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?

@flourpot

Just seen your reply to my previous post. It's so hard x Unmumsnetty hug coming your way. Don't feel guilty for looking after yourself x You're doing a grand job advocating for her in a system that is incredibly challenging to navigate xxx

The final say is yours but legally, only based on the options that are available. They do not have to provide resources e.g. interim care home, if they don’t feel your relative is suitable or if they don’t have space.

As PoA, you are the decision maker but only out of the available options.

That said, if you concerned about an unsafe discharge, regardless of PoA, you should be pushing back. They can legally say “X is medically fit for discharge” and you should be saying “yes but Y risks are too high”. Ask for a face to face or
video meeting.

@Tahinii

The final say is yours but legally, only based on the options that are available. They do not have to provide resources e.g. interim care home, if they don’t feel your relative is suitable or if they don’t have space.

Legally is what I'm trying to find out. You say legally only the options that are available but they are not giving options. I'm looking for legal proof that I can ask for those to be considered.

Hi, sorry I didn't make it clear, but you are saying I don't want her discharged from the hospital unless she goes into a care home. You don't have the right to say that, and if you are self funding, the best thing to do is present them with the option of "I've chosen care home X, they would like to come and assess her on tuesday"

Yes, sorry I can see that. I suppose what I should say is your POA can't compel Social services to provide a level of care they haven't assessed is necessary. So you can't use the POA to insist she is provided with residential care arranged by SS, but you can source this care.

After PALs I think trying to get a SW might be helpful then x

Unfortunately being a squeaky but polite and firm wheel seems to work... I also find learning some of the lingo like "safeguarding" etc helps. Also try and get something in writing from a doctor or registrar clearly explaining their position and reasoning.

This may be useful if you involve PALs or other agencies.

I'm using my thread on Elderly Parents as a kind of diary x If, heaven forbid we end up escalating to complaint, I'll have a bit of a timeline to refer to if nothing else. I've been guilty of not making enough notes of names and dates because it's been a whirlwind 3 weeks with a never ending cast of various professionals.

Overall I think the system needs an overhaul - and one registrar agreed with me, though her hands are tied.

Hi, sorry I didn't make it clear, but you are saying I don't want her discharged from the hospital unless she goes into a care home.

I'm absolutely not saying that.

There is an 'in between' option that I would be quite happy with. They want to send her home. I'm not happy with that. It doesn't have to happen. I have never said at any point I don't want her discharged from hospital until she can go to a home/.

Generally, first the care team/hospital would have to say (or give a diagnosis) that the patient can no longer make decisions for themselves----deemed incapable of making their own decisions. Only then would a healthcare power of attorney kick in.

If you want her to go to a care home you will need to organise this yourself. You have no legal right to force Social Services to arrange this. They will arrange the post discharge care they think is best. You can disagree and put forward your views but if you want an alternative then you need to arrange and pay for this.

If you don't have a social worker perhaps try and contact your local social work department ASAP - see if you can find an out of hours number if relative is going to be discharged unsafely over the weekend. Our SW is invaluable in helping us to navigate the system.

The care home I spoke to about my relative said that the social worker would send the home the assessment information (they assess my relative's needs) and info stuff relating to funding which comes to about £233pw for personal care and and additional £104 for nursing. You'd presumably top up the rest.

This is already sorted.

I'm m not trying to force anyone to arrange something but when there are 3 possible options for discharge set out in the 'framework. (Guess word it's in their flow chart on the wall) I think I should have some input

Thank you I might try this over the weekend

They don’t have to give options. Their recommendation may well be she is not suitable for a community based hospital or interim bed. Your options are; relative goes home with their proposed care arrangements or your family privately arranges something else.

Forgot to add, they should explain it to you though!

@Tahinii

They don’t have to give options. Their recommendation may well be she is not suitable for a community based hospital or interim bed. Your options are; relative goes home with their proposed care arrangements or your family privately arranges something else.

Do you have any link to the legal position?

The simple answer is that you have input but not the final say.

