Is it me or are social services being unreasonable?

[Rogersgal7]

Hi I have been lurking around and not posted until now, just wondered if anyone else has had a similar experience and what they have done.

My nan is in hospital as a result of a fall (this is the 2nd time she has been hospitalised for this in the last 18 months). First time she was discharged home with a package of care from S.S where a carer visited twice a day. She was able to live quite independently then.

This time however she has deteriorated and the GP has advised she has dementia. She has been acting quite strange when we visit her in hospital , hiding her food and saying that she will make us a cup of tea. She also gets confused about where she will sleep that night and worries that there are people trying to get in her bed at night.

I understand that a lot of how she presents is typical of dementia however social services now want her to be discharged home (she lives alone) with someone who will visit her twice a day. My problem with this is that she is not safe on her own she has full support in hospital and at times she even forgets to use her walking frame and is a high falls risk. It also concerns me that last time she was sent home there were times when her carers didn't turn up so she would be left alone.

I visit her 3 times a week and working full time (as does my mum) we cannot be there as often as we would like. It also doesn't help that she is telling all of the hospital staff and social services that she wants to go home , she doesn't understand the implications of what this means and without sounding mean she probably doesn't know what her home looks like.

I just want what is best for her and feel that S.S do not understand the full extent of how dangerous her living alone could be. I would love nothing more than her being in her own home with 24 hour care but this wouldn't happen.

If you have managed to stay with me through this post , thank you and does anyone have any advice as to how I can support my nan or where to go next as I feel I have hit a wall with S.S. I understand that S.S are doing their job in trying to support people at home as long as they can however I believe if she went home they would have a safeguarding issue on their hands as I am sure she would forget to lock her doors or forget to eat/drink . With some of her behaviours I am worried what she would do when alone at home. She is also in a large 3 bed council house and has little income so wouldn't be able to fund all of her care herself if she went into a care home. I feel so stuck and let down by the system.

Hi OP. How's old is your nan?

I have similar experience when my nan was early 70s she had a few falls (broke the same hip 3 times in 2 years).

She eventually got the same as your nan a few hours a day wih a carer, unfortunately she also had early set dementia and her limited mobility decreased further.

Eventually she had to go into a care home, she has 3 daughter and lots of grandkids so is never short of visitors.

How do you feel your nan would adjust to being in a care home?

To be fair, mine struggles suffers from depression but this is relieved with regular visitors and trips out.

So no real advice but please don't feel guilty if a care home is the only option to keep her safe. My own nan raised me as a baby so I felt awful hat I couldn't care for her independently but work and such is life.

Think of you op

Sorry your nan is so poorly it must be a very stressful time for you all

If she went into residential care she'd have support 24 hrs a day, I don't know how funding works if she has little income but it must be possible

Hopefully someone with more knowledge about the finances of residential care will come along soon and be able to help

If she's confused, you could argue she doesn't have capacity to make the decision.

spidey66

It needs to be assumed she has full capacity before any decisions can be made for her.

It's not a case of she's confused therfore incapable of making her own decisions.

Human rights and all.

Such a tough situation. Has your Name had an OT assessment and a capacity assessment? In our hospital discharge has to be signed off by an OT, who should look at all the issues you've raised. SS don't get to decide what's needed, just what level of support they can provide.

Thank you for your kind words, she is 90 and we have suggested to S.S that she would be safer in a home, but they are not listening to us and want to send her home (because she has said this is what she wants).

I think S.S are looking for the cheapest option first and make me feel like I want to put her in a home and forget about her which is so far from the truth.

I might have to phone CAB on Monday.

Your nan is an adult who is able to make her own decisions, even if they are ones that perhaps put her at risk. Until she has been deemed as lacking in capacity to make her own decisions then your nan cannot be discharged to a care home.

You might find that when she is home she perks up, often being in hospital adds to confusion.

Your nan may well end up in a care home but does she not deserve the chance to go home and try to live independently for a little bit longer?

thanks unconsidered - I know she hasn't had an OT assessment I will check if the cap assmt has been done.

We are looking for social care funding for my Mum, who also has dementia. She has little income and her savings are below the 14,000 threshold ( nor does she own a house) So in theory she is entitled to social care finding to cover the costs of residential care. In practice, we can't find a home that doesn't demand a top up to bridge the gap between what social care will pay and what there fees are set. The top up required is around £200 a week for homes in this area. The rules state that this top up must come from a third party-ie either my dad ( who only has his pension) or me.

We are still looking!

Can a GP diagnose dementia? I know when my dad worked in that area that certainly wasn't the case. At 90 it would be expected that there will be some level of natural deterioration anyway but that won't necessarily mean she can't live independently with the correct support in place.

2 falls in 18 months again isn't unusual at 90.

Ensuring a full OT assessment is done before discharge is fair enough but if she wants to go home and there is little medical evidence at this point to suggest she isn't capable then there is limited else you can do.

A colleague of mine had a similar experience with her mum. The mum was in and out of hospital due to falls, was incontinent and unable to do anything for herself really but the most SS ever offered was two visits per day. I was really shocked that they would not agree to fund a care home for her, they insisted she was capable of living independently when she really needed looking after full time.

