Refusing a Care Assessment - any advice?

[BlueLegume]

Hi lovely people. I will try and keep this brief. Mother has been referred to Adult Social Care. She is self neglecting - not showering, not dressing, not eating food provided, not taking medication. Adult Social services contacted her earlier this month but she has refused to let them do a care assessment and refused them permission to contact her GP surgery. The ASW was excellent in terms of saying she will do an unannounced visit BUT what then happens if mother refuses access to them. Any experience or advice on this stage of things would be appreciated.

@Louisetopaz21 thanks. I have not quoted the legislation so that might be the next move. The issue we have is that the self neglect doesn’t extend to things like cleaning her teeth for example. She is fastidious about this and flossing, same for skincare regime on her face. It’s unpopular with our brother but the not showering seems to be an act of defiance or control meaning we pay her attention- to which she seems addicted. Thanks though I might try the serious approach again.

www.scie.org.uk/self-neglect/at-a-glance/ self neglect is wider than that and includes hoarding behaviours. I would raise a safeguarding concern and there is a duty to assess even if she refuses. www.legislation.gov.uk/ukpga/2014/23/section/11/notes explains section 11. I would suspect some capacity issues are going on which needs assessing formally. Social workers sometimes don't fully understand the legislation and the duty it imposes on them. Good luck with this x

got our brother on board who said she just needed more support from us.

And did your DB then step up and provide the help required?

I guess we just wait for the crisis.

One of the most difficult aspects of care of elderly relatives is exactly this, seeing the car crash coming and no way to avoid it.

Ask your brother to itemise what the 'doing more' is in practical terms then say that is why you have requested a care assessment so the 'more' can be done. Explain why you cannot do all of the 'more' and that your mother is actively blocking the 'more' from being done. Say the priority is to get the care assessment done and then you can all work out a rota to share the rest of the work. It's extremely difficult though when the elderly person refuses all help and if your brother is colluding with her, you have to get him to understand you are not able to do this alone.

Thanks all…’sharing the load’ and doing more seems to mean…..you don’t work, take mum for coffee/have her for meals/take her to social groups. All of which we have tried for decades. All of which she has criticised. She hates ‘boring/ordinary’ people and always has. We, I say we, my sis, her partner and kids, me and my husband have all tried to make our (baby) brother understand just how difficult our mother, parents - excluding Dad now as he has no voice - were/are. He seems to have only seen it recently. We have tried to explain we have had 60 years of our mother being difficult. He is either very blind to it or irritated and wants us to fix it. However apparently us being people who want solutions is the problem. Please make that make sense!

Maybe a sexist here - and I might be reading it completely wrong - but DB seems to be under the impression that care giving/organising falls into the ‘women’s work’ category and is therefore the responsibility of daughters more than sons. It reads as though, by raising concerns and talking the talk, he feels he’s made his contribution, so it’s over to you now to do the practical work.

Without prying into any financial situation, do you think he’s also concerned that employing an outside care agency would be potentially expensive and long term eat into any inheritance? So if you and your sister could take over that side of things, there would be little cost and ease the burden.

Finally, is your mother one that generation that values a male opinion over that of a female? Mine certainly was and tended to listen to advice from my DH more than me. Much as it irritated me, I used to get DH to suggest things to her, even if they were my ideas, as she had this old fashioned concept of deferring to a man. I think she was perversely over flattered by male attention too. I don’t know what your DH’s or BIL relationship is like with her, but could one of them ‘persuade’ her to consider home help/care?

Often the unspoken expectation is that daughters will quietly and discreetly step in to do all the background work, caring and facilitating of the elderly person's life - but in a way that makes it look like the elderly person is independent and 'doesn't need carers like an old person' . Very hard mindset to deal with !

This is so common these days. Won't do this, refuses to do that. While the relatives and friends run round doing everything and getting more and more stressed. And other family members who don't help much putting in their two pennyworth. I agree with stepping away. Logic and persuasion and pleading and dressing it up. None of it works.

Absolutely this.
I always send dh in first with our elderly friend.
She laps it up

Sadly yes.
We had to say carers or a home - and step back.
Carers it was then.

Definitely this! I went through this with my dad before Xmas, 2 hospital stays, we organised help for him when he came home, everything put in place, and he refused simple things like a microwave and toaster for carers to make him quick meals ( "I don't want that! I want to make things the old fashioned way!") To turning carers away, and making abusive phone calls to me telling me I should be doing his care and he shouldn't have to pay for a cleaner ( he can afford it! He just doesn't want to pay). He's put me down my whole life; sneering remarks, indifference, despite me & DH being the only ones to help him. So I'm done with him, I had to step back for my own health. He's got a Keysafe so next time he needs an ambulance they can get in without my involvement. I haven't heard from him for 2 months and it's been so peaceful. My younger sister is in contact with him, but she struggles with his attitude as well. Don't let your mum dictate your life; I'm 60 this year and my dad is 92 and still going strong, I wish I'd stepped back sooner.

