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 wanted to know if I had the right to say she cannot be discharged to home. I don't understand how they can consider it. I don't know what to do to prevent it. I don't know how to access help. I don't know how to be involved. Im drowning.

But yes are moment I would prefer the interim option over home because I do not believe she would be safe at home. If she needs to be varies into her house because cannot manage the status she is not safe in there alone

Here's a question for you to pose to the team.

The care package - who will provide access? Is the patient expected to go down the stairs to open the door for every carer then lock it afterwards? That's 16 times on the stairs everyday.

Also very easy way to stop a discharge. With hold the 🔑 until you're satisfied and comfortable with the discharge.

@halfshutknife they will get a key safe put in, that is standard if you have carers.

I think they would just for a key safe outside?

I am aware of this. Was more for OP to ask the team this to see if they have considered it.

Not all therapists are thorough and sometimes there's human error.

Hi

if you hold full POA then you have the right to speak on behalf of your relative if you feel long term care is needed.

you need to speak with the assessors who I would assume is the occupational and physio therapists. Speak with the care staff. Ask to see the notes. What is the over night needs. How many times a day are they seeking staff. Are they incontanent of urine and bowels. Do they need encouragement to eat?

you can ask for an assessment to be done for a social worker to be allocated.

sometimes people get sent home to fail if they haven’t had a package of care before. This can be 4 times daily. Not over night. Then they would consider lo g term care

there’s nothing stopping you to put loved one into a care home but without the correct assessment of needs they wouldn’t have the personal care fees paid. So wait for an assessment from social work

hope this helps.

They will but someone has to organise it, pay for it and put keys in.

As Poa of someone who's incapax you would need to ok it and pay unless it's a council that provide for free you'll also need to go get keys cut.

Unlikely you'll manage that before Monday so she can't be discharged on Monday.

Good luck OP. It is so difficult. The reality is as POA you are only able to make the decisions that your relative would make. You effectively are your relative when talking to health care providers etc. Unfortunately this doesn’t count for much as the NHS isn’t in a good place. People can’t even get a GP or dentist appointments never mind the care and treatment they need.

Unfortunately resources are so limited that if a patient has support from a relative then they are often discharged when they shouldn’t be.

You have had a lot of advice and I appreciate you may not feel comfortable with some of it eg making sure your relative doesn’t have a house key etc so they can’t go home. It’s appalling that you would have to resort to this but you may have too.

Another thing I learned was that the number of falls affected the care offered eg. 3 falls triggered a certain level of care so make sure the hospital are aware of any previous falls.

Also please look at the legislation I mentioned above. Asking for this review bought us a lot of time. I can’t really remember the ins and outs of it but it was something about people without capacity being released into a safe environment. My relative was hospitalised with a broken foot not anything to do with their capacity. This was something a health care professional (at a local dementia group) advised us to do.

I hope everything works out for you.

Not in England and Wales there isn't. You still haven't said why the NHS should pay for social care needs? And saying it will cost them more if she falls at home isn't an answer to that question. Patients also fall in hospital and in care homes, you can't mitigate against everything.

This is why the NHS is on It's knees. For every patient like your relative, there is another patient out in the community or stuck on an ambulance who needs a bed because they are medically sick and could die without rapid intervention. I'm not saying it's right - it isn't, the NHS has been underfunded and totally inefficient for years - Tory Austerity and COVID have excerbated these effects, but I still don't think patients should be kept in hospital because of social care needs - social services and self funding families should be responsible for that.

I am not unsympathetic to your situation - as I said, I went through very similar with my Mum. We were self funding and eventually sorted a care home out for her. But I really wouldn't have wanted her in hospital when she didn't need to be there (by that I mean didn't have NHS needs, not, didn't have social care needs) because she could have ended up a lot sicker if she had remained in hospital.

Not in England and Wales there isn't

I'm not in England or Wales. I'm talking about Scotland and what the options are here/

. You still haven't said why the NHS should pay for social care needs?

I don't have to. Please don’t challenge me needlessly, I'm having a bad enough time right now without this crap

And saying it will cost them more if she falls at home isn't an answer to that question.

I was being sarcastic.

Patients also fall in hospital and in care homes, you can't mitigate against everything.

Less likely to break their necks on stairs in those settings though. Also able to be evacuated in case of emergency which would not happen immediately at home/

Re not preventing the falls.

As op said people do fall in care homes and hospitals but the fall doesn't tend to be the biggest issue. The amount of time they lie and effect that causes is often worse.
In hospitals and care homes it's highly unlikely that the will be a long lie associated with a fall. This managing the risk rather than taking it away.

Oops. I meant pp and I don't know how to edit 🤦🏼‍♀️

She already fell in hospital. My consideration was simply a fall at home can potentially be much worse because of stairs but actually I didn't consider that she could be lying for ages as well. No idea how becsue this is what lenses us in the situation we are in.

Depends on the council but you can also manage that risk in the community with a falls detector. It's an upgrade to the community alarm and detects a change in height. The alert goes straight through to the call centre without the person pressing it.

A great piece of technology if someone wants peace of mind and to stay in their own home.

All of these safe guarding measures are great but my view (as a professional with 20+ years of experience) is want my loved one in 24 hour care

I don't want to know when she has fallen down a flight of stairs though . I want to prevent it.