Have the hospital checked that your Nan has not got a water infection? That makes confusion much worse.

Funding is sorted about between Health and Social Services.
The one side is always trying to get the other to take the responsibility.

Your Nan has to meet the criteria for continuing care and needs to have high medical needs for that.

I am sorry its so hard.

You say the GP has 'advised' she has dementia? Does she have a diagnosis?

She is also entitled to a full assessment. Request one of these.

Agree it's possible she may be better at home in familiar circumstances than in hospital. Get her home and get her assessed.

In my experience social services push to keep the elderly at home for as long as they can and in my personal experience that's sometimes too long.

I would request an ot assessment before she's discharged and see what services social services can offer to keep your nan as safe as possible at home e.g mobility aids, lifeline etc.

I feel for you it's a very difficult situation

I work for the NHS and have dealt with similar situations. I would ask the nursing staff for behavioural charts including what they help her with, I.e feeding, washing and dressing and include night time needs! Then ask to meet with the social worker to discuss the findings or have an MDT meeting on the ward. The weekend will be a good time for the staff to complete charts for a few days too.

Has a capacity assessment been carried out?

Thanks for all of your posts, perhaps I was unrealistic in thinking that she would go somewhere else after hospital. It sounds like there are many people living alone with concerned relatives trying to do what they feel is best. The system seems a real minefield to navigate and trying to balance a best interest decision with her human rights is such a headache

The problem is that the system is so under resourced at the moment there is a backlog of assessments needing to be done in some areas and they just don't have the manpower.
My mum has stage 5 Alzheimer's and lives at home with support from a carer (which we have to pay for privately) she was diagnosed through the hospital after a refferal from the GP but that took quite a long time to sort out (9mths) and although she got the official diagnosis in feb we are still trying to sort out assessments.
You may find that they don't have a suitable care home place for her (there are a shortage of council funded ones) and are trying to find the best alternative. It's hard if she says she wants to go home as without an official diagnosis of diminished capability or a power of attorney that enables you to make decisions on her behalf, they have to respect her wishes where possible.

I'm an OT.

Yes, a GP can diagnose dementia, but that should trigger a referral to an Elderly Mental Health consultant. Please ensure this has been done, OP, as there is so much that can be done medically to slow progression. It's miserable when GPS diagnose dementia like it's the end of the line and don't refer to the experts.

I also second an OT assessment while she's still in hospital. She's going to be more confused in hospital than in her own home. Taking her on a home visit with an OT while she's still an inpatient may reassure you that she will actually be OK in her own home, or it will give you hard and fast evidence that she won't be. I've taken many patients who were absolutely doolally on an unfamiliar hospital ward, but took them home and it was like a switch flicked once they were back in familiar surroundings.

A capacity assessment will also be essential as others have said, since she's saying she wants to go home. Ensure this is NOT just delegated to a doctor - they're usually the worst-placed people to comment. A good combination is a ward nurse who knows her, an OT and a social worker.

Good luck OP.

She needs to be assessed for 'capacity' to make the decision to go home as it's all very well to want to go home but if she will be unable to function safely but doesn't have the ability to recognise this she's doesn't have the capacity to make this level of decision. Her social worker should hold a meeting with you and her to discuss the options.

We had to fight tooth and nail to get my mum into a care home even though she was bedridden and incapable of doing anything for herself including communication. Social services wanted to send her home with 4 care visits a day and that was it. We argued that she would try and do something, fall and be rehospitalised within 24 hrs of being sent home and she was because on the first day the carer didn't turn up so she tried to get to the bathroom. She's in a home now because it was simply unsafe for her not to have care all the time and we are lucky that it is funded because I don't know what we'd have done otherwise.

I don't know what happens to people who don't have family to fight for them

My mum went into hospital three weeks ago, she fell and banged her head, she was also dehydrated as she won't drink. She spent a week in a general hospital, then a week in a geriatric unit before being moved into a residential care home funded by the NHS. We are having the dst meeting next week, apparently everyone sits round and argues about what should happen to Mum and how much they will provide. At that point, NHS funding stops and social care funding comes into play. She is doubly incontinent, can't walk, is incoherent with speech, has to be fed and washed, needs turning in bed as she is virtually bed bound. My father has had two heart attacks, has diabetes, arthritis and clogged arteries which means he can't walk very far. Yet he has been caring for my Mum with one half hour support a day. I can honestly say that, if they say she needs to be home then they will BOTH end up dead.

The doctor (Psychiatrist) cannot diagnose dementia from a one-off assessment. They have to do a baseline assessment and then a follow-up to compare scores approx 3 or 6 months later.

If she has a 3 bed council house then there is room for a live-in carer but that would be expensive, though perhaps less expensive than a care home.

Are you and your Mum able to privately fund some extra care for her once she returns home, perhaps an extra visit each day? Unfortunately funding for social care is getting less and less each day and won't get any better under the current government proposals.

I understand that a lot of how she presents is typical of dementia

As a pp said , it's also very typical of having a UTI or other (e.g. chest) infection. Please try and rule these out first, before assuming it's dementia, especially if these symptoms have come on suddenly, or while in hospital. With the best will in the world, hospital staff do not have time to check whether someone is drinking enough, or sit with them, prompting them to drink.