Advice vulnerable elderly

[itispersonal]

Any tips: advice needed and welcome

My aunty doesn't have a LPA but has 'mild cognitive disorder' apparently but not dementia- for several months she has been seeing her dead husband and although she knows he is dead (has been for 12 years) she is going to a care home (her husband never was in one) and demanding to see her husband. Police have picked her up a few times, she has a social worker, on anti psychotic drugs but not improving.

A few months ago she was walking the street at 3am to find her husband and on Sunday when snowed she walked over 2 mile uphill to go to see my mum at before 8am, who didn't hear her knock as hard of hearing so walked back in the snow back to hers. This morning at 6.30am she has walked to the local supermarket and was confused as she couldn't remember where she lived.

What can we do? She is refusing to go into a home or pay for care- though she is currently having carers come 3 times a day to give her medication as she isn't trusted to do it herself.

Can we raise a safeguarding complaint to the social services, how can we keep her safe- we have put trackers on her phone and she turns them off. Ring doorbell on but not reliable! We are worried about her, but as no LPA we are waiting for her to be deemed as not having capacity which doesn't seem to be happening.

I would contact her gp and adult social services safeguarding, I am surprised nothing has been done if the police have been involved, is she under a mental health social worker?

The gp won't talk to myself due to data protection and they haven't been great in general. I'm not sure what social worker it is - think it's just adult social worker but no direct number for them. Her son calls gp/ social worker but doesn't seem to get anywhere but it is my mum who sees her several times a week and speaks daily to her who gets the stress.

If you don't know the name of the social worker, you can try calling the main number for the local authority and asking to be put through to the duty social worker for adults and raising a safeguarding concern that way.

Your mum may also be eligible for some support as a carer, might be worth looking into.

This sounds like more than "mild cognitive disorder", I'm afraid. I think she needs another assessment of her mental health. And someone needs to check that she truly does have capacity - not just that she thinks she does.

Just a quick question -- is she a drinker?

If you contact any third parties (GP, SS etc) then without LPA they cannot give you any info without the consent of your aunt. But you can give them information. And the best way to get them to accept it might be to keep repeating the phrase "vulnerable elderly woman" over and over and over. It can trigger the appropriate assessments etc.

The carers or their agency will know who the social worker is, they can also raise a concern, AgeUK have a lot of online info. Your mum can raise a concern with the gp, email them to start a paper trail,

Its not a Safeguarding concern.

Safeguarding in an adult services context is a statutory term under s.42 of the Care Act 2014 specifically relating to protecting adults from abuse or neglect.

Your aunt isn't being abused or neglected - although there are significant risks to her from her unmet care needs relating to her cognitive decline.

Although her behaviour is risky it doesn't sound like she has come to any significant harm from it, yet.

The social worker will be having to balance the risk of harm against depriving her of her liberty against her wishes - it's a fine balance and they usually err on the side of not putting someone in a care home against their will if the risks can still be managed at home.

It usually takes a crisis/fall for that balance to tip I'm afraid.

Its normal to want to protect someone, but care homes against someone's will should always be a last resort unless the risks in not doing so are greater

Sounds as if she needs a mental health act assessment

When you 'doesn't have an LPA' - do you mean she has never filled out the paperwork for one, or that she has done the paperwork but you can't act as she has capacity?

Because you absolutely cannot wait until she lacks capacity to get the LPA done. It has to be done while she still knows what she is signing and can agree to it.

So if she hasn't done the paperwork for an LPA you need to do it now! For both Health and Finance.

Like other posters, she may have a diagnosis of Mild Cognitive Impairment but what you are describing is not MCI so clearly things have changed.

On what basis?

No AHMP is going to justify a detention under MHA because of someone wandering/ hallucinating with no harm caused.

They would look to the allocated social worker to exhaust the options under the Mental Capacity Act first and ask the older adults Mental Health team to review meds.

You can get small trackers that can be sewn into the lining of a coat or fastened into a shoe.

I totally get this the balance of my Auntys wants and her safety and adult safeguarding being based on abuse and neglect. Which she isn't 'technically' going to meet as self neglect as her house is clean, she is clean and she sometimes remembers to eat and drink. Though the carers are for medication.

I still don't think she is ready for a home but the stress of my mum is massive and she is in her 70s and isn't sleeping.

No LPA at all and she won't do it!

She won't pay for carers as she doesn't think she needs them , though nurse and carers have spoken to her about a home and paid carers and she says yes but won't do it!

if it's agreed that she lacks capacity then a best interests decision can be made using the mental capacity act 2005 to put carers in or arrange for her to go into care even if she disagrees if that's felt to be the right/ least restrictive option for her.

it doesn't matter what level of cognitive impairment she was diagnosed with whenever, and it doesn't matter if she had a capacity assessment last week that said she had capacity, mental capacity is time and decision specific and the social worker should, hopefully, be in the process of completing the necessary assessment to reduce the risks if needed in whatever way is felt to be most appropriate.

Any LPA is a red herring at this stage probably - without it the state takes responsibility for decision making instead and they must always consider the least restrictive options first.

Yes the LPA is pointless now as if we are saying she has lucid capacity , she therefore doesn't have capacity to authorise the LPA that needed to be done years ago. My point of that was that we are stuck waiting for medical to deem she is lacking in capacity in order to do what's right for her whether that be more carers / home.

When her son speaks to her social worker about her wondering early morning/ going to care homes looking for dead husband, they just say it's a medical issue and to speak to the mental health team and MHT say to speak to social worker. Can we ask for a meeting family, social worker and the mental health team to again start working collectively in aunts best interest as this has been going on months - she is deteriorating weekly. Getting confused with days and nights, calling police as she's seeing people trying to break in! As well her other regular hallucinations. She is 82 years old.

Yes ask for a meeting, start an email trail. Son can apply for deputyship if she lacks capacity now instead of LPA. The mht, gp or social worker can do the capacity assessment. Keep pushing the point she is vulnerable, at risk of harm, this is a safeguarding issue and she is high risk.

Not had a good week with my aunty- she has continued to call police several times and went out the house this evening as she said 4 young lads were inside the house and robbing it.

Estranged daughter has emailed her gp and asked for her to be sectioned, detailing her current erratic behaviour, sundowning, wondering etc. I am taking aunty to drs tomorrow as dr has asked to see her, to discuss email and for me to raise the families concerns as son unable to. I've also written a note to her carers detailing the issues we are having as although they have started to record her being erratic looking for dead husband etc- they have also cut down her visits to 2 times a day without us knowing.

Can the dr section her from our visit tomorrow? don't know if I'm mentally prepared for that! Or can he just refer her to the hospital for a visit?

How did it go today, was the gp any help.

I didn't end up going son did was he said was a waste of time - they were talking about email sent and dr mentioned sectioning which got her back up and caused her to be defensive and she was just sent home. No water or bloods taken.

I spoke to the mental health team who don't think it's right to be hospitalising her but they are worried and have pushed forward the psychiatric appointment to today and changing care plan but still seems like the left hand doesn't know what the right hand is doing - no one is informing family or each other it seems.

That sounds rubbish, hopefully the psych appointment was helpful, I wonder how the careplan will change. I guess the carehome need to keep calling the police when she turns up and the many police reports actually help in her being in a safe place..