Mum has dementia and refusing help

[notanaturalmum]

My mum has mid to late stage dementia and lives at home with my dad. They are late 70s.
My dad tries his best to care for her - cooks/cleans/encourages her to take her meds. i visit once a week to give my dad some respite.
Home instead visit every day so my dad can leave the house to go for a walk etc.
My mum is starting to struggle with personal care and wont accept help from anyone. She hasnt had a bath in weeks and we've
all tried to encourage her but shes having none of it.
she complains of pain in her foot, we cant get her to take her socks off, she won't let us or the carers or the chiropodist near. she's not brushing her teeth either.
she changes outfits multiple times a day but sleeps in her day clothes as shes quite confused with time. And she shuts the door and won't let you in to help when she's changing
the carers can't really force her against her will and we're worried for her hygiene.
what can we do. we can't hold her down or force her - she has hit my dad whilst he was trying to look at her foot.
I'm worried for the long term - if she has a sore on her foot it's just going to get worse without intervention.
we've tried all the health care professionals, they are very sympathetic but the advice doesn't really work.
i was actually contemplating sedating her today so that we could look at her foot but I'm sure thats illegal.
we want to support her but its nigh on impossible.
any suggestions please?

@unsync what a kind, understanding and gracious post. I f feel bad for jumping on you now
sorry!

TheShell
GPs do the SS referral

Wow all your posts are helpful and I'm not offended in the least.
Will try to answer. Yes it pains me that my father is spending is twilight years caring for my mum. He has accepted his fate I think and we (me) do look after him. He does his daily walks with the neighbours, has respite trips to london sometimes. Day to day life is hard for him but mainly because he is seeing his high school sweatheart change before his eyes. He's okay (for now)
In terms of social work, I do recall people visiting and doing assessments- they said my mum needed a hand rail and that was about it.
I think my parents don't qualify for support because they have too much in savings etc
The carers are paid for privately.
Regarding the feet - a private chiropodist comes every 2 months. She does my dads feet and really tries with my mum - she will sit there the full hour and get nowhere but she does try.
In terms of POA, yes i have it for her - health and welfare. Not sure how it can help in the short term.
I get that sending her to a care home is best now rather than when my dad passes. I just worry that it will send her over the edge and she doesnt deserve the treatment that she'll no doubt have to have in order to get her into one.
Police etc sound drastic and how can i be sure she won't be violent to the staff. Will they sedate her regularly when shes a resident. It doesn't seem right.
Appreciate your responses.
I don't want to make it look like I'm making excuses for her. I just want to be able to help her and right now its just a mission to do anything.
Other than that, she just sits in her room and sings to herself and folds napkins. In her own little world. And as long as you don't try to touch her, or tell her to wash etc then she's perfectly agreeable. We laugh together, she holds my hand. she won't let me do her nails (and she always used to have her nails done).
I just wish she was like this the whole time i guess.

The right sedation for aggressive elderly dementia patients can make their lives much more bearable, OP.
The aggression is due to fear. Sedation calms fears down.

I'm not suggesting turning her into a zombie. But getting her calmer would make her happier and she'd be more cooperative, too.

As previously said, it may be possible to provide medication for your mother which will make her more content and amenable. Care homes don't tend to like 'sedation' as such, because it can make the person more like to have falls.

My mother had carers from Home Instead when she was still at home and the manager was absolutely brilliant, whatever issue I called her with she would go the extra mile. So if you have not had a conversation with the manager it is worth doing so, she may well have helpful suggestions.

Re moving to a care home, I would not assume your mother will be distressed by the move. She may be initially, but it may actually work out very well for her. Quite often people who are distressed and anxious at home will settle once in a care home environment. It is easy to think the person is better off in their own home, but that isn't necessarily the case with later stage dementia.

As your parents pay privately for care, you do not need to involve social services. The first step would be to identify a few suitable care homes, and then make an appointment to go in and meet the manager and have a look around. The manager will then want to visit your mother to ensure they can meet her needs (refusal of personal care is a common problem so they will not be phased by that). Visiting care homes and meeting the staff should help to relieve some of your anxiety about the potential issues.

If the only outcome from the previous assessment was a handrail then it sounds like an occupational therapy assessment not a social work assessment. Even if a social work assessment was completed then it can be done again if things have changed and your dad could also have a carers assessment just for him.

Even if your mum will be self funding her care (does she personally have over £24k in savings in her name or a high income - the house won't be taken be taken into account if your dad still lives in it?) then social services can still be involved if needed - they aren't just there to fund care homes they can assist with the practicalities as well in complex situation like this.

If your mum does go into care then she will be subject to a Deprivation of Liberty order (DoL) which will be applied for by the care home and agreed with the local authority and the court of protection if required. If your mum does require any of the mood calming medications then this will be agreed with the local older adults mental health team and included in the DoL.

When was she last reviewed by the Older Adults Mental Health team and are they aware of the aggression? Most sedating medications such as Lorazepam are only prescribed on an 'as needed' basis and are reviewed regularly, so it would only be given if she was having a particularly agitated day and your dad could/should discuss this with the mental health nurses in much the same way a care home would if she was with them.

Carers are specifically included in the legislation for Safeguarding because it's recognised how vulnerable their caring role leaves them to abuse from the person they care for and how few options they can feel they have to change the situation.

I regularly get involved in these kinds of situations where it no longer becomes manageable and the risks to the people involved if we don't intervene outweigh their right not to have state interference. These things rarely get better if left alone they usually get worse and end in a crisis admission to hospital / care homes/ mental health ward. The earlier professional are aware of the situation to try and help reduce the risks the better.

The current carers will also have a professional duty to report to adult social care if they witness or become aware of aggression towards your dad.

@SafeguardingSocialWorker you are an angel. Will follow up on all of these today. Thankyou so much

How are things going, OP?