How to explain to MIL she’s in a care home

[Meandacat]

MIL is in her 80s. BIL lives a half hour drive from her home, DH and I live a hour away but DH doesn’t drive. After a series of events late last year, she was taken into hospital where she stayed for several months before being transferred on the recommendation of social work into care. She has no formal diagnosis… there is no dementia or Alzheimer’s. She does have a history of depression and I have long suspected bipolar but they haven’t diagnosed that either. But at home she refused help from carers but was unable to care for herself, was making silly mistakes (like switching the fridge off) and had started having delusions and paranoia which put her safety at risk.

Since being in the care home she has thrived. She still thinks she’s in a hospital situation and is therefore accepting of the care. She enjoys the activities and is very well, to the extent one might question why she’s even there! She still talks about going home but has refused point blank to accept having carers there. We want her to stay in the care home as it seems to suit her very well and is such a weight off our minds. However, BIL is now talking about selling her home as it’s costing money to keep it. We agree, but don’t want to do this behind MIL’s back.

How can we gently explain to MIL where she is and that it’s not temporary? She is a very stubborn lady and, like many her generation, has a “you’re not putting me in a care home” mentality. We’d let her just coast but selling her home without her knowing feels like a betrayal.

By the time you take off state pension, possibly private pension and sometimes othee benefit what actually neexs paid from a houde sale is less.

Going into a care home literally saved my mums life. She was severely neglected by her husband. Once in the home she thrived. It was council run but was set up like an old fashioned house. No sterile corridors or ultra modern bedrooms. She thought it was her own home, but never questioned why she had other people there.

The fact that she gave you POA meant she trusted you to make the right decisions for her. You have no alternative but to sell, to ensure her future.
i told my mum she was in a convalescence home.

If she is asking to go home then legally this needs to be explored. A capacity assessment needs to be carried out and then a best interest meeting arranged with family, social work, the care home etc. The decision needs to be the least restrictive for her, with all the pros and cons considered.

If she’s deemed to have capacity then it is her choice, even if this is thought of as ‘unwise’.

After a bumpy start my late DM settled in to her care home and quickly became institutionalised, she enjoyed the company, the food and the routine. She felt safe.
She did sometimes ask about when she would be going home and we said she was in a convalescent home for now. She accepted that well but used to ask how her house was, she worried about it. We said her neighbour was looking after it, and we checked on it regularly too. All true. That reassured her.
My DB and I had POA that she signed when she realised she needed help managing her finances (lots of forgotten and hence unpaid bills!) so we were able to sell her house later on, when it became necessary. She had forgotten all about it by then.
She had medium dementia when she first went into care but of course it worsened.

I doubt that legally you can sell her home without her knowing. Even with a LPA that will only come into effect if she doesn't have capacity to.l make decisions herself or if she has given her permission for you to act for her and doesn't seem to be the case here.
I think you just have to be honest with her. It's extremely hard and if she goes home I suspect she may end up back in hospital but if she has capacity and if she fully understands the implications of her actions and she refuses to stay in the care home I don't think you have any choice.
She may suprise you though and decide she wants to stay

With an LPA for property and affairs you are obliged to act in the donor's best interests where you believe, on balance, that she cannot make a specific financial decision.

Given that she doesn't understand her care needs you are on pretty solid ground in terms of the donor not being able to make a decision about whether to sell the house she is no longer able to live in.

If you want to be absolutely certain if your position you can ask the home for their views about mental capacity to decide on care/residence.

If the care home is looking after her on the basis that she cannot positively consent to the care (which is not the same as objecting), and it's being provided as necessary in her best interests, the care home should have applied to the local social services authority for a Deprivation of Liberty Safeguards (DOLS) authorisation.

Checking out her "DOLS status" may give you some peace of mind although most LA have multi year waiting lists for actual assessment of mental capacity and best interests so it's more about seeing how the CH perceives her.

You don’t need a DOLs assessment to assess capacity. Any professional can do this, although for accommodation it is usually best being a social worker. You can call adult social care and say she is requesting to go home and they can come and assess her capacity.

You can’t make such huge financial decisions like selling someone’s house just by getting views from the care home.

That. My mum had regular capacity assessments after her stroke and need for 24 hour care. She passed them all with flying colours, despite choosing to make some terrible decisions.

I chose not to do anything without her permission. We desperately wanted to clear the storage unit that had stored the entire contents of her former home for ten years, but I felt strongly that if I were in her position I'd be furious if my belongings were disposed of without my knowledge. No way would I sell someone's house if they had capacity and refused permission.

One of the most helpful things my aunt's care home key worker ever said to me was that it is ok to lie if it will make her happy. Explaining things as they were was frequently impossible, but referring back to things in her past worked. For example, she would be upset when I needed to leave so I would say I needed to collect the children from school. She had no concept of day, time or their ages, but the need to be at the school gate was in her memory still. She would then send me off, telling me not to be late.

