Scotland - care home. Who has the legal 'say'

[flourpot]

Looking for a bit of advice as I'm in a situation where I have POA for a relative and I disagree with the discharge team at hospital.

Relative is 93, has no capacity, no idea what's going on and lives upstairs flat. I think it would be dangerous to send her home.

Brief phone call today indicated the team think home with carers is acceptable

I did not realise that when the decision needed to be made about a care home it might not be my decision.

I'm struggling to find out whether my POA means I can disagree with the team at the hospital or if I have to accept their choice.

Any ideas?

I assume the care would be funded in Scotland, so I suspect they do get to decide but you are her advocate and you can push back - presumably it would be unsafe? Does she have dementia?

The care is funded either way and she can easily afford the cost of the home on top anyway.

There is no diagnosis of dementia. She definitely has dementia though.

Sorry yes definitely unsafe I'm astounded they think it's an acceptable option

Sorry what I'm really asking is who has the legal right to make the decision regarding what happens now.

Not all care in Scotland is government funded. If the individual needing care has the means to do so they will be expected to pay a significant amount of their care needs (eg owning a house, large amount of savings).

The best way to deal with this is to check if your POA covers both financial and welfare; and then ask to see a social worker. Or phone social work yourself and ask for a care review.

We have just spent the last 2 years dealing with all of this.

You can PM me if you want to chat about it!!

Yes the POA covers everything and the funds are available for a care home.

But can I insist is what I really need to know?

@redastra

Sorry. Thank you

I didn't mean to sound rude

You absolutely have the right to disagree with this decision.
ask them to call a case conference with physio, ot, nursing staff, medics, social work and yourself. Where her needs can be discussed with all the mdt. Does she have paperwork in place to support the lack of capacity? What does she want also?
if they are saying that she will manage at home with a full package of care tell them you believe they are setting her up to fail. Which will mean a further hospital admission.
good luck.
there is pressure for beds but your relative should not be made to suffer due to this x

Have they formally assessed capacity? If you’re Attorney for Finances, as well as Health and Welfare and the person is using their own funds, you’re the decision maker.
Make sure you have a copy of the document to share with those involved.

@Antihistamine62

ask them to call a case conference with physio, ot, nursing staff, medics, social work and yourself.

They are meeting on Monday but I don't get to go she said she will catch up with me after it so I am trying to get as much info as I can

Where her needs can be discussed with all the mdt. Does she have paperwork in place to support the lack of capacity? What does she want also?

The consultant said today he would sort the paperwork re lack of capacity for me. She doesn’t know what she wants she has no idea where she is or that’s she is not at home literally nothing

if they are saying that she will manage at home with a full package of care tell them you believe they are setting her up to fail. Which will mean a further hospital admission.

I have told the discharge team this today but she kept saying a move from hospital to care home without trying a care package is unlikely

I am trying to find the legal position if I want the care home option/

I have told them a fall necklace is no use when she has fallen down 13 stairs and landed in a cold hard tiles floor. I want to prevent it not for community alarm to find out about once she has broken her bloody neck

Thank you it's a nightmare to navigate

Can you point me to somewhere that shows me this?

I want to go in armed and if I can say 'I have the legal power' and show them evidence I feel it might be helpful/. I juts can't find it!

I'm looking for a needle in a haystack and there is so much information I just can't quite find the exact legal info

Unfortunately until she has a capacity assessment (and fails) or chooses to enact her POA, you can't decide for her. However, if your relative is willing to go into a care home and is self funding then there's no issue with that whatsoever.

This is not in question

I'm trying to find out if my POA can override the discharge teams decision

Sorry I'm not being too clear it's been a really hard day!

You absolutely can attend this meeting. As a hcp it’s really not uncommon for family to attend them- I see it often and have been involved.

Might be an idea to speak to the nursing staff or OT’s in the ward and make your feelings known to them (incase they aren’t aware)

discharge teams push for discharges sometimes not thinking of the bigger picture.

legally I think you can veto this. But I think they may try and push for admission to nursing home from home which can take much much longer than from a hospital x

I have spoken to the OT once and today the nurse asked her to talk to me and she said it's up to the discharge team. I asked that I'm involved and all I get is 'your concerns are noted' so I want to be able to say that I know I can make the decision, but at the moments I can't find any evidence that I can

If the consultant seems her to lack capacity, you can process the POA at the office of the public guardian here: https://www.publicguardian-scotland.gov.uk/general/news/2024/01/30/poas-to-be-processed-this-week

If self funding she needs to have significantly more than 38k in the bank or a house to sell or social work won't approve the move as once assets dip below 38k the person moves to national contract rate - which if they don't seem her suitable for care, she could end up with no home or you as POA would be eligible to pay.

This has all been done/. Sorry I'm not actually asking this

I'm asking if I can insist she goes to a care home when the discharge team are telling me she can go home with a care package/

From experience if you’re self funding you can just make the arrangements. It’s what we did. Social worker insisting he was fine at home with carers going in 4x daily. We’re in Scotland. We just moved them in then informed the social worker. He wasn’t safe.

Thank you I actually had no idea this was an option. Did you juts approach the care home? I have been led to believe this is all out of my hands and I'm fighting to keep her safe

You have the right to disagree and the right to make private provision, what you can't do is make them keep her in hospital until you find a place, nor can you get funding for full time residential care when she's been assessed as suitable for domiciliary visits (which is a lot cheaper). You also can contest their assessment

Are you visiting her? If you really don’t want her sent home, make sure she has no house keys on her, and if necessary let the discharge team know that nobody will be there at her flat.

I’m sure nobody wants to have to go to such lengths, but sometimes it’s a case of needs must.

Sorry - yes, just approach the care home you like and arrange discharge to there. I work organising the care home side and it's done all the time (so long as she definitely has the funds).

I would tackle this from the other side and start talking to care homes so see if they have spaces. Sounds like it will be a nursing home she needs. They can also advise on process. As above the problem is that you have no right to insist she remains in hospital but you can tell them that you have arrange a care home place for when they discharge her.

Is there anywhere local that will take her for respite till you've got something better in place. We did this for DF recently. His POA had been sitting in the queue for a year, but we got it finalised within a week. He went for respite at the local care home (which he had to pay for but has funds) to recover after a broken hip. No dementia, he didn't have capacity because he was on so much pain relief he couldn't speak. The care home staff are also able to add their thoughts then to the case for needing permanent care.

The discharge routes were home or community hospital for further assessment or care home. I'm not trying to keep her in hospital and would be happy for a move to the elderly ward at the 'in between' stage so it buys us more time while she is safe and being further assessed