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Please help - vulnerable adult and social services, GP failings

115 replies

soworriedaboutthis · 27/01/2022 17:20

Hi, posting for traffic.

My dad is a type 1 diabetic and has mobility issues that came on quite suddenly last year. He was self-neglecting, refusing all help from family, basically hiding himself away at home. He's very reclusive.

We took him to the GP regarding his lack of mobility and issues at home (he's not managing basic self care) and they didn't really do much. Suggested he wait for a neurology appointment that he'd already been waiting months for but did order some blood tests to be done by the district nurse at home.

A few days later the district nurse arrived at his home to find him unresponsive on the sofa. Firemen had to be called to force entry to the home and an ambulance. He was having a serious hypo and was taken to hospital.

At this point we contacted social services to raise a safeguarding concern and the paramedics said they would also raise a safeguarding concern. We discovered he wasn't buying food, eating properly, washing, showering. Totally self-neglecting. Social services said that because he was in hospital, his needs were being met so they could log it but not do anything at that time.

Throughout his hospital stay he took his insulin incorrectly (though insisted he was taking it right) and had numerous hypos. He had various scans and tests to uncover the reason for his sudden mobility problems and nothing serious was found. He was diagnosed with peripheral neuropathy but the drs said they didn't understand why he couldn't walk as he should be able to.

He was discharged home and given a care package to help him. He refused them entry to his house once he went home and that was the end of it. He's deemed as having capacity to make his own decisions and so was entitled to refuse care.

In December he had another serious hypo, unresponsive in bed. This time he was found by a district nurse who had come to review how he was getting on with his diabetes. Again, the firemen had to force entry to his home and an ambulance was called. Again he went to hospital. He continued to mismanage his insulin and was difficult with staff.

This time he was discharged in January this year with a reablement care package meaning that he would have a lunch and dinner time carer to assist with meals. He allowed them in for the most part although wouldn't have food in for them to cook. The care company don't relay information to us reliably so we don't always know what's going on.

On Saturday my dad turned his lunch time carer away - he can't explain why and thinks he was already in the early stages of a hypo. We weren't informed by the care company. The dinner time carer found him unresponsive in bed later that day and called an ambulance (she had access to the house because he now has a key safe installed) This time was the worst he's been. His blood sugar was 1.4 which is extremely low. Previous times it was around 2.

He refused to go to hospital against paramedics advice and then was left at home. I called the emergency social services on Sunday and was told I needed to call back on Monday. On Monday I called Social services again and was told I needed to contact his care worker that had been assigned after his hospital stay - she's in charge of his reablement package. I wasn't able to get hold of her until Wednesday despite numerous calls and messages but she said she's looking into it. Whatever that means.

GP was also contacted on Monday morning in an urgent request as we wanted to request that district nurses visit him every day to help him check his blood sugar, help him administer his insulin and check that he's eaten as the carers aren't able to do any medical care. GP said she would visit him the next day to speak to him about a way to move forward.

She never came back to us to update us. We have no idea what was discussed at that appointment as my dad is extremely difficult to speak to and he frequently lies/gets confused.

Contacted the GP surgery on Wednesday for an update - no response.

Today, I messaged my dad to check in and he informed me that he'd had another serious hypo, ambulance called etc. Found out from the care company after calling them that he'd been found by his lunch time carer unresponsive in bed again. Extremely low blood sugar. The care company didn't inform us until we called them.

We've contacted the GP again to explain that something isn't right with his health, he's complaining that he's hypoing in his sleep because he's too tired to wake up and eat and she's unavailable but the receptionist relayed a message to us that there's nothing she can do yet because she's waiting on advice from the diabetic team.

The care worker in charge is kicking off with the care agency about their lack of communication with us but other than that, she's not done anything. She said he still hasn't been allocated an actual social worker - I'm not sure what the difference is between her and a social worker.

I'm at an absolute loss as to where to go from here. The GP has described him as a ticking time bomb and it's only a matter of time before he has his next serious hypo but nothing really seems to be happening. No one is standing up and taking charge of the situation, it's just me and my sister desperately trying to call around everyone to find out what we can do.

If anyone has any experience with social services or is a GP and can advise what we can do it would be really appreciated. This latest hypo is only 5 days after his last one and I'm so worried about him. These aren't minor episodes, each time he is completely unresponsive, very close to death with no way of helping himself or communicating to someone that he's unwell.

