Advice pls! Elderly parents separating, various issues with DF

[SueDenim7475]

Name change, facing a few horrible issues and would be grateful for any experiences or advice anyone can share. I'm afraid the below is rather rambling.

My parents are in their 70s, living fairly active lives until recently. DF has become increasingly ill-tempered/aggressive/borderline abusive to DM (we suspect he may have suffered minor brain damage during v long surgery a number of years ago but don't know). He flies of the handle and rages about very minor things and struggles to understand that his reactions are not rational/socially acceptable. He had been having some anger management counselling which was helping a bit.

DF then had to have further major surgery early this year, surgery itself went OK but he spent a long time in intensive care and functionally his recovery has been extremely slow, partly due to muscle wastage. Long stint in hospital, self-discharged after neglectful care there, but my mother really struggled as his sole carer (literally impossible to get any carers to visit where they live - a small village 20 mins from nearest town). Can walk a bit with zimmerframe but needs help showering/dressing and has some continence issues that may or may not be permanent.

He had a number of falls requiring ambulance and paramedics to pick him up so finally agreed to go into a care home for short-term rehabilitative care, working with physio to get strength and mobility back to a level where he can return home without needing DM to do everything.

He is due to be there for another 3 weeks or so, but he is agitating to come home. DM has said no way can he come home until the falls stop as she cannot cope.

However, even if his strength does come back, from what DM has said it is not sustainable for him to return home due to his behavioural issues.

We are likely to need to report him to DVLA to get his driving licence taken away (I'll do a separate post about that...) meaning he will lose independence and would have to rely on her or taxis to get around. This in turn will make him even more ill-tempered and abusive towards DM.

I think physically he will continue to have care needs of some kind - unlikely he could cope with preparing meals/doing laundry/cleaning etc if he didn't have my mother to do all this for him and I think my mother would generally struggle.

I suggested some sort of "assisted living" (I don't know much about the options, and they obviously vary in different places). DM has said there is no way she is giving up the home she loves or her own life/independence to move into assisted living accommodation with DF, but does not seem to think it is sustainable for her to continue living at home with him given his behaviour. He belittles DM, attacks her over nothing (eg putting dish cloth down in the wrong place), was v demanding and ungrateful when she was having to care for him 24/7 etc.

Where that would leave them/us I don't know. DF seems to think he can leave care home after a couple more weeks and go back to life as it was before (including driving). V unlikely simply to agree to move out of family home, so may just refuse to go, but if DM then leaves him he could not cope there on his own (though he may think he can). And DM definitely would not want to leave the family home.

Not sure what I'm asking other than wondering if anyone has had any vaguely similar experiences:

• elderly parents separating generally / refusing to agree on who stays in family home / potentially getting lawyers involved and divorcing??
• trying to persuade elderly parents that it's not realistic for them to continue living independently - having an 'intervention' or tackling this another way
• Experiences of assisted living places or other options for older people who need some level of care but not necessarily permanent move to a care home (but bearing in mind the struggles we have had to get any kind of home carers to visit).

Thank you in advance for anything you can share.

We had this with DF, he was in respite care for a fortnight. DM refused to allow him home as she felt she coudn't cope anymore. Similar problems to your DF he also had a drink problem.

We were assigned a Social Worker and DF went into a care home. He did have to pay for it himself.

Thank you @Anystarinthesky, I'm sorry you and your DM have been through something similar.

That's interesting re the social worker - did you and DM seek the help of social services yourselves, or how else did they get involved? And what was the social worker able to do for you - were they involved in trying to persuade your DF that living at home was no longer sustainable?

Thankfully money isn't too much of a concern - my parents were both public sector workers but very careful savers, meaning they/we are fortunate that we can self-fund things.

I reported a relative to the DVLA anonymously. They had their licence suspended, then removed, and they never found out it was me.
I feel no guilt, I did it for every pedestrian and road user.

Make a referral for both parents to adult social care. They’ll assess your Dad’s care needs and there should be an adult safeguarding referral for your mum because it sounds like she may be experiencing abuse from him.

And we got Social Services involved. She eventually went into a home, but she didn’t want to.

Because DF was in respite care the home helped us get in touch with a Social Worker.

This link below advises how to get in touch, or perhaps your GP surgery could advise.

www.familylives.org.uk/advice/your-family/social-services-and-your-family/social-services-and-your-family

The Social Worker did help us explain to DF that DM coudn't cope with him at home anymore. He just had to accept that.

The Social Worker was able to find homes that would be suitable for DF. Because he could pay he was able to get in right away.

If he has mental capacity then I am afraid your mum doesn't have a right to exclude him from his own home. However unwise you may feel his decision to come home is he legally has a right to make an unwise decision and a right to reside in his own home.

Your mum is at liberty to decline to care for him and just live separately in the house and she is at liberty to leave the home herself but what she hasn't got the right to do as things stand is to force him to leave.

The only way he can be forced into some facility against his will is if he has a diagnosed mental disorder eg dementia or vascular brain damage and he is assessed to lack capacity to make the decision about where to live. That would require a Dr to diagnose and probably a social worker to make a capacity assessment.

