Health&welfareLPA anyone implemented with regard to eg carers when donor not willing?

[whatwouldyoudoifisangoutofkey]

Or any other scenario where an action is resisted but clearly needed by donor?
eg dementia ,insulin dependent diabetic living alone and refusing access to nurse ?
or
unable to prepare even a sandwich unwilling to eat but refusing delivery of food or preparation of snacks to be left
I understand the concept of an LPA but struggle with imagining how,in practice ,one might be used .
These aren't current or real life situations but I just wondered if anyone had any experience .
I appreciate capability needs to be assessed and also that it is decision dependent.

@whatwouldyoudoifisangoutofkey great thread/post. Will watch with interest. My parents made a song and dance about us organising LPA s several years ago. Mother is not unwell but the final part of your post really resonates. Can’t or won’t prepare food. Throws food away we supply. Won’t have a cleaner but will let us clean. Frankly I think the LPA is pointless for us. Interested in responses.

I'm in the pointless camp as well.
Do they perhaps have a role in medical settings ?

If you have a health and welfare lpa for a relative it means that heath care professionals will discuss their medical issues with you without having that relative with you/giving permission every time. It has proved helpful when a relative was in early stages dementia.

Health and care power of attorney only comes into play when capacity has been lost.

If someone has capacity it cannot be over-ridden, even if there is a LPA.

Each decision is separate - some people will be able to make some decisions but not others due to fluctuating capacity.

So capacity has to be constantly assessed for each situation - it is necessary to assess if the person understands what the decision is, what the options are and the consequences of them and whether they can retain this information. If it shown they can do this they can make the decision.

This includes them making what other people deem bad decisions.

If there is a concern about self-neglect that is leading to actual harm, this should be seen as a safeguarding issue and adult social care can be asked for advice, but again if capacity is shown there is not much they can do.

We did have to supply the LPA to the nursing facility when our father was admitted but not sure what the reason is other than if Dad needs decisions made those of us named all have to be consulted. This is helpful hopefully as our mother makes unsuitable decisions generally- which is why they ended up in the mess in the first place 🙄

@EducatingArti I'm not sure that is true in all settings and situations.

It would be true if the HCP has made the decision that the person has fully lost capacity but otherwise they should be involved in all decisions and discussions about themselves

Was just about to post but this is very much what I was going to say. It is very hard to be at the stage where someone's capacity is diminishing as they will still have capacity for some things but potentially not others. My DM who is in the early stages of dementia also seems to vary from day to day as well. Keep talking with them and include them in any discussions as far as you can.

It’s an awful situation when the person is deemed to have lost capacity but has lucid intervals where they’re angry or upset at decisions being made for them. Facing that with unwilling admission to nursing home for long term bed bound relative.

I'm not sure in your examples how "implementation" of the LPA would help though. You can arrange for a nurse/carer to attend but if the person concerned refuses to take the medication and is clear that they are refusing to do so/don't agree the need then how is that going to move things forward? Similarly you don't need LPA in place to send food to them but it's not going to force them to eat it. They would have to be deemed to not have capacity in those instances rather than just being stubborn/strong-willed and not wishing to engage with care, which unfortunately is all too common. H&W LPA helped us with FIL some years ago though as medical professionals would all speak to us and we could agree actions on his behalf. It did help though that he was compliant and later on unfortunately too unwell to disagree anyway.

This hasn't been our experience. Eg, GP happy to discuss situation with us once copy of LPA sent. This was a phone conversation that the person in question was not on. It was mainly about practical details about appointments but also means we can phone and book for eg flu jab on their behalf ( they would now get stressed about making the call but still understand what flu jab is and why they should have it etc)

Health and care power of attorney only comes into play when capacity has been lost.
If someone has capacity it cannot be over-ridden, even if there is a LPA.
Each decision is separate - some people will be able to make some decisions but not others due to fluctuating capacity.
So capacity has to be constantly assessed for each situation - it is necessary to assess if the person understands what the decision is, what the options are and the consequences of them and whether they can retain this information. If it shown they can do this they can make the decision.
I do know this but you've explained it so well !

But it seems so difficult ,both people I'm involved with (and they don't have the circumstances I gave as examples above ) would struggle with understanding consequences .They would be able to retain information during a discussion about a choice but they wouldn't retain it the next day or that evening .

I'm not sure in your examples how "implementation" of the LPA would help though. You can arrange for a nurse/carer to attend but if the person concerned refuses to take the medication and is clear that they are refusing to do so/don't agree the need then how is that going to move things forward?

Yes ,thats my point ,an LPA wouldn't help '

Interesting point about safeguarding - though self neglect and danger to self might be a fine distinction .
But if the GP ,SS etc involved because of concerns re neglect or self harm aren't there other mechanisms ( sectioning) that wouldn't involve an LPA anyway ?

Even with an LPA in place, it doesn't override a persons own agency.

It's crap, but as I understand it - it's still a person in their own driving seat UNTIL they're unable to make the decisions, which is very bloody far gone.

I have LPA for finance for DH - which has proved useful, health one hasn't been completed as it doesn't provide more for DH than the respect form does.

I just count myself incredibly lucky DH (end stage Brian tumour) is broadly sensible, but when he rejected some very badly needed antipsychotics the same issue applied, you can't make someone to do something they don't want.

Every intervention has had to have a very carefully laid plan of approach to maximise the chance of being accepted, from hospital beds, shower chairs, carers, medication change - it's all been laid out as a choice, but with me as a trusted adviser and advocate.

It’s a very interesting question and I don’t have an answer.

when we set up POA for my parents, my mum envisaged a situation where she might just want to hand a lot things over - mostly financial things like bill paying tbh. We didn’t really talk about how and when the health / medical could be used.

there are posters on here who talk about fulfilling the health / medical from a distance. I assume that once their parent has gone into care, they become they contact and the decision maker when any decisions are needed.

