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 thought it was clear she can't go home. I had no idea people were sent home to juts live dangerously.

Social services would be right on your back if you left your toddler home alone, this is essentially the same thing. Except the toddler would be safe in the stairs

I wonder if the funding is clouding the issue - naturally if they think they are paying they will push for the cheapest option (sadly)

If you can get through to them that you will be self funding perhaps they will start to listen?

I know how stressful this is, hang in there.

Set out your decision clearly and the basis for it and email it to everyone you can think of who is involved, call anyone you can and stand firm.

We were warned we didn't have time to find a care home and had left it too late -- only to find that every care home I contacted had loads of spaces, sadly since Covid many haven't been full so I'm sure that won't be an issue.

Neither do I but if you look at section 5.17 it mentions Community Care Assessment - can they show that this has been done before she is sent home?

also
5.44 If you are unable to persuade others to accept your judgement, you may wish to seek additional advice, for example from the MWC, from the local authority, from a solicitor, a medical practitioner or a voluntary body. If you can produce written advice that supports your decision, this may help in defending your actions. In particular, you should seek advice if the person disagrees with a particular course of action which you are convinced is in his/her best interests, for example a move to care home.

I got good advice from Change Mental Health Advice and Support: 0808 8010 515 because my relative has been certified as having incapacity

I will be honest I have no idea who is involved. It's been over a week and I only spoke to the consultant today and that only happened because sue I was so upset in the ward when the nurse said they were looking at discharge to home. Then he for the discharge woman to phone me but she kept saying the same crap about her going home. Some nonsense about how both of us can feel supported.

I feel a lot better after everyone's comments I actually can't believe so many people have tried to help me. I have taken a lot of good points here

Do they know that you are self funding (and apologies for asking, but are you sure there is enough money? The fees are eyewatering)?

If you say "I'm self funding, and we are looking for a care home, they will usually respect that, however you cannot insist that she remains in hospital while you take your time looking for a care home - they will probably accept a few days, especially if the care home want to come and assess her, but not longer.

In your shoes, assuming there is enough money, I'd be looking at care homes, starting tomorrow.

Ah I see, thank you so much

There is an official route which means if your care home is not available you can be discharged to a different home or the community hospital. I'm not trying to keep her in hospital at all but they are not entertaining the idea

Funding now an issue, but again nobody has even bothered to ask this.

Sorry this is why I'm looking to find out if I am legally allowed to challenge discharge to home.

Lack of communication and inconsistency is my current bugbear. I've had to repeat myself about a billion times to a never ending cast of nurses registrars, social workers etc. I also don't understand why you're not included in the meeting, especially having POA.

Also the emotional toll of this is monumental and switching off is so difficult - i hope you can take a little time out for yourself over the weekend x

They are saying they are looking to discharge to home with a care package and saying that discharge to care home or interim care is not an option. I am looking for evidence that the final say is mine and not theirs. It doesn't seem to exist though

It doesn’t exist. They can and do turf anyone out of hospital even when it’s completely inappropriate and unsafe for them to be sent home.
we had this happen in my family last year, in Scotland. Whether you have POA or not is completely irrelevant. They make the decision, based on ‘clinical need’ (which I think means how desperately they need the bed freed up. It’s an absolute disgrace).
My family member was discharged from hospital after a 3 month stay, giving us 24 hours notice. The hospital said this was fine as ‘a care package will be provided’. They were an amputee with many health issues and couldn’t even get in and out of bed.

best of luck to you OP.

So sorry OP this all sounds horrendous and as her principal advocate & carer you should be a full part of the discussions

age uk Scotland have this that could be worth looking at
https://www.ageuk.org.uk/globalassets/age-scotland/documents/ia---factsheets/health-and-wellbeing/hwb-11-hospital-discharge-nov-2022.pdf

and a helpline you can call

https://www.ageuk.org.uk/scotland/what-we-do/tackling-loneliness/age-scotland-helpline/

As another poster has mentioned home with carer support would be the “least restrictive option” but it still needs to be the in the person’s “best interests” - IF they lack the mental capacity to make this decision for themselves. Plenty of people are discharged to care homes, that were previously managing at home with no care package in place.

Why was your relative admitted to hospital in the first place? Do they have a history of falls? Would they be able to call for help in an emergency? I would be surprised that an OT would agree it was a safe discharge, if there are known risks.

