Mental Capacity Act

[NK346f2849X127d8bca260]

Looks like my mother has been deemed to have capacity after having this done for a second time, i just don't understand why.

Back in July my father was admitted to hospital, he is now on end of life care at home in a hospital bed, carers 4 times a day.
My mother was put in a home for repite in July, she has mild dementia but biggest issue is her controlling/abusive personality.
She self dischared from home August bank holiday and went into a rage towards my father. I called police, paramedics attended and took her to hospital, she was later sent to a community one. Two weeks ago she self discharged and spent the next 9 days calling 999 seven times. During the time she was taken into hospital three times, still there now.
A meeting was held re capacity but it looks like they are discharging to SS who will put in carers, but as my mother is so demanding that is never going to work.
My dad is in a state, he doesn't want her home as she threatens to kill him and has attacked him in past.
I am so exhausted by it all and don't know what to do .

I Want to acknowledge your having a difficult time

Here’s a link MCA

MCA capacity is capacity regard a specific decision, not global capacity per se. So essentially one can lack capacity in some area eg Money management but have capacity regard package of care

The Capacity assessment is assessment of one specific decision
The central tenet of mca is assume a person has the capacity to make a decision themselves, unless it's proved otherwise
Also health and local authority will try to provide packages of care least restrictive environment eg domestic setting before considering a residential setting

Regard potential risk and your father If your mother mental health is deteriorating ask the gp to make a referral to community mental health team. In event of crisis Is there an out of hours home treatment team the gp can refer to?

Top of the list is your dad's safety. I think i would raise an urgent safeguarding concern- safeguarding team works for the council so Google them - and inform them that your mother has made death threats against a vulnerable adult in the house she us being discharged to. I'd then ring the ward your mum is on and tell the medical team ehat you've done and ask to be putthrough to the social work team and tell them too.

This sounds so hard, I’m so sorry for you.
Was there a safeguarding enquiry regarding your mum going into a rage to your dad?
I think you need to write a very clear email to the social care team regarding your serious concerns and your dads apprehension/unwillingness to have her at home. Also outline the concern you have about the risk they might both be at.

You need to enlist the GP and SW discuss concernsegard mum mental health
Dad as older adult,exposed to potential risk. Mum with erratic presentation
Your Mum who undertook the assessment that deemed her capacitous?

Adult social services can help but you need to really advocate for your father.

There was a safeguarding meeting after her rage episode, there were reports from paramedics and police.
The next day police got a report from my father in reguards to long term abuse. They also rang and spoke to me but said as they both have capacity it is classed as a domestic dispute.
Social worker did visit dad and offered him a nursing home place for his safety but he refused as he wants to be at home.

Do you think it might be worth speaking to the police about getting an injunction?

@freshcarnation

Do you think it might be worth speaking to the police about getting an injunction?

No This needs a sensitive and thorough assessment of both their health & care needs Police don’t issue injunctions. Courts do after presentation of events and a timeline etc Both the adults are vulnerable (in different ways) the dad and the mum

It's hard to accept that actually there is very little that you can do in this situation. They are both judged to have capacity and they won't cop-operate, so you are powerless.

Of course your DM sounds like a nightmare, and of course your DF wants to stay in his own home, that is perfectly understandable poor chap.

It is awful and unfair on him but the sad truth is that him taking up the offer of a safe place is the only workable solution in these particular set of circumstances, you cannot magic up the ideal situation he wants.

Sorry OP, it sounds really traumatic for you and your dad

I work in adult safeguarding and this situation is not uncommon. Both have capacity but are making unwise decisions. Frustrating for you and all professionals involved. Rather than move to a home would your Dad move elsewhere?

This is common, I'm a GP and I've done lots of safeguarding referrals due to domestic abuse. In the end if your dad has capacity and chooses to stay there's nothing anyone can do, just like a victim of abuse of any age. You need sadly, to call the police on your Mum next time she is abusive.

Essentially if an adult has capacity they can make an unwise decision
Mum has been assessed as being capacitous
They want to stay together as a couple

I work in end of life care. My experience is these situations run and run, repeatedly bouncing back to safeguarding, multiple capacity assessments and generally everyone being unhappy.

Your Dad has capacity but sounds as if he wants your Mum to be nicer which isn't a realistic endpoint.

Your Mum may or may not have capacity - current assessors say she has - but even if she hasn't her views would be taken into account and the least restrictive option chosen so you would likely end up with the same decision made i.e. home with a care package.

Yes, she may behave in exactly the same way phoning 999 and going to hospital on this discharge. The best option you have is to let it happen - it's all evidence that either her dementia is worse than the capacity assessor said, care package is insufficient, your Dad needs to change his mind etc...

Your dad has capacity too and there is reported domestic abuse that led to a safeguarding enquiry.
Your dad can seek advice on domestic abuse legal protections such as a non mil and an occupancy order - that is the only legal way he could prevent mum from being discharged home if she has capacity and she wants to go home.
Speak to national domestic violence helpline for advice. It may cost your dad a few thousands, he may be entitled to legal aid, but NDVH will help him through it. Find the police crime reference number for incident

I'd dd agrees to it and it goes ahead- eg it can be done ex parte initially as urgent if she is about to be discharged home- then a. You can tell ward dad is seeking legal order so she will not be allowed near him nor home and b. It can be served on her when he gets it with copies to ward for medical notes / discharge planning team.

That is the only situation that MDT can over-ride her capacitated wish to go home- if there is legal order in place that prevents her from doing so. Snd they might need to do capacity assessment to see if she understands and can follow that legal order and then best interest with that in mind, if not.

Alternatively your dad would be offered option to move into carehome to have his last days in peace.

Non Mol - non molestation order- I meant

Thank you all for your replies, i really appreciate it.
My mother was sent home on tuesday, with a care package. That afternoon i received a call from community mental health asking for background info as hospital had contacted them on morning of discharge to say she was threatening to kill herself and my father. Why on earth did they send her home?!

This morning i got a phone call from mental health team, they had just visited my mother, asking if was i aware that my father had been taken into hospital during night after he contacted 999 because he feared for his safety.
My father is now stuck on an observation ward whilst they try to find an emergency nursing home placement.
Mental health team are saying the dementia, all though it is still mild stage, has exacerbated her underlying personality disorder.

Hope it makes sense, i am so stressed and upset. My dad has been getter weaker these last couple of weeks and i think this will hasten his decline.

She was taunting and making threats towards him.

So sorry. What a terrible situation. It sounds like the safest place for your poor dad now would be in a nursing home.