Care Home/Live-in carer refusal

[FishermansFool]

Hoping that someone can help with the legalities or procedures that lie ahead in this situation.

We are in stalemate as mother is currently bed-blocking and medically fit for discharge but refusing to have a live-in carer or go into a care home. She would be self-funding.

The hospital will not release /discharge her unless it is to either of these scenarios though.
I have no POA, she has no diagnosed condition under the mental health act only cognitive decline in the hospital notes.

The hospital say they will act through the Court of Protection but does anyone know how long this would take? Would she stay on the ward whilst this is going through?

I have read that she can't be compelled to go into a home (and pay for it) against her will if she has mental capacity? But this is debatable and she has not been diagnosed.
Just to add that there is a spouse at home but unable to care for her fully.

I don't know how to go forward. Pressure from the hospital results in even more stubborn adamant behaviour.

(I don't live in the same country)

Bump. Don’t know, sorry. Expect somebody else does though.

All I know is that cases brought before the Court of Protection cost a fortune. FIL was threatened with Court of Protection and he only relented when told how much it would cost him to defend his position. It was something like £25-30k. Tell your Mum this - may well focus her mind.

If she's assessed to have mental capacity, she can be made to do nothing. If the hospital has decided she can't go home, she likewise could go to court to discharge herself. In fact if she was physically able, she could literally just walk out, and no one could physically stop her. She can decline any and all assistance - if she is deemed capable - there is a very low bar here.

But I'm guessing she can't just get up and walk out.

Honestly - I would leave the hospital to negotiate with her. They and social services have more experience than you at this.

Who has mentioned the Court of Protection? Tbh that sounds like potentially a garbled understanding of the law on someone's part, or they're not telling you everything.

So there is a dispute about the best way forward- your mum wants to go home without 24 hour care, the hospital says she must have it (what do you think?)

Next step is to identify whether she could potentially have lost mental capacity - mostly people have mental capacity to make their own decisions so the hospital should assume she does. That sounds like why they have mentioned the cognitive decline they are talking about. But the reason many acute services won't diagnose dementia is that temporary cognitive impairment is very common in hospital. And that's relevant here when thinking about potential eecovery from needing care. I would want to know more about this cognitive impairment, what they think has caused it and whether a medical psychiatrist has seen her? (We may be lucky in our local trust in having a med psych service on the wards).

Then a mental capacity assessment should be done. And I'd want to know who did it, how it was approached and what it found.

At that point if she is found at this time to lack mental capacity for the decision on discharge destination, the consultant can make a decision in her best interests, which should include discussing with family, sicial worker, occupational therapists what the best options are. And I guess it might be it would become clear at that point that application to the Court of Protection for longer term management of her affairs might be a good idea. But tbh it wouldn't usually be the hospital's focus.

Who is caring for the spouse at home right now?

Is there an argument for them going into a nursing home together?

Do you have siblings in the country? What do they think? Do you agree?

You could join meetings by video call?

I think in your case I would prioritise speaking to the occupational therapist (try around 7.50 am) and then the consultant.

I have been involved in court of protection when someone refused ti be discharged from hospital as they cannot force someone who they have determined to lack capacity to make the decision to go into care without permission from a judge so it does happen obviously the last resort. There does not need to be a diagnosis of a mental impairment just reasonable belief. If the decision cannot wait and usually in a hospital setting it can't as they need the bed. To approach court there needs to be a outcome determining the person lacks mental capacity from an assessment. If they have a DoLS in place which doesn't sound like they do they get entitlement to legal aid so no costs to them. If they don't it is a section 16 application which the court can determine their capacity and make a best interest decision where they are discharged to but would be costs for mum. If it turns into long term proceedings they can get the local authority to complete a DoLS and it would convert to a Section 21a challenge where mum would get legal aid. If she is found to have capacity by the hospital they can start their eviction process. Hope this helps.

When my father broke his hip, he was discharged into an NHS funded nursing home. There was no question of him agreeing or disagreeing, it was the next step in his medical recovery. Can you get the hospital to phrase it that this is the next step in the recovery process? She needs to go to the "nursing" home because she isn't quite back to full health yet? But of course she will go home when she is well enough.

