Circumstances where elderly parent forced to go to care home after multiple falls

[Museumland]

My mother is in her 90s, she is frail and has Parkinson's, but mentally she is okay. She lives with my dad who is also fine and also in his 90s. She has 4 carers a day. My mum has been admitted to hospital for falls twice in 3 weeks and 5 times in less than a year. Despite talking to her she insists on trying to walk around when no one is in her room or the carer is not there. We have spoken to her about going to a care home because it will be safer for her and put less physical and mental stress on my dad. I live in a constant state of anxiety and can't get on with aspects of my life because I have no mental energy left. Has anyone been in a situation where social services have made an assessment that their parent is a danger to themselves and must go into a care home against their will.

Hi there if she is mentally ok, I think it is unlikely they could force her into a home. My DM fell recently 6 times and 5 days. When the paramedics arrived, they said that the frequently get called out to the same elderly folk who fall, they pick them up or take them into hospital where they are dispatched home to inevitably do it all again.

My DM has dementia so was sent to a care home for 6 weeks re-enablement care as she lives alone. I don't think she will be coming home though, she really cant cope being on her own at all anymore. She never wanted to go into a home (who does) but there really is no option if she is to be keptsafe.

Do you think if your DM went for some respite care she might then consider moving to a home if she liked it? Would your DF consider moving with her?

So difficult. I assume she doesn't want to go? If she did go would she be self-funding or council funded?

If she has full capacity it's unlikely if she doesn't want it, as I understand it. Unfortunately this does mean she will continue the loop of fall > hospital > home unless she decides not to walk alone or she does herself some damage (broken hip, broken wrist/arm/ribs). At that point she is more likely to be offered some respite care in a rehab hospital or care home but only until she's fit to be at home again.

I know this sounds impossible given the inevitability of her falling and the worry of her hurting yourself, but can you find a way of reducing your anxiety around it? Maybe some counselling would help?

Yes sadly. DM was assessed and it was deemed that she had limited capacity and simply couldn’t recognise the consequences if she didn’t stop trying to get about.

It was traumatic but her last fall meant a long stay in hospital and within 6 months of going into a home she simply gave up trying to walk and has been bed bound since. She hates being in a home but couldn’t have stayed on her own. We know she’s warm, fed and safe even though she’s very unhappy but there really was no alternative.

That is very hard. My aunt was similar- Parkinson's and many falls because she just didn't understand that she was too frail to walk and should use a Zimmer frame. She had capacity do decide some things but not to organise how to move about safely. And she had to go to a care home. The move happened after a fall when she needed to recover but we knew she wouldn't come home.

But it is hard to find a good care home in a rush from hospital. If you can, start checking out the options and get on the waiting list for a good place.

She needs a mental capacity assessment and if she's deemed to have capacity to make the decision about how her risk of falls is managed, and she chooses to remain at home, then there's nothing anyone can do to force her in to a home.

If it helps, a care home may not be helpful. I work in this area and assess lots of people like this. I've had several patients who live in care homes and continue to mobilise against advice, continue to have unwitnessed falls and the associated hospitalisation. One reason for this is to have a 1:1 worker with someone watching them mobilise is incredibly intrusive and goes against the "least restrictive option" principle. And even in a care home, people are left alone in their rooms and you can't force people to sit in communal areas.

No. Not if they have capacity. Does your Mum have all the aids and adaptations available? Including telecare? In my experience, even when people don't have capacity, social services need to go through all of these options anyway.

Do your parents live in their own home or social housing? Do your parents LA offer a lifting service if someone has fallen and is uninjured?

Has anyone been in a situation where social services have made an assessment that their parent is a danger to themselves and must go into a care home against their will.

Adult (social) services have no lawful means to force her into care home against her wishes, you said she is "mentally okay" so she gets to decide to stay on her own home.

Your DM can choose to live at home with high falls risk and multiple hospital admissions and choose not to listen to social workers,OTs, her GP, her husband (DF who is her main informal carer) nor you as her family.

So there won't be any legal means to make her decide a 'safer' option that would provide 24 hour care not reliant on dad nor family, as she already has 4 x daily care package.

Unfortunately from your POV all you can do is encourage her and decide what you can cope with and do, and what not to get drawn into. If mum has Parkinson's disease then, over time that can affect cognition and cause a dementia type issue once really progressed, but it doesn't sound like it is yet at level is affecting her capacity for decision making (under Mental capacity act 2005) because legislation allows for "unwise" decisions.

It's a huge deal to override someone expressed wishes when they lack capacity even and has to be 'bullet proof' and shown to absolutely be in their best interests (not others best interests even if a strain on family). The bar is set so high as it is about Human Rights to autonomy and freedom.

The thing to remember here is that Mum wants to live at home and accepts she will fall, and doesn't mitigate those risks herself. She may well come to a crisis one day and fall and seriously injure herself, when she has less options, but for Mum it is more important to be at home despite those risks.

Dad and you can only do what you can and accept this is important to mum. Please don't feel guilty if you aren't available sometimes. It's her choice and yours for when you can help and when you need to sleep or give priority to your own family and need for a break from being endlessly on call. Dad can call an ambulance. GP can talk to her after next crisis.

You'll find social workers sympathetic to your frustration. They may ask but actually don't expect, if they fully understand your perspective.

Also there is no Local Authority "lifting service" in any of the areas I have worked in nor heard about.. That sounds very specific to the area the PP may practice lin. It's ambulance call out each time to check for injuries and then GP who may talk to patient about number of ambulance call outs and falls.

I'm really sorry to hear how worried and stressed you are OP. Keep encouraging mum to consider alternatives and hopefully she may agree at a time she feels ready. She'll afire better in residential care when it's her decision

Personally, as I have a sibling in a care home, I would let her fall. Care homes are in deep trouble if a resident falls and injured themselves. The upshot is they are encouraged to sit about all day, not allowed out in the garden (no one there to supervise) and life is very limited imv.

No one can (lawfully) make your mum go into a care home against her will if she still has the ability to understand the decision/risk she is taking.

Have all protective steps been taken already? Trip hazards removed, falls alarm systems in place, all mobility equipment in, rails fitted where possible?

Most areas now off some sort of support from the 'falls team' its called different things in different places but ultimately its about assessing why she is falling and trying to put a plan in place to manage the risk as much as possible. Ask their GP if they can make a referral.

Our LA have a lifting service, it's actually a general checking service hooked up to a home phone- ours is called "care on call" and people who subscribe to it get a pendant around their neck they can press if there is an issue, including falls. They have a lifting service if needed, it's a special inflatable cushion. Dave's ambulance call outs which can take 8+ hours.

Yes, I work in a LA team that provides a lifting service. We carry manger elk lifting cushions to support safe lifting. We've also had joint training with the local ambulance service due to long waiting times for an ambulance. So we can request for a call back to discuss lifting someone where an overnight lie or equivalent would be worse than them waiting 8/10 hours+.