You need to get onto the GP for a diagnosis and/ or referral as first port of call

Similarly with the driving you can report him to the DVLA anonymously but it helps if he has a diagnosed medical condition that he can be reported for. If that's the case then the DVLA will ask the GP for a report and they can make a medical recommendation that he doesn't drive if they agree he shouldn't and they will then revoke his license. The Dr will then get the blame rather than his family.

A person does have to consent to a social care assessment. It can't be done against their will or without their co-operation unless, again, they lack capacity. Often social care will ask the person if they want to be assessed, they say no and it's case closed.

You either have to
persuade him that he needs to look at permanent care options and your mum needs to be crystal clear about what she is and isn't willing to do
Or
If he is still completely unrealistic when faced with the facts then get GP to assess his mental state and capacity. Social care are often not very interested in self funders and will likely just sign post to available options and you will have to look into them your self. Technically speaking there is still a right to an assessment but they have their hands very full with LA funded people and usually try to get self funding people with capable family to do it for themselves. If they do arrange care they can charge a fee.

As others have said your first port of call is to social services to carry out a care needs assessment.

If your father has capacity, and social services can’t persuade him
to go into sheltered housing or a care home, and your mum doesn’t feel she can live with him because of his behaviour, you will need to consult a family law solicitor.

The family court in England has wide powers and regularly imposes orders to exclude a home owner from living in their own home if they have harassed or abused their spouse. You would need legal advice to pursue this route (obviously as a last resort).

Difficult times - all the best OP

www.gov.uk/injunction-domestic-violence

If she can't cope with him, she can't cope! Is there any possibility he could be suffering from dementia?

My mother had vascular dementia but went into complete denial early on that her mind was failing her. Eventually it became such a struggle for her she couldn't do it any more. In the meantime my dad had been doing his best but both of them were concealing the extent of her difficulties from us until it got really bad.

Eventually mum had another fall and ended up in hospital. Where they diagnosed the dementia and she went from bad to worse. The change in my dad once the pressure was off him with mum in hospital and he could relax made me completely sure that mum coming home shouldn't be an option. It also happened to be the best thing we could have done for mum, she was very happy in the home we chose not to mention far safer than she would have been at home with 4 care visits a day.

So my experience of them having to live separately due to health issues was very good.

Sorry you are going through this OP. I think this is a very common issue.

I'm sorry I've no advice but I'm sure any social workers or healthcare professionals that you deal,with will,have seen it all before.
Good luck.

One other thing to mention
Does anyone have an LPA for him?
If you or your mum have health and welfare LPA and can get it registered then you can legally make the decision to place him in care and financial LPA would allow you to use his funds to pay for it
Again he would have to lack capacity (or he would have to consent) for the LPA to be registered and used
If you only have financial LPA then it does get you much further forward

Thank you all for your helpful responses, and I'm sorry to hear of the various difficulties you've faced.

Fortunately a good friend is a family lawyer but I'm obviously hoping we won't need to go down that route. Surprisingly, despite his behavioural issues DF has been quite compliant with some things (eg going to anger management counselling and going into the care home). But there's a big difference between that and trying to insist he leaves the family home effectively to start a new and less independent life in eg a retirement community or sheltered accommodation in a different place.

And you're absolutely right @CovoidOfAllHumanity that we can't throw him out against his will without going down a legal route but my gut instinct is it won't come to that. However, he does seem to think he can just return to life as it was before which is clearly wholly unrealistic (slash delusional) in terms of his physical capabilities, aside from anything else.

He's had contact with numerous medical professionals over the last few months and none has suggested he may have dementia etc, but in the family I think we're all agreed he does have cognitive issues and I'm surprised this hasn't been raised by anyone. A sibling thinks he may have Parkinson's but none of us has a medical background.

My parents do have in place both financial and health and welfare lasting powers of attorney, having appointed each other and sibling and me, so that would make things much easier if necessary. But even if he does have some cognitive decline I imagine it falls short of what would be required to deem him unable to make his own decisions.

@GeneLovesJezebel good for you for reporting your relative - there would be no point trying to report DF anonymously but I'm reasonably comfortable with the prospect of me, DM and sibling jointly reporting him if it comes to it.

I suspect where we'll end up is with him initially coming home but trying to set some very clear boundaries about what DM will and won't do for him and about his behaviour towards her, and that if he breaches those (which almost invariably he will) then we will be insisting on other living arrangements for him.

I'd suggest you ask the professionals looking after him now about driving - it's likely no-one realised he does drive so nobody has mentioned it too him but he needs to be physically able to do things like an emergency stop.

You should also get on to his GP with your concerns about dementia to start the ball rolling for a diagnosis.

I reported my FIL anonymously to the DVLA - it is much easier to do if they have a clear diagnosis which means they shouldn't drive! However be prepared for your DF to be suspicious about who reported him and have some sort of story ready about who it could be.

