What happens if an elderly person refuses care?

[HappyGirl86]

Hi All,

Sorry for the long post:
My grandmother has been in hospital for 3 weeks with sepsis and kidney problems. She now has a kidney drain and a catheter, both of which are permanent. She is 88 and was becoming more and more frail prior to the hospital admission. She has arthritis and various other medical problems and she was struggling more with day to day activities at home.
Hospital said they wouldn't discharge her until social services had done an assessment. They said she was very frail and needed a lot of assistance e.g going to the toilet etc We then had a call to say a care package had been agreed and district nurses will also be visiting to assist with her kidney drains etc...
She came home last night and it now has become clear that she is having intermediate care which is free for a few weeks and then a social worker will have to make a decision on further care. District nurse and the carers are saying she will need long term care at home, possibly even a care Home.
My grandmother lives with my grandad who is 90. I love him to bits but he is very stubborn and he does not like to spend any money. He has plenty of savings but he will not spend on anything to assist them in living a happier, easier life. He seems to be saving his money to pass on to his family and we just want him to spend it on themselves. We have had so many conversations with him but he doesn't listen.
The district nurse has told him my grandmother really needs a stairlift and that it is dangerous for her to be on the stairs. He just makes excuses as to why he doesn't want to do it and this has been common place throughout their 67 year marriage!
I think that social services are going to assess my grandmother as needing care but I imagine they will have to pay towards this? Even if this was carers coming to their home.
So I'm wondering what happens if my grandad refuses to spend the money? I think he will say that they can manage on their own. They clearly can't and I am very worried what would happen next.
My grandmother has capacity.
Sorry for the long post but does anyone have any advice or experience of this sort of situation?
Thanks!

Very tricky.

How much of the money is in your grandma's name? She is assessed as an individual not as the couple.

I would let the social worker know your concerns. We can be very persuasive in these kinds of situations, and it's sadly extremely common.

I'm going through similar. If they both have capacity there is nothing you can do. Not what you want or need to hear.

Assuming you are based in the UK and it was an NHS hospital, I'd have expected physiotherapists to have assessed your grandma on stairs and for an OT to have assessed her ability to care for herself. It sounds like the OT felt she needed help with self care, hence the carers. If she needed help on the stairs I'd have expected downstairs or upstairs living to have been discussed with immediate family as they'd be reluctant to discharge her straight home without something being in place to prevent her struggling on the stairs.

Social services should have already looked at the carer situation and have looked at who would pay for this. Similar should have happened if she was going to need to go into residential care.

You mention intermediate care - is she having physio or OT at home during this period? Intermediate care as I know it involves rehab at home and this may be why the social services are going to reassess care as they're hoping it will be no longer needed at the current level.

As for what happens if your grandma refuses to pay for anything, if she has capacity there is nothing you can do other than try to persuade her to pay. If she is having physio/OT at home they may be able to make suggestions to increase safety etc. but I'd have normally expected this to have been done prior to discharge.

Sorry I can't give you any more help.

Im going through the exact same with my great aunt who is 85. She had a hospital stay and after she got out she was getting carers three times a day from the council but wasnt being charged but she had a fall last week and has a fractured hip (on top if heart disease, kidney disease and the issue she was last in hospital for) and now her memories going rapidly over the last week.

She is in hospital and we are waiting for an occupational therapist assessment then they will put a care plan in place. However she's been trying to get out bed in the middle of the night and shouting non stop even though she's not mobile on her own. So hoping the nurses also say she isn't safe to go home as she will try get up in the night and fall again and she is forgetting to put her little buzzer round her neck that calls for help if she falls. Only issue is we don't have a power of attorney in place for her to try get her in a nursing home and access her money to pay for it.

Hopefully social work will help you with convincing your grandad if she needs to go into a home. Otherwise hopefully council carers will come in. Up to four times a day you can get them here (I'm in Scotland) is there any rooms downstairs that can be turned into a room for her with a bed? I know my aunt had a commode but she wouldn't use it but they can be provided to prevent going upstairs for the toilet.

