Doctor referral to SS

[Janedownourlane]

Hi, I hope someone with experience of this could tell me what the procedure is when an elderly person's GP decides that a referral is necessary to SS due to that person becoming unable to manage at home independently. This is the situation with DM. She is adamant (and in denial) that she will not move from her home or accept help, and will decide what to do next 'when the time comes'. Unfortunately it probably has but she will not accept this.
Thank you.

Has she been seen by her g.p now, do you know why the dr thinks she cannot manage, is it her physical frailty ., the Dr can only refer her to s.s with her permission unless the dr has decided that she does not have the mental capacity to make her own decisions. If the dr has made the referral they will contact your dm to make an appointment to come and see her, to see what help she needs or would accept. If she does accept help they may arrange for a therapist or member of the elderly community team to visit her, provide equipment, made small home adaptations.

What help do you think she needs. Do you have power of attorney, without that and if she has capacity it's quite a struggle to get someone to accept help if they dont want to.
What's her home situation, does she own, rent, would she manage in a warden controlled flat.
I am no expert, just speaking from personal experience, someone else will come along with more info.

The GP should do it herself/himself. If they don't, you can - ring Emergency Adult Protection (find number on council website) and a very nice social worker will get back to you. SW then visits DM at home.

There is a risk here - if DM convinces the SW that she is sane and refuses help, there's 0 anyone can do - including Social Services.

Except wait until the inevitable crisis, which is what a lot of families end up doing. Usually the person falls and ends up in hospital, where NHS can't let them out without doing a care assessment.

If the intervention works, however, SS arrange for carers etc to help DM. DM usually has to pay for this.

If she has capacity, social services will offer an assessment of her needs and (with her consent) make suggestions about how best she can retain her independence.

She doesn’t need to ‘convince them of capacity’. The law requires an assumption that people have capacity unless there is reasonable evidence to to contrary.

GP doesnt need to decide, anyone can make a referral. You find the number or email for your local adult social care department and ask for a care act assessment. However they will only do it for a person with capacity with their agreement. Would usually be done by a social worker. They will look at the person's eligible needs and potential care to meet those needs. If a person has mental capacity to decide, it will always be up to them what happens. If they lack capacity it would be a relevant power of attorney or the social worker making a "best interests" decision if you live in England/Wales.

Thank you sausages and Supersimkin that's useful info. The main issue is her memory loss which has led to some safety concerns, but her general health is ok and managed by medication and she has capability. It seems likely, based on what you have both said that she will maybe have a SW visit and we will take it from there.
I suspect that we will be waiting for the crisis before much changes. She owns her own home but is relying more and more on family to help out. She doesnt like to pay when we can do it for free

Thanks Lemonroses and Keha It is the GP who is making the referral after seeing her recently. But based on what you are all saying, she will decide what happens and when if a SW visits.

Has anyone been given Lasting Power of Attorney- it would be a sensible conversation to have now before she does lose capacity.

There are lots of things that can be offered to make life safer and easier. It doesn’t necessarily mean a care home.

As a social worker I find GPs are very trigger happy abs will make all kinds of referrals for people who neither want nor need help.

If your mum doesn't consent to an assessment then we can't do it.

If she has more than £23,250 savings we can assess but she will have to pay for all her care herself and can decide not to.

People have a right to say no and make bad decisions if they have mental capacity. Poor memory or an early diagnosis of dementia does not mean no capacity. Also capacity is decision specific.

She may have agreed to getting help with her g.p, a conversation must have taken place and I am sure the doctor was only doing her job.

Thanks for your messages. I think that she must have agreed to the referral based on what you have all said. She does have capacity I am pretty sure of that, so she will have agreed . She has a lot of health anxiety and spends a lot of time contacting her GP. However, she will not be willing to pay for any care regardless of the fact that she can well afford it. I expect that wasnt mentioned to her at the appointment.
I have PoA as does DB.
Thank you for the information and I'll just have to wait at the moment and see how this pans out!

It can feel very frustrating, some people don't like the idea of being referred to social services, it can scare people and make them feel they are being monitored. You might have better luck with asking the g.p if a physiotherapist, occupational therapist or community nurse could see her, they might just suggest a few adaptations or equipment that she could benefit from and maybe set up some sort of befriending system if she calle her g.p a lot.

She will no doubt refuse help she has to pay for, despite 'scrimping and saving all her life' and struggle on getting progressively unsafe with family run ragged and plugging the gaps. Whilst you do this, ss will not intervene. Only when you step back, refuse to prop up the situation and the inevitable crisis occurs will they be forced to step in and things will move forward.

