Using LPA Health & Social Care

[womananddog]

I have LPA for DM. I want to be informed of her (many) medical appointments so I can arrange transport in good time. Do I notify her GP or do I have to notify each hospital department separately?

My experience is that every hospital department plus the gp needs to be informed separately as there is nothing joined up within the NHS system. It is very frustrating. Others may have had different experiences depending on the area they live in and which hospital is involved.

is she competent?

my understanding of H&w LPA is unless they are unable to make their own decisions then you can’t invoke it.

if she is competent your mum would need to speak to the GP herself and see what can be done about you having access to her appointments.

our experience with this was that letters are always sent. We just had to monitor mail.

i believe my sil simply had all the post redirected to her own address. But that’s not the best example as she also had bank statements redirected to hide them.

We give my mobile number for all their health appointments, and I can access their emails. I tend therefore to know about appts before they do.

I will try to arrange to redirect the post if she agrees (she has online banking so can see her bank statements!). She "files" letters in random places and I only visit once a week so can't monitor things in between.

She probably would be deemed to have capacity but she can't organise things and forgets what day it is so ends up with no transport arranged - she then either misses the appointment or spends ££££ on a cab (she is rural and miles from the hospital). Her short term memory is appalling.

The easiest thing is to put your own mobile number as a contact number instead of hers. You will need to do this anywhere she has appointments.

LPOA for Health only applies if the person has lost capacity. So if your DM has not lost capacity, the GP will want a letter signed by her to say they can discuss her issues with you.

If her short term memory is appalling, is she already referred to Memory Clinic for a diagnosis?

To lack capacity you need to have 'a disorder of brain or mind'. If the person has dementia but has never been to memory clinic for a diagnosis this can cause a lot of trouble as everyone can see something is wrong but there is no diagnosis.

She went to the memory clinic 2 or 3 years ago and was referred for a scan but as far as I am aware did not go. I have no idea if there was a diagnosis as it was/is a taboo subject and she gets very angry at any suggestion that she forgets things. However, she does acknowledge that she is not coping with life admin

It's obviously in her best interests for you to know about her appointments. I would certainly talk to her about redirecting her post. Our local Trust wants everyone to transfer to getting their hospital letters via email or maybe its the NHS app - could you get login details for her? Maybe contact the GP surgery about what communication options there might be.

The NHS app is a great idea - I will get login details for that, redirect the post and get her emails copied to my email account.. Her house was uninsured for about 6 months as she do not pay the renewal and, at that point, I had no idea she wasn't coping. It is now on automatic renewal but it is an example of the type of thing she is not doing

You need to get her to go with you to the surgery and sign a form to allow you to be her proxy. You shouldn't be accessing the app using her login details - there is a specific proxy arrangement. I have it for DD1 (SN). I log in on my own NHS App, then click 'linked users' and it takes me to DD1's NHS account.

@Lougle thank you that is helpful advice. I am finding this a nightmare and extremely stressful

You cannot do any of that unless she gives express permission for it.

As long as your DM gives consent, you can be third party authorised for any of her financial affairs. I've been third party authorised for DF & DM for their mortgage, Motability, water, gas and electricity, etc., for years. The business just adds me in as a third party agent and I clear security with my own security questions. Some companies still like DF to give permission to speak, but largely I can act on their behalf.

@Soontobe60 i will ask her permission - I think she will be relieved as she admits she feels overwhelmed.

Yes it all has to be with her permission. You can’t just step in and take over, even if you do think it’s best.

You can’t just redirect post or log in with her details. You need a third party authority.

technically using someone else’s log in etc is fraud by false representation, as you’re effectively pretending to be them.

if you help out with banking etc keep detailed records. Don’t use their cards or logins, get a third party authority or POA.

If you have POA you can go to the post office and change her address to yours. I would also tell utilities that you have POA and register your phone with them. When I did this I found out my step father was still paying car insurance even though he was not a car owner. Contact the various hospitals and give them a new phone number. The dementia clinic was leaving messages on his phone.

Your local NHS trust can put an alert on her records that says to copy all appointment letters to daughter. That will cover hospital appointments

@womananddog it is very typical of dementia that:
she didn't remember to go to the scan
she doesn't think she has a problem - because everyone else is just being weird and she doesn't understand why life admin is suddenly much more difficult, it must be everyone else's fault

If you are now organizing all her appointments it's time to go back to Memory Clinic. She doesn't have to accept or agree with the diagnosis, she just needs it made.

That sounds exactly like my mum. But be warned DBs mobile number is down on mum's records, he has access to her NHS app etc but we still missed a heart scan appointment because 3 times they phoned mum on her landline to make it and despite her alzheimers diagnosis they didn't confirm by text/letter etc. Even the letter say she was being removed from the list due to missing 3 appointments didn't get picked up (nothing on app) because it went to mum and she "filed it" in a pile of crap brochures.

It may well be too late to instill now, but for PIL 20 years ago and my DPs now, we have given them filing trays with the instruction that everything goes into them and we go through when we visit.

It must be everyone else's fault

@AnnaMagnani this is what I am finding so stressful - I am constantly being accused of doing/not doing things. She forgets passwords and then blames the computer or the website and is furious if you suggest she's forgotten. Writing that highlights the importance of doing everything properly and getting her written permission before making any changes

@womananddog 'It must be everyone else's fault' doesn't happen to everyone with dementia but it happens to a lot.

Essentially if you can't remember that your memory is bad, and something goes wrong, then it can't be your fault, it must be someone else. Their world must be really stressful and confusing, they get angrier and angry and it's like they are living in some giant conspiracy.

The best strategy is to agree with her and move on. Unfortunately I can see her forgetting that she gave you written permission and then accusing you of forging it/it being someone else/some other mad conspiracy.

I can't see how that could be possible.

@womananddog totally empathy- our mother made a huge song and dance about me organising her LPA s a few years back. Lots of fawning “I’ll just go with whatever you think is best”. Fast forward to now and the past couple of years. She utterly refuses to co operate. She will not agree to me taking her to the GP. She will not co operate with suggestions of carers/food deliveries/ cleaners/etc etc. Social services have suggested a care assessment. She refuses. Awful place to be.