Abusive situation. Please help me think.

[helpformymumplease]

I've name changed for this but been here for donkeys years - since mouldies.

I apologise in advance if this is upsetting for others but I really need some advice on this please.

My mum has Alzheimer's. Quite advanced. Dysphagia and a pureed diet. Housebound and vulnerable following a fall resulting in a broken pelvis a couple of months ago.

She lives at home with my dad. He is her main carer. They are both 86. She has professional carers come in and wash and feed her and put her to bed each day.

Yesterday I was round there at the same time as the carer and my dad had to give my mum her medication. It's a tablet. She has trouble swallowing and, in my opinion, she needs any meds in liquid form. I have asked for this repeatedly.

My mum struggled to swallow the tablet. She spat it out repeatedly. He shouted at her. Held her nose to make her swallow it. Carer sitting right next to her and made no attempt to stop him. I did. I told him to stop. I told him it wasn't ok and she couldn't swallow it. It was awful. He kept on and on and bullied her. She couldn't swallow it. Carer just watched on. I told him to leave her alone. He was angry. She wouldn't or couldn't swallow the tablet. He shouted at her that she'd take it and he would win in the end and she would swallow it. I tried to stop him and he just went on. This went on for maybe 3-4 minutes. I told him to leave her and it didn't matter (tablet is to make her go to the loo and liquid forms are available) I told him we'd get a liquid form and to leave it. He went on and on. In the end I couldn't stand it any more and left the house. I feel ashamed that I didn't co time yo advocate for her but I tried and tried and I got upset.

The carer did nothing. Just watched.

I feel that he is abusive towards her. This was not really about the medication and its importance or otherwise. It was about him winning and making her do what he wants.

My dad is not a nice man. He was a nasty mean dad and my mum should have left him when we were little. But she didn't for whatever reason - to protect us I suppose. He shows a nice side to the outside world but historically he has been mean. Although I really did think he had mellowed but clearly it's still there in him.

My question is, what to do, I think he needs reporting from a safeguarding perspective (any safeguarding knowledge I have is for children but I would assume that's the case?) Should the carer have reported him? Do you think she would have (they are obviously making a lot of money from my parents, as a company, so I'm not sure she would have). Am I over reacting? I don't think I am. But would appreciate your thoughts.

I've wanted to be looked after in a nursing home for a while and he has always insisted he wants to care for her. They've been married for 69 years.

Please be gentle as I'm all over the place. She needs to be looked after.

You're not over-reacting. How awful for your mum to be treated like that.
Can you flag up the safeguarding yourself to report it? The NHS website suggests social services or her GP but there's a glitch atm and it won't let me link the NHS page.
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@helpformymumplease I think it might be time for a referral to adult social care, he is probably past being able to care for her from what you are saying.

I will say though that caring does not come easy for some people and clearly your father does not have that nature but and it is awful to say but even substandard care at home might be better than the alternatives sometimes.

@KoalaShaker that's the thought process I had. He won't let her go in a home as he's heard stories about what happens to people in homes. And then he does this himself.

Social care and the nhs have literally been in their house in the last week and praised him for the good work he's doing. I know I need to report it but I'm not sure if anything will happen.

If you don't report it then no nothing will happen.

I'd be reporting this by phone right now and following it up with an email. I'd also name the carer who was a witness to this, and ask that the carers are spoken to about why they have not been raising concerns themselves as this is clearly not a one off.

Then I'd contact the GP, have the same safeguarding concerns conversation with the receptionist, and ask for the email address to follow it up in writing. Include the concerns about why someone with advanced dysphagia is being prescribed medication in tablet form and not liquid. Ask for an urgent appointment for the GP to meet your mum, review her meds and ideally come to the house to do this.

Contact everyone with a duty of care here. Make it a clear report of abuse and safeguarding.

Sounds like it's time for you mum to be in care I'm afraid, your dad isn't coping.

Yes report it. You've even got a witness.

I would take my hat off to anyone who cares for a partner with Alzheimers but it sounds like there's a good case that he has burned out (as you say it may be similar to the past though - in a way it might be less difficult to call it something new). I don't think at this stage she will live any longer going into a home, tbh it might actually be a stage on a final decline, but this can't just go on as it is. I would get safeguarding involved.