The emotional impact of this situation is enormous for you, your siblings and mother.
I would advise that you work on practical ways to support your mums practical needs and try to emotionally ‘ back off’ from some of the other issues that are causing you distress.
My two sisters and I (one uninvolved brother) have a sort of ‘rota’ for being on call. Sometimes in person, and other times phone calls twice in the day. We have a WhatsApp group chat for info etc on mum.
We do as much as possible on our days and try to have time for our own lives on others. She is much more co operative than your mum but at times we’ve had to just tell her that things are like this today because A and B sisters are busy and I am here to help.
You will know what she likes to eat, so make an online grocery order and have it delivered when you are there. Take a photo of the list for your siblings for your WhatsApp group. They won’t double up on food for her if they know what’s in. Show her everything, put it away and rest easy that her fridge is full. You will have done your best.
If you know that she has plenty of clothes, try not to take it on when she rings to complain about them. She has plenty of clothes.
Each time you are there, take a bagful of underwear, clothes worn next to the skin etc home to wash, dry and take back the next time. She doesn’t need to know you are doing this but you will know that she has clean clothes to wear. You will have done your best.
Ask around about neighbours/ friends cleaners. Would it be possible for you to book them to come when you are there, to do a job ( cleaning inside windows or similar?)
If she accepts them, she may come to even like them - there are some lovely hard working and chatty cleaners out there. With careful introduction, you may be able to book them weekly after that.

Your situation sounds utterly exhausting - you can only do your best.
Can you get together with your siblings very soon to work on. ‘Timetable’ for the next two weeks as a trial?
Sending you heartfelt support.

Your DM likes to be in control and have you all running round after her but you and your DSis can do no right so for your own sanity just step back and drop the rope. If she tells you to jump, don't! If she's run out of x, y - "well I know you have food in so I'll see you at the weekend (or whever) and sort it out then".

Book a nice holiday and go have a great time! You could have another 10 years or more of pandering to her behaviour until she has some sort of medical crisis - is this how you wish to spend your retirement? If she calls you by mistake, don't call her back straightaway - be busy with your own life. Take back control. When she bitches about you or your DSis behind your back tell whomever that the lies and confabulation are due to her undiagnosed dementia.
If your DB has all these ideas for her care, let him organise it. He sounds very similar (superior) like your DM. Let the Golden Child get on with it!

Thanks again you lovely people. As ever brilliant suggestions we have honestly tried to implement to help our mother. Sadly @Fushia123 she refuses to have a food delivery to the point she turned them away when I had zero option to drop stuff due to an operation last summer. Literally turned the delivery away. I did a few food shops myself and sent photos of them to my brother and sister - as you said to ensure we didn’t double up - sis really great gave a thumbs up - brother passive aggressive text ‘stop sending me lists Blue we are all doing our bit’. Sadly neighbours have all been alienated as well.

She had a cleaner - lovely lady but she alienated her and even though I offered her double rate to return she declined - understandably.

@Dragonfly97 yeah I sympathise with the lifetime of contempt towards me - yet it was all I knew so I thought for a long time that I was the problem. Good for you. I am definitely at the junction where I think there is no option but to step completely away. It is a horrible feeling but I have nothing left in me emotionally or mentally to deal with her.

@Boredwiththeoldusername CONTROL. You are spot on. Thank you everyone for taking time to read the thread and also to put really sensible ideas into your responses, without judgement. It is like speaking to a therapist!.

Blue, I’ve just read this thread in one go and one thing that stands out to me is that actually you and your sister are dealing with two unreasonable people - your mum and your brother. Based on this thread alone I would be sorely tempted to leave them both to it and you and your sister live your lives as you would wish.

@funnelfan absolutely spot on. We are utterly exhausted and as @sockfluffinthebath mentioned on another thread ‘resigned sadness’ has seeped into our psyche. It goes so against my nature to ‘quit’ trying but I genuinely have nothing left that I can add to the situation. I won’t speak for sis but I have spent the weekend facing the stark reality that I cannot see any light at the end of the tunnel. I am very tempted to do as you say but it really hurts knowing how we get badmouthed by our brother, criticising everything. I feel so grateful to this forum for the kindness shown. It could so easily have backfired with people telling me to ‘care’ more like my brother does.

I second this.
Blue and her sister have been amazing - with very little reward and a heck of a lot of abuse.
I'd have told the Golden child brother to do one at long time ago.
He doesn't help - he has no say to what happens then.

100%. Excellent advice. Your brother sounds like he’s either very much of the same mould as your mother - or he’s her flying monkey*

I also get the guilt and the sense of obligation, but you and your sister are sharing the burden between you both, when it should be split 3 ways.

*Worth reading this too:

https://www.psychologytoday.com/gb/blog/women-autism-spectrum-disorder/202010/are-you-narcissist-s-flying-monkey?amp

“Flying monkeys get caught up in a narcissist’s plan — often to damage the life of another person. The narcissist may use their flying monkeys as piggy in the middle, carrying information from party to party. The flying monkey may use gaslighting tactics, open aggression, and guilt-tripping in order to make another person feel bad and weak, whilst shoring up the narcissist. And they’re often involved in pleading the case of the narcissist. Narcissists love having at least one flying monkey, as it makes them feel important and means they can appear to be above the people below them (on both sides) who are caught up in the messy parts of the drama.“

I know this wasnt aimed at me but thank you Its a big help as i am going through something similar to the OP

@JohnPrescottsPyjamas thanks for the link to the article-so interesting and so true. Really related to this. @JenniferBooth feel free to join us - so many similar stories and shared experiences. Do feel free to share on this thread we are all here to support each other. If we can hear your story and help we will.

No problem I am a social worker so I am use to working with people who self neglect. It is so hard for families who do their best x

@Louisetopaz21 so much respect for your profession. I genuinely thought they would tell me to step up and be a better daughter. They were so completely the opposite making sure I looked after myself-in fairness I completely broke down on the call - full on sobbing - and I am not that person. I am going to re read the advice you gave regarding the legal side of things. I guess the issue is if my mother won’t let ANYONE other than us over the doorstep what do we do?

@BlueLegume

Its this one
https://www.mumsnet.com/talk/elderly_parents/5261085-dm-refusing-any-kind-of-professional-help?reply=141866876

Thankyou for what you do

If she has capacity she can refuse all care and face the consequences.