After many years as a district nurse I have seen this situation play out hundreds of times, and suspect you have a long hard road to the last bit, unless you can harden yourself to stepping back now and preserve yourself years of anguish and resentment.

Cptartapp is spot on, the more you do the less she will accept from other paid carers. Maybe she could apply for attendance allowance, therapists can arrange small adaptations and equipment for free. I do wonder why people wont pay, what else will she do with her money.

Can you step back but just make vague soothing noises?

I do wonder why people wont pay, what else will she do with her money. Because no matter how dire your situation now, you can imagine it getting much worse in the future, so you need to save your money for then.

And because most people don't save for their old age (or if they do, it's for the foreign travel, fulfil all your dreams phase of old age, not for hiring people to do things you've done for yourself all your life), they save to be able to pass something to their children.

Many children would rather forego the 'inheritance' and have the parent buy in services as needed, rather than as busy working adult DC with families, jobs, health issues and stresses of their own be running round indefinitely doing the cleaning, gardening, taxiing, shopping etc of parents with money sitting idle in the bank.
Misguided parenting.

Another social worker here, agree you need to decide what you are prepared to do for your mum, if someone tells me 'I don't need any help because my daughter does it for me' (which I hear a lot) then its hard for me to argue, although I do try. Agree often all I can do is wait for things to come to a head, which is hard for everyone, also agree capacity is key. If we thought someone was really at risk at home it could become a safeguarding issue with self neglect. She can have a financial assessment to check how much she would be assessed as being able to financially contribute

Thank you all for your comments and insights. I will definitely look into Attendance Allowance, dont know why I missed that as I have heard about it.
Yes, stepping back is probably the way to go, but it feels harsh as there will be an inevitable crisis. I often hear how independent she is in comparison with others she knows, but it just doesnt register that its only due to all the help she gets from me and DB.
So many of these posts and replies have been so useful to me, thank you for all your wise words. I am making a short list of points to pass on to DB as he does more than me.
Regarding money, she often declares 'I paid my stamp...' which I believe means that she thinks she has an entitlement to all care for free. I know she wants to leave an inheritance but I really would rather she used her money on helping herself, surely this is now the rainy day! Once when she wanted a lift to the hospital rather than pay for a taxi I couldnt help myself say that my petrol wasn't free, she looked totally amazed and said well surely you were putting it in anyway! She wanted me to do a 4 hour round trip at that time to take her 5 miles! And breathe...

@Janedownourlane err yeah, l know about the big demands and little recognition for them. I get “it’s only a 1.5 hour drive, do x y and z. Then drive 1.5 hours back”. Often on my only non-working or free day that week

Be prepared for a tussle with SS.

Three years ago, after a conversation with the Alzheimer's Society, I tried to alert them to the fact that my MIL, with dementia, without capacity and physically disabled, was being neglected by the family member who had been entrusted with her care. They told me they could only do something if MIL herself contacted them!

Soonshammie is right
Super skin isn't

The GP should do it herself/himself. If they don't, you can - ring Emergency Adult Protection (find number on council website) and a very nice social worker will get back to you. SW then visits DM at home. Is incorrect where someone has capacity under the mental capacity act 2005, which is what you have said

Whoops it saved before I finished typing

If your mum is severely self neglecting then Gp can refer but otherwise GO can only refer where someone has capacity with their consent. And adult services will be unable to take referral where the person has capacity to decide on these care and support, unless they are SEVERELY self neglecting (& lots of evidence) that is the only time it hits safeguarding

It annoys me when medical people or lay propel say it must be safeguarding when it is actually care needs and par for the course normal stuff we deal with. Don't cry wolf

Mum needs to hear from you what you can or can't do. Social workers can't do that for you, you have to tell her and write to GP to state that if she isn't listening and tells them different.

But adult social workers have no more to intervene if someone is mostly coping but not making wise decisions. We can only intervene when the legislation allows us to and believe me it is a very high criteria

Always best to go with what she will agree and Encourage her to see a social worker at home die a visit with you there

• social workers gave no more pier to intervene And
• for not die !

Argh*power

Thank you for the advice threeteens this seems to be where we are now. I had a difficult week dealing with her issues last week, which are not helped by the frantic calls and panicking over things that are easily resolved. I'm sure a Social worker would certainly not see this as 'high criteria', we are talking about losing household items!
She has a very poor short term memory which inevitably results in her losing things but the GP has decided to refer so we'll see.
Thanks for your comments.