Hospital inpatients and consent to procedures

[ReluctantPOA]

I wonder if anyone can help. My father is currently in hospital for some tests and observation following a 'cardiac event'. He seems to have recovered well but obviously they're taking a look at him. But he has dementia and while he is at the moment more lucid than not - and can certainly seem lucid, he does find some things hard to remember, has unfounded paranoia about many things and can often recount conversations and events unreliably. Not always - he remains very sharp in some ways. Until he's not.

To what extent can / should the doctors be having discussions with him and be taking his consent (or lack thereof) for procedures without letting my mum (next of kin) or me (POA) know?

I don't think you could truly say he lacks capacity so this isn't a case of me taking over his decisions. But we're not even in the loop and find out later when we visit what's been agreed or done in our absence?

CAN the doctors even be informing us of the decisions what with patient confidentiality? And I understand how time consuming it would be to talk to every patient and then have to ring their family as well. It's documented he has dementia but they still seem to talk to him directly.

Any advice would be gratefully received.

As long as he appears to have capacity they will talk to him. Can you arrange to go in for doctors rounds?

Are you worried he is agreeing to things that he doesn't understand or are not in his interests? They should be assessing his capacity as they go along ,but if you are worried he doesn't gave capacity you should discuss this. If your dad isn't talking to you or updating you,that's another issue and not about capacity for the decision.

I'm worried that he isn't able to always understand what he's agreeing to, yes - but it's not a clear-cut case of him being unable to understand every time so I don't know that he would be declared incompetent.

Sometimes he'll be fine and you can hold a perfectly normal conversation - he's aware of current events and can answer questions, and other days he'll deny having a catheter, even though it's right there (he'll say it's a ploy by the doctors to 'keep him there' but it's not attached to anything) and tell me that while I wasn't there the people came out of the cupboards and he's started a criminal investigation with the Vatican. That sort of thing.

It's not that he's deliberately witholding information from us, it's that he clean forgets what has been discussed and so if the docs/nurses don't tell us we won't know anything has been planned or has taken place.

Believe me, I've tried,! Trying to catch the doctors rounds is impossible, unless I just set up camp from 7am to tea time

i would ring and speak to his named nurse and discuss your concerns.

You could ask your dad if you could have a meeting with the docs? is the POA active and do the ward have a copy? At the end of the day, if your dad has capacity and has agreed to treatment, I wouldn’t then run decisions by the POA. A general discussion as to what’s happening, prognosis, discharge planning etc may be helpful.

Have a discussion with the senior ward nurse or dr if you can catch them about your concerns.
It was easier with my mum when she was in as she clearly doesn't have capacity and also doesn't have much speech left, so they had to talk to us even though due to a mix up by my brother we only have financial LPA not health.
However her hospital stay left her much more confused and agitated because the staff were terrible (even the well meaning ones) with people with dementia. I kept on being shouted at that they were "dementia trained" but clearly most didn't have a clue.
It precipitated a massive change in her condition and with hindsight I would have pushed to get her out of there much quicker.

Thanks for your reply. Yes, I agree, the hospital stay certainly is adding to his confusion and agitation. The staff are very nice but I feel that his dementia is often forgotten or overlooked and they are simply dealing with a cardiology patient.

It's in his notes to call my mum, and she leaves a written note on his table every day with her number and a request to call her to be updated - but it often doesn't happen. Speaking to the nurse one day only works for as long as they're on shift, then it all seems to be forgotten again. So frustrating!

I've left a message with PALS to see if they can suggest a better way to alert people to the need to keep us up to date. Will wait and see.

Hi. The POA is active and I have a copy, yes. I'm not looking to take over his decisions really, I don't think anyone would agree he doesn't have capacity all of the time. He does sometimes but other times he absolutely does not - he is excellent at coming across as if he's understanding but later on he'll say something about 'oh they came round to tell me they're going to amputate both my legs and so I'll have to try and get a special driving license' or something like that - when actually they came to get consent for an angiogram (which he 'agreed' to)

Having dealt with parents ill in hospital I wouldn’t be waiting for them to ring. I would be ringing at 11.30 each day (usualy ward rounds have finished but lunch not started) to find out what the current plan is.

@ReluctantPOA
Unfortunately the only way to get some information for us was dogged nagging to the point of nuisance
There isn't enough staff so it's easy to slip between the cracks

Yes I'm beginning to realise this is the case. I know they're busy and don't want to be 'that' person but I think that's probably the way forward

That's a good idea, thanks