Am I right to call 111?

[JamieFrasersSassenach]

DM has definitely got cognitive decline.
This week it has got markedly worse.

Today she has been telling me things have happened that I know have not.

Examples are that her heating isn't working - it's 23 in her house.

She says people have been coming in and out of her house all week - British Gas Homecare came twice to put new batteries in her hive thermostat and then to show her how to set her boiler temperature - their records say she was confused.

I live an hours drive away from her, I came over this morning to check everything for her - all good, spent about 2.5 hours with her.

I got home at lunchtime, by 3.30 she had phoned me 3 times to say her heating was not working and she was freezing (her hive account which I have access to was showing the house temperature to be 23) and then that none of her 3 TVs were working.

I came back - everything working fine, DM wearing a vest top because she is so warm.

She then said she phoned me because there were electrical wires all over the floor and she did not know where to put them.

She said I had left the wires there when I was stripping down electrical equipment this morning.

There were no electrical wires and I had not had any electrical equipment out this morning.

I called 111 and spoke to them about her confusion. I am waiting for a call back.

Is there anyone else I could contact for help this evening?

I can't stay here with her and simply cannot keep driving over, or to be honest cope with constant phone calls. I'm thinking maybe she has a uti and this is making her a bit delusional.

Anyone have experience of similar - ideas of what I should do to get DM some help tonight/tomorrow?

I have PoA set up so if she is deemed in the future to lack capacity I can act on her behalf.

OP, maybe by herself your DM will be quieter and more likely to catch up on sleep until Tuesday.
I would also not be on the phone very much to her in the meantime.
Depending on how today plays out then you can take up @gimmegimmegimmeagin suggestion if things still high alert.

Thank you - great suggestions. I have spoken to her friend (who she phoned last night to tell them I was having her locked up and she would never be able to speak to her again.)
Friend has phoned her and thinks that she is now looking for the antibiotics in the bin and will take them.
Otherwise I think I will have to phone her GP first thing tomorrow and request a home visit.
I really want to avoid her needing to go into hospital, despite her delusional beliefs on the matter.
DM friend will keep me updated today which is good

I’m really pleased for you that your dm’s friend is communicative with you. It relieves a small part of the responsibility you must feel.

i understand why you’d rather avoid hospital but if she doesn’t cooperate with the antibiotics it will be the best place for her.

@Cornettoninja you are right - my concern is that she is nearly 80 and if she goes into hospital she might not come back out.
She has just phoned me to tell me that she has retrieved the antibiotics from the bin but that the leaflet says she should not take them with metformin which she takes for type 2 diabetes.
I think I have persuaded her to take them.

Can you check the info leaflet online, should they be prescribed for someone on metformin?
God what a stressful situation, particularly when they become abusive, you feel so bad leaving them but you can't just sit and be abused either!!

Yes - I've just checked the leaflet online - it says to check with your GP before taking them if you have diabetes. The OOH doctor was very aware of her diabetes, I have no doubt that they are fine for her to take.
I am torn between worry and frustration!

Op how is your mum??? Has she seen anyone yet??? Biggest hugs to you both x

One thing to bear in mind is that medical professionals have the power to take people in under the mental capacity act for these exact scenarios. Eg someone is so unwell they aren't capable of making a decision re treatment. Ambulance use it quite a bit as sometimes we go and assist (I work in the police control room). To make it clear this is a completely different scenario to "sectioning" under the MHA or a DOLS and is just temporary for the best medical interests at the time to get treatment in a life threatening situation.

@StiffyByngsDogBartholomew - is that something I can request? She is now telling me that she won't take them until she has been to the chemist tomorrow to check with them. She intends to drive to the chemist.
I have tried to explain to her that she can safely take the antibiotics and that she must not drive.
I am frightened that
A she'll be even more delusional tomorrow and
B she'll cause an accident or worse hurt someone

Any recommendations on what I should do?

My thinking is to phone her GP first thing tomorrow and explain everything to them and ask them to do a home visit - but I'm not sure if that will be enough.

im not sure, however thought it would be useful info for you to bear in mind if gp etc is not helpful
I think you should phone 111 tonight and say she is refusing the medication and getting worse and more confused. Hopefully they will say this meets the threshold for ambulance as if it's a UTI waiting 12+ hrs untreated will just make it worse

Do you think she would be receptive to talking to 111 herself if you arrange the call? Is her friend able to be of any practical help to you?

I obviously don't know the ins and outs of her history but I’ve had some nightmares trying to get someone, anyone, on board when the person next to me is loudly refusing. It’s a very high threshold to override a patients stated wishes. My DP had 02 stats that kept dipping into the 50’s, never getting higher than 80, and was horrendous with his treatment of me/others and the paramedics wouldn’t take him when he refused them. I questioned why hypoxia doesn’t mean decision making is obviously impaired and was basically told I’d have to wait until he was unable to advocate for himself.