My sister and I both have a very strained relationship with him and he's awful to us both but I just can't leave him to deal with this alone. He's so reluctant for help and we don't know if he's abusing his insulin or not eating on purpose to make himself unwell or if he's genuinely struggling to manage his diabetes alone. It's all such a mess.

Please if anyone can help in any way, it would mean a lot. Where do we go from here?

OP posts:
HeyBlaby · 27/01/2022 17:34

He needs the DN's in to check blood sugars/administer insulin, or at least supervise this, obviously if he refuses and has capacity to do so then that's an issue.

hoochyhag · 27/01/2022 17:38

Gosh you poor thing, and poor dad 😔

Who has assessed him for the capacity to manage his diabetes? This needs to be decision specific and he must be aware of the outcomes to not looking after himself.
Often people are discharged from hospital with 'has capacity' statements but this can be meaningless, and just a way to free up beds.

It does sound like a safeguarding concern as he would be eligible for services and at risk of harm due to self neglect.

I would get back to the local authority social services and ask for a social worker to do a mental capacity assessment around this. They have out of hours social work oversight.

If there is no response I would complain to your mp, they will then get on to the relevant department.

Sadly he sounds as if he needs to be in residential care.

It sounds tricky if you don't get on that well with him. But he also sounds unable to manage his own care.

You poor loves, sending lots of good wishes your way.

hoochyhag · 27/01/2022 17:39

Sadly depending on financial assessments he may have to fund longer term care himself.

Cherryblossomtree99 · 27/01/2022 17:43

He needs a care home.

MayThePawsBeWithYou · 27/01/2022 17:51

He wont have capacity when he is severely hypo, do you have power of attorney for his health. He is not safe at home, he needs his insulin doses reviewed by the g.p and administered by nurses and his food intake and blood glucose monitored. His insulin should be locked away safely, does he have a pen or syringes. Does he have a siabetes specialist doctor or nurse at the hospital who can help.

OverByYer · 27/01/2022 17:54

He needs a capacity assessment, in particular around health and finances as other posters have said. Until he does it will be assumed that he does have capacity to make those decisions for himself.
I would push it back to Social services and ask if the Care agency can also make a referral to them with their concerns.

soworriedaboutthis · 27/01/2022 17:54

I've had tried to beg him to consider residential care, even for the short term but he refuses.

The hospital deemed him as having capacity as far as I'm aware but we've just had an update from the GP that when she went out to visit him, she did a memory test on him and he was below the normal range so she's referred him to a memory clinic. I have no idea when this will be. She's arranged to visit him again next week to see how he's getting on but there's no plan in the mean time.

I will try social services again but last time I called them they said I needed to take it up with his allocated care worker - I'm not sure what her full job title is but he was under the ICAT team when he was discharged from hospital and then they handed over to this care worker who is managing his care package. It was her that said he needs to be allocated a proper social worker.

He should be in hospital right now after his latest hypo today but he point blank refuses to go. Again, I've begged him to go as they'll probably keep him in again for a week or so whilst he receives help from the diabetic team. At least when he's in hospital we know he's safe.

OP posts:
Soontobe60 · 27/01/2022 17:55

If he has been assessed as having capacity, then there isn’t much that can be done I’m afraid. He can’t be admitted to hospital or a care home against his wishes.

Saz12 · 27/01/2022 17:56

Carers can do medication prompts - ie check that he’s taken it correctly. That’s a very normal thing for home care to include. I’m not sure on diabetes, but it’s likely they’d be able to get him to check his levels during their visits.
Number of visits can be increased, DF had 4 a day (obviously depends on where he is and assessed needs).

Can you get on to Adult Social Work team and explain all the issues. Keep a log of all incidents you’re aware of. Explain your relationship with him if needed.

Remember: their staffing issues are not your responsibility. You can only help that by making sure care visits are cancelled if they’re not necessary and that they know the issues so can manage them.

I found it very frustrating to deal with the lack of communication from care agency. Can you leave your phone number in a prominent place (with a note of who you are) to encourage them to phone you if there’s an issue? They’ll not have the time to update you on every visit, but should leave paperwork / tick sheet showing what’s been done.

