Care package wasn't enough

[thecatsarecrazy]

Sorry if this is long but need to get it all out..
Dad has dementia and lives with my brother. He was doing what he could to care for dad, getting him up giving breakfast, plating up tea in the fridge. Then helping with bedtime routine when he got in from work.
A few weeks ago dad stopped heating his dinner up or making cups of tea for himself. I went round to heat it up on one day because I was able to get a lift, and was going to leave at 2 to get back for my kids. But things were bad. My dad kept soiling himself and saying he needed to pee but not passing anything.
I called an ambulance in pure desperation Hoping they would take dad in and we could go about getting the care he needs. I called for an assessment and was told it would take weeks. ,
They wouldn't take him but the following day a district nurse came round, my brother had left him in bed and he had soiled himself. They called an ambulance and he ended up in hospital.
They agreed that it wasn't safe at home and they would sort out a care package.
After about 2 weeks one came into place. They called me to say it was happening but dropped him off home, didn't tell me he had no belongings, was confused thought he was in someone else's house and would get into trouble. I had to have DH stay with him until my brother came home.
The next morning someone came and got him up, dressed medication and breakfast but the district nurse came at some point, found him confused and unable to stand and he was taken into hospital again.
That was last Monday. I went to visit him yesterday. He's now on the dementia ward but he was in bed, all uncovered in a pair of incontinence pants, more confused. I saw him the Friday before he was sent home and he was sat in the chair, dressed having a good conversation with me and smiling. But yesterday was awful. He kept saying when are you taking me home?
I don't know what is happening now. I've been talking to the admiral nurses and I've explained that my brother fucked up and hasn't put the poa in place, so I don't know how I can put any form of care in place. What are my options? She said the Dr would be doing a mental capacity assessment. If a social worker gets involved what do they actually do?

It sounds like he's no longer well enough to be at home with a care package, and needs 24hr residential care.

my brother fucked up and hasn't put the poa in place

There is a more complicated route for when the person has lost capacity.

That aside, I'm sorry you're going through this, it must be horrendous. Your dad does need 24 hour nursing care now though.

www.gov.uk/become-deputy

It's becoming a deputy rather than power of attorney.

It takes ages to get power of attorney. Who is his next of kin? That person should be able to sort stuff out.

Yes I realize that as the poa isn't in place it's now going to the courts, and become a deputy and all that but until they have done a MCA I can't do anything. I agree he needs 24 hour care but what do I do now? My brother has been dealing with his finances, and living in his house but now the shit has hit the fan he just goes off to work and leaves me on read.

@Puppermam

It takes ages to get power of attorney. Who is his next of kin? That person should be able to sort stuff out.

What do you mean? Me and my brother are next of kin as far as on the hospital as in they will Call us. What do you mean we should be able to sort it out? I'm asking how to sort it out

In a different scenario with my mum, adult social care (through the hospital) were very good at sorting out what she needed.

Its awful isnt it. We are all living longer and not in the best of health. In some cases (i.e my DF he is just existing in a care home.) No real quality of life yet we pride ourselves on keeping everyone going.

We do have POA for him thank goodness but he had capacity when it was done. Applying to the courts sadly when someone has lost capacity will take months and cost £££. Does he have money to pay for a care home? My DF was at risk and the GP sent in a urgent care referral but in the end I just couldnt wait and he moved into a care home funded by the sale of his house.

After 6 months some twit from social services called and had got the story all wrong about what had happened. NHS need to hang their heads in shame re this. They all started blaming each other and honestly I just told them to get their processes and policies joined up and put the phone down.

My DF is in a safer place now although it is costing tens of thousands of ££

Are you close, distance wise, to where your dad is?

You need to think about what home(s) you would consider for him, what location, and how the care would be funded.

Can someone on the dementia ward talk you through everything?

I live an hour away from him, I don't drive public transport is a joke, and I have a small child who's just started school. If I lived closer I could help more. They keep saying oh you're brother lives with him doesn't he u say yes but he's out all day. My brother thinks more of his job than anything else

You need to think about what is the best location for your dad to be to make it convenient for all.

Don't panic, this happens all the time, hospitals and social care are used to managing it all.

As I understand it the hospital will be assessing him (joint responsibility with social services) to see what care he needs in the future, and your brother (and possibly you) should be included in those discussions as his carers. With no POA in place don't panic, they will make a 'best interests' decision for him and your brother (as main carer) and you should be consulted as part of that.

Listen out for anything to do with "MDT" (multidisciplinary team = social services, nurses, OT etc) who will all contribute to the decisions as to what happens next. Also listen out for "Discharge coordinator" or latch on to the social worker to keep tabs on what's happening.

The financial situation is a bit more complicated - if it's your father's house and he goes into residential care his home will be taken into account in the financial assessment and will probably have to be sold to pay for his care. Also does your brother have legal access to your father's money, or has it all been done on the nod?

