Elderly going into a home when they don’t want to?

[frailfamily]

I look after my Nan full-time as she’s 90. I’m in my mid twenties and I get one afternoon (four hours) respite a week - when I first started looking after her I had a career but after a series of falls I had to give it up.

I’ve realised that life in lockdown and life out of lockdown is essentially the same; as everyone is talking about getting back to life I can’t think of anything worse.

I love my Nan lots and she does she have her stubborn marbles. Does anyone have any positive experiences of elderly going into a home (when they didn’t want to) and enjoyed it? I feel really guilty but I can’t imagine what it’s going to do for my mental health if I don’t have a plan to leave.

Please don’t spend the best years of your life like this. I did the same thing with my Gran and then my mum and now aged 39 I am starting over (my mum died last year, I ended up getting her into a nursing home - she had copd, bowel cancer and mental health issues). Contact adult social services and ask for a continuing healthcare assessment and get your nan into a home, for both your sakes. You will have to be very firm with people that you can’t carry on doing this, the more they see you are able / willing to do things the less they will offer. I have health conditions myself and a young child with autism to care for so I had to be really firm that I was unable to do things for my Mum as her care needs were increasing. Be prepared to chase and chase to get the help you need.

I have seen it work well because at home the person was isolated (along with the carer). In residential care they are thriving with socialising, a variety of carers can be a good thing, rather than the same one. It all depends on the care.

It is different to the care you’d get at home though and that individual attention from a family member. But that’s not necessarily worse.

Has your nan had to move into a home during the pandemic for lack of home carers?

Is it worth starting the process and seeing what’s available? It might end up with more help at home or a professional saying that a residential setting is really the best place. You can have a proper conversation about it.

You’ve done a very loving thing for your nan. You don’t need to do it in the same way forever. Good luck.

Contact adult social services and ask for a continuing healthcare assessment and get your nan into a home

Thankfully the law in this country doesn't allow people to put their elderly relatives into a care home against their will just because they don't want to look after them anymore.

The OP can control what level of care she is prepared to offer. If that is none and her nan 'has all her marbles' then it's up to her nan to decide what she wants to do, there's a whole range of options before residential care especially if she is currently managed to be cared for in her own home.

Absolutely contact adult social care for an assessment, but don't expect them to turn up and whisk her away into a care home, because they won't unless she wants to go AND needs to be there (and their idea of 'needs to' maybe very different to yours).

I think the thing I’m worried about most is that she’s going to refuse to go into a home (she’s sociable and probably would love it).

She cannot walk without someone behind her as she often has falls. She hasn’t made herself a cup of tea in ten years. She doesn’t have the mobility to put on her own cardigan. She needs help pulling her knickers up. There’s no way I can leave unless she gets 24/7 care as I’d be worried that she’ll die on her bathroom floor.

And OP - you will still be able to do a lot for your nan - your presence and attention will make a massive difference to her. It’ll just be different.

@hatgirl

You're not strictly correct. If following an assessment of need it is determined that a person cannot be kept safe in their own home without full time care, and the person does not have funds to pay for this, then the options are that the LA will fund up to 4 visits daily, or a care home.
My MIL went into hospital following a fall, after having a series of falls. She went into respite then went back home with a full care package, i.e. 4 visits a day to get her up, make lunch, make tea then put her to bed. She lasted a week at home, fell several more times and ended up back in hospital. From there, she never returned home even though she wanted to as she was deemed to no longer have capacity to make decisions about her safety.
OP, I'm assuming you live with your nan? Please contact adult social care (they are still working during the crisis) and ask for an assessment of need. It may take a couple of weeks for this to happen. Make sure when they visit, you are there and be very clear what you are able to provide. It may be that she needs carers coming in to provide some support initially, I very much doubt she will be taken into a care home immediately. If you receive carers or attendance, this will be used to pay for carers coming in.

