@Tara336 We care for our daughter who has MS so we can understand how things are for you and we know that the stress of your situation will have an adverse effect on your health. Sorry you are going through this.
Very long to see if this helps you
In summary your situation is not unlike ours. Of course every situation is unique and different authorites have different systems. However, I believe from my own experience that they are some basic things that should be followed.
From what I understand your dad is now in hospital with low sodium and potassium levels. This happened to mum and she was in hospital for 3 weeks last June. It was the Sertraline they put her on and not the dementia. Her sodium levels have dropped again now that she is in hospital but that is not uncommon for elederly people in hospital.
We have the hospital records on an app which allows us to see each time something happens to mum such as a lab test etc. We then follow this up with the nurses as they are usually unaware and we have the information much quicker. We also have the NHS app for her GP so can see things from that side as well. Access was granted by the GP on presentation of an LPA.
The major difference between our situations is the mum was in a 'standard' dementia care home for 9 days and she smashed up her room and assaulted staff to the point they could no manage her. In hospital she was on a specialist dementia ward for 1 night and they also could not cope as she assaulted staff and tried to smash windows with an oxygen bottle.
We therefore have a history that shows she cannot go to a standard care home and certainly cannot go back home.
Your dad doesnt have this but he does have the section and from that alone I would expect that they would not allow him home. If they did then they would need a 24hr care package which may not be suitable given his aggression and that means you mum would have a live in carer which in turn is a huge disruption to her life.
With your dad in hospital they have to discharge him at some point. As the LPA holder you can righty say that a care package must be in place before he leaves. They cannot argue against this and you also have to agree if the care package is suitable or not. So you have some aces in your hand even though it may not seem like it.
So assuming he is not going home then it will be to a care/nursing home. He cannot take risperidone so I assume he cannot take other anti-psych drugs? Is he on ADs?
In our case the OPMH liaison psychiatry (hospital OPMH) assessed mum daily. We called the team every 3 days for updates. This is important and also to keep a log of exactly what has been happening and who said what to whom. We have kept a detailed diary since last June and there have been 2 instances where it has been invaluable. Especially where they tried to put mum back onto sertraline. No one had updated the hospital pharmacy system to say she could not take it. Cue the psych team running to the ward to stop it happening (yes really).
So if you can call the OPMH I would recommend it and you will get a fuller picture of what is happening and what medication they may have been trying. They did this without our knowledge as it did not show up on the systems we had access to. Regular calls caught it though and also when medication changed such as her risperidone going from 2 x 0.5mg to 2 x 0.25mg
With the OPMH involved they worked with the Dementia and Delirium team to produce a care report. This report was passed onto the ICB. Parallel with this we spoke regularly with the LA Adult Social Services and had a social worker involved. They called the social worker and Independent Living Advisor. I see your dad has a social worker and I would recommend updating them regularly to ensure they are in the loop as they can have an input on care. It is also important if you need to seek LA funding.
With the ICB involved they kept in touch with us. In reality we kept in touch with them and pushed for regular updates. They then worked with the LA placement team who looked for a home for mum. This was very limited given her complex needs. On the face of it this looks like the situation your dad is in and he will need more care than a standard care home. If they do put him into a standard care home then you might be back to where you started from if he becomes to much of an issue for them. Trying to avoid this is really important for two reasons: 1. You will have to be more involved 2. The standard of care for you dad will be lower.
This means CHC funding is super important. You say he scored Bs rather than As. I really dont know what this means and therefore it may be a local system they have. The OPMH team should assess with the Dementia and delerium team and it should not be a tick box exercise. This is not just me saying it, it is the law. Any tick box is not allowed to provide an answer and is ONLY to be use as guidance with all stakeholders being involved. So going back over what I have written it now may make more sense. A detailed log, all of the departments involved both NHS and LA and you yourselves. That is where the decision is made. The Health and Care Act 2022 was quite explicit with this point. Healthcare is now 'Integrated and Personalised'.
There are a number of cases that point the way and the better management your dad has received in hospital has possibly meant that his behaviour has improved. If this is the case, and we are pushing this ourselves, is shows that he needs more care than a standard care package.
I hope this all helps.
On our case I spoke with the ICB today and although she said she is not really allowed to tell me the propsed charge from the specialist home she did tell me. Honestly it is eyewatering. My point here is that if you able to establish kind/gentle relationships with each area or responsibility they include you a lot more. I appreciate it is a lot of phone calls and emails and I have said in the past my Dh should be sainted after what he has done so I know it is no small feat.
You truly are in my thoughts xx