How to get someone into nursing care if they refuse? No capacity

[user12743052]

D parent has dementia and complex medical needs, the family member who's caring for them is unwell and DP needs emergency admission to a nursing home.

DP will refuse, scream, wail etc and also I don't have my own transport or anyone else to help. They have been certified as lacking capacity due to the dementia but have their wits about them enough to know we're telling lies if we say we're going on holiday. How on earth do I get DP to the nursing home? I can't pick them up and bung them into a car seat!

Can the home help? Or the gp?

Does anyone have Powers in place?

does anyone have power of attorney?

it never works to argue with a person with dementia, you've got to work with whatever they believe at that moment. so is there any plausible reason they would go in the car - to tesco or the doctor or something? you can bring a suitcase of clothes etc later.

Do you have power of attorney in place? Private ambulance and speak to the GP about possible medication to help keep them calm during the transfer.

Who is organising the emergency care place? Are Adult social care involved in any capacity. They must deal with people in this situation all the time. (I admit I've only witnessed this in the case of someone with no family being discharged from hospital and taken to a care setting).

We had to say we were going to an ‘expert dr’to get an appointment due to an ongoing health complaint they had and that they needed to stay a few days to get checked over. And that was it. I’ve never felt so wretched in my whole life.

Assuming in this description no one has power of attorney in place- contact your local social services team - (just google for the number) and you can request a best interests meeting to weigh up the pro's and cons of where the person should be, ie a care home, or at home. The person's safety will be a key consideration. Their wishes are really important though- and putting care in place for example in their own home should be an option. (Assuming they want to stay at home)
There are a few big however's here though- I'm assuming you are in England or wales (as I don't know how this works elsewhere) also, if it's a crisis now- a duty social worker will come out quickly, however, care placements are not easy to find, and care packages can take a while too.

You need to contact the crisis team in adult social services. They will need to ensure people are acting in your parents best interest if they do not have capacity to make this decision themselves.

Have been in this position twice:
we had to wait for them to fall to get them to A&E in ambulance. Nursing home team collected them from Hospital and took them directly to nursing home
Will they get into a wheelchair? You could park in an adjacent street with no visible nursing home in sight, and wheel them there
Does the nursing home have its own mini bus or transport? Can you ask them to pick up relative?
Can you employ a private ambulance and team of two private paramedics as a private collection service?
can you ask GP for some anti- anxiety meds for 72 hrs before journey
After that it comes down to straight lies:
We’re going to a hotel for coffee…
The garden centre is at the back of this building..
We’re taking you for a flu jab …
This mission has kept me awake at night. I don’t envy you

Hey I'm an adult social worker. You really need to contact your local adult services, they will come out and assess the situation. You say she needs a nursing home, has she been assessed previously as having nursing needs?
Could her needs be met at home with a care package?
Funding wise, will she be self funding? (Does she have savings over £23250) if not you will need to contact social services anyway to access local authority funding.
Which will involve a care act assessment, a mental capacity assessment on place of residence and a best interests meeting if she lacks capacity.

Thank you for all your replies. I have POA, SW and medical assessments have all been done, self funding with some LA contribution organised. SW and medics, carers manager and I agree that an emergency nursing home placement is needed due to escalating medical needs and dementia.

@MsCrawford At home care isn't possible due to their complex medical needs, hence nursing care not just a care home. It's arranged, except getting them there.

@parietal @skibiditoilet Wheelchair + drive them isn't possible unfortunately as I can't drive. I can't say we're going to the garden centre, Tesco etc as I've got no car to drive them and nobody else who can help. GP useless.

I spoke to SW yesterday after a team meeting including the family member who cares for them and is ill. SW have been helpful otherwise but basically told me to "just" phone a taxi. Parent refuses to get a taxi anywhere and is generally very stubborn, bad-tempered and always gets their own way as their outbursts are such hard work - they are likely autistic. Significant meltdown now likely. They have for years said they would rather die than move to an "old folks' home".

I will try phoning the home and see if they can help, I think this must happen sometimes.

Would something like this help? They handle people with MH crises

https://emapatienttransport.co.uk

@SeaToSki that's an idea, thank you, I hadn't thought of that. I'll see if there's something similar near parent.

@SeaToSki Just saw that it operates in MIL’s area. If only we’d known of that one. MIL was a prisoner in her own upstairs with fluctuating capacity for 18 months. Would not venture downstairs as she was too scared- even with a stairlift. Then lost all her muscle tone.

The only answer is wait till the wheels fall off ( and allow them to do so 😢) so eg they fall , are found wandering by police , cause a public disturbance or just get too ill to refuse. It’s very hard.

it is possible to take someone for medical attention by force in an emergency but usually involves waiting till patient weak . Police will intervene if danger to self / others in public place.

good luck. Been there. It’s awful.

