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?

Yes I'm in 2/3 times a day. They know I have keys though. I did tell them I haven't even had the carpet cleaned and it's been soiled by her not going to the toilet. Because she has been using the toilet in hospital (with a nurse) for 3 days she is deemed to be ok in that area

There was no hospital stay first, but we did the same with my self funded DM (dementia). Except that the very good care home we’d chosen sent a social worker for a brief ‘tick box’ visit, to make sure we weren’t trying to tidy away anyone who didn’t need it, we didn’t involve social services at all.

I might add that my DM was pretty bad by then, but even when she could no,longer even make herself a cup of tea, she couldn’t understand that there was anything wrong with her. She would never have agreed to go to the care home - we had to get her there by stealth. But by then she simply wasn’t safe to be left alone at all any more - in fact the move was overdue.

The thing is you need to keep pushing and pushing it’s bloody exhausting. My gran set fire to her home (the family upstairs alerted my uncle as they couldn’t get her to answer the door but could hear her alarm). We could see her in the door drying with her hands over her ears and kept shouting to take the bolt off the door. Eventually me and my cousins boyfriend climbed in the bathroom window. Her cooker was up in flames and she had got confused about what to do (this was a smart independent woman who had been a nurse for years).

Once she had been in hospital the Social Worker said ‘well I think she can return to her own home!’ I looked at the Social Worker and asked if she was all there or if stupidity was a new skill for her. She had set fire to her kitchen and didn’t know what to do, there was a family upstairs with a baby! I kept pushing the fact that she hadn’t used a fire blanket, got out or called for help. She just sat on the floor with her hands over her ears in fear crying and saying ‘I don’t know what to do!’ We’re in Scotland.

Keep pushing them! Keep questioning them, ‘what if..,’

This is what I keep doing. It's awful isn't it. If I could juts find something legal that says I can decide what happens next

Have you visited any potential Care Homes, I assume they will have lots of experience of this scenario and can hopefully guide you.

No. I made the stupid mistake of thinking the whole time she was in hospital that there is no way she would get sent home/.

Of the social worker is being a hand wit like my grans was ask for someone else. I believe she would have been happy for my gran to manage to burn herself and the family’s around her as she lived in a ‘4 in a block’

I haven't had any contact with social worker.

Communication with anyone has been hard the whole way through this.

We refused to have my DF discharged home. DSM and I had joint POA and the hospital wanted to send him home with 4 carer visits a day. The council couldn't even manage 2 visits a day before he went into hospital so we knew that was a non-starter. DSM then tried to employ live-in carers because we knew that 4 visits was insufficient and that fell through but they still wanted to send him home with a care package that we knew the council couldn't fulfil.
DSM took advice from medical staff rather than the discharge manager as to what homes would be able to cope with his condition and we moved him to a home the next week.

Do you have the paperwork that confirms the PoA?

Do you have written confirmation from the hospital that they’ve undertaken a mental capacity assessment around discharge destination and that your relative lacks capacity?

That is all you need. 🙂

@snoopyfanaccountant

Do you know any legislation that says I can refuse this move?

I have had my eyes well and truly opened this week I had no idea how utterly awful things are

@flourpot

I am based in England and I know the law is different but there is an OPG in Scotland. This website should be helpful https://www.publicguardian-scotland.gov.uk/power-of-attorney

Thanks. The question isn't about whether my POA is active it's rather about whether these people can just decide a care home is not an option. I cant find any legal information and all the woman kept saying was basically it's not an option. I asked her who has the legal say so here and she said my concerns are noted

I just feel like the POA isn't with the paper it's written in now as I'm not getting to advocate for her to be in a care home anyway

@Tahinii

Do you have the paperwork that confirms the PoA?

Do you have written confirmation from the hospital that they’ve undertaken a mental capacity assessment around discharge destination and that your relative lacks capacity?

Yes I have this all sorted

That is all you need. 🙂

It isn't though. I have POA but the discharge team seem to have the ultimate deciding power here

Hello

The decision to discharge from hospital is a clinical decision. You can challenge it and ask for it to be reviewed but ultimately there is no legal right for her to be kept in hospital if it has been assessed that she should be discharged.

