Hi, This can be very hard for the family to manage.
And its best, if possible that all of the family agree to notify the Social Worker (SW) that they will no longer be providing any care as of X date and that the care plan needs to be updated to reflect this.
This puts the ownership of everything back on the SW.
What you are trying to establish is if the SW is willing to leave him in his current situation with little or no cleaning being carried out. And that the SW is will to document its "normal" for someone with capacity to live surrounded by their own waste and this is not neglect by their agency to allow this to happen.
(This is not to say that you as a family can not visit. Just that in theory you will leave the house and Grandfather (GF) exactly how he is when you entered the home. And as the SW claims its "normal" you can not be neglectful for leaving it to the SW who has put the best care package in place. )
As for accepting "no"
GF is of the age where Grandmum (GM) would have done most /all the housework so he may not actually accept that it is as his 'job' to clean up.
One or more children (if all agree) may need to do tough love (good cop/ bad cop & treat him like a three year old in a strop) by have a proper family fight with GF over his "choice" of not using pads. His children should know how far to push and yes if it can work bully him into submission by guilt. Soft and nice is not working If he has capacity (as the SW claims) then he can be subjected to a robust descussiin on why he is "choosing" to soil himself.
Pointing out that it is the carers job to dress him including the pads and that he would not like to have to clean up after someone who is choosing to not use the pads etc. He may open up a defence as to why he is not willing to use them.
Give the carers and SW notice of this so there is no "suprise" if GF is out of sorts after this happens.
As suggested GP should be contacted if the family want to get a medical assessment /opinion of his capacity to make choices. And the GP may be able to provide a different brand of meds if someone can attend the appointment and explain the hoped outcome of him using the pads and also hopefully feeling better overall.
I would also request a follow up with the nurse to have a report on how the carers can or can not manage long term if he is continuing to refuse to use any products.
You need a "wedge" to push back on to the SW so the care plan needs to be amended as the SW has confirmed that SW is aware that he is doubly incontinent and will be allowed to remain without protection and will continue to soil the floors and countertops.
I would start with getting very detailed on what is listed in the plan for the duties of the care staff.
As the house now has an obvious fall danger of wet floors and hygine risk for GF and visitors plus staff cant be in contact with waste materials and tracking it out to their next job.
Your question is how will that be managed on a day to day basis.
Taking it task by task, the first thing on the care plan has to be the obligation that the carer removes all waste matter from the floor and checks the kitchen, countertops /sink and bathroom sink etc.
Eg care plan is amended to:
First task of visit:
Clean floor by washing using mop and hygine product A stored in X place in home.
>Now the care staff are 100% moving him over wet floors how is this risk managed.
(He or they can fall.)
The Carer must details what was done in the end of visit notes so that each step is recorded.
If the carer is not provided with a document make up one which has a detail copy of the care plan for each visit during the day.
Second task:
Cleaning of waste from kitchen by
a) cleaning kitchen sinks and
b) wipe down of counters,
c) wipe down fridge,
d) wipe cabinets doors,
e) wipe door handles,
f) wipe light switches
e) wash dishes.
Washing liquid, cloth and other hygine product stored in Y place in home.
Same type of cleaning would be needed for each room he uses.
Note the counters and food storage is at high risk of cross contaminated if he makes any use of the kitchen in between visits.
How will the SW arrange for this be managed....
Again Carer details what was cleaned in the notes.
The SW needs to confirm that the provider is willing to provide this service and that additional time is provided to the care staff to ensure that they have time to carry out the tasks.
If this is not happening on each visit the good/ last carer of the day gets left with the blame and cleanup.
Over time the good ones who clean will get fed up with poor carers and/or the ones who just cant spend the extra time and leave.
Then as the urine will break down his skin the staff will have to strip him to wash him and change all his clothing on every visit plus apply a barrier cream and check his skin for damage etc etc
Ask his GP or the nurse on best pratice
As before this needs to be detailed into the care plan and time allocated for this.
Third task:
Wash body by showering or by basin and change all clothing.
Soap, towels and wash cloth stored X
Top, slax underware and socks stored X
Pads stored X
Shower chair provided and stored X
Again at the end of the visit the carer need to be recording this in details in the notes.
And where there is a refusal what additional steps were taken other than to just accept the no and leave him as is.
An important thing would be for the carers to record when they stay over the time as frequent overstays means additional time is needed.
Next how will the SW instruct how are the care staff to manage the soiled personal items and the bedding changed daily the morning and after he naps plus any furniture he has been using in between visits. Plus the cleaning materials.
What time will be provded to do the extra laundry and changing the bedding etc.
Then have every other task listed and allocated a reasonable time so that the care staff can provide the level of care needed for each visit.
And again the carer must document each individual task as done or not.
As the family are aware that he is not eating / drinking request that the carers be given time to see GF eating and drinking and that what he is eating be documented. Plus the counters and other surfaces may not be clean once the carer leaves so he should not be left to eat food once they have left, and water should if possible be in a sealed container
Task no __
prepare breakfast.
2 toasted slice of bread with butter and jam, 1 boiled egg, tea with milk 1 spoon of sugar
Task no__
Transfer to bed/chair
Task no __
Fill beaker with water and leave beside bed/chair
I suspect that the SW may be unwilling / unable to allocate the time needed to safely manage GF. However this is what needs to be documented so that failures can be documented.
But the hard part would be to get the care plan in place and then step back from it week by week and only record the results.