Sorry I'm not arguing with you I'm annoyed at the situation

That's what I'm trying to say. They work well in some situations but not in all.

I get you're not arguing but these are the types of things an mdt will suggest and im preparing you so you know what your response will be and what questions to ask.

As I said as a professional I know what can be recommended. As a daughter/wife/niece I know what I'd want for a 92 yr old with an inability to recognise risk and safe guard them self. Your humanity always forms part of the assessment.

@Jadebanditchillipepper with respect, the OP has asked for help not a discussion on NHS versus social care.. if you want to discuss that then start another thread instead of adding to the OP stress. Both nhs and social are on their knees in terms of funding and that is why most social care packages are carers in the home as it's cheaper than admitting a person needs a care home.

@flourpot you have to be strong, request everything in writing as well. It doesn't sound like they have fully done a social care assessment yet or at least they should have been asking you questions too as their POA as part of the social care discharge assessment. This is where our social worker outright ignored things we said (and had medical evidence to back up). Our complaint was upheld against her for just simply believing we should be caring for our nan and she was downright rude to us about it, judging us for saying we work full time and have young kids. She outright said you should give up work for your nan (our mum has already passed away). I really hope she isn't in the same role.

Unfortunately It is the difference between being clinically ready to discharge from hospital and then being safe at home etc but unfortunately it does involve having to push and hold your ground. It is not easy and so stressful!

OP, I would try to switch off this weekend. There’s nothing that can be done over the weekend anyway. You say there’s a meeting on Monday - ask the ward staff if it’s a ‘best interest’ meeting and tell them you will be attending with your relative.
At that meeting, there should be a discussion on what is best for the relative, and how that will be implemented. If they decide the relative needs to go home with a care package, then a care package will need to be implemented before she leaves the hospital. That could, quite frankly, take weeks. There are no carers around at the moment! In the meantime, tell them you are investigating care homes as your relative has expressed a desire for this. Contact care homes, ask them to assess your relative and set those wheels in motion. Just be cautious about how you word your concerns. Yes, you have POA, but if in the eyes of the medical professionals or Social workers you are trying to make decisions that they consider to NOT be in her best interest, they can apply to the courts to have the POA rescinded.
‘When dealing with my stepfather in a similar situation, I found that saying things like ‘I appreciate what you’re telling me, but there is no one to visit him at home and he is not safe’ said with a smile meant they didn’t see me as being obstructive. After several weeks in hospital, bed blocking, he was transferred to a care home for respite, and is still there 2 years later.

ask the ward staff if it’s a ‘best interest’ meeting and tell them you will be attending with your relative.

She is lying in a hospital bed and would be utterly confused by being wheeled into a meeting full of strangers talking about things she doesn't understand. That's not an option.

Just be cautious about how you word your concerns. Yes, you have POA, but if in the eyes of the medical professionals or Social workers you are trying to make decisions that they consider to NOT be in her best interest, they can apply to the courts to have the POA rescinded.

This is my sticking point. How can anyone think k sending her home is in her best interest.

I though POA being rescinded would be the opposite of I was trying to keep her home to be for myself in the future with inheritance, not by speaking up to get her to a lace of safety.

This is something i need to seriously consider as I am absolutely here for her and I didn't realise trying to push for a after environment could result in me losing the POA

You can't force the hospital even a community hospital to keep in a patient they have assessed as suitable for home care, just as I can't demand I stay in hospital rather than go home. POA is irrelevant. You and your relative can decide between you depending on capacity and funding whether a care home may be a better alternative available if there is one you can fund but you can't force them to keep anyone in hospital

Thank you for this it really made a difference when I read it this morning.

The idea that I can do her shopping is all good and well but what happens when she tries to cook said shopping is what I'm trying to impress upon them.

Look at adults with incapacity (Scotland) act 2000. Section 1 general principles . And section 15 or 16 (?) and the POA doc, to check your powers are definitely in force

And mental welfare commission Scotland guidance on deprivation of liberty and powers of attorney

My take is, you can't insist she stays in any form of hospital if healthcare professionals say she's ready for discharge

Instead of fighting hospital about that,
I would contact a care home or two urgently, ask them to assess if they could care for your relative and progress that, as attorney. Emphasise that she'll be self funding. I think they usually need evidence that she can pay the fees for a set period, perhaps between 6 and 18 montgs, not sure

(Technically, you should probably seek guardianship to comply with deprivation of liberty issues, but that's a long journey and you don't have time on your side, so perhaps leave that for now)

Hope this helps

I'd bet my house on the fact that your poa will not be revoked based on what you are saying.

I get the impression that the mdt just haven't appreciated your significant concerns.

Everything you are saying is completely valid.

Which hospital is your relative in?

As her carer you also have rights under the Carers Scotland Act. This includes the right to be involved in decisions about hospital discharge.

This leaflet explains it https://www.carersnet.org/wp-content/uploads/2021/06/6.-What-to-expect-when-the-person-you-care-for-is-discharged-from-hospital.pdf

My advice would be to point this out to them, even send them the leaflet to make sure you get to attend the meeting on Monday to have your say.

Someone else up thread also suggested contacting your local carers centre, who might have a hospital discharge worker. You can find them here careinfoscotland.scot/topics/support-for-carers/carer-centres/