This.

I contacted them when my father was declining and was at the stage where he was not safe to be left unattended even for 3 minutes. I was worried what would happen to him if anything happened to my mother. The very nice social worker I spoke to explained that they had a 24 hour emergency line which I could call and they would take over and keep him safe.

We talk about "sectioning" in terms of people who have serious mental illness but it can also be used to keep people with dementia safe, and take them somewhere they don't particularly want to go.

I never knew this existed. We have a motability wheelchair van but don’t use it enough for their liking. We couldn’t think of a suitable way to get to hospital appointments etc but this service seems perfect.

Sorry to derail the initial post.

@user12743052 I’m sure it’s probably not allowed, but what about asking the GP for medication? Maybe a sedative would help?

@Helenloveslee4eva the wheels have fallen off hence it being an emergency admission. They can't wander and get picked up by the police as they are not mobile; they are at home and at risk of a medical episode which can result in death within a few hours. Their carer is on their knees and seriously unwell.

I have already contacted the crisis team who have helpfully suggested getting a fecking taxi. I also live 180 miles away and cannot just take 2 weeks off work for a fortnight of protracted negotiations, incessant crying and attempts at persuading the stubborn old bugger.

GP is useless. Sedation is unethical apparently.

A&E in ambulance. Nursing home team collected them from Hospital and took them directly to nursing home

This was had to happen in my case. Social Services said we had to back off helping until they failed on their own. It was horrible, but it took less than a week for her to fall and get admitted to hospital. It is hideous that that was the only way we could get her support and she broke her elbow in the process. I had a LPA but was still unable to do anything.

Ok I've been here. Literally, with a parent with dementia and undiagnosed autism. Feel free to pm

You will need to explain the ways in which the person is a danger to themselves and to others, and that you can't provide the care they need to support them and keep them safe. They will need to be sectioned under a Section 2 of the Mental Health Act (up to 28 days for assessment). If it is found that they need further treatment they can apply for a Section 3 hold which also means that Section 117 aftercare kicks in.

@GivePeopleGrapes thank you I think this may be the route we have to go down. Their SW is inexperienced and I might need to escalate it to discuss a possible solution like this.

I think they will be OK once in care but it's the fear of the unknown, naturally enough.

@user12743052 yes, the first time we approached social services, we were patted on the head and gently dismissed. They suggested my 80 yo relative could apply for carers allowance to continue looking after their sick partner when they were sobbing saying they couldn't cope. Rather quickly, this escalated when I gave written and photographic evidence of things like the condition of their house and the actions that were physically dangerous to themselves and to others. My parent wouldn't engage with social services and in the end they were sectioned. They were in hospital for nearly a year while a suitable placement was found. During that time, their assessments showed that although they had a good facade, they had no skills behind it, and their lack of insight into their condition made it hard to support them.

Good luck x

@user12743052 as others have said you need to keep throwing it back at your SW - the mental health act isn't always able to be used, sometimes the court of protection route for a deprivation of liberty order needs to be gone down. Are there no other options like 24hr care at home? i have rather horrible memories of taking a parent on a 4hr car journey in the midst of a psychotic episode because the nhs wouldn't transfer them back to their home city! i know you don't want to take "2 wks off work" to persuade them but sometimes things are most definitely easier when you are in the same city, we had a horrendous time trying to be in 2 places at once. Professionally i would say the only other thing to do if all else fails is to disavow all responsibility for your parent , in my NHS time i did literally see family members rock up with someone in a wheelchair & a suitcase and leave them at the door!

@user12743052 I really empathise. My dad did not have autism but dementia changed him hugely into this anxious, paranoid person. He couldn't cope with ANY deviation from the normal routine of just him and my mum, even my sibling or I visiting for lunch was an enormous issue, someone coming to service the boiler or similar meant he was unsettled and worried for days about strange people in the house.

I also understand - as many others will too - that social services are so stretched and can't just deal with it, so they expect family to pick up the pieces. You just need to stand very firm in face of the guilt tripping about what other families do, or couldn't you just... or that it's just for a short period.

Good luck - do you have siblings who can support you in this?

@tippitytop 24h care isn't possible as the complex needs require a nurse. Too much even for community nurses + live-in (I spent a while trying to get this sorted and got nowhere).

Taking more time off is really impossible, colleagues are on annual leave, my job can't be left without cover and I've already stretched colleague goodwill recently. Basically I'm in the middle of a lot of people saying "can't help, sorry". It would be OK after the summer holidays but not now.