It should be your grandmothers choice to have care or not?

If your gm also refuses to pay for care or continue with care after her 6 weeks are up there's not much you can do except get as much equipment as you can now, maybe move her downstairs as someone suggested with a hospital style bed, commode, walking aids, riser chair, falls alarm, careline all these can come free from the community. She will also n3ed to have nurses coming in to keep an eye on her kidney drain and catheter. We spend 4k on a stairlift, it never got used and ended up in a skip. If she needs care and wants care and gd refuses to,pay for it you have to let social services know as this is not in her best interests.

Thanks everyone for the replies. It's good to hear others experiences.
In answer to the questions, yes my grandmother does have her own pension etc and her name is also on their bank accounts. They are a very 'traditional' couple and she has always let my grandad deal with all of this. It seems very strange to me and my mum as we both do things very differently but this has always been their way. She accesses her state pension and spends that on her bits of shopping each week.
My grandmother definitely wants the carers and I know she will plead with my grandad to agree to it but he can be very strong willed and actually quite nasty to get people to do things his way. I guess I need to give him chance to see what he does but I do worry he will try to tell her not to agree to care when she has to pay.

We will definitely speak to the social worker in advance, thanks for that tip!

She did see a physio and an OT in hospital and the physio felt she was "ok" on the stairs but needed more assistance. She is getting OT and physio assessments as part of this package at home. The OT visited today and said she may need a bed downstairs.
The district nurse wanted to order a bed for downstairs but my grandmother refused and said she would not sleep downstairs and that she wanted her own bedroom.

It's so difficult, I just want her to have exactly what she needs and wants, and not for her to have to fight my grandad to get it all.

@ShesABelter sorry to hear you are having such a tough time with your great aunt. I hope you manage to get the right care in place. It's awful to see them in this position isn't it!

rightsofwomen.org.uk/get-information/violence-against-women-and-international-law/coercive-control-and-the-law/

Yeah and you just worry that if you don't get the right care in place they will then hurt themselves further. In my aunt's case she doesn't have children or anyone living with her and she's really losing her mind but is utterly refusing a care home.

I hope it's all resolved and your grandad comes though and funds what ever is needed to make life easier for you all as knowing your grans getting the right care will be a load off all of you.

@LuxuryBed I said to my grandmother today that although they have had a good marriage in lots of ways, controlling her money is financial abuse. She did listen but I obviously don't want to upset her any more. It's up to us to stick up for her and stand up for her rights.

I hope you can work something out so she can get home safely, he has no legal right to refuse care for her if she is requesting, that is not fair on her at all, definately tell the social worker. Once home she can apply for attendance allowance and he may get carers allowance to help with the cost if that's his main issue.

Bit of a roundabout solution, but if he's saving up the money to give to you as an inheritance, do you think he would be willing to give you a portion of your "inheritance" early and then you could spend that money on installing a stairlift?

Either that or guilt trip - if you don't spend the money then relatives are going to have to go without to save up and pay for the stairlift on their behalf...

... or the logic that a stairlift is cheaper than a care home or a funeral when she falls down the stairs

In England care after hospital is only funded for a few weeks, then the person will be assessed whether they need to pay for ongoing care at home or out of the home. Some people get better, some people their health will deteriorate. Either way the best care should be provided, this sounds like rainy day time, where savings should be spent. However, it is their money. I would not want to suffer unnecessarily.

I suppose if your grandad won't allow the money to be spent then it could possibly be raised as a SOVA/safeguarding issue as he would be denying grandma access to her money and to fund the care that she needs as recomended by nurses/district nurse/ot/pt.

I'm sad to say that sometimes doing the right things aren't always easy. I've been on both sides of the fence,professional and personal,in similar cases.

I agree with Pandora, if she needs equipment which is usually free anyway except for the stairlift then it should be made available for her. If she needs carers and she is happy to have them then it is a safeguarding issue if he refuses to have them or allow her to pay for them. The inheritance is irrelevant, her needs are the priority at the moment. If there's less money at the end then so be it.