is this wrong? Family and Care Workers views

[Anarchyinateacup]

Client F has severe disability in regards to movement and speech, but can understand and respond to yes or no questions. Client F gets PJs on but has been refusing to change out of this and into fresh nightwear at bedtime by shaking his head and responding no when asked if he wants fresh nightwear(usually no to the top half only) on. He is often extremely tired and is falling asleep as you are moving/handling.

Family want client Fs changed regardless of his wishes/mood etc. Of course I will carry this out but I feel very uncomfortable with it, employer has basically said tough its the family wishes, and I'm wondering what the views are from other families with loved ones receiving daily care? Should someone be forced to change an already clean top for another, just because they've had it on for a few hours, even though they are showing signs of refusal and are extremely tired and sometimes in pain.

I read enough on here about in rape cases that if someone says no or is unable to consent then it is assault.

What is the difference?

Nodding or shaking your head 'no' is a form of communication. And capacity can be varying, he may be able to make a decision about whether he wants to change his clothes but have difficulty with financial decisions for example.

Also even if his top was filthy he still has the right to refuse. Making unwise choices does not mean he lacks capacity if he understands the consequences. I'm sure you do anyway but you need to explain the repercussions of not changing his top and document every detail of his refusal. If he has a capacity assessment/DoLs every option should be explored how you made a decision regarding the situation and the decision needs to be the least restrictive and what's in his best interests not his families. Is it really worth the distress every night if he has clean clothes every morning? I would involve safeguarding in this also.

There may need to be a best interest meeting to decide, if it is deemed that his head nod / shakes are not capacitous. If he is not in a care setting (so living in family home) the DoLS will be completely irelevant, and even if he is in an institution then DoLS can only prevent him from leaving, not specify how often he's to change his pyjamas.

Thank you for the replies everyone. I am under the impression that next of kin think we are being lazy on visits at night, when in fact we are often left with the chaos of his default carers during the day, another matter entirely but in general F is very well cared for. I get the impression that he is fed up and frustrated with his circumstances as F wasn't always disabled, and sometimes that extra 2 minutes to change a top, which involves rolling/moving/handling can sometimes just bee too much for him.

I will speak to my employers about it but I doubt it will get far. I have reported and witnessed carers abuse clients, and they are still working. I'm trying to escape the company but it's difficult. 99% of the girls out in the field are fantastic, compassionate people who work themselves to death providing care at home, unfortunately there is the small percentage who ruin our reputation and are perhaps giving this clients family reason to suspect we are being lazy despite documenting evidence .

I can't give any informed advice OP but I did want to say how admirable it is that you think so seriously about the wishes of the person in your care and about his comfort above all.

Thank you Butterymuffin.

I never used to understand just how much I take for granted being able-bodied, like being able to scratch my nose or adjust an annoying piece of clothing. I like to make sure the little things that seem insignificant are looked out for, because some clients have a hard enough time as it is in life.

Op, I presume this isn't 24 hour care then?
Is it possible to make his visit earlier when he is less tired to get him changed as a compromise as it sounds like the visit is too late for him anyway (I accept there shouldn't have to be any compromise).

Deprivation of liberty or dols can only occur if a patient is unable to give consent because they are unable to comprehend what is happening.

If the patient is able to communicate and understand and chooses not to have an intervention that is their right. You - or the family- cannot take away that fundamental right to choose what happens to that patient. Even if you believe that decision is unwise, if the patient is capable of making it, it is their choice.

Eg old lady going home from hospital refuses nursing home. Cannot get to the toilet etc alone. Can only have 4 home care calls a day if goes to own home. Can understand the implications of her decision. Can retain the information. Can communicate her wishes. In no other persons view can this lady manage with this little support and decision is viewed as unwise and unsafe however lady is entitled to make this choice as she is deemed to have the capacity to understand the impact.

If the lady had an illness that made her unable to understand eg confusion caused by an acute urine infection then she would temporarily not have capacity. But if she were treated and got better then she would.

Agree with above posters regarding safeguarding input and MDT meetings to determine what is and isn't necessary and what the wishes of the patient are. If patient can respond to yes/no questions then it would be possible to determine consent for intervention.

If I couldn't move I wouldn't want anything forced upon me. Advocate for your patient and be his voice.

Well done for speaking our OP

I'm not answering your question I'm afraid OP, I just wanted to express my truly heartfelt gratitude for the work you and your colleagues do. My dFiL is in a very similar situation to your client F, his carers are utterly brilliant - and thank God for them, and for you x

We only do what any decent human being would and look out for those who need it!!

F lives alone at home, so has 4 visits per day. He has almost zero mobility, and nodding and shaking, and facial expressions are his only form of communication. I will have another read of care plan for more information before bringing it up with employers.

Roll on the day I can switch employer, although most care companies are equally atrocious pen pushers with no thought or common sense for us doing the "dirty work" in the community.

If this is care at home - DOLS won't apply as they only apply to people in care homes or hospitals. For people in their own home you must apply to the Court of Protection.

So you need to contact Social worker and safeguarding team to assess capacity to consent to personal care and they will help you in applying to COP and get guidelines on how to work with the gentleman.

I have done your job and it's horrible with situations like this.

I had an issue when doing night shifts, I was the senior carer in one unit and there was a team of carers and then a mirror of that in the other unit. By 6am, the other unit would have residents getting up, dressed, and sat in chairs. By 7.45am, all were asleep, dressed in chairs, normally soiled.
My residents, on the other hand, were checked and pads changed at 6am and out back to bed. They were then dressed and washed by night staff. If at 6am they asked to get up and dressed, I told my cares to do it, but on no occasion or under any circumstance should they suggest it. The residents liked sleeping in, and were tired. When I was questioned as to why they were all still lying in their beds, I told senior managers why. I was then told that the day staff do not have time to dr s and wash them all, so night staff are expected to get the majority washed and dressed before handover at 7.30/7.45am.
This really unsettled me. Two particular residents were dragged from their beds, and they lashed out at staff frequently. That level of distress was not right.
I reported to the care quality commission and social work register people in Scotland and then quit.

It should always, always be about the person who is being cared for. Not the staff, the family or the setting. Jesus Christ if someone tried to make me change my pjs after a pyjama day just to go to bed in clean ones I would do my nut! He is saying no, you know you are doing the right thing. Stick to your guns.

If you want to message me, go ahead. I can chat you through how I complained, and the issues I faced.

You know it's people like you that need to stay in the service. Real angels.