That sounds utterly shit and frustrating. I do know from experience that paramedics are super reluctant to use the powers in the MCA

@Cornettoninja she talked to both 111 and a nurse from the ambulance service last night - both of whom wanted her seen, she refused point blank to let me take her to the nearest hospital (what the nurse wanted to happen.) So they sent an OOH doctor in a car to her house.
She argued with him and said that she did not have a UTI.
I don't know if she would answer a call herself from 111.
I think it's going to end up going down the path of her becoming increasingly confused and delusional to the point that she is taken to hospital.
There is no reasoning with her sadly.

So I've had another conversation with DM - she still doesn't want to take the tablets.
She is also saying that she is stuck in her house and she does not recognise any of it.
I have called 111 again and asked them to call her - they have said a clinician will call her and will then call me.
She is definitely getting more and more confused.

@JamieFrasersSassenach how worrying for you and frightening for your mum.I really hope someone steps up for you both x

Really hope you are getting things sorted.

Why do you think she'll never come out of hospital if she's admitted, OP?

She can be treated then discharged - possibly with a care package.

I have only once taken in someone against their will and it was not pleasant. But she failed the mental capacity act questions.

if your mum was asked the basics, like,
where are you right now?
what year is it?
who is this person (you or ambulance crew or someone familiar)?
etc

what would she say, would she ‘pass’? If so then they can’t override her wishes. But she will eventually fail. It’s horrid for you to sit back and watch though so I sympathise.

i had similar but different with my mother who would refuse to eat and drink as she wanted to die, until she started hallucinating through dehydration and a carer would ring 999. Ambulance crews would take her in, get a drip running and she’d recover. And repeat. I tried telling her that this method of suicide would not succeed many times!

@LivingInaBuiltSite I think she would not be able to answer those questions - last night she said it was May 4043.

Today she told me the building she is living in is not her house and outside looks unfamiliar - she doesn't know where she is.

It's so frustrating because I think if she would just take the antibiotics then she would lose the confusion.

To the pp who asked why I think she wouldn't come back out - I think the lack of movement and stimulation along with the real possibility of picking up other infections would age her incredibly - until this week she has been forgetful but active and very independent.

It would be wonderful if she could go into hospital, get the infection cleared up and go back to her life as it was a few days ago.

I am definitely going to phone her GP surgery first thing tomorrow.

Ok, so make sure to say you feel she does not have capacity right now.

https://assets.publishing.service.gov.uk/media/5f6cc6138fa8f541f6763295/Mental-capacity-act-code-of-practice.pdf

page 41 is helpful.

guessing her answers atm would be:
Impairment to brain function? Yes
can patient understand the info? No
can they retain the info? No
can they weigh the decision? No
can they communicate the decision? yes

she would be deemed not to have capacity in my work situation.

@LivingInaBuiltSite I have just spoken to her GP surgery and said that I don't believe that she has capacity. They say there is nothing that they can do and that I need to go and make her take her medication. This is despite me explaining that I cannot get there before tomorrow afternoon. I twice said she is vulnerable but the receptionist was adamant that it's down to me.
I have requested a call back from the practice manager.
It's a shambles.

@JamieFrasersSassenach deep breath! I know this seems like an enormous crisis, but, those of us that have been doing this a while…this is how it goes. If they are unwilling/unable to accept things need to happed, medication, hospital visits, carers, and are deemed to have capacity. There really isnt anything you can do. I tied myself up in knots when i had young kids and an elderly who wasn’t awkward, just their idea of not being a nuisance was to pretend everything was fine and dandy, when it really wasn’t.

My advice is to let the crisis happen, however hard that is to watch from the sidelines. Only then will the authorities (and in our case relatives who visited regularly every 18mths!) see and believe.

Dont know how old your mum is, but you could be just starting on a decade or more of this. It’s definitely a marathon not a sprint.

That's ridiculous. What does she expect you to do, strap her down and force her mouth open? A receptionist isn't qualified to give advice like this.

I have had a call back from the practice manager who very helpfully told me that usually they would send the practice care coordinator out to do a welfare check, however she is off this week.
I have persuaded them to get someone from the practice to call DM to see if they can persuade her to take the medication.
They will then call me back.
Other option is for me to call adult social care and make a safeguarding referral.

@FictionalCharacter I did point that out with the receptionist, and the practice manager - that even if I go and stand over her she won't take the medication.
With the best will in the world I can't be there every morning and evening to watch her take them. If I lived ten minutes away it would be very different. But I don't.