If they keep refusing carers...

[Orangeblossom78]

in the future will SS say no to more care? Or am I overthinking this.

Context: elderly dad, refused carers in past to make meals and check meds, now talking of refusing it again (new referral)

Will they then say in future if he gets worse, well he has refused it twice now? Or does it not work like that.

I mean this time they have granted it again after he refused in the past, guess each time os a new referral. Frustrating situation.

slightly missing the point here with my reply but would be be happier with a meals on wheels type service where they deliver a ready to eat meal rather than a career come in? If he has a lifeline pendant, they will often have medication prompts as part of that service where they will phone and remind you. Or a medication dispenser that will alarm at the time of a medication and keep alarming until you take the pills.
Re SS, they will be used to this scenario and I would hope, will continue to try and help persuade him.

If he has capacity, then he’s entitled to refuse anything he likes, including life saving treatment.
Do you think he’s reached the stage of lacking capacity, eg due to dementia? If so, you could approach his GP and SS on that basis. If not, then he just has to suffer the consequences of his own stubbornness - all you can try is gentle persuasion.

My sister and I arranged for carers to go into help our mother, she refuses all help, but we have continued with the carer going in, she just goes in, asks my mother how she is, if she needs anything. Mother always says she is fine and needs nothing; carer signs her book and leaves.
We leave the contract in place, because we know there will come a day when the carer is needed.

If your father has capacity to decide to refuse - and the legal assumption is that he does, then he retains the right to make what others might consider an unwise choice.

It might be worth talking to the social worker and your father to look at alternatives to enable hims to retain his independence. Hot meals delivered, something like Wiltshire Farm microwave meals and a fixed setting on the microwave or sandwiches even. Is there a neighbour who might cook an e tea portion and drop it round each evening for small recompense?

Medicine can be put into a dosimeter. Some have timers and alarms to remind people to take them.

They have a statutory duty to assess and signpost towards appropriate care. Depending on income, they may or may not fund it. They can’t refuse because he’s refused in the past.

If he has capacity then yes he can decline it but if his care contract is closed and in the future his needs change then SS would do a new referral and care act assessment. It might be worth getting a health and welfare power of attorney put in place so that in future if his mental capacity goes down you would have the power to make sure he is having care that he might need but not necessarily want it you follow me?

I’m pretty sure it doesn’t work like that - my understanding is that if there is a need then that need has to be met. Hopefully someone who knows the Care Act will come along and answer properly.

However, some councils are moving to an assessment system that is less focussed on ‘needs = paid carers coming in’ and more focussed on ‘ok, what can you do, what social resources do you have, what do you need, how can we get that done in other ways’ like vdb’s suggestions. The danger for you in that is that you might get emotionally blackmailed by DF into doing more than you can manage.

Does he have a particular problem with the carers or is it just that he doesn’t like breezy strangers wandering in and out of his home and doesn’t like the loss of independence?

Hi thanks for the replies, it is common isn't it.

The care package is for two visits daily to prepare meals and check taken meds, might be better with bringing food it but thing they prepare it e.g. wiltshire farm foods for him rather than bring it

i will have to check as he might not order the food in himself etc so what will they cook him as he lives on random bought pies and the like.

Maybe they can set up the food order also. I live far away but sibling closer maybe they will deal with it. not sure.

They told me it is as a health professional did the referral it is just done automatically. In Scotland.

Brother is getting power of attorney, unsure about capacity.

100% his previous refusals will have no impact on future care.

Brother is getting power of attorney, unsure about capacity. Can you be put on form too, or is this a responsibility you don't want? It's useful to have two attorneys, in case anything is needed when one is on holiday.

I've got my mum loads of M&S meals and put them in her freezer. She can choose what she wants for them the next day and take it out to defrost then just pop in the microwave.

You can’t get LPA. It must be given.
It must be registered with OPG to be lawful.
It is only effective at a point when someone loses capacity around the decision being made.
Capacity is decision specific; it’s not a case of having capacity or not it is about having the capacity to make a specific decision. Someone with quite advanced dementia might retain the capacity to decide whether they want crumble with custard or ice cream, but not have the capacity to decide to drive. They might be able to decide whether to wear a coat outside when it’s raining. Someone in a coma does not have the capacity to agree to surgery.

So in this case it might be the person doesn't understand the need for care, for example have memory problems and forget meds but think they are Ok for example. It is a difficult thing. Because there is also a thing I saw about being able to make 'unwise' decisions also. It's not simple is it.

I mean my dad's decisions to eat ready foods and hoard stuff might be unwise and a health and safety risk, but does he not have the right to make 'unwise' decisions as well.

As an aside, as well as not taking on P o A for another reason, it is partly as dad does make what some may consider 'unwise' decisions.