Is there a hospital social worker who can help put it like this?

If not, can you just keep saying "you need to go to the nursing home so you can get back to your own home as soon possible".

But perhaps @DPotter is right. It's the hospital's problem, not yours or your mum's. You can say you support them but realistically, if there aren't family locally, they will have to decide how to proceed.

It's funny how that generation are often much happier to stay in a long term hospital bed than to countenance long term care. It must feel less stigmatising/less like the beginning of the end for them. But very hard for those trying to support them.

My experience is that if the person is assessed as having mental capacity then they will start formal ‘eviction’ proceedings eventually. If deemed not to have capacity then yes COP.

@FishermansFool if you don’t even live in the same country then I would just let the hospital deal with it…they are quite used to dealing with difficult situations. I’ve attached a document that may explain potential steps the nhs trust will take but I would try and get an email for the hospital SW and ask them to explain to you the process for your relative executive.nhs.wales/functions/six-goals-uec/goal-6/goal-6-resources/the-management-of-reluctant-discharge-transfer-of-care-to-a-more-appropriate-care-setting-guidance-pdf/#:~:text=If%20following%20the%20letter%20the,around%20the%20refusal%20of%20discharge.

@FishermansFool just be aware that if she is assessed to have the capacity to make the decision to go home, then that is what she is allowed to do, even if that comes with risks.

p.S. that may be a fairly old document but it’s just to give you an idea, the nhs trust involved will have their own policy .

Thankyou to all for the detailed information that has given.

The COP was mentioned by the ANP who joined in a best interests meeting that I wasn't able to attend (my sister had flown over to UK at this point). We didn't know if it was a realistic possibility or that they were trying to worry us into immediate action.

Unfortunately my mother wouldn't fall for the "just until you get better approach" as she had a 6 week reenablement stint in a care home last year and hated it.

It is indeed strange that being in hospital and having people to speak to and healthcare staff attending to her is usually thoroughly enjoyed 🙄but to have this set up permanently is an absolute no.
There is no formal diagnosis by the memory clinic of dementia and they are the only professionals able to do this in our area.It is glaringly obviously to all that she is at least stage 6 though.

The cost of the COP is shocking to me and I hope it would have some impact but it possibly won't to her. I'm 100% certain that she would be judged to lack capacity at some level so will explain this emphatically.
My sis and I are long resigned to having no inheritance so it's not something we're hanging on for either.

I'll ask if she already has a DOL and what the psych team have noted after her admission. We really don't want to go down the COP route after reading that is very likely that the decision will be made for her and she will have to go into care anyway.
We all agree except for my mum and dad.(He is at home with 3xday carers and managing fine).

I will read the link now.
Just booked a flight back to join in the chaos.

Probably should have mentioned that she has a very strong narcissistic personality!

Update - Mother was assessed as not having mental capacity and so her transition to a residential/nursing home would need a judgement, if I have understood correctly.

So after a few tours my sister has found some lovely local ones and so we are actually going to try a gentle "let's see how a few weeks here helps before you go home" approach. Maybe this time it will work before we need the COP to intervene.
The only problem I forsee, apart from the absolute refusal of any help, is how to get her there.

The last time she was moved to reablement care, the hospital discharged and transported her without letting us know. Would they be allowed to send her by ambulance transport if we have organised the home ourselves? I fear that car transportation by family wouldn't even work.

Not sure if anyone can answer the weirdly specific questions.

Would they be allowed to send her by ambulance transport if we have organised the home ourselves?

I can't see why the destination matters - in any event they're discharging her to a safe destination and they only know they've done it if they hand her over themselves.

I would expect the hospital to transport... you're both coming from abroad so may not have a car anyway.

When my ex grandmother in law (I sorted it despite being ex) was discharged to a nursing facility the hospital arranged transportation by non emergency ambulance. The date was agreed but the time was sorted between the hospital, home and ambulance transfer service

Thankyou for your help.
Transport was thankfully arranged by the hospital using the Red Cross service but my mother refused to get out of the car. I'm glad that the staff at the home had the experience and knowledge of how to deal with the situation.

Needless to say, she doesn't like the care home but the staff there seem very good and skilled with dementia and violence.