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?

I know you feel that your brother is not doing enough but he does need to put boundaries in place for his own sake. Caring can be absolutely brutal and exhausting and the more your brother does, the less help you father will get as social services will see him as coping. He will not be able to sustain a full time job and full time care for someone whose health is sadly only likely to deteriorate.

Yes, I think you need to stop blaming your brother. You are in for a rough ride now and you need each other so put that aside and just try to work together, guilt and blame don't help anyone. I know it's very, very hard to deal with things like this (I've been there). With regard to the POA, it can be quite difficult to get it all signed - you need independent witnesses etc - so it may have been difficult for your brother to sort this out during lockdown.

My mum was in this position with my grandmother. She had dementia and had always refused to sign anything to give poa when she had capacity. In the end it was decided for her after she ended up in hospital with a broken hip. She was fully assessed and the doctors and social worker provided suppirt for my mum to be made deputy. She also had someone from the Office of the Public Guardian advising on what she could do and record keeping. When my Grandma went in to the home she had some funded care and then she built up a debt which was paid off when the deputy had been put in place and had control of the finances. Everyone involved from the NHS, Social Services and the OPG was very supportive and guided my mum through each step. They also took the lead on telling my Grandma she couldn't go home, which had been worrying her family as she'd always been adament she wouldn't go in a care home. Just take everything one step at a time and let the professionals guide you, without letting anyone push you or your brother to have him home if he won't be safe there. It's hard but you will come out the other side and have the relief of knowing you've done the best to keep your dad safe.

We've been in a similar position last year.

My best advice would be to speak to the discharge team in his ward. Ask them what the plans are. If you don't have POA they should still listen to what you have to say.

There is usually a multi-disciplinary meeting before discharge.

If he's not coping with Carers the next step is usually a care-home.

You can speak to his SW (I called MILs very regularly. Find out what they will be suggesting happens to your DF and if it's a home you can say if you'd prefer one near to you or near to your DB, although you may not get either.

We started reading reports and reviews of local care homes when DMIL was still in Hospital so we had a good view of which ones would be suitable and more importantly, which ones wouldn't.

There's probably some paperwork involved, fit instance if he hasn't got it already you will probably have to apply for Attendance Allowance and maybe Pension Credit.

Are you able to go to his home and find details if his bank accounts, savings, NI Number etc?

You are being harsh on your brother.

We didn’t realise just how much mil deteriorated during lockdown. In the end it was making fil ill (he was the one who ended up in hospital. Ambulances were called to mil and in the end fil refused to have her back as she needed more care than he could give, even with care packages.

Your brother has to put his job first.

If he is living there (& it was a genuine arrangement before you knew residential care would be needed, then they can’t sell the house).

My brother thinks more of his job than anything else

He told me he had sorted poa then confessed he hadn't. It was too much

OP, by your own admission your brother has told you he's been struggling, and you've known this for a while. My mum is facing some major health issues but is still able and aware, and I'm still overwhelmed with everything. He's going to work and probably finds that a blessed relief - 8 hours out of 24 where he's not on-call to deal with a shadow of a man who used to be your dad, and the grimness of bodily fluids, the constant grind of food and drink prep, as well as looking after the home, with no partner that you've mentioned to offload on, and likely no social life.

The hospital should not discharge him if your brother cannot support him (he is not obliged to do so either), and support agencies need to step up.

It sounds like this is the 'crisis' I often read of on here, which is the final acknowledgement for the family that they, and their relative can't cope any more.