Are you sure that there is no possibility of getting a care package? Private agencies are a lot more flexible than LA funded ones and they will do what is required if the price is right. Many would have a minimum one hour call requirement to make it worth their while but they would do it.
I would suggest you ring round some local agencies or even see if someone in the village will do a private arrangement
It seems to me that your dad is going to put on your mum to do stuff if there is no one else there to do it ie a carer.

The time to get him sorted out is whilst he's out of the house. Once he's back home your mum may well end up with little to no support again. What does she want?

@CovoidOfAllHumanity

Are you sure that there is no possibility of getting a care package? Private agencies are a lot more flexible than LA funded ones and they will do what is required if the price is right. Many would have a minimum one hour call requirement to make it worth their while but they would do it. I would suggest you ring round some local agencies or even see if someone in the village will do a private arrangement It seems to me that your dad is going to put on your mum to do stuff if there is no one else there to do it ie a carer.

We must have tried a dozen agencies between us but almost all said they wouldn't send someone to my parents' village. The closest we got was an agency that wanted to charge £480 p/w for 1 hour of care a day (!!!) and even then they weren't sure they had anyone they could actually send. Ironically the only care they did manage to get was publicly funded, NHS carers that were part of some hospital discharge package. They were meant to come for only a few days but seemed happy to continue until DF went into the care home, but I very much doubt we'd be eligible to get them to come back again.

At the moment it's quite hard to know what DF's care needs will be as the point of going into the home is to have intensive physio to get him back to not needing very much.

So he should - hopefully - be able to shower/dress/manage the toilet all fine on his own.

My main concern (aside from behaviour) is that even if his strength comes back and he's more mobile, his balance is still poor and falls may continue, and DM just cannot help him get up.

That kind of issue would be harder to deal with by way of home carers I think, unless you had someone there all day (they don't have room for a live in carer unfortunately).

But if DM insists he can no longer live at home and DF does agree to move out, then his needs would be greater as I don't think he could cope with laundry/cooking/food shopping/cleaning etc as my mother has always done all this.

@freshcarnation

The time to get him sorted out is whilst he's out of the house. Once he's back home your mum may well end up with little to no support again. What does she want?

I agree completely and this is what I've said to DM - when DF comes back she won't have the time or headspace to investigate options including other living arrangements potentially to propose to DF.

If they plan to discharge him home your DM needs to move out ('indefinitely') under the guise of cater breakdown. Come and stay at yours or whatever. Whilst family are propping up the situation nothing will change. Only a crisis usually gets things moving, and if there's no one there to shop, cook, clean, etc etc then that won't take long.
IME, I wouldn't hold out much hope that rehab will improve things enough to make the situation manageable.

carer breakdown

I also think that sadly you might be putting too much hope in rehab. After a certain age it's very rare to get completely back to previous baseline after such a significant illness needing ITU and even if he did get somewhere near then it's overwhelmingly likely there will be another crisis in the future and/ or he will gradually deteriorate further.

Falling is hard to mitigate. You can do strength and balance exercises, use balance aids like a stick or frame and remove obvious trip hazards but some people are just prone to fall and it's more about learning ways to get up again like crawling to a chair and pulling up on it. He should have a falls alarm but that will result in you getting called out to get him up or failing family help being available then the ambulance.

They basically need to plan for a future with him having significant needs as that is the reality. If they were happy together then the solution would be to move somewhere more supported together but the difficulty is that your mum can't really stay where she is and just him move unless he agrees to that. The only way to force him is to have him assessed as lacking capacity and even then its pretty hard to put someone in a care place against their will if they have the ability to call a taxi and leave.

I do definitely think you need to talk it over with his GP and ask them to assess him mentally and physically in regard to his capabilities for going home with no care and the driving issue. He might take it better from a medical person anyway.

Very hard OP.

What does your mother want to happen? Assuming that your father does return home. Would she be willing to do anything for him ? Is she expecting him to make his own meals - or have a carer come in to feed him - while she cooks something for herself ? When you say «it won’t come to that» do you mean she will give in and take him back / do the caring rather than push for him to leave ?

Does your father know that your mum doesn’t want him back home and will not be cooking / cleaning / caring for him ?

If you don’t already, you definitely need a social worker involved at the very least.

This is so difficult- it sounds like your dm wants her old husband back, not the one she's been living with recently.
The tough question is whether she genuinely wants separation/ divorce or 'just' a way of making her life in the current house work.
@SueDenim7475 have you put is as bluntly as that to her?

(To be fair the figure you queue from the agency doesn't sound far off the mark for where I live unfortunately)

DF has become increasingly ill-tempered/aggressive/borderline abusive to DM (we suspect he may have suffered minor brain damage during v long surgery a number of years ago but don't know). He flies of the handle and rages about very minor things and struggles to understand that his reactions are not rational/socially acceptable. He had been having some anger management counselling which was helping a bit.

I would think an assessment for mental impairment/cognitive issues is appropriate, given the information here and the fact that his ill temper is a fairly recent change to his personality. Bad temper can be a symptom of the onset of dementia, but I notice you don't mention memory problems, so a brain injury sounds more likely. Either way, it's worth requesting a cognitive assessment as well as intervention from adult social care. Has he already had this? Is his GP aware of what you say above?