Ultimately, if the person is deemed to lack capacity, you can challenge the hospital’s decision as LPA and hire legal representation but obviously that’s a worse case scenario option. It would go to court and a judge would make the final decision.

@RachLeeds

Why was your relative admitted to hospital in the first place? Do they have a history of falls? Would they be able to call for help in an emergency? I would be surprised that an OT would agree it was a safe discharge, if there are known risks.

It was a flak where she was in the floor for several hours. Severe dehydration and delirium they have said. Also there was a chest infection and throat infection found on admission. There was a cooking issue last year and the neighbours went in after the smoke alarm was going off for ages and she didn't react at all. She would have no idea if something was wrong and if the house went up in flames she wouldn't be able to get out anyway

OP contact your local dementia group/charity for advice. There is a bit of legislation that may help in Scotland but I can’t remember what it is called. I found out about it from my local dementia group. It is something along the lines of section 6jz.

I have been in a similar situation before. We ended up doing as a previous poster said, we told the hospital we wouldn’t be coming to pick our relative up and that our relative didn’t have any house keys. We were the only ones with keys.

Discharge ended up being delayed long enough for us to find a care home.

Just beware though. Care home fees are extortionate. Care is “supposedly” free in Scotland but accommodation, meals etc are not. The care contribution from the Council was around £180 per week (5 years ago) meaning that my relative had to fund over £1000 per week from their assets ie from the sale of their house. It increased to around £590 per week once their assets were below a certain amount.

Thank you for these

I'm going to raise this. I thought what was happening was normal but this thread has made me realise otherwise

@RachLeeds

I've been told that lack of capacity can fluctuate and it depends which areas they are deemed to lack capacity in as well.

Also with my SM we might be able to get her into respite in a home for six weeks to allow my Dad to get over his chest infection and the exhaustion brought on by dealing with SMs delirium for two weeks prior to hospital admission BUT despite SM currently lacking capacity she would have to be in agreement.

Not having previously had any care package seems to indicate "release into the wild" with whatever care package the hospital recommends, and hang the consequences..... I am beyond frustrated.

Thank you. I actually left the hospital at lunchtime after 30 mins and didn't go back whereas usually I spend 2/3 hours then go back in the evening. I want to be there but I needed some time away from it all. She doesn't know if I am there or not. She doesn't even know my name and calls me her sisters name sometimes

POA means that you get the right to make the decisions for that person, but only to the extent that they would be able to themselves IYSWIM.

Patients are not allowed to be the final arbiter of whether they stay in hospital or not. A patient that had capacity to make decisions could not insist that they stayed in hospital if there was no medical need for them to do so, and so as POA, you can't either.

My best advice is to tell them you are self funding the care home place and get on with organising it ASAP.

This week we have had communication with a SW who seems very on board and stated she is very determined to include family in the process but it's taken three weeks. She's on leave next week so has stated that SM won't be going anywhere until She's back. I'm wary but hopeful.

Apologies if I've missed it @flourpot but do you have a SW involvement,?

Hi OP

A couple of observations. If they are saying she is fit for discharge home with a package of care, this will take time to set up. Unless Scotland is in a very different situation to England and has an abundance of home care ready to be put in place at a moment's notice, it's unlikely she'll be discharged immediately

I suspect the issue here is that there are two decisions involved one is a clinical decision about fitness for discharge. Your Poa can't compel the hospital to continue to provide care. However, I'm perplexed why they've advised residential care isn't an option if she's self funding? Your question seems to be can I stop the discharge using my Poa? I suspect the answer is no because they've assessed her as fit for discharge to what they view as appropriate care. But equally you can use you Poa and finances to find an alternative arrangement.

@ApiratesaysYarrr

Patients are not allowed to be the final arbiter of whether they stay in hospital or not. A patient that had capacity to make decisions could not insist that they stayed in hospital if there was no medical need for them to do so, and so as POA, you can't either.

That's really not what I'm trying to do. I understand she is to be discharged from hospital, the issue is that info not what her discharged to her home. It's not safe

@Bryterlayter1

Your question seems to be can I stop the discharge using my POA

No, it's not. I am not against discharge. They told me 2 days ago the 3 possible routes of discharge. I am trying to say I do not agree with the one they have chosen.

No. I have had nobody.