If you're not happy for her to be discharged home you can ask for that aspect of it to be reviewed to be a care home instead, however you do not have the legal right to state where she should be discharged to.

Ultimately it is a clinical decision and the hospital can go ahead and discharge against your wishes if necessary. However in my experience it rarely reaches this point, most of the time the hospital, social work and Attorney work together to reach a compromise.

If you’ve got financial POA, and there is sufficient funds available you can just find a home that’s willing/able to accommodate her. ( And of course she’s willing to go if any mental capacity still )

Are there cross wires that they think you’re asking social services to fund it? They’ll obviously want to try the cheapest option first, but if you’re self funding, and you have POA you’re in charge OP.

It is completely up to you whether or not she goes to a care home. If you are/she is paying for it then it’s nothing to do with the hospital. However, they may not want to wait while you find her a place, if she’s medically fit for discharge. It’s not best practice to discharge straight to a care home, though, for her own sake in terms of organising what she wants to take with her/keep, being able to say goodbye. That doesn’t apply if she’s incapable of managing at home even for a short period, though.

They may also feel that she could manage at home with support. This is an option, particularly if she was living independently prior to admission. Was she, and what has changed to make you feel like she can no longer manage at home? People do live at home with carers - what does she want to do? Speaking to social work is your best bet here. They will see hundreds and thousands of elderly people living at home with a range of support and will give you an informed opinion on what’s best for your relative.

Thank you. Can you point me to the legal information regarding this?

Nobody seems to know where to find it.

I don't believe it's much of a clinical decision tbh. Once ready for medical discharge it does to the team who are not clinicians, half of whom haven't even met the patient and look at a few notes before deciding what's best for them.

What's the point in having POA in place if I can't advocate for her when she really really needs it

They haven't even discussed funding with me because they don't see it as an option

They can decide she needs to be discharged from hospital.

They can decide that in their opinion she does not need a care home therefore they are not funding one.

They cannot stop you turning up, loading her up and taking her to a care home you/she will privately fund, if they have decided she needs to be discharged.

You may have POA but she needs a formal diagnosis of lacking capacity for you to be able to invoke it.

@TooExtraImmatureCheddar

It is completely up to you whether or not she goes to a care home. If you are/she is paying for it then it’s nothing to do with the hospital. However, they may not want to wait while you find her a place, if she’s medically fit for discharge.

The pathway should be community hospital or temporary care home if medically fit for discharge but becsue they are saying she can go home with carers I seem to have lost that option/.

It’s not best practice to discharge straight to a care home, though, for her own sake in terms of organising what she wants to take with her/keep, being able to say goodbye. That doesn’t apply if she’s incapable of managing at home even for a short period, though.

She doesn't know anything

They may also feel that she could manage at home with support. This is an option, particularly if she was living independently prior to admission. Was she, and what has changed to make you feel like she can no longer manage at home? People do live at home with carers - what does she want to do?

She doesn't know where she is so she can't decide what she wants to do. I want her to be safe. We have been hanging on a threat for the past few years and she has a fall and ended up in hospital. She had delirium and it has set her back and she knows nothing how she can't even identify she is in a hospital

Speaking to social work is your best bet here. They will see hundreds and thousands of elderly people living at home with a range of support and will give you an informed opinion on what’s best for your relative.

I want them to listen to my opinion though. I don't want her to fall down a flight of stairs and that is a real risk. Nobody seems to care telling me how they will be alerted if she falls. Too bloody late if she breaks her neck though

Make it clear you will be withdrawing all contact with her if they send her home. No further visits whatsoever. From the word go.
No shopping, no washing, no calls, zero contact.
Hand the keys over to the ward for her (and secretly keep a copy).
Not an answer to your question but I've known this approach to work.

Any care home worth their salt will want to carry out an assessment of a potential new admission, you can’t just book in like an hotel.

It all sounds like miscommunication - if she’s fit to leave hospital, then they’re most likely allowed to turf her out, but they can’t dictate what happens next - carers at home, or moving into a care home if your funding it yourselves. That’s your decision as POA.
Have you any homes in mind? First step is to have a look round a few and see if they might be a match. Bit like schools, you’ll get a feel for a place from the first pone call!