District nurse/elderly relative

[Eckhart]

My grandad fell, and has an open wound. It has been dressed by the district nurse, who was going to come back twice a week to re-dress it. I visited him on day 2 after it was dressed and it stank to high heaven. He said he'd told the nurse not to re-dress it for a week and she'd agreed.
We contacted the district nurse today to tell her about the smell. She went to see him and he told her in no uncertain terms to go away.
I fear that he will be gangrenous or get septicemia if it's left a week.
Does the district nurse have a duty of care, or is it ok for the NHS to just let a vulnerable old person rot alive because they say they don't want a dressing changing? He has full mental capacity. I have no idea why he's refusing. I've never known anyone so stubborn. I'm very worried about him.

@hatgirl It's useful to know that the safeguarding process would still not be able to do anything, even if they were involved. I just need to know I've done everything I can, really. That's a good suggestion re getting the carer involved when the nurse is there. It might help. I doubt she'd be able to move her schedule around if I asked her, but if the nurse does it might be different.
Thanks for your input. and insider knowledge.

@SpecLosers I WANT this to turn out the best for the stubborn person! I'm not trying to look after myself here - I want him to have appropriate care and as much independence as he can. If he dies because he chooses to, I'm ok with that. I'm not ok with him not realising what a problem something is, and it killing him because he didn't realise he needed help, and me not being the person to step in and let him know.
I just need to feel I've done everything I can for him.

Sorry skimmed the thread - phone the Gp?
Sounds like he'll need antibiotics which will need the gp, also gp will do an assessment of capacity (if s/he's allowed in)

It's really difficult if patients decline help. The nurse may have acted inappropriately but many are sent out with 20 patients a day to see, who might be very ill, many are newly qualified and they might've just assumed he's fine as that's what he's said.

See if you can speak to the Gp/ or a nurse triager on the phone.

Yes, @hattyhatshats, that's my concern really. I don't want anybody to get in trouble, I just want to make sure nobody's accidentally missed something important. I make mistakes all the time and I suspect I'd be more likely to do so if I was trying to deal with a sweary angry patient. Really I wouldn't blame anyone for poking him in the eye!

this does sound to me like it is his personality and it also sounds like he, like many elderly people I see, have decided they have been around too long and would welcome an illness that will finish them off. We had a similar patient who ignored a wound for a year and then needed a limb amputated as a result. The family had begged them to get it seen to but they refused. I think what people need to understand it's that unless someone has an underlying condition that makes them unable to act rationally, they, like you and me, can make unwise decisions about life for whatever reason they choose. As adults we can choose to eat too much, drink too much, have totally sex, smoke etc. This does not stop just because you get to 85 years but suddenly families feel they get to dictate because someone is old. OP, I know your heart is in the right place but you have done all you can and you have to let him decide. It is hard to see this happen, rather like having teenagers again!!

I think you've hit the nail on the head vdbfamily
It's me that's struggling about this, not him. As long as I've done everything I should, it's ok. The last thing I want him to feel is that he's lost his right to make his own decisions.

He wants to die and I support him in that, I just hope it isn't painful or involving time as an amputee first.

I hope he has let the nurse in and is happy with any plan they come up with. The carer can always.call an ambulance if she is worried his health is deteriorating.

i remember (as a student nurse wayyy back) the dn`s used to time some visits with the carers on purpose for patients like these or for example when the they were bedbathing or something and the wound was on the bum or something and the 2 carers could roll etc.

worked well.
I would find out if this carer with the magic touch (people do like 1 carer like your grandad quite often) can be there when dn comes. OR could the dn and carer work together? say can she take photo`s etc ???? be worth asking?

or can the carer talk grandad into seeing the dn?

@theweebleshavelanded I'll investigate your suggestions, thank you. Good ideas.

He needs admitting to hospital for his own good. Contact the GP and insist that he is admitted. There comes a point where others have to act in his best interests.

If he has capacity then he can’t be admitted against his wishes.

Agree with Alexa..... people talk about acting in someone's'Best Interests' but in healthcare this is a legal term and it is something you have to do if someone is deemed to lack capacity. If a person is just stubborn,determined,bad tempered,antisocial,etc etc and driving their family crazy with demands to do this and that, the family reserve the right to say enough is enough, I am not providing that care any more but they do not have the right to say, this is causing me too much stress and anxiety so you must go in a home.
There was an old lady, deemed to not have capacity, who was moved into a home and she fought the decision legally. The judge ruled in her favour and allowed her to go home unsafely. His summary was along the lines of....what is the point of keeping people fed and safe and alive in an environment where they are miserable...what are you achieving? If someone's dearest wish is to be at home and being there is risky but does not endanger anyone other than them, I personally would try and support that. I draw a line when they are endangering others though such as living in a block of flats and being a fire risk or wandering around in the middle of a road at night. Sometimes you have to protect others too.

Oh Gawd. I can imagine this happening with my Aunt. She is going down that road.....