Adult Social Services and GP intervention

[BlueLegume]

Hi lovely people. I have a couple of other threads and have contributed to several on the Elderly Parents section. I am going to be very cautious what I post so as not to reveal too much if that is ok.

My elderly mother has refused to have a care assessment by Adult Social Services. Her GP thinks she needs one but as Adult Social Services deem her to have full capacity then they cannot force her.

Things with her are absolutely dire. I have taken a step back again this week as when Adult Social Services contacted me they told me they had spoken to my brother who had reassured them he ‘has eyes on Mum’, and proceeded to tell them an absolute pack of lies as to what he is doing for her. I have no expectation of him at all but he has fabricated a story which makes it sound like everything is ok. It is not. I understand we cannot make her do anything she does not want but her situation is without revealing too much, completely unsustainable.

Any advice? What I can’t understand is why Adult Social Services have not corroborated what our brother has said with our mother. She was shocked when I showed her the email detailing what notes they hold on her taken from brother.

I feel like you have two not mutually exclusive options:

1/ you (and ?your mother) write back to Adult social services correcting the errors in your brother’s account

2/ you make clear to your brother that given he’s told them everything is hunky dorey, caring for your mother is now his problem

Oh and also…

3/ keep working on your Mum to have the assessment. I’m sure ASS will be used to some flip flopping.

Thanks @Daffidale
Option 1 - I immediately responded to ASS stating, having confirmed with my mother and with my sister present, that the list of things he has stated are not true. I have not had a response.
Option 2 - definitely where we are at now, but then we cave in.
Option 3 - sadly it is an absolute refusal. “I won’t let them in’ - they did a no notice visit a few weeks ago and she refused to even speak. Even if they did an assessment she has made it very clear she will not let anyone into the house.

As with many of my other threads we have such a difficult personality to deal with it is awful. The stress has really got to me this week. I am quite aghast that ASS know from both my mother, sister and I that what he has told them is fictitious albeit it sounds fabulous-yet they are prepared to take his word for it.

But if your mother has capacity then SS cannot really help if she continues to refuse. Do you disagree that she has capacity or do you want a better life for her? All you can do is step back think.

@Thistooshallpsss yes I agree she has capacity she sadly tends and always has done to over complicate things, bury her head in the sand about problems so they escalate and then kicks off at the outcome she has essentially created. She is incredibly grandiose and sees doing things normally as beneath her.

She is so difficult. Yes, I do want her to have a better life - and this may be selfish, I also want to not feel permanently anxious and stressed. Every time we ‘solve’ something she moves the goal posts to make something else a problem. Simple day to day things most of us have to accept we need help with she refuses. She refuses to have food delivered, refuses everything except from us. We are not medical professionals and we have been broken by her for too long.

It’s not selfish at all to want to not be stressed and anxious all the time.

Is the idea that putting your own wants and needs above hers “selfish” the kind of thing your mother would say (or imply?)

Ultimately if she has capacity and prefers to live like this, then for your own wellbeing and sanity at some point you have to let her (it’s different when someone doesn’t really have the capacity to understand the risks and tradeoffs they are making)

What’s incredibly difficult is when the solution they come up with is that you have to do it , and implying you are selfish or a “bad daughter” for not doing everything and anything to help her. But at some point you have to steel yourself to put in place some boundaries that protect your own health

Oh, Blue. The ‘easy’ answer is to tell her it’s her choice to refuse intervention, so it’s your choice to refuse to run to the dog whistle. Then to block DM and DB on all forms of contact and let them crack on.

I know it’s not that simple. I just don’t know. FIL didn’t accept an assessment until DH totally lost his mind at him and refused to physically damage himself for FIL’s benefit anymore.

Commonly accepted wisdom is they persist until not saved from a crisis, but it’s up to you to know what you can watch/ignore. I feel for you, it’s utterly awful to be in this spot.

I am sorry she is so difficult and you aren’t in any way being selfish. Saying no in these situations is very hard but you don’t really have a choice you need to protect your own health and wellbeing.

