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?

Is there anyway you could get him into a care home for respite or just rehabilitation of some sort
often once someone is in a care home they rarely get back home again

We use the discharge to assess pathway, 2-4 weeks NHS funded in a care or nursing home, gives patients chance to settle then another assessment of needs is undertaken and longer term care needs established. The second assessment involves nurses/carers, social workers, relatives and the CCG.

He is adamant he won't go to a care home, not even for respite.
SW told mil that they would need to separate if she didn't want him home which seems drastic. She loves him dearly after 40 years of marriage but just can't physically care for him. He believes they can muddle along together.
I think I will get her to lay it out to SW (is social services one I think) again.
She is being kept out of the hospital now after being allowed to visit daily as he has capacity. Apparently only dementia patients can have visitors.

It's really hard. Both my DM and my MIL have had dementia.
My DM was very good at seeming to have capacity as she was very good in the moment, but had excellent coping strategies around her memory loss but it only took being with her for maybe half an hour for you to realise she retained virtually nothing. I had to fight unsafe discharge from hospital several times. Health staff are under pressure to move people on. My MIL is still alive and in a care home - dementia and poor mobility, she can't walk unaided but keeps trying. She's had a broken hip since living there.
Is the home your FIL wants to go back to suitable for adapting to make it easier? Everything on one level for example. Would they be able to afford carers if not eligible? DM really does need to stand firm though which is difficult..

Had this with my parents. They sent my dad home and the sw told my mum they’d phone the police if she didn’t let him in. So we played the game, I think he was home 24 hours before there was another crisis, he went back into hospital and then to a home.

@SpudsIluv if a family disagrees with a capacity assessment (which will have been done without family input or presence) what happens then? Is there a formal route to challenge it? I see mild versions of this a lot - eg ReSPECT forms completed with "patient has capacity" ticked when the patient barely has capacity to choose tea over coffee.

She is being kept out of the hospital now after being allowed to visit daily as he has capacity. Apparently only dementia patients can have visitors.

You said in your OP that he has dementia

My mil has dementia and was becoming violent to fil.

He did get to the stage where he refused to have her home. She went into the care home sort of willingly but she did no longer have capacity.

If he needs someone 1 to 1, 24 hours a day to keep him safe on a ward, I can't honestly see anywhere being a completely 'safe' discharge. A residential setting might have to manage him at floor level to reduce the risk of injury from falls, but I can't think of any that would be able to provide 1 to 1 care.
Four carers a day would still leave your MIL dealing with at least the other 20 hours, what if he decides to try and get up whilst she goes to the toilet ?
The only other alternative is a live in carer , which is expensive and intrusive.

fluffycereal he does have dementia or so mil has been told so this is why it's ludicrous. It's almost as if she is being punished for not taking him home.

They live in a terraced house with a downstairs toilet and stair lift but he can't mobilise to the stairlift or toilet. I don't think they could afford private care

He won't be if you hold your nerve. Tell the SS and people in charge of his discharge that there is nobody at home to care for him and if they discharge him to an empty house, the responsibility will stay on them.

You need nerves of steel and it may include cutting off visits in the meantime. Total pulling up of drawbridge.

OP my heart goes out to you it's such an awful stressful situation. We had similar with my mil except she lived alone and refused a care home and we found the community health workers really took her side with everything I think they expected DH to do 24/7 care despite him having a young family and a job it was ludicrous. We had already spent years leading up to this supporting her at home and helping out it certainly wasn't that we were uncaring or unconcerned about her but like your fil it had gone too far and life was miserable for everyone. The final straw for us was when DH had another phone call to say she had fallen and he left work and realised he was driving down the wrong side of the road as he was just so stressed and tired and unable to concentrate on anything so that's when he actually got mad and said enough is enough his own health and well-being was now severely impacted.

It is so stressful. Mil crashed her car recently as she was so stressed out. Not an easy situation for anyone.
Thanks to everyone for their comments and advice. I am going to encourage Mil to stay strong and say no and if they are likely to send him home she will come to stay with us so his discharge would be unsafe.

She can refuse to be involved in any discharge, the hospital would then need to arrange transport home, settling him in, getting him something to eat. This happened to us, he fell getting out the ambulance chair so straight back to hospital who discharged him to carehome.

