MIL needs proper care, sFIL intransigent

[Jux]

MIL is gone. There isn't really anything left except one or two memories which no one recognises, so probably from childhood.

She has been in hospital 5 times this year with UTIs, this last time they kept her in for nearly 4 weeks, as they were worried about stroke and some other things and were also treating a rather nasty bed sore. She is back home now. SFIL is in hospital now though, with a UTI.

They have a 24hr carer, and other carers come in 4 times a day to help move MIL for loo, wash, etc. AFAICS they are not particularly trained to deal with dementia patients.

SFIL and a solicitor have PoA for MIL (it's not PoA as she was too incapacitated so they've got whatever the equivalent is).

Their GP, the SWs, solicitor and dh and SIL all think she should be in a proper dementia care home. SFIL disagrees. His children think they should both be in some sort of care home, but won't go against him.

She has no life. She sits in a chair staring out of the window onto a bit of lawn. They never go out. They have no visitors except the carers.

I want to take her away while sFIL is in hospital and have her somewhere where she'll see people, there are activities, she can get outside and look at flowers. Where she is surrounded by people who are qualified to care for her and will recognise when she needs medical attention so she wOn't end up with UTIs and bed sores.

DH is beside himself, but is powerless against the wishes of sFIL.

Is there really nothing we can do to force it? We live 150 miles away, too, which makes it harder.

Is there any way SFIL is actually unfit to hold her POA and can have it taken off him?

He may be, RandomMess; how could we tell?

Poor MIL. I didn't much like her, tbh, but what's been happening to her over the last year is simply appalling. In the space of a few months she's gone from a very dotty and forgetful old lady to a heap sitting on a chair in the corner. It's heartbreaking.

I don't know

But even if she were living elsewhere I'm not sure it would improve her dementia? So long as she is getting appropriate physical care staying in her normal surroundings may be for the best?

I know where you are coming from, I really do as my mum has dementia has been hospitalised a number of times this year and my dad is also frail and has early stage dementia and has been in hospital lots as well.

But I also know what it means to my dad to have mum at home - she's his reason to get up in the morning. Every meal is about finding something she'll eat. His delight when she decides to kiss him is amazing. And if she was in residential care all that would go.

Your MIL could get more stimulation at home (though its your sFIL who would benefit more) - mums carer takes her out for a couple of hours each week in the wheelchair just for a change of scene and to give dad a break. We've tried the local day centre as well, but mum hated it - it is a great resource though as they have a hoisted bath, do physio, chiropody, hairdressing etc there and have a wheelchair accesible bus to collect people.

I was in a similar position several years ago. Only the fact that both my mum and step father were admitted to hospital on the same day, allowed us to get the care my mum needed.

I would approach the Local Authority And ask for respite care for your Mil, while your SFil is in hospital. You may have to pay and this could be between 500 to 700 per week.

If you are successful it may let your S FiL see that she is being cared for better in the home.

Thanks everyone.

Months ago, when MIL still recognised sFIL, yes, she would have been upset to be parted from him even if he visited every day. That is no longer the case. So from his pov, it's better she's there, it's what he's used to and he loves her in his way. From her pov, it's just not.

The carers don't take her out. The road's not safe, no pavement, so no putting her in a wheelchair and taking her for a walk to the park round the corner. You have to drive to places, and though the carer(s) do drive, they don't take her out. She sits, looking at a small stretch of boring lawn and a hedge. No flowers, nothing to break the monotony. It's no wonder her mind's deteriorated quicker than the doctors expected.

CMOT, if sfil were like your dad, we wouldn't be nearly so worried. He's not. He really only consults his own interests and doesn't do any of that. He used to complain that she hadn't got his breakfast ready, or if the house was messy, only a few months ago! Things like that.

Now the carers do all the practical things, food prep, cleaning etc. He will occasionally ask her a question. But the sort of things your dad does? No way. And his interactions with her are more like he's exasperated with her.

Their GP, the SWs, solicitor and dh and SIL all think she should be in a proper dementia care home. SFIL disagrees. His children think they should both be in some sort of care home, but won't go against him.

You might like to consult an independent solicitor. If your step father in law obtained a deputyship from the court of protection (ie, your mother in law was not able to sign a power of attorney and they had to obtain it subsequently) then that is equivalent to a financial PoA, not a health and welfare PoA. A next of kin, as I understand it, has far more power to override the opinion of doctors as to the patient's best interests if they hold a health and welfare PoA, which in this case I don't.

A lawyer will correct me, I'm sure, but as I understand it someone who holds a H&W PoA can make the same decisions the donor can.

If you have capacity, you can refuse treatment for any and all reasons; for example, Jehovah's Witnesses refusing blood transfusions, or people insisting on DNR over the wishes of their relatives.

Someone who holds a H&W PoA can make decisions on your behalf on the same basis, and a doctor who treats you contrary to that decision does so at their own peril. Courts can overturn such decisions, but the presumptions are high and the threshold for overturning decisions is extreme.

But if you don't have a H&W PoA and the patient lacks capacity, all a next of kin can do is offer advice and opinion to doctors making a best-interests decision. The next of kin can't speak for the patient, they can only comment.

Thank you, Ricardian. That's really useful information. I don't know whether the PoA is H&W as well as financial, so I'll ask dh when he gets home. There's a glimmer of hope, as I know sFIL only got the PoA in order to sell the house (which he has subsequently changed his mind on).

My aunt bought a small flat which was part of a fabulous care home/complex. I don't know quite how it worked, but all the professional help was there, she was part of it all, and got all the benefits, but she owned the flat she lived in. MIL would have loved something like that. She'd been wanting to sell for nearly 20 years, always talked wistfully about having a smaller place in a more accessible spot, no big road outside etc. It's so sad. She'd wanted to have a cat, but didn't dare because of the road.

I don't know whether the PoA is H&W as well as financial

If it's a court of protection deputyship, I believe it can only be financial.

You can obtain what amounts to a financial power of attorney via that route without the donor's consent; it's more onerous to run that a lasting power of attorney drawn up by the donor prior to their losing capacity, but means that if someone becomes incapable without previously having drawn up an enduring PoA then there is a way to deal with the financial situation.

The court of protection adjudicates its granting, and then monitors its operation; the accounts you have to produce are much more detailed, and the limits on what you can do more stringent, than with a standard lasting or enduring power of attorney.

So far as I understand it, you cannot obtain a health and welfare PoA, or anything like one, via this route: if it wasn't done prior to the person losing capacity, that's the end of it.

Right, I see. It was definitely obtained after she lost capacity as dh and sil were contacted to see if they had objections, and it was explained to dh that they couldn't do the usual PoA. She is unlikely to have done a H&W PoA, and would certainly have ensured that dh knew about it, if she had.

Thank you.

DH may still not be able to do anything concrete for her, but it will almost certainly make him feel better to know that ^^.

She is unlikely to have done a H&W PoA

Indeed. Presumably someone, somewhere has done H&W without financial, but I suspect it's very rare: usually people do the (well-known) financial, and then add the H&W if/when prompted by their solicitor.

It's also not well understood that H&W PoAs give additional powers to next of kin, which they otherwise don't have; doctors only have to consult next of kin, and sometimes not even that, but require a court order to override someone wielding an H&W PoA. Therefore a lot of people assume you only need an H&W PoA when there isn't a spouse.

There was, I gather, some lee-way in the past that although an old-style enduring PoA only covered finance, someone with one would be assumed to be slightly more trusted than they might otherwise be when time came to discuss health and welfare. That's not the case now.