4 visits daily isn't strictly true either, it's a needs assessment but some authorities esp in Wales have a 4 visits a day max policy but this isn't a legal thing. I've arranged 5 /6 visits a day also live in carers

You are acting as her 24/7 carer then? In her home or your home? You can't put her in a home if she has capacity to make that decision for herself, but the maximum care she'll get if it's council funded would be 4 x carer visits a day of maybe ½ an hour each. Would that be enough for her if you weren't living with her?

Does she realise she is ruining your life? Does she want you to sacrifice your life for her?

If she has capacity, then you will struggle to get her moved anywhere against her wishes - she has the right to live where she wants, just as you do, and she may feel that the benefits of being in her own home outweighs the risks in doing so.

What you can do is make sure she has the support she needs. Ring your council Adult Social Care department and request a Needs Assessment. Be very clear what you can and can not do. Even if DGM won't comply, you can request, and they will have to carry out, a Carer's Assessment on you. If how she is living is not safe and/ or you are also classed as a vulnerable adult, then make sure you tell them.

Two things to do first:-

1. Check with Citizen's Advice Bureau, Carer's Trust or Age UK what you are entitled to as you may need to ask specifically for it rather than the social worker suggest it. The relevant legislation in the UK is the Care Act 2014, but the Corona Virus emergency legislation has put easements in place regarding what the Local Authority has to do during the crisis.

1. Find out what effect it will have on where you can live if she does move. If you are both living in her house, whether rented or privately-owned, you may not be able to remain in it if she does move, so you need to find out what your situation will be and plan what you will do.

OP, you're absolutely within your rights to give up your caring role. Caring is HARD and you do not have to do it.

As pp have said, contact Adult Care Services and ask for a social care assessment. Depending on your Nan's needs and wishes, it may be possible for her to have carers visit her at home. If you want to, you could be involved in that to whatever level you feel would be right for you both. Eg, you might want to do two days with her and the rest paid carers or you might want to do none at all.

You don't have to care for your Nan, just because she wants you to. And you can still be there for her, just not doing everything.

It could be that having paid carers come in enables you to go back to a more healthy grandmother/grandaughter relationship with each other, where you see each other for pleasure as well as practical help.

Social services will consider 'putting her in a home' as the absolute last resort because it is so expensive. Therefore, they will prefer to keep her in her own place as long as they can. They may put pressure on you to be part of the caring workforce for your nan, so it would be good to have a clear idea of what you are and are not willing to do now. If you don't want to do care anymore it is OK to say, "I cannot and will not do this anymore. It is affecting life and health in this way..."

Also, as pp said, be prepared to chase and chase. In my experience, it's the squeaky he'll that gets the grease. Social services are so stretched that they can end up prioritising people in crisis (rightly so) but then some people do get forgotten about or fobbed off if they do not have someone to advocate on their behalf. Good luck

It's not solving your problems, but is your Nan getting attendance allowance? If not, then you need to do that. It's not a lot of money but would buy a small amount of private care, or would pay a small proportion of care home fees if your Nan was completely self-funding.

@Soontobe60

No I am correct. The OP indicates that her nan has capacity.

The local authority can assess and can say what they would offer/ recommend. But even if they assess that someone needs 24 hour care they can't then force someone with capacity to go into a residential care home if they don't want to. They can strongly recommend but it would be a breach of their human rights and an unlawful deprivation of liberty to take them there against their will.

The local authority doesn't have to pay instead for 24 hour care at home, but they would have to be certain that the person understood the implications of remaining at home without the level of support they felt was needed , I.e the right to make unwise decisions.

I've re-read my post and I'm not sure which bit you feel I've got wrong?

Can I ask does your nan own her own home.

Dmil 95 had to go in a home last year.

It is £1200 per week and by no means the most expensive place.