You DB sounds manipulative. Is money involved?

@Thistooshallpsss absolutely-the stress has really hit me this week. I feel listless and anxious all at the same time.

@fridaynight1 brother is a tricky personality. Top surface of very charming but quite divisive and nasty when it suits. He never listens just talks over you. As for the money question- I hadn’t really thought about that. He is known for being very mean with money in terms of gifts etc - lots of clearly re gifted items. What do you mean by the question? I might have missed the point. Yes he is manipulative-he tells me that ‘everybody can’t believe how Blue has behaved’. Yet I am supported wholeheartedly by people in the family who can see what I/we have done. Not sure his comment is anything other than a guilt trip. No one has come forward and told me I am not doing enough-except for his wife.

I suspect the question about money was along the lines of "does your brother not want money spent on your mother's care because he wants it for himself".

As said previously, ASS are not going to intervene if your mother has capacity and refuses help. It makes no difference what your brother or you tell ASS. They cannot intervene, because a person with capacity has the right to make bad choices.

Your only option is to step back. Do not do anything to facilitate the current situation, let your brother deal with it, or fail to deal with it. You are not obliged to do anything.

Unfortunately I think you will have to let things get worse, hard as that may be.
SS will be more than happy to back off given the opportunity and the fact that your brother has said its all OK means that they are covered.

Even if your brother hadn't lied there's nothing Adult Social Care can do if your Mum refuses help and has capacity to do so. She's an adult and is allowed to put herself at risk if she wishes unfortunately. She is not your responsibility and anything that subsequently happens is not your fault.

Simple day to day things most of us have to accept we need help with she refuses. She refuses to have food delivered, refuses everything except from us.

So, your mum does accept support but only from you and your sister?

In ASC eyes, your mum is not neglected as she is having support from her adult children.

Just to add, if someone self neglecting then even if they have capacity, ASC cannot discharge their service so your mother must not be self neglecting? More information would be useful regarding your mum care needs.

@Oldermum84 thanks - it is helpful when someone puts it in simple language like that. Helps me reinstall some boundaries and realise I have to leave her to it.

@safetyfreak she ‘accepts’ us 3 doing things for her BUT nothing is ever right. She will not accepts anything external that would actually help us. For example she will accept food from our brother as he will buy exactly what she asks. She is very specific about what brands she will eat. If he is away and we have to cover the grocery delivery she will purposely throw it away if it from me. I cannot always get exactly the brands she is prepared to accept.

My cleaning does not meet her standards.

More specific information about the ‘self neglect’ would be very outing. Sorry if that is unhelpful.

@BlueLegume I have been through all this with an elderly relative. The hard truth is that there is no easy way through this where you come out feeling you did a good job and everyone acknowledges this. Various people will intervene and either cause problems or accuse you of not doing enough or doing things wrong. You have to accept that to protect your own life and sanity that there are no good options, only bad ones most of the time. While your mother has capacity, social services will not intervene. Even if she loses capacity, while they think she won't die somehow because you are providing her with care (however much it is breaking you and however less than ideal the care is) they will not intervene. You have to step back and risk the wrath of your mother and judgment of other people to protect your own life. Just stop doing the things she insists on. If she chucks your shopping away just don't do it anymore until she gets the message. Only do what you can manage and ignore the criticism, grow a thicker skin. If your mother makes bad choices, they are her choices to make. Chances are she will be fine. My relative lived for seven years with dementia, they were completely non-co-operative and refused all care from outsiders. Eventually they were wandering at night, not eating properly and walking around with their bank PIN written on their handbag. Social services only intervened after a number of neighbours reported this - they took no notice of me. Miraculously, my relative never actually came to any harm, despite all this.

@BlueLegume It's simple to say, and I grant you harder to do when it's your own family, but the obvious answer is leave your DM and your DB to fail.
Let them do it their way. It is not your job to fix them or change things.
I mean this gently, but look back on the timeline of your threads and entries on Mumsnet and see how many months you have been posting about them. Look at the absolute hours you have devoted trying to help and how they have put objection after objection in your way.
You deserve your own life back.

