Can fil be forced into a care home?

[emilyofnewmoon]

Fil has Parkinson and dementia and has been in hospital for 3 months following a fall at home. He falls constantly and mil was at her wits end looking after him before he was admitted (she is not in best of health either)
They want to discharge him shortly and he has refused to go into a care home. Mil has refused to have him home as she can no longer cope. He is deemed to have capacity at present so can he be forced into a care home if mil refuses to look after him?

If he has capacity to make the decision to return home then no he can't be forced to move into a care home.

Could you request a care package / respite to help your mil?

If MiL refuses to look after him and he refuses to go into a care home, would the solution be to have outside carers come in to look after him? They can't just discharge him with no care plan if he is assessed as needing one, and they can't force his wife to provide the care, but if he is co-owner/renter of the home, I don't think she can stop him coming back. If she really doesn't want to get involved, can she go and stay elsewhere for a while to make it clear that she refuses to step in?

This is what I feared. She can't and won't look after him again and he can't look after himself. Awful situation for them both. Not sure how it's going to be resolved.

A care package wouldn't be enough. He has a nurse watching him constantly in hospital or he gets up and falls. She can't watch him constantly or lift him when he falls.

It could happen under an adult welfare situation if they feel he isn’t safe or possibly vulnerable and potentially homeless. Social work would need to prove it along with medical reports. It’s not always down to having mental capacity.

I think mil will have to move in with us but then I can't bear to think of fil alone in the house.

Make it VERY clear to the hospital that MIL is not coping at home and is unable to cope with him at home to the point that she is going to go stay with relatives if he returns home.
Hospital will do their absolute best to sort it.

Oh that is interesting, he does have a social worker but she seems a bit clueless unfortunately

She has made it clear and so has fil's son so hopefully they will listen and act.
Thanks for your replies

My father ended up going to a care home straight from hospital in the same situation as you describe with Parkinsons disease and a nasty fall. My mum didn't want it although she was struggling and he didn't want it but it was deemed to be in his best interests. If the hospital say it's the best thing then also make sure you ask about continuous care funding. I thing that's what it's called but the social worker should know.

I really did not rate the hospital social workers. That's putting it mildly.
Is your Dad's hospital or social services? Maybe MIL also needs some kind of assessment to make it clear that she isn't fit enough to care for him.
Be persistent and keep copies of all contact.

It really doesn't sound as if he actually does have capacity. Could you ask for him to be reassessed, taking into account the physical risks he would face in his own home?

MiL needs to go and stay with relatives or elsewhere for a while, and tell whoever it is that there will be nobody at home to look after him.,

The alternative is a 4 times a day care package, but you can almost guarantee that he won’t fall when carers are there. Frail elderly neighbours of ours, one of whom was often falling (we had endless calls for help) now have 2 carers 4 times a day, plus a hospital type bed has been installed downstairs. Something like this might just about be enough.,

These are both vulnerable people with needs to be assessed. They cannot disregard FILs wishes. But if MIL is suffering from cater breakdown, and is staying with you or someone else to be cared for herself, this may force a reassessment of FILs needs, as they would then be responsible for returning him to home alone. They may the suggest interim or respite care, in a care home. If it is a good home, take it from there.

This, and he has a diagnosis of dementia so I would imagine an assessment would find he lacks capacity now.

Aargh carer breakdown not cater

My late DM received continuous care funding under the NHS in similar circumstances - she had dementia and was at severe risk of falling. She actually fell while in hospital and broke her hip, before she was discharged to a nursing home.
(I had a huge row with her SW who was adamant she had capacity and could go back home as that was what she said she wanted. He hadn't read her notes correctly. Or at all, really. )

You say he is being 1-1 by a HCA in hospital other wise he gets up alone and falls, is this because he forgets he will fall or just because he chooses to and understands the consequences, ie that he could fracture something. If he is forgetting how can he be deemed to have capacity and be safe at home. If he is choosing to do so but is fully aware of what is going to happen, is he able to verbalise what he would do if he was alone at home and he fell, ie how would he get help (presuming his wife would not be there). If he truly has capacity he cannot be stopped from going to his home but hopefully would agree to a care package. If there is any doubts about capacity then a best interest meeting needs to be arranged by the hospital with relatives and relevant MDT there.

I'm a specialist nurse in the discharge team at a large hospital and employed to make decisions like these in conjunction with SW's a Best Interest Meeting might be required if no resolve can be found. I feel it would be in his best interest to be placed in 24 he care with such high risk of falling. A decision specific MCA (mental capacity assessment) would be needed.

Really this. If he is judged to have capacity then he will be able to return home. However, MIL cannot be forced to care for him. It is best done by her not being there on his return and everyone, especially the ward staff and the social worker, being aware of this. Tell his GP too. If possible, I would get some relevant email addresses and put it very, very clearly, follow up with phone calls.

I'm 24/7 carer for my husband but I'm younger, he does not have dementia and it is my choice. I've seen too many brave older spouses destroy themselves trying to cope, in a way the cared for person would not have wanted in their real personality. Good luck and I'm sorry, horrible situation.

The best interest meeting was cancelled as he was deemed fit to go home and has capacity. I believe his psychiatrist is coming soon for another assessment.
He thinks he can walk so tries to get up despite cot sides. He has little to no insight into what he can do but appears very lucid at other times.
It's a awkward situation as it's dh's stepfather and his own children are involved too. Luckily they realise mil can't look after him.

@fluffycereal a diagnosis of dementia does not mean that somebody lacks capacity, it depends how severe it is and on a decision by decision basis. An adult is allowed to make unwise choices if they are able to retain information and understand consequences of said choices/actions.

Sounds like fluctuating capacity, I'd ask for decision specific MCA, in my experience patients with that history (dementia/Parkinson's) at best have fluctuating capacity but I'd obviously have to see his noted to make an informed decision. If he was my patient I'd be very worried about him going home and there would be a strong possibility it would be a failed discharge.

What happened with my dad is mum called an ambulance every time he fell (because she couldn’t get him up by herself) and he was usually taken into hospital so he was in and out constantly, once within a few minutes of being deposited home, until everyone realised it was bloody ridiculous and he was discharged into a care home.