I think in all honesty by brother just knows his pin number and draws cash out for shopping. My dad's eye sight has been terrible for years. I used to be on a joint account with him for emergencies but I came off it because for a short time I needed to claim housing benefit, and they would have assumed it was my money.

so sorry you are all going through this.

on the ward the mental capacity assessment will be done for preferred place of care . If (when) your DF is deemed not to have capacity for this decision a "best interests" decision will likely be made in the short term. Currently it is likely he would be listed for a short term bed to further evaluate his needs (short term is health care funded and may be for up to 8 weeks or so) you an your brother would be asked for input during this time. From here social services would get involved with finances and placement (or less likely a large package of care at home).
None of this will happen quickly and unfortunately given the state of health and social care over the whole country currently will be stressful and involve a lot of waiting PLUS possibly some pressure for Dad to go home just through shear desparation in the system.
Living with uncertainty will be very difficult I hope you and your brother can find ways to help and support one another and Dad through this.
It's easy to end up fighting one another because of the stress, and blaming for past problems but you don;t really need more stress from that.

all the best. I'm so sorry it's so hard to see your Dad reduced to this.

Do you think he, or your brother, may have suggested he had more help at home than in reality? You need to be involved in any meetings and especially an OT assessment. Is there a rehab programme in place? He may seem less lucid on hospital if he has any infections (uti is common), different medication, change of environment. Take him some familiar items and photos so he can take comfort and therapists can talk about it with him.

I understand you have a small child and live far away so can’t be there, but I think you are being harsh on your brother.
He lives with him and sees him everyday, he can’t just quit his job and be his full time carer. Going to work might be his was of managing the situation and helping his own mental health. He doesn’t have the option of going home and relaxing from it.

He didn’t sort POA, but neither did you!

You need to stop blaming your brother who has been doing most of the care up until now. Of course he needs to make sure he keeps his job. But it sounds like your Dad needs to be in residential care. It isnt really feasible he lives with your brother if your brother is out at work all day. Its a pretty poor show that you are the one who does the least and yet are highly critical of the other persons efforts Sadly this is too often the way in these situations.

Stop blaming your brother! He's your dad too! You obviously just left him to it so perhaps put the blame closer to home!

My brother lives with my dad, he was diagnosed during lockdown. My brother told me he didn't want myself and family coming round and breaking the rules. He told me he had sorted poa then confessed he hadn't. It was too much. So before you try and kick someone looking for support maybe know what you are talking about first and try not to be so bloody rude!

@Viviennemary

You need to stop blaming your brother who has been doing most of the care up until now. Of course he needs to make sure he keeps his job. But it sounds like your Dad needs to be in residential care. It isnt really feasible he lives with your brother if your brother is out at work all day. Its a pretty poor show that you are the one who does the least and yet are highly critical of the other persons efforts Sadly this is too often the way in these situations.

Ok what else was I meant to do? Diagnosed during a pandemic,not allowed to take my children round and visit for months. I have a family to support and a 4 year old child. My brother told me he had done poa then confessed it was sat on the side.

Dad may be more confused at the moment if he has got an infection, you said he couldn't wee so he could have been dehydrated or developed a UTI. The ward staff will assess his mental capacity once they feel he is ready, sometimes there is a delay if he is acutely confused. He will have a care diary, the nurses and therapists will assess his mobility, continence, eating and all the help they think he will need. They may keep a 72hr diary, including any behaviour concerns then probably arrange a best interests meeting which you or your brother can attend, dad can too if he is able to discuss the safest option for the future. If he needs 24hr residential care they will Carry out a financial assessment to see what he may need to pay for. It would be worth getting copies of his back statements, savings, pensions, benefits, a house valuation as the sw does this but it takes them forever. Does he own his house, if he goes into a carehome where will your brother live.

During the best interest meeting it may be agreed by everyone that he needs to be in a carehome, the courts dont get too involved in everyone is in agreement and can appoint someone as a deputy to act on his behalf.
The hospital,where at fault just sending him home, you need to make sure that is not allowed to happen again, you can contact PALS and make a complaint that it was an unsafe discharge.
I wouldnt get involved in looking for a carehome yet, wait until he has had the capacity assessment, you and your brother can refuse to take him home. I would let the hospital advise you of the next steps. I dont think your brother effed up, if dad has dementia then it may have been too late for poa anyway.

Hi OP, I agree with other PP about not blaming your brother he was probably (like most) going through an array of emotions and with lockdown on top it would of been a tough time aswel. Have you tried calling adult social services yourself and explained the situation they seem to move things along a little faster that the hospital can. They can access if it’s in your father’s interest to put him into a care home or assisted living with 24hour care. Do you know if he has savings? I think if he has over £16k in savings he will need to pay until it drops below the £16k then he will be entitled to local council care. I’m really sorry you are going through this 💐

Whose house do they live in? That's the biggie. If it's your dads, your brother could find himself needing to find another home sharpish.
You and DB need to make it very clear to the social worker you will take no further part in his care. If they get a sniff of you plugging the gaps they'll be pushing to get him home. If it's your brothers home he can simply refuse to have him back which sounds dreadful but the current situation is not sustainable.
Agree with a pp, the wonders of modern medicine eh. Your poor dad.

Not sure the house will have to be sold immediately if it is also your brother's current home? In some local authorities at least, they get a valuation and then will wait until the house can be sold to claim "arrears" from the owner (or the owner's estate :( ) for their social care.

Hi,
Don't declare/make your Dad homeless if it's your brother's house...it slows the whole process down as the legal paperwork is different. No-one will want to put your dad in the worng place......the hospital team cares too you know.....just good communication and stating facts will be enough and keep re-iterating when you get fed up that it's the third different OT/discharge person/etc it won't be their fault either.