Won’t engage with carers

[Edinlassy]

Hi

looking for some advice. My mother has been sick for a long time and this year has really went downhill. After a 7 week stay in hospital she was discharged with carers 4 times per day. Huge relief to me that care was coming in as she was not managing and I was struggling so much to keep on top of everything. Her house was infested with flies, poo on the floor, mouldy cups everywhere. It was a bad state of affairs.

Lots if back story but my issue is now she is refusing to allow the carers into her home. She barricades the door shut so they can’t let themselves in and shouts at them to f@@@ off. They still attend but never gain entry. Her house is back to all levels of disgusting and I’m so worried medical help couldn’t get into her flat if needed. She is wheelchair bound and fell out of it the other day and instead of pulling her help cord she pulled herself into the hallway and made the other elderly residents (sheltered accom) lift her up.

i am wondering what happens when they condition of someone getting home is that they accept carers but when they get home they refuse access? Has anyone ever been in this situation?

thanks

If she has capacity and refuses care then it will be withdrawn.

This happened with my Nan who got vascular dementia & psychosis.
She needed personal care badly but would literally chase the (very nice) carers out of her flat shouting fuck off. Even my mum couldn't help her.
She never swore before the psychosis & would have been mortified at her own behaviour.
She was sectioned in the end as she became a danger to herself and others and covertly medicated with anti psychotics which returned her to a state of pleasant forgetfulness and she was 'nice Nan' again... sadly she died soon after of aspiration pneumonia.

I'm not saying your mum has actual psychosis or even dementia like my Nan; but her mental state could be worth getting looked at by her Gp or by the community mental health team in case there's anything they can do to help.

She has been assessed whilst in hospital and was deemed to have no capacity to make medical decisions in her best interest. Carers want to stop due to the abuse and waste of their time but hospital social worker said they need to keep attending.

If she's in sheltered accommodation can the management not advise/help?

You would think but not they won’t get involved unless she becomes not independent enough to love there anymore.

This sounds familiar!
i had to basically fall out with my DM and say I wasn’t visiting such squalor, she is really stubborn ‘in not doing this, no one can make me do that’ etc. I basically played her at the same game and said I wasn’t going to be made to visit someone refusing help and living in a mess as I found it distressing and had to put my mental health first.

This upset her but she just pulled out all the usual emotional manipulative comments and I stuck to my guns! The. She had another fall and ended up in hospital! This then made her reluctantly agree to have them. Bloody awful times but stick to your guns 💪

Been here with FIL.

It's like watching a slow motion car crash -and you can do absolutely nothing about it.

As she's been judged not to have capacity, you could try speaking to the social worker about how they plan to keep her safe if she is refusing access to the carers. Ask that specific question - how are you going to keep her safe ?

Like LookingforMolly's Nan, FIL was sectioned in the end. The house was in absolute squalor - we would have been prosecuted if we'd kept animals in that environment, but we couldn't force anything on FIL as he was capable of expressing an opinion, even though it was quite clear he had dementia.

It's an awful situation and I really feel for you

If she doesn't have capacity then you'll have to contact her social worker pronto.

Sorry missed the bit about not having capacity. Jesus! Yes throw this back at Social Care, there is a safeguarding duty here.

Thanks folks. That was the situation that lead to her being in hospital so long we went down and found her sat naked covered in poo it was everywhere head to toe and all over furniture. She had forgot
to charge her wheelchair and couldn’t get to her phone so just sat there until I cake down. I live just over an hour away from her. I guessed something was wrong as she hadn’t been on her phone but she was sat there like that for over 24hr. Didn’t pull her help cords though she could have.

Her delerium comes and goes to an extent as in some days are worse than others. As you said above it’s like watching a car crash in slow motion. My kids don’t want to go there anymore and if they sit in the day room with her whilst I clean her flat it’s absolutely vile what she is choosing to live in. She is blocking her sink constantly with cigarette ends or just throwing them in the floor. I have taken a huge step back in the hope she would see sense and at least open the doors to the carers so they know she is ok.

The social work are well aware as there was a meeting when the carers said they would not attend anymore. As they deem her to have capacity to some extent as she can make a cup of tea and mobilise from wheelchair to sofa, they just deem
her no capacity to make medical decisions. They had to section her in the summer to keep her in hospital. In reality she couldn’t tell you what year it is, will tell
any old lie when asked a question and couldn’t tell you what she has done in the week.

So what should social works next steps be?

Social workers should contact a psychiatrist who assesses older people.

I'm not 100% sure though as what happened with my Nan was spring 2017 and I'm unclear now about the order of events.
But she was definitely assessed & sectioned by her gp & a psychiatrist. A policeman attended when she was taken away. She was 91.

