Carer's capabiilty assessment?

[Watchagotcha]

I've posted several times about PIL. MIL has Parkinsons, dementia and osteoporosis. She was admitted to hospital about a month ago with severe dehydration, delirium, UTI and pneumonia. We found out after that she'd been incontinent on occasion and fallen a few times in the run up to this. She has been stabilised, rehydrated, on ABS for the infections. But she has lost a lot of mobility - currently unable to walk and being hoisted out of bed etc. She's still quite incontinent - asking to go to the toilet, but too late. It's a mess and very hard on them all.

The hospital has said that she will be kept in for another week, as from their POV everything that is curable has been cured. The physio is working with her daily to get her back on her feet.

FIL is determined to bring her home. DH and I are - frankly - dismayed at the prospect. He is well intentioned, but he's not good at caring for her at the best of times. He doesn't get her to take her medication, he clearly doesn't keep her fluids up. He has made one bad decision after another about showers, beds, chairs, furnishing, cars etc that either put her in danger or that she just can't use. He doesn't seem to notice when she smells because she has been unable to wash in the shower, or that she's put a skirt on as a top.

Our worry is that when it comes to discharge, he's just going to say "Yes, yes, I can do that" and that social services will hand her over to him. Will anyone actually check whether he's able to take this on? To do some kind of check that he actually can get her to take her tablets on time, or to drink every day? to actually get in the shower with her and clean her?

We are trying to talk him out of it, but he seems to feel that he'd be letting her down if he didn't do his best to get her home. I think he'd be letting her down if she's back in the same state in a month, and back in hospital.

This sounds like such a difficult situation

I would express your concerns to the ward staff to let them know you think it will be an unsafe discharge home for your MIL. Are Social Services involved? Does your MIL have an assigned Social Worker you could speak to? If so they should have conducted a needs assessment for your MIL and a Carers Assessment for your FIL.

Would FIL accept a package of short term care initially? Once a care package in is place he may realise that the support is beneficial for both of them. Is there any additional support family members could provide to facilitate these changes?

Sorry for all the questions, it’s the type of things I would consider myself. Apologies if you and your DH have already discussed these things.

Thank you for replying. We are really hoping that the staff will recognise FILs limitations and propose some sort of care package - and that he accepts it. He is not the most rational, once he gets fixed on an idea. And he gets confused very easily with anything medical.

Unfortunately DH and I don’t live in the UK, so our only contact with the staff is by phone. SIL is there, but she’s so passive and reluctant to upset her dad, I don’t think she will speak up in front of him. Visits are very restricted due to Covid, we are all having to do this by phone.

I don’t think she has a social worker. Most contact has been with the medical side, plus various council people to do care / carers assessments in the past. I’m not convinced by the worth of these - as I said, the assumption seems to be that if FIL is there and willing, he will somehow be able to fulfil quite a complex and challenging caring role - no one ever seems to go into the detail of it with him and assess whether he’s actually capable of doing the job he’s agreeing to do!

I really hope there is some resolution to this situation soon for you all and that things work out well for your MIL and FIL. It’s so hard when things are happening that are out of your control. If I was you I would speak to the named nurse for your MIL, make her aware of your concerns and ask that a Social Worker from the Hospital team assess the situation further.

I have never heard of a carer’s capability assessment; but the other way of tackling it, could be to raise your concerns as safeguarding with Social Services?

Your MIL should be seen by the hospital discharge team who will decide how and where she is discharged to. You need to speak the them and to adult social services in order to discuss the care she will need and whether it’s possible, because the hospital will, wherever possible, just send her home if she wants that and if she’s deemed to have capacity to make that decision.

Yes, we have just had that with MIL in hospital with a broken hip! She was telling everybody 2 days after surgery, she could not wait to go home! It must have been music to their ears! DH and SIL had to ask her to stop it, as how did she think she could manage?

She was discharged from a rehab home on Friday, with 4 care visits a day reablement. She was determined to show she could wash up, heat her ready meals in the microwave and get dressed by herself over the weekend - so on Monday, they cut the care visits to two a day!

Thank you again.

One of our big problems is definitely communication. FIL is the person that the hospital contact, he then passes info to DH and SIL - and gets a lot of it wrong. He can’t tell you who’s in charge, he doesn’t push to speak to anyone specific, has never asked about the discharge team or a social worker, he gets all the medical terms muddled and when he doesn’t know, he makes things up. DH then has to phone the hospital and get them to tell him what’s actually going on. Sometimes they will, sometimes they just say “talk to your dad, we’ve already explained all this to him this morning”. With Covid only one person can visit In person - and that’s FIL. So SIL doesn’t even get the chance to see the nurses face to face.

It’s so infuriating that FIL, the least competent of them, has to be the main channel of communication and decision making.

MIL will only have a hospital social worker if wars have identified she requires needs assessment for LA funded care - so if FIL says he's her main carer and PiL

What you are really talking about if safeguarding- is FIL neglecting her, failing to give her sufficient fluid and medication. Even if unintentional, neglect is neglect

There might already be some flags- repeated admissions for dehydration? Irregular blood results?

You said there's a SiL in this country? Even if PIL decline assessment /social work involvement in the hospital , SiL can report safeguarding concerns to local community social services if she sees neglect & decline at home, but better that SiL talks to ward and requests hospital Social work assessment mentioning safeguarding /possible unintentional neglect

It'd be hard for you to do from out of country as you're not visiting nor seeing PIL, so hard to see how you could have accurate information about neglect if he denies it

Sorry I didn't finish first paragraph, ward not wars and if PIL decline assessment or help, it makes it difficult