I don’t think carers can generally help re: food shop. But a company like Wiltshire Farm Foods will deliver frozen meals. My DF used them and they were good about putting food into freezer etc. Is it realistic for you (or sister) to order a few weeks worth and be in for the delivery slot?

soworriedaboutthis · 27/01/2022 17:58

We've been talking about capacity with everyone since November as all of this is so out of character for him and his behaviour has changed massively but everyone keeps saying 'oh as long as he has capacity, we can't do anything' but no one has said 'yes we did a capacity test on x date and he passed' The hospital just repeatedly stated he had capacity so it was his choice.

We have no power of attorney but my sister has been signed over to have access to his medical records so can liaise with drs about his condition.

OP posts:
soworriedaboutthis · 27/01/2022 18:01

@Saz12

Carers can do medication prompts - ie check that he’s taken it correctly. That’s a very normal thing for home care to include. I’m not sure on diabetes, but it’s likely they’d be able to get him to check his levels during their visits. Number of visits can be increased, DF had 4 a day (obviously depends on where he is and assessed needs).

Can you get on to Adult Social Work team and explain all the issues. Keep a log of all incidents you’re aware of. Explain your relationship with him if needed.

Remember: their staffing issues are not your responsibility. You can only help that by making sure care visits are cancelled if they’re not necessary and that they know the issues so can manage them.

I found it very frustrating to deal with the lack of communication from care agency. Can you leave your phone number in a prominent place (with a note of who you are) to encourage them to phone you if there’s an issue? They’ll not have the time to update you on every visit, but should leave paperwork / tick sheet showing what’s been done.

I don’t think carers can generally help re: food shop. But a company like Wiltshire Farm Foods will deliver frozen meals. My DF used them and they were good about putting food into freezer etc. Is it realistic for you (or sister) to order a few weeks worth and be in for the delivery slot?

Thank you.

With regards to food shopping for him he has repeatedly refused food deliveries up until yesterday. He has now said he will accept a weekly food shop but whether he then eats the food or not is another thing.

OP posts:
Bagamoyo1 · 27/01/2022 18:02

What are the GP failings?
It sounds as if he’s had a lot of input and has been very difficult, refusing help etc.

Plenty of people have capacity and choose to neglect themselves. Sadly it’s just the way it is.

soworriedaboutthis · 27/01/2022 18:06

@MayThePawsBeWithYou

He wont have capacity when he is severely hypo, do you have power of attorney for his health. He is not safe at home, he needs his insulin doses reviewed by the g.p and administered by nurses and his food intake and blood glucose monitored. His insulin should be locked away safely, does he have a pen or syringes. Does he have a siabetes specialist doctor or nurse at the hospital who can help.
He self administers insulin with syringes but will let his prescriptions run out and not order more and we have to chase it for him, loses his blood sugar monitor so just doesn't check his blood sugar and then obviously doesn't eat properly.

When he was in the hospital, the diabetic nurses were telling him an amount of insulin he should be taking but then he'd administer 3x as much because it's 'what he's always done' and then would hypo. Eventually I think they took it away from him and administered it themselves but he was handed it back on discharge. So frustrating!

OP posts:
cptartapp · 27/01/2022 18:08

Agreed. The GP can't do a great lot more. People are allowed to make unwise decisions.
A lesson for everyone to get POA for elderly relatives if at all possible way before this stage. Me and DH sorted ours for each other during lockdown and we're 50!
As an ex district nurse I've seen similar situations many times. Family stepped right back and we had to go in regularly. That's probably your best bet. Unfortunately it will likely take a crisis otherwise before anything changes and your DF may end up with no choice in what happens.

Suzi888 · 27/01/2022 18:12

I’m sorry Flowers
I don’t know much, only have experience from what happened to my aunt. We fought and fought for social services assessments to assess her capacity or rather lack of. She was referred to a memory clinic by her GP and saw a Psychiatrist who performed some tests, she passed these tests apart from one which involved drawing a clock. It’s that type of assessment that may be needed…

soworriedaboutthis · 27/01/2022 18:13

@Bagamoyo1

What are the GP failings? It sounds as if he’s had a lot of input and has been very difficult, refusing help etc. Plenty of people have capacity and choose to neglect themselves. Sadly it’s just the way it is.
We raised safeguarding concerns with the GP at the start of November. Nothing was done. No follow up.

Safeguarding concerns were raised with the GP clinic again in December. They said they had concerns re. his capacity. That was it. He was in hospital until mid January so I assume they wanted to let hospital staff manage his care.