She sounds like a vulnerable adult. If she doesn’t have mental capacity to make the decision to have or not have carers and is refusing their support then the care agancy should be letting her SW know. It sounds as if a safeguarding referral should be made, you can make one to your local authority’s adult social services dept and that’ll be quicker than waiting for the SW to do it.

It sounds as if she needs to be re admitted, under section if she refuses.

Is there a warden, she cannot be allowed to get other elderly residents involved in lifting her, that's unsafe and not their responsibility at all. She needs an urgent referral to the social services safeguarding team, she is at risk of personal harm to herself and self neglect and also to the other residents. Is it her own flat or council? She is not safe for independent living if she smokes and throws them on the floor, blocks the sink, doesn't charge her battery, get to the toilet or keep herself clean. What advice could her g.p give.

In FIL's case, DP got the GP to visit who arranged SW and Psychiatrist to attend. DP sat in on the interview with the psychiatrist which was a very good idea as FIL could be very convincing and was spinning a plausible but totally confabulated story to the psychiatrist. DP was able to explain the true situation.

@HappyHamsters it is her own flat within sheltered housing accommodation. The warden wasn’t aware she had asked for help she lives on the 1st floor (she is an amputee) so dragged herself into the hall and banged on doors. The poor souls are all older but got her up. They were unhappy about it though and reported it to her carers. They have told the other residents if it happens again to refuse and pull her emergency cord.
Her GP is not really involved with her as she is under hospital care 3 times per week for another condition so they look after everything. The last update was she could only be at home with carers 4 times a day, this was all agreed and put in place and then as I knew she would be refused entry. The social worker just tells them to keep going. Nothing else seems to be happening. It’s the blocking the front door that scares me I have asked her not to do it as there is no other way in and she laughs in my face and calls me dramatic

I would highlight the unsafe smoking /disposing of cig ends to the SW and the warden……she is putting the other occupants at risk; people setting themselves on fire is sadly not unusual.

Why did the hospital discharge her back to sheltered accommodation with carers 4x daily? Sounds like she needed a nursing home / EMI placement before the 7week hospital admission; never mind the hospital discharging back to the same albeit with carer visits. The warden is very remiss not to do something about this, they should have done a safeguarding referral well before now but definitely at the point when other residents are lifting her up off the floor.

i am guessing her she she is still in her 60’s and had the capacity to say she wanted to be at home they felt she would be ok with the carer support. I told them exactly what she would do but like the last time they didn’t believe me. I just feel like the send the carers, they know they are not getting in but they have sent them so box ticked.

If you contact her local social services you can raise an urgent safeguarding concern (self neglect) and ask them to review if her needs can be met where she is or if 24 hour care needs to be considered in her best interests. I would do this if you feel she is unable to meet / understand her own needs.

If you feel the cause is more mental health related you can ask the local authority to complete a mental health act assessment (consider if she needs to be sectioned). They can only section her if she has a mental health issue that is causing a risk to either herself or others - the self neglect could be considered a risk.

Either way, get in touch with her local social services, it doesn't sound like this is sustainable as it is.

@Edinlassy Does she really have capacity or is this a case of dementia setting in?? Can social worker get a mental referral? Sounds like she really is not able to care for herself!

It’s hard to know as delerium symptoms are very similar to the start of dememtia. When the delerium started she had a brain scan as it came on so suddenly so we thought she may have had another stroke but everything looked normal. As she has been on treatment for 17 years for another condition they think that treatment is not causing the delerium.

There is absolutely no way she would engage with social work or agree to moving into a facility. I have nobody else family wise to help and she had alienated every single person pretty much in her life so it’s very isolating to be the only one to pick up the pieces

How are the carers approaching her?
Sometimes you have to be a bit inventive about how you go about getting people to cooperate with care. (I've been a carer for more than a decade).
Sometimes you just need to need to enter the house on a false context. So im popping round to have a cup of tea or bringing x y or a round. Anything that gets them in the door.
I've once gained entry by asking a client for some hot water for a neighbour!

Are the carers the same people each time or different ones? At this point she needs consistency so she needs a small team going in at most. She needs to be able to build a relationship with them and for them not to be easily put off.

Can you or someone she trusts be there for a few visits from the carers to help break the ice until she gets to know them. It must be very scary for her accepting people she doesn't know coming into her home and expecting her to be ok with having personal care. Especially if she knows her mind and memory are not great.
If someone could be there to get over the initial hurdle of getting through the door so she can't just not let them in. Then once she's more used to it she is likely to be much happier to let them in.