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?

In my local area (England), discharge to community hospital is only an option where someone is thought to have some rehab potential. So it wouldn't be an option where that potential is thought not to exist.

It also seems to be the case that policy now is to discharge home first, with care home only once that's been tried. In principle I agree with this to some extent, though I think the amount of care you have been providing is not being taken into account - ie somehow they think that she will be safe between visits even if you have had to withdraw care due to total burnout/other responsibilities.

What I am absolutely sure about though is that you should be at that meeting.

As I understand it, legally the person with the PoA should be treated as the decision-maker, from the options that are clinically appropriate. Even if you were not the decision-maker, you should be consulted.

@Saz12

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.

She doesn't know what home means, so she can't 'want' home/

And noI do not want her to die by falling down the stairs

I can't read the rest of your post after this comment and it might be helpful but suggesting such a death is better

Something to consider, if you are self funding, would you expect the funds to last until the end (life expectancy is only a best guess I know), depending on where you are and if it's residential or nursing home you'll be probably be looking at minimum £1000 per week. If you aren't on a 'Council contract' and organised yourself what will you do if the money runs out?

Really hope this works out okay in the end.

@flourpot good luck to them getting a proper care package in place, even in scotland!! the councils and social care departments do not have enough staff as it is. she could be in hospital for ages waiting for package to be organised. the longer the better actually, because it will save a fortune. her house will need to be sold to fund her care but dont go putting it on the market just yet. you will end up paying the full whack once she is in a home and i guarantee her money wont last that long because you can be not far short of 10k per month!

The money is not an issue

Her house won't be sold it will be rented

There may be 3 possible options dispayed on the wall, but it doesn't mean that all of them are suitable - there may be criteria for the cottage hospital/ "halfway house" that your relative doesn't meet e.g. if it's a rehab placement and the therapists don't feel that she would benefit from rehab (often if there are cognition issues it can impact on their ability to make progress with rehab), then they wouldn't send your relative there rather than someone who would benefit from rehab

HI OP,

Of course you can disagree, you could complain formally if you think the assessment is wrong. However, what you are asking about is what powers you have as a POA and unfortunately you wouldn't have the power to force them to provide a higher level of support. If your DM had capacity she wouldn't be able to insist they to provide care higher level either.

I know this I very stressful, I would never wish to minimise this. In your shoes I would be focusing on finding an alternative provision you are happy with. As I said in my first post it takes time for home care to be set up if they have only just mentioned this to you I could still take weeks (it does in England) for this to be put in place.

@ApiratesaysYarrr

They are suitable. Of course they are. And interim placement with further assessment is totally suitable. A care home is also suitable.

Gong home is not suitable.

If anyone who thinks home with a care package is a reasonable option here can tell me how she will be safe I would be very interested to hear it.

Requiring an extensive care package might work in your favour as the care sector is bursting at the seams.

I waited 4 months with daily chasing up for a relative with Dementia and we never did get a care package set up in the end. No carers anywhere, even charity sector couldn't help.

Keep up with delay tactics, try and get her moved to a community hospital and push for a care home place.

@Bryterlayter1

Of course you can disagree, you could complain formally if you think the assessment is wrong. However, what you are asking about is what powers you have as a POA and unfortunately you wouldn't have the power to force them to provide a higher level of support. If your DM had capacity she wouldn't be able to insist they to provide care higher level either.

If she had capacity she wouldn't need to

Also. She is not my DM

Sorry those links don't work!

I'll try again

I'm in Scotland and dealing with similar right now. 102 year old grandmother broke hip three weeks ago, had had operation and 'physio' (getting her out of bed and onto chair with zimmer) and been sent home with a care package, two carers four times a day. She cannot toilet, walk and is registered blind. It's carnage. My 81 year old mother is expected to clean her up and wash bedding twice a day as the carers are not there overnight obviously. I despair and have such empathy for you.

If you Google
Home First Scottish Gov

That's actually horrendous, I'm so sorry.

I had no idea until this week how awful things were, both in hospital and out

You can put it in place. If she has access to funds, she’s given you the power to find her a care home and to arrange payment.

I have read the home first stuff/

The point is that I don't agree it's an appropriate option. She would not be safe and I don't know how anyone could consider she would be

@Tahinii

You can put it in place. If she has access to funds, she’s given you the power to find her a care home and to arrange payment.

I understand that now but I need the interim care whilst it's sorted/. Not at home

My apologies for saying DM.

I don't know if it's the same in Scotland but we had exactly the same in England. I am presuming it is social care who are funding the package of care at home. I had to challenge social care on their decision of care package and the social worker outright lied on the assessment form. I complained and used the medical evidence provided (mostly OT and physio reports) to counter evidence the level of care they had seemed suitable (at home carers 4 Times a day).

It took ages and we refused to allow my nan to be discharged stating that we're were unable to care for her and if anything happened to her it would be on their responsibility.

Social care manager reviewed the assesment and admitted the social worker had completely missed relevant medical information that completely changed the outcome and agreed that care home was more relevant.

I also then requested a CHC assessment, and did an assessment and used the checklist myself with evidence of all medical reports from the hospital and previous hospital admissions and provided this in writing. They then completed their own chc checklist and agreed that she met the criteria for funded nursing care. We still had to sell her house to fund the care home fees as nursing care didn't fund enough.

Ultimately the first thing you want in writing is the assessment and what evidence was used to determine the current care package they are deeming suitable and then you challenge that. Our social worker was very sneaky in only selecting bits info and deliberately ignoring other quite clear evidence of why she couldn't be safe at home.

Link to CHC here: https://www.nhs.uk/conditions/social-care-and-support-guide/money-work-and-benefits/nhs-continuing-healthcare/

If I recall once you request this assessment, they have to delay discharge until this assessment is completed.

It is so stressful having to go through all this!

If you have access to funds, is a live-in carer an option for her so she could go home but safely?

If I recall once you request this assessment, they have to delay discharge until this assessment is completed.

This is not the situation in Scotland now. The assessments are usually done at home now since the introduction of Home First

If she is to be 'discharged home' then the OT should be making a home visit to assess what the home is like and what 'aids' will be required..
Bear with me on this...
Without a home visit they cannot carry out a risk assessment for the discharge.
If she can mobilise with a zimmer or similar at all then I would suggest if she has been able to go to the toilet in hospital ' with assistance', then who will assist her when she is in the house alone and decides to head to the loo?
... at this point she becomes a 'falls risk'.. and it therefore becomes ' an unsafe discharge'.

If she is recognising that she is in hospital, then she will not recognise she is at home and the stairs are lethal in those circumstances as she will be incapable of assessing any danger in using them... especially if she is also coping with a zimmer/ walkkng aid.

Make sure you get the names of everyone you speak to... and make it clear that you will not forget them.

@op
the mdt to discuss her discharge hasn’t happened yet. you’ve been told no one is discharging her anywhere until her case is discussed there.

you sound utterly frantic but please, try to take the weekend to draw breath as she isn’t going anywhere right now.

in the mean time you raise your concerns. You tell OT, Physio, charge nurse and do your best to get in touch with her consultant. Actually any one of these will do but u don’t want your concerns getting lost. You ask for a social work referral. You state it would in your view be a unsafe discharge.

you acknowledge she hasn’t had homecare but stress that’s because you’ve been doing that, and it is no longer keeping her safe (falls, confusion, delirium).

you can also contact your local social work dept to self refer.

which local authority are you in?