Hi OP. The legislation I was referring to above is Section 13ZA Adults with Incapacity (Scotland) Act 2000. I don’t know if it will be any help to you but our local dementia group told us to quote this to the hospital. This resulted in a section 13ZA meeting being convened where health professionals, social work, relatives and an independent advocate representing the patient all met to discuss and agree on the best course of action after discharge.

Obviously our circumstances may have been different from yours but worth looking into. We were looking at our relative being discharged to an unsafe environment (home) before we quoted this. In the end they remained in hospital for around 7 weeks until we were able to find a suitable care home.

I think the Care home thing is throwing you OP. I think what you are asking here is does your POA give you the right to refuse the pathway they have assessed for your DM and instead insist on one of the higher support Pathways? For example community rehabilitation.

No. That is SS's assessment what what they are willing to provide, POA cannot compel a service to offer a higher level of care (whatever form that may take). BUT you can go out and source your own alternatives to this care.

You have LPoA, legally they can’t stop you from discharging your mum to a care home if you have found one before they can source a POC. I’m in England and mental health so lower priority but we have patients waiting weeks for a care agency!

It is normal for adult social care to want to trial package of care first if there has never been care going in before, in line with least restrictive measures and ultimately because residential and nursing homes are ridiculously costly.

This isn’t the situation though, you are saying it will be self funded so be very clear you will be looking for a placement and start as soon as you are able.

I have supported relatives through the minefield of navigating adult social care and pressure for their relative to leave hospital and it is immensely stressful so I do really feel for you.

If you feel you aren’t being listened to, a complaint to PALs will often work wonders. I manage complaints for my ward and they are taken seriously. I this case the hospital absolutely are in the wrong to exclude you so I would urge you to complain!

@flourpot

I may be repeating previous advice or the link may have been provided but I just googled " 6 weeks respite care on discharge from hospital scotland" and found a government page about "Independent living" that might help.

As I say apologies if I'm going over old ground but this is what I'm angling for in my position for my SM to give my Dad a proper break.

@helpfulperson

The simple answer is that you have input but not the final say.

Can you point me to any legal information to prove this to be the case?

I'm actually devastated that I can't help her I don't know why they think this is at all an acceptable course of action and having read all the replies I have no idea why they haven't even asked me for history

I know you have so much to organise but I echo those suggesting that you contact Social Services as a SW can be an ally.

When I called the Local Authority I found that we had already been allocated a SW as part of the discharge process and they were keen to get involved and help.

I know that they were also motivated by trying to get FIL out of the hospital quickly but they helped me when they realised I'd do everything to block him going home. If they realise you will be difficult then they'll be more likely to consider your option!

SW also helped with the mental capacity assessment and applying for benefits.

I dont know you, so this isnt a dig: if she wanted home and the stairs were deemed acceptable by a trained person, would it be worth the risk of shortening her life (due to risk of an accident), rather than a longer but sadder life somewhere else? Im not havibg a go, youre in an awful situation.

Otherwise, the glimmer of a potential loophole - carers (in Scotland, anyway) don't do food shopping. If your relative isnt able to do that, and you refuse to do it, then I would imagine they cant discharge her home. There may be suggestions that she pays someone to do food shop, weekly house clean, etc., which they wont be able to organise - if thats not in place beforehand, then I dont think they could say it was a safe discharge.
They could claim you werent providing the least restrictive option, but the POA doesnt mean that you have to physically do her cleaning and food shopping etc, only that you make decisions when they cant.

IF you are absolutely confident that they'll not run out of money, then visit a handful of homes, find a couple you like, the manager will visit your relative and when a place comes up move in. In February theres often a bit if a higher death rate in care homes, so whilst the wait could be long, it could also be quicker than a home care package.

Its staggeringly unlikely that anyone will be able to argue that a self-funding individuals POA has acted in their own interests by using a care home.

@Bryterlayter1

I don't agree with their assessment.

How can it be ok to send her home? She will fall downstairs and that's if she doesn't burn the place down. How would she ask for help?

Why can't I disagree?

I'm gutted that she put everything in place so I could step up when needed but they won't let me