Dmil has her own flat and some cash but because of her physical health and genetics. (Father was nearly 100) her mind is failing the money sale of the flat and all her possessions will run out before she does.
If she has no money I would look around the homes carefully because there are some truly dreadful ones out there and even if you pay it is by no means guaranteed that it is any better.

Would you be better off paying for regular carers or just someone to sit with her whilst you go to work

@hatgirl

The point I was trying to make was that if the person is not able to make appropriate decisions about their own safety, e.g. cannot attend to their own personal care needs, and is unable to see that leaving them in their home could be very unsafe for them, that in itself is an indication of losing capacity. It may well be the case that they accept a degree of care in the home, and then end up having a fall or some such thing that puts them into hospital, as happened with my MIL. From that point, following further assessments from social care, occupational therapists etc, they most likely will end up in a care home eventually. Unless, of course, the person is able to pay for full time carers in their home themselves.

Yes, I'm a social worker for older adults so I understand how it works.

The point of the OP though is that her nan does have capacity and doesn't want to go into a care home. The OP is currently her carer and doesn't want to do it any more. The OP wants to know if anyone has any positive stories that she can use to convince her nan into residential care so that she is 'released' from her caring role without feeling too guilty about it.

The situation with your MIL who it sounds like was assessed as lacking capacity isn't relevant to the question being asked.

For what it's worth OP I have lots of positive stories about people moving into care homes but none of them are your nan. You don't have to provide care for her at all if you don't want to, there are other options in between you doing everything and her having to go into care against her will. The local authority will be able to help you navigate this, let the, be the 'bad guy'.

I think you should wait until this period of uncertainty has passed, because she's much safer at home with you right now, but start to make plans in your head for the near future.

Start to ask around - ask friends which nursing homes they'd recommend and why. You could even visit her every evening - she has no right to expect more than that from you. Then start to think what you could with your own life. You can't go on like this - she could live until 110!

Now is not the time anyone elderly with capacity would think is a good time to move to a nursing home.

@hatgirl

I guess the challenge comes when a family member ends up being a full time carer by default, because over time their relatives care needs increase dramatically, as with the OP. My MIL live alone so didn't have the option of family looking after her.
In the OPs case, if her nan ended up in hospital and was assessed as needing full time care on discharge for her own safety, what protocol would your service follow? (Assuming she wasn't self funding). Would you send her home with the maximum care package the LA will fund (which in my LA is 4 visits for 1/2 hr daily)? This is what my MILs SW did as MIL wanted that, and was denying the fact that she was falling daily, despite evidence to the contrary. It's such a dilemma. My MIL was only at home for a week before being taken back to hospital with a fractured skull and sternum from her latest fall. As a result of the injuries, her final few months were very challenging for her.
I'm a Senco and truly believe that the approach to care has to be totally person centred, but it also has to ensure ultimately that the person is safe.

I've every sympathy with the OP, and I don't know why anyone would opt for a care home with the Covid-19 thing the way it is. I mean, you'd have no idea how many have the infection in the home. Figures aren't released, the CQC doesn't have to tell you, and of course it also depends where you live. If you live in N Ireland you might be okay but London and the South East... not so great.
In my experience, the local authority need no encouragement to be 'the bad guy'! But maybe that's just Surrey.

Do you have Lasting Power of Attorney in Health and Welfare? Because if your nan doesn't grant you that, then later on it won't be your decision whether she comes out of any deathtrap care home. Social Services own your parent, if it looks like she has lost mental capacity, and that is a very nebulous area. Just a change of circs can bring that about.
And of course, if your nan has a bit of cash on her, like the property she owns, then the Council will want her money to subsidise Council-funded care home residents.
I don't know how carer visits work these days in the coronavirus crisis.

Anyway, research research ask around locally. It's hard to find out what care homes are like because the CQC isn't reliable and sits on bad care home reviews for up to eight months. Though often enough the reviews seem rigged anyway. As are reviews on NHS Choices - they simply won't allow bad care home reviews, unless very brief and slightly inarticulate.