I guess he is going to have memory tests soon and based on that and mental state we'll see. I don't want it to get into a situation of refusing then getting into crises and needing 'rescued' again.

So...if he refuses the carers but has given P o A and considered to not have capacity then the carers will still come despite of him saying no? What happens then

If he doesn't have capacity he cannot grant POA, it will have to be a best interest decision made by everyone. If POA has already been granted and he lacks capacity then yes carers can try and go in but they need to weigh up the risks to him and themselves and will have to hold a meeting with all the people involved. If he gets to that stage when he lacks capacity and refuses care then would he be safer in a carehome where he can be looked after.

Ok the P o A is being done, the initial part has been done just the final part to go I understand, the interview has been done a few weeks ago. Maybe I will mention to him the care home in case the sees they might do that unless he takes the care

It’s an absolute minefield.The LPA is basically the representative who acts on behalf of the person where they have given consent whilst they have capacity. If a capacity assessment shows they are unable to consent they cannot agree to an LPA. You’d need to apply for deputyship.

The assumption is he has capacity unless proven otherwise.The law requires minimal control over the person’s decisions and gives them as much decision making power as possible.

An LPA can’t force him to accept things that deprive him of his liberty. He cannot be forced to take medication against his will, for example. Covert administration requires a DOLS if he is not co-operating. An LPA can consent to surgery or (if financial LPA) set up direct debits for the electricity bill or buy an oil filled radiator.

He’d need a Deprivation of liberty Safeguard assessment completed by the local authority if the idea is to stop unwise decisions. That is not the purpose of the LPA. He can go ice skating if he understands the risks.
He is absolutely entitled to eat or refuse to eat what he wants. That can be a diet of liquorice allsorts and pork pies, if that is his preference. An LPA can’t override that - very few courts would overrule his right to choose what he eats regardless of capacity.
Moving someone into a care home against their will is unlikely to be successful. If he reaches a point where he cannot understands or be involved in the decision then he’s unlikely to put up a fight.

Blackmailing him to accept the care you want him to have isn’t particularly kind - even if done with kindly intent. Threatening a care home is just nasty. If he has capacity to agree a LPA he can remove it very easily. It cannot be used until he loses capacity. So no, you cannot force care upon him. You cannot force him to do it your way, however well intentioned. If he can agree an LPA he can make his own decisions. Using an LPA inappropriately to make decisions on his behalf but without his permission whilst he retains capacity is abusive and a criminal matter.

OK, well it is not really me who is in charge of the housing situation, he is in shattered housing and he needs to keep in in reasonable care or he can't keep it, and he isn't. His housing warden is in charge there. So he could be homeless then if he continues to make that hoarding decision.

I won;t mention a care home then, even if it opens his eyes to the future regarding housing options as / she he declines, his health is not very good. Maybe I just need to stand back a bit and let him see the consequences of his decisions.

sheltered

Cherry I find your words a bit harsh. the situation is the housing warden is being supportive as much as she can be but has written a letter saying she hopes with support he can stay in his home independently and in the community where he knows people.

it was clear is he doesn't start to engage he could lose his home or be moved somewhere else and the only other option is more supported care. / home

So it's not just about 'doing it my way', it is about being safe and looking after things so he can keep his home / independence as long as possible, which means his engaging with the SS / housing place

Yes I guess the words seem a bit harsh but then so does depriving someone of their freedom to make choices.

I just want you to be aware how serious any breaches of the Mental Capacity Act are. Whilst I’m sure the intention is kind, a gilded or cotton wool cage is still a cage - Justice Hales words not mine. Control over our lives is a fundamental right.

You cannot detain someone except under the Mental Health Act or via an approved DoLS. It’s important to know that an LPA doesn’t give you that authority. However much the urge is to protect.Removing someone’s rights is abuse unless done through proper route. Using threats ‘You’ll be put in a care home if you don’t do what we want/we think you need’ is a threat.

It’s hugely difficult and you do need to help him understand the risks and options but it has to remain his decision. That’s hard to watch and entirely understandable that offspring want to protect but he’s still allowed to do unwise things. Even if there are consequences he hasn’t foreseen.

Ok I agree he should have the right to do what he wants.

It was a social services assessment from the hospital last admission resulted in this decision to have two free care visits a day and to check he has taken his meds.

It's nothing I've imposed on him or suggested, I won't mention about the care home etc.

i'm staying out of the P o A anyway. In fact going to step back quite a bit for my own mental health.

It was actually my brother started on about getting power of attorney and his wife. Took dad to the solicitors etc. Asked me to join, I said no.

They also didn't like it when the hospital sent him home last time, wanted them to keep him on for further assessment etc. I thought the hospital was right he was fit to go home.

It is tricky between siblings, dealing with this stuff. I kind of had the feeling they were 'taking over' things a bit and it made me want to step back.

Maybe that was the right decision.