I'm not very happy that the carer was just sitting there but you could check k if they reported anything to their agency.

Thanks everyone. It's good to see that I'm not overreacting. Now to open the can of worms. Thanks.

I have experience of this. You can contact adult social care and they will investigate. In my dad’s case, the cognitive decline was not sufficient for them to say he had no agency. It sounds like your mum is much further along that road, so it’s possible they may be able to move her to a facility, and your dad would not get a say.

You need to report to the safeguarding team asap

also report the carer for witnessing abuse and not acting on this .

i work in this field

No you definitely are not overreacting in any way. I’ve seen carer burnout in our situation too and that acceptance that the person needs a home can be very hard to take across the line.

The reality is though long term care of an adult can be gruelling beyond belief. We are eternally grateful to the family member who took on the lions share in our family and we had complaints from the care company about their interactions straying across the line on occasion similar to your own observations but these situations are extremely difficult and sometimes it is easier to see where it is not working from the outside. If your father is not a caring man the problem might be that he is a controlling man and that is a very tricky dynamic to overcome.

That’s awful, but in the meantime phone the GP and tell him she CANNOT swallow the tablet, and they need to stop it, or give her the liquid version..

Agree with everyone that there is a clear safeguarding issue here and that you should report it. It sounds like your dad is struggling and that is coming out in his behaviour. Does he understand why she can’t swallow the tablet? Do you think involving the speech and language therapist who made the recommendations would be useful? If they could provide some accessible information on the risks involved?

I've spoken to the GP. Feel sick.

You have done the right thing. Is GP reporting to safeguarding? You can always do this yourself as well but contacting you local councils older persons / adults department.

It is understandable @helpformymumplease you are doing the right thing here.

What have you actually said to the GP?

When you said before you'd asked for liquid medication repeatedly, who had you asked and what did they say? Sadly just asking often isn't enough, you have to become a nuisance.

Is your mum able to speak for herself at all, or is her dementia too advanced now?

Completely coincidentally the GP was going for a home visit later today (bizarre as they have never been before) so I've been able to get a message to them so I assume they will talk to him to see if he's coping?

Adding to all the comments above.

Definitely time for safeguarding, your Mum is at risk.

I would also put in a safeguarding referral relating to the carer. The carer should have put in a safeguarding report herself, or at least reported back to the care agency. If he/she hasn't then they are also putting your mum at risk.

I'm sorry, this must be hideously hard, you must be anticipating your dad making it all really difficult and unpleasant, but you need to advocate for your mum.

Well done, you have done the right thing x

Don’t let this drop, please

based on this I would also be putting in a safeguarding referral yourself. It sounds like your mum isn’t able to advocate for herself and your dad may not be open about the difficulties. In addition you were the one who witnessed it, not the GP, so best coming from you.

You need to speak to the care agency about if this carer had reported this event. And any other past events that have been reported. And if not, why not. You need to speak to the adult safeguarding team for your local authority. Everyone clearly needs more support. And it’s not up to your dad if she needs to go into a home, he doesn’t own her. A court protection order can be applied for to remove her from his care. Who has power of attorney for her?

Can you go round and be there for the home visit? You don't know that your dad will be truthful with the GP.

I would report this to the police to be honest, as it is severe abuse. They will then pass on to safeguarding, and you will then know a full and proper investigation will take place.

That's absolutely horrendous, your poor mother. So vulnerable, and has no voice or agency. If he is already an abusive man, this is not carer burnout. And the care worker needs to be reported too.

Agree with this. But also be prepared for the carer to lie and say they didn't witness anything if they have failed in their duty to report. If nothing is done, I'd consider trying to conceal cameras in the house. If this is how he treats your mum in front of two witnesses, I'd be extremely concerned at what he is capable of behind closed doors. I'm sorry I don't have anymore positive to add. This must be so difficult for you.

I'm not sure your dad will admit to the GP he is not coping, I would request to the practice that you have a follow up appointment and see what options there are for her.