It is so hard to decide about a house but when we sold my aunt's we didn't tell her. One day she asked about it and I told her a lovely couple with three children were looking after it for her. She was pleased about that, she had no idea they were the buyers.

Really? A care home round here is approx £750 a week - £3250 per calendar month whilst the average rent for a 3 bed house is around £1200 a month. So thats a shortfall of £2000 a month. The rental income is taxable, so leaves even less money.

My mum's care home was £6000 a month. So I'm amazed that anyone's getting residential care for half of that.

A bit unrelated but if you can, see if she has some photo albums at home. She might be up to looking through obe when you visit and it can be a nice focus.

I live in the north of England. How expensive is this house to bring in above £4000 a month in rent?!

If the council are funding it as the elderly person has no assets or has spent it already, they can usually negotiate cheaper rates of around £700 a week, maybe less. Something like 80% of the average persons council tax goes to private companies providing elderly care nowadays.

I live in the north of England too. I’d probably get enough rent on my mother’s 2/3 bed property to pay for one week’s residential care. Perhaps I’d achieve that if I did airB&B with constant occupancy, but I haven’t time to do that.

Why does she need to be told?

I have an aunt who firmly believes her situation is temporary until her own house can be equipped with various adaptations (wink wink). She calls her daughter when something comes up like a stomach upset or other ailment, and D relays the info to the staff. She keeps busy and chats with the other residents. She's perfectly happy, safe, and well fed while she waits to 'go home'.

BIL needs to talk to a solicitor about whether he has the right to sell the house, even if he has financial PoA.

I work in a care home and it has a tell them once rule. In other words residents are generally told once about major things, after which staff will brush off questions how they see fit. Usually it is used when their spouse dies. I suspect she either has dementia or doesn't want to back down on the care home opinion. Frankly can you imagine your kids making these decisions for you ? I assume she isn't paying council tax as she is exempt.

Don't get me started. I had no issue with mum paying her own fees. What I resent is that she was subsidising other residents. When she ran out of money and the council took over, magically the fees went from £6k to £4k. Same room, same care, same food. So basically a large chunk of her original fees were to help pay for others.

Genius!

I would do that.

Call it a convalescent or nursing home, because whilst she doesn't need full-blown hospital care the doctors felt it best that she continue to be monitored.

Don't tell her

Her brain doesn't work the way it used to work, there will be executive dysfunction. She can't process the information, can't weigh it up, can't see the consequences of any actions and can't judge your motivations

She will forget the actual information you have given her pretty quickly, but will probably remember the feelings she experienced on hearing what you had to say (distress, anger, etc) and will associate them with her situation and with the people who told her. This will lead to a vague feeling of distrust and unhappiness that she can't pin to anything so may start to affect her relationships and the way she sees her current situation. This won't be good for anyone, least of all MIL.

I can't emphasise enough, not only would it be unwise and unhelpful to tell her you're selling her house, it would be outright harmful. Please don't do it. The only people it will help is you, to assuage your guilt. If you're confident you're acting in her best interests, just do it and keep quiet

It's not what everyone would do but we decided to tell our relative that her house had to be knocked down so she couldn't go back home...she accepted that fine tbh. Before we said that she was pretty much packing her bags to go home every day

As a former nurse who worked in discharge planning as a few posters have said its a little more complicated than just selling. Ased on you saying she has no nursing needs in that she is qell, she would be self funding. It gets complicated when cognition is questioned. Apologies if I'm repeating too much, you said she has no formal diagnosis, is she confused, you will need to involve social care and she will need a formal capacity assessment. Power of attorney is no use at all unless the person lacks capacity. Capacity assessments are also usually decision specific so it could just be around her understanding of issues involved in going home. Also she is allowed to make an unwise decision if she is thought to understand the risks behind it. Subject to her not having capacity then yes a best interest decision can be employed. Make sure that you involve social services as you don't want to be accused of any wrongdoing or depriving her of assets in the future when you are trying to do your best and keep her safe.

How do you know any of this? She has no formal diagnosis of any cognitive impairment and even if she did you’d have no idea how this would affect her.

Reading threads like this is really frustrating with anyone over a certain age with any element of memory issue being deemed as incapable and people saying just to make all decisions for them, what do they know, they’re old and can’t control their lives.

Every single person is different, presents differently. She might not have capacity to make a decision regarding whether she has a flu jab but she may have capacity to decide whether to move home. Only a professional doing these assessments would know this. Making blanket assumptions just on one description of someone is really unhelpful.

And once again it’s worth repeating to those saying just sell. You cannot just quietly sell someone’s house without assessing capacity and doing a best interest meeting. This means it has to be discussed with them.