Currently we are where you are with FIL. We can see the things that he needs to do to. He’s currently refusing all offers of help from outside the family, refusing all the aids that might make life at home easier. He’s cancelled several medical rdv that he needs to have. He eats really badly, doesn’t drink enough water, has taken up smoking again. he doesn’t have dementia but he’s never been the most rational of people.

But we can’t force him, even if he’s making what look to us like really bad decisions. We can’t force feed him. We can’t force him to drink more water. We can’t make him take his medication. We can’t force him into a car and take him to a dr rdv of he doesn’t want to go. All we can do is persuade, and that takes time. And doesn’t always work.

At some point he will get ill to the point where he needs treatment, at some point he won’t have a choice. Until then, it’s his decision.

Yes, I've only done health and welfare one at a distance as the person had gone into a home before they lost capacity. I did have a conversation when it was taken out to make sure I was clear on their views about actively treating infections, vaccinations, CPR etc. So I can be confident I'm acting in their best interests.

It involves giving consent for anything medical so the annual flu/Covid jab, talking through treatment options with hospital staff should it be needed (can be done over phone or Zoom), six monthly care review with the home staff and SW (can be done over phone/Zoom).

The finance one is harder I've found as they can choose when to let you take it over, it's not about capacity. But in practice that can mean turning into their admin assistant as they still want umpteen bank accounts opening in person to chase interest rates and then keep track off. And arguments when they think you're going to take over writing the many Christmas cards they insist on sending and you have to point out that's not what the finance one covers and you barely have time to write any yourself!

. But in practice that can mean turning into their admin assistant as they still want umpteen bank accounts opening in person to chase interest rates and then keep track off. And arguments when they think you're going to take over writing the many Christmas cards they insist on sending and you have to point out that's not what the finance one covers and you barely have time to write any yourself!
Ooof,, that sounds hard @EmotionalBlackmail

Just a word on the reasons people say no to things, as it's been a proper eye opener with DH.

Lots of things which have been recommended by well intentioned professionals have failed, and that's ok - making it clear that nothing will be magic and give back your ability, if your lucky a tool working is just bargaining for a bit of time.

Tools like walking sticks and frames need to be learnt and practiced, and they hurt to use especially in the beginning, a caring arm is easier to use than a walking stick. The risk of failure can be enough to stop people trying in the first place. Persuaded DH to use one as I said he was pulling my back out leaning on me.

Refusing food and drink, oral thrush is really common and really bloody painful - and the medication is a fiddly medicine dropper four times a day. Taste changes quite a bit with it and everything tastes rubbish. DH refused it at first as didn't see it as a problem, until I said that eating is one of the few pleasures he had left and I showed pictures of his tongue.

Carers coming in for personal care - honestly, it's a complete ball ache, unpredictable times, and you need to be really specific about what's needed, otherwise it's a very brief wipe with a flannel which would make even the most soap dodging teen blush. I completely understand why people refuse them if they can possibly get away with it. I agree with DH that it's not great, but if I did a really good clean it would take three times as long on my own (and he'd be absolutely shattered) - so compromised on a twice weekly carer clean.

Falls have been much harder to discuss as DH believed he'd be able to get up with me lifting him, unfortunately, he ended up on the floor for over 5 hours waiting for an ambulance which never came - it needed to get to that point before he accepted his mobility had gone.

@Timeforabiscuit what a lovely kind caring person you are .
I can't imagine coping with a loved one with an end stage brain tumour .
It sounds as though you do it with love , insight and ingenuity.
I hear you about carers and know how difficult this can be .
Sometimes one gets an outstanding carer who, despite the low pay , status and pressure of time is a joy to see come through the door.
If I were a religious person I'd pray one comes your way .
But as I'm not I'm crossing my fingers .

Thank you , Good, amazing and incredible carers are definitely out there! They just aren't always on rota for our two days 😁.

@whatwouldyoudoifisangoutofkey you haven't mentioned whether this is a developing concern in your own life or someone else's, or purely theoretical? Are you trying to work out if a Health LPA is worth pursuing?

I'm actively involved with two people at the moment.
Both have cognitive issues /dementia/ memory loss , both have Health and Welfare LPAs .
Fortunately I am not the attorney in either case because there are very difficult situations with both that need addressing.
They are being addressed with persistence, ingenuity, etc but it's just got me researching LPAs and the misconceptions around them.
And reflecting on the H&W one and it's purpose ( if that's the right word ) and the point of it .

Yup - it's a very overhyped document in my opinion, as it only kicks in once someone has lost capacity, which is (rightly!) a fairly extreme and uncommon situation.

Your local council adult safeguarding team could provide a bit more advice about what processes they have i.e. multi agency safeguarding hub. Usually a person would need to come to the attention of multiple agencies (i.e. concerned neighbour reports, police, fire service, safeguarding, environment al health, ambulance) before being an appropriate referral in my area, but there might be an early intervention team in yours?

The more I mull it over the more pointless it seems to become.
Capacity is assessed in relation to the decision that the donor is being asked to make.
But supposing they were deemed not to have capacity but were opposed to agreeing to a particular course of action .... Then what ?

I never got H&W LPA, only financial. Not really sure if that was the right decision, but I sort of...don't want the responsibility 😣

@whatwouldyoudoifisangoutofkey

When we were encouraging DHs parents to organise POAs the main selling point was that it would give DH and SIL the power to choose what happened to them, rather than the council / social services making decisions about care etc. MILs own mum was basically put in a home against the family’s wishes, so she was very keen to not be in that situation.