increased because it's taking ages to get her to go to bed or b) refusing to support her saying she's too difficult for the service they provide and so they can't accommodate her needs. Eventually, social services will cave and re-assess her, putting her into residential care.

If the carer is less good, they'll start putting her to bed at 6pm or something stupid to account for the 3hrs it occasionally takes to get her into bed, then if she's asleep at 7pm they'll be skiving off home early. If social services find out they won't care, except perhaps to say that since she's usually asleep by 7pm they'll make that the new ending time for the carer.

If they're bad, when she's found the next morning having had an accident at home or picked up by the police for wandering the streets at night, they'll lie about her being in bed asleep when they left. Social services will eventually cave and re-assess her putting her into residential care.

If you start getting involved to pick up the slack, you'll end up in an early grave yourself and social services won't GAF or do anything about your mum's care to prevent that.

I am a social worker and I just wanted to say even though she is subjected to a DoLS authorisation in the rehab centre does not mean they should not look at supporting her back home with a care package and tech as a least restrictive option. I would perhaps check if an OT assessment within her home is going to be completed to give them more evidence of her ability to live independently. I would also ask if they are going to complete a COPDoL in her own home as she will still meet the Lady Hale's acid test.

I'm in a very similar situation, and quite surprised that people are surprised that this is what's been agreed. The approach I'm taking? Say a little prayer to whatever gods have kept my relative safe through all the other times she's made terrible decisions and put herself at risk. Then hope that if there is a crisis, the carers can deal with it in the morning. Oh and expecting that the inevitable crisis will cause Social Services to have a rethink....

It sounds harsh, but it's the only way I can deal with a situation which is completely outside my control....