They may argue that he will fall in a carehome, few places offer 1 to 1. He should have a falls assessment, a chc checklist which does identify risks, its not just for funding, if she wants to visit then she can contact PALS, although it might be a blessing in disguise if she doesnt get involved. The social worker is only part of the discharge team, their word is not final and there may be a nurse discharge coordinator who is involved.

We had the reverse of this with my parents, dad adamant mum was going home, mum wanted to go into a nursing home ‘for convalescence’.
Dad did absolutely nothing for mum and repeatedly cancelled care packages arranged by the hospital on discharge because they didn’t come when hewanted them - 8am and 9pm.
in the end I said I would instigate safeguarding (he was, it transpired, verbally abusive to mum as well). Mum was immobile, unable to do personal care or cooking etc, couldn’t have a bed downstairs because she wanted to sleep upstairs and the whole situation was dreadful.
In the end she had yet another fall and I got a bank loan to pay for her placement. Dad ended up in the same home 2 months later.
It was dreadful and even more so when following their deaths we discovered he had a small fortune in the bank and building societies.

They can't break the door down to put him inside and compel her to be his carer. Doesn't matter if she says 'fine, we're separated, then'. They have to find somewhere for him to live and they cannot force her out of her home / make her homeless for him to be left there alone.

Have been though this exact situation. Fact if the matter is, he needs to go in a care home. His situation is not going to improve, and Parkinson's is not terminal. He could carry on slowly deteriorating for years. It's brutally unfair on your MIL to expect her to manage his care. Nobody has been through this could m possibly expect her to. Sending my deepest sympathies, it's a really awful and upsetting thing to go through.

Thats true but I dont know if anyone can refuse to give him a key either

They can - physically taking one would be illegal as well. They would have to leave and take him back with them.

Even if SS/LA/whoever tried to force it through the courts, a judge is not going to say 'of course you can break the door down, push past the woman living there to put her disabled husband on the sofa and demand that she looks after his personal needs'. A judge would ask 'why have you not found this man suitable accommodation where his care needs can be met by professionals instead of attempting to coerce his wife into fulfilling your obligations towards him?'

When the hospital SW was trying to unsafely discharge my DM (who has capacity, lived alone, quite disabled, and was completely incapable of looking after herself) they fully expected me to move in to care for her, possibly because DM led them to believe I would. I live 30 miles away, a FT job and other commitments, and it was never going to happen.

They then told me they would put DM in a taxi to send her home, because she wanted to go, and if I didn't bring keys they would get a locksmith to change the locks. Goodness knows how they thought she would get from the taxi into the house. I treated this with the disdain it deserved, but I can totally see how people can be bullied into taking responsibility for an unsafe discharge.

Ultimately it was a conversation with her Dr who said "Er no... she's medically fit to go, but no way can she go anywhere without a serious care package" that things became sensible.

A month at home between a respite stay and finally moving into her care home, which involved huge weight loss, falls, a gazillion phone calls to me, and another hospital admission, despite having carers in, showed her that this was the only viable decision. She's great now. Doesn't need to be there - except she would do if she wasn't.

Does anyone have poa for either of them. If the psychiatrist deems loss of capacity then a best interest meeting will be held and the decision taken for them.
If he does have capacity has anyone sat down with him and told him they dont think its safe at home, his wife cannot care for him he will be in the house on his own, will fall and potentially suffer a serious injury. Even if he did go home, he may not allow the carers in anyway. I am surprised he has cotsides as they shouldnt be used for someone who constantly tries to get out of bed unsafely, he should have a falls and bedrails assessment and a bedrail consent form as they are a form of restraint and a hazard if not used approprately. He should be on a low bed with a falls mat.
Has mil spoken to the ward manager and the discharge co ordinator, she can also inform her adult social services dept to put in a safeguarding concern.
If he has capacity she cannot refuse to let him be discharged home but she doesnt need to get involved with any plans to facilitate it.

You can request another capacity assessment if you don't agree, capacity can fluctuate a lot, like other have said stay strong, sounds to me like he needs 24 hour placement. The discharge to assess process is perfect for this kind of situation. It's not a permanent placement and just gives time to establish longer term needs.

I inform the patients it is a further period of recuperation...it is and gives time for a more accurate picture of their needs long term.

(It can become permanent if needed)