Well, your mother being demanding and expecting certain food brands would not constitute her needing ASC support. Your mother has the right to be particular and demanding. She accepts food from your brother, so she is being fed.

The mental capacity act determines people have the right to make unwise decisions. I think this is a case of you taking a step back for your mental health.

ASC will step up when/if it all goes to shit.

I work in elderly social work. Social services don't assess capacity, this can only be done by GP/doctor. If a person has been assessed by a medical professional as having capacity and the person refuses to have a care package or assessment, then by law we can't force care onto someone. It makes very little difference whether a GP thinks they need a social work assessment or not. Social services aren't dictated to by GPs in the same we social work doesn't dictate to a GP.

That said it's incredibly hard on families who feel they have to plug the gap if a family member refuses care. You by no means are obligated to do this and it's important you look after your own health and wellbeing too and if this means stepping back so be it. As someone said it isn't your job to fix this

@Everleybear interesting information regarding the GP being the only person able to assess capacity. ASC repeat that our mother ‘has full capacity’ yet she has not seen a GP for well over 12 months. And she refuses to see a GP. The anti depressants are just delivered month on month and she has not had any follow up to check if the dose is correct or indeed if they have made any difference . She has now been on them for 18 months.

It is unbelievably difficult. Everyone judges us as though we are not doing enough. I am weary of people ‘suggesting’ trying x,y,z. SIL seems to think ‘taking her out for a coffee’ might help. I have never ever been out for a coffee with my mother. She thinks that is a waste of money and time. Thanks for the info - it is interesting that ASC are very clear they see her as having capacity-how do they decide this?

It will go on the information they have. If they don't have any documentation stating she doesn't have capacity then that's why they will be saying she has full capacity. Social services wouldn't be able to tell if someone has capacity or not if there is no Incapacity certificate in place and until there is, they legally have to assume she does have capacity. Incapacity certificates can only be issues by a medical professional, so if you have doubts about your mums capacity I'd really get the ball rolling with your GP.

I must stress you must ensure you look after yourself too. It's incredibly hard when families refuse care packages however you can only do what you can and have to ensure your health and wellbeing is looked after too. I'm sorry you are going through such a difficult time.

@Everleybear thank you. I don’t live near my mother so we have different GPs. She refuses to allow me to have permission to speak to her GP. I have contacted them with very detailed concerns-rightly so they say they can’t discuss her with me. They referred me to ASC. The reality is external agencies will eventually have to deal with a crisis situation as opposed to us dealing with things now and preventing a crisis. Thanks for your response. It’s very hard to live in this situation.

It isn't true that only GPs can do Mental Capacity Assessments, as an ex social worker I was trained to do these and did many of them. A MCA is made on a specific aspect, at that time eg 'is Mrs X capable of keeping herself safe with regards to..'..ie not a blanket decision around capacity in general.

@BlueLegume I remember your other threads in the other section… I echo pp, it isn’t just GP’s who assess capacity. Ultimately, people are allowed to make poor / bad decisions for themselves…as much as it impacts on your life ,sometimes the only solution is to step back and let them get on with it until a crisis forces their hand. There is a point where you have to accept that an old dog can’t learn new tricks , a mum- daughter relationship that has never been good will not become good just because that person is now old and vulnerable.

This is false.

You are giving OP the wrong information. Social Workers do complete MCAs.

Also, if it is clear someone has capacity then a formal MCA does not need to be completed.

Thanks all for the information. Either way our mother refuses to engage with her GP and ASC so whoever could do an assessment cannot because she refuses. Yet expects us to deliver her food, do her washing etc etc etc. As PP have said we will have to step back, deal with the consequences and the crisis. She is a master of manipulation and always has been. My sister and I have taken a stance to not provide her with food unless she agrees to a supermarket delivery. It is too time consuming for us as we do not live near her. Our brother continues to take her food deliveries but she told me today that she ‘throws it away if it is a supermarket own brand’. As rude as she has ever been frankly.