10 days after his hospital release he hypoed again and we contacted the GP with urgent welfare concerns. We received no updates until 5 days later when he's subsequently hypoed again.

I understand it's incredibly difficult and gps are under a lot of pressure at the moment but he's seriously unwell and we need an urgent plan. She's repeatedly told us she doesn't know what to do.

OP posts:
user1493494961 · 27/01/2022 18:14

Do you and your sister live local to him.

soworriedaboutthis · 27/01/2022 18:16

@user1493494961

Do you and your sister live local to him.
No which makes it really difficult. My sister is closer so tries to do as much as she can but there's only so much we can do when he won't let us help him.
OP posts:
Jellycatspyjamas · 27/01/2022 18:17

People are assumed to have capacity unless and until they are assessed not to. It’s a nightmare actually getting someone to do a capacity assessment so you may need to really argue the case, I’d also ask to be present for the assessment which should cover a range of areas. It’s entirely possible to have capacity in one area but not another - eg to be able to manage finances, but not to manage a complex health condition. I’d also be checking they are considering the impact of his health condition on him in terms of capacity eg if he starts getting confused in the early stages of a hypo.

I’d also say that the whole “he has capacity, he’s making a choice” can often be used as a way of just not providing a service or support. You may need to be prepared to make a lot of noise to get the care that he needs.

purplecorkheart · 27/01/2022 18:17

To be honest it sounds like this is beyond the gp area and it is Social Services you need to be pushing rather than GP with Welfare concerns.

soworriedaboutthis · 27/01/2022 18:17

@cptartapp

Agreed. The GP can't do a great lot more. People are allowed to make unwise decisions. A lesson for everyone to get POA for elderly relatives if at all possible way before this stage. Me and DH sorted ours for each other during lockdown and we're 50! As an ex district nurse I've seen similar situations many times. Family stepped right back and we had to go in regularly. That's probably your best bet. Unfortunately it will likely take a crisis otherwise before anything changes and your DF may end up with no choice in what happens.
We raised POA with him, he refused
OP posts:
soworriedaboutthis · 27/01/2022 18:21

@purplecorkheart

To be honest it sounds like this is beyond the gp area and it is Social Services you need to be pushing rather than GP with Welfare concerns.
Thanks. When I contacted Adult Social services they passed me onto this allocated care worker.

The allocated care worker said he needs a proper social worker allocated but that we need to contact his GP.

ICAT said it needs to be taken up with the GP.

It's so confusing trying to figure out who to turn to.

OP posts:
soworriedaboutthis · 27/01/2022 18:26

@Jellycatspyjamas

People are assumed to have capacity unless and until they are assessed not to. It’s a nightmare actually getting someone to do a capacity assessment so you may need to really argue the case, I’d also ask to be present for the assessment which should cover a range of areas. It’s entirely possible to have capacity in one area but not another - eg to be able to manage finances, but not to manage a complex health condition. I’d also be checking they are considering the impact of his health condition on him in terms of capacity eg if he starts getting confused in the early stages of a hypo.

I’d also say that the whole “he has capacity, he’s making a choice” can often be used as a way of just not providing a service or support. You may need to be prepared to make a lot of noise to get the care that he needs.

Thank you. This sounds like what's going on. Everyone keeps talking about capacity but nobody has turned around and said:

You're dad was tested on x date and he was deemed to have capacity so that's it

We've said a thousand times that we don't believe he has capacity because this isn't like him, he's saying things that are odd and out of character, he's become extremely difficult, he's declined in health massively over a very short space of time. It doesn't make sense.

I'm going to raise it again that we want an urgent capacity assessment and a date for this to be done as we really don't know how they're judging it at this stage.

OP posts:
toconclude · 27/01/2022 18:26

@Suzi888

I’m sorry Flowers I don’t know much, only have experience from what happened to my aunt. We fought and fought for social services assessments to assess her capacity or rather lack of. She was referred to a memory clinic by her GP and saw a Psychiatrist who performed some tests, she passed these tests apart from one which involved drawing a clock. It’s that type of assessment that may be needed…
No, a memory test is NOT a test of capacity which is always time and decision specific.
toconclude · 27/01/2022 18:28

Capacity tests can and ideally should be repeated to check for fluctuating capacity. It's not enough to do it once and rely on it forever.