Health power of attorney.

[tobee]

Has anyone got knowledge of health and welfare power of attorney please?

So I've got a thread going called mum in hospital.

So to set the scene:
My mum is still there and no definite idea of how long she will need to stay there. My sister and I are currently taking it in turns to stay at their house and look after dad who has dementia (relatively mild - however that is determined?) and visit mum. Today at hospital visiting mum dad said he wanted to be dropped off by me and I should go home because family would be missing me. Mum and I said no I would be staying as he needs to be looked after. He can put himself to bed. Go to the loo and shower and dress. Mum sometimes used to have to help him with his pyjamas when she was not in hospital. He also seems to favour wearing the same clothes for days on end. He can make himself tea and do bread and cheese. Mum says he mustn't be allowed to use the oven or stove. He likes a glass of wine but would want to drink more without realising.

We can leave him for a few hours.

He is 90 and falls over sometimes. Has poor mobility and uses a stick

My sister and I today think we need more help from carers as we can't stay down here indefinitely. We have our own family, work and lives. (Although we have guilt)

Parents have a carer who comes for a couple of hours once a week or a fortnight (it's been changed). She now recognises that more is needed.

We can set up an emergency carer for however long to look after dad. Look in on him, give him breakfast and dinner etc.

So I think he will not like this. Or be resistant initially. Can we enforce a carer for him if we have h&w power of attorney when he has this kind of capacity?

it sounds like he needs one, but you may have to he careful how you pose it to him. it also takes 12 weeks to register so you need to allow enough time for that.

A power of attorney is important because even a spouse cannot make those critical health and end of life care decisions without one. You can draft them yourself online (https://www.gov.uk/power-of-attorney/make-lasting-power) but you have to be careful not to provide instructions that are clear and dont conflict with eachother. You also need to consider carefully if more than one person will be the POA. If multiple people are joint POA, if one of them dies the POA becomes invalid. This can be prevented by making them joint and several but that means one person can make a decision without the other's consent.

It would be a good time to get one for your mum too. Really it should be on everyone's radar - as well as a financial power of attorney.

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sorry realise i didn't answer the question. No you.cannot force him to have a carer if he still has capacity. you may need a doctor or solicitor to help determine if he has sufficient capacity to make appropriate health and welfare decisions.

Unfortunately not, lpa for health can only come into play when someone loses capacity to make their own decisions and capacity is decision specific. People can also make what would be considered ‘unwise’ decisions if they have the capacity to do so. I’m an elderly nurse and like previous people have said, I would still look into them both before either lose capacity as once they are deemed not to have capacity it’s a whole difficult process

Right so to clarify we have the power of attorney for health and wellbeing set uo for dad.
Me and my sister have poa for him.

Ok. I think I understand the answers .

Thanks for the replies

Has anyone got any knowledge of what the capacity threshold is? I mean in practice, a rough idea?

I mean I would say no as he doesn't remember that he can't look after himself and what has been agreed before

Someone has mental capacity to make a decision if they can at the time understand the information needed to make the decision, weigh it up, remember it for long enough to make the decision, and can communicate the decision with appropriate support (Mental Capacity Act 2005).

Mental capacity is assumed to be present unless questioned because of a disorder of mind or brain, temporary or permanent. So capacity wouldn’t normally be assessed unless there is a disorder.

People can have capacity for some decisions and not others. Unfortunately capacity can also fluctuate.

Methods of assessment and how it is done can vary a bit. If a person appears to make a capacitors decision one day, but then keeps changing their mind repeatedly, it may be decided that they don’t have capacity after all.

I think from what you say, there is at least a question about your dad’s mental capacity for a decision to refuse care. It sounds as if that needs assessing.

if he doesn’t have capacity, his attorney can make a decision in his best interests. That should definitely take his expressed wishes into account.

is that some help?

Capacity assessments aren’t always very good. Do ask to be present.

Thank you @PermanentTemporary .

That is helpful. He might fail on remembering that he'd agreed.

Hopefully it won't come to it - that he pushes back. But he's very resistant.

Do you also have finance POA? Because if you don't, you won't be able to make payments for care (unless your parents are capable of making the payments themselves and agree to do so).

If you do have finance POA I would simply set up the carer and tell your dad someone is coming in to help him. That is what I did with my mother.

If your dad is resistant and disagrees/refuses to let them in/makes a fuss etc, it makes no difference whether you have H&W LPA or not really - he is still going to make a fuss regardless, you cannot force him to open the door. Sorry if that sounds a bit blunt, I know how difficult it is so good luck.

Yes we do have financial poa and this is what we have now done. We will be presenting as a fait accompli. And my mum agrees that we should do this for my dad at this time.

I'm glad you have LPA in H&A but I would tread carefully with it. My sour experience of the State with the elderly is that if you don't have it, they can have fun at your expense, but even if you do, it's not clear whether it can actually be activated on your behalf at a crucial moment. We asked our GP surgery to do this and they said, no, his GP is on extended leave and we don't want to do it - they passed us to some mental health hub social services thing - but as we found Surrey's social services to be nasty and corrupt, we didn't do that.

His GP returned and he drafted a two line letter saying Dad lacked mental capacity though I did feel a bit uneasy about it.

I would not suggest you press the button on having your Dad diagnosed as lacking in mental capacity because it puts him in a different place when it comes to being kept alive by the State. They don't feel they have to, and when it comes to admittance to hospital, while your LPA in Health & Welfare in theory can get him out when you want... it does not stop them imposing a DNR on a parent, which in my experience of Surrey means 'the doctor can kill you now' - I think they use an injection to do it, and it'd done within three days, they don't mess about.

On the other hand, if you haven't activated the LPA... well, we got Dad out of the Acute Medical Ward in Epsom six months before he died as they were trying to pull a fast one, it got very sinister. We waved a hard copy of the LPA as we anticipated their move, but luckily the then matron didn't know that we hadn't activated it yet or that countermove... they tried the trick of being friendly to Dad suddenly and asking if he wanted to stay... 'You like it here don't you?' He said he wanted to go back home so it didn't work, but if he'd agreed, suddenly his 'mental capacity' would have been deemed okay by them.

My god they were a bunch of bastards.

It's a tight rope really but my advice is to frame it so the visitors are at your Dad's service and there to help, appeal to any narcissism on his part, otherwise it's into a home he goes and it will be out of his and your hands.

It wouldn't really be appropriate for the OP to be present for the capacity assessment if they are the holder of the PoA.

OP, there are some great resources showing videos of example capacity assessments and explaining the process here - https://www.scie.org.uk/mca/practice/assessing-capacity/

Oh, I don't know. Why not 'appropriate'?

I made sure to be present when my mother was tested by the SALT team, who were alright actually, not corrupt, but the care home had clearly been tasked by the Surrey Safeguarding head to have Mum fail her swallowing test, so make out she was 'further along the line' than she was and confine her to puree. They didn't get her up out of bed, she was slumped at a bad angle, that sort of thing.

Can you present the carer as being something your mum wants to put her mind at rest that dad is being looked after in her absence? I often find that reframing something can get the required response.

It's not appropriate because they have an interest in the outcome, as the holder of the PoA. The assessment should be completely neutral and not "led" or in any way influenced by interested parties.

Also, just for reference, you can't "pass" or "fail" a swallowing assessment. It is just that, an assessment of function to determine what, if any, safety measures are required to reduce the risk of aspiration and choking while feeding.

Erm, yeah, you do - your response is a bit of sophistry. My Mum would have 'failed' her SALT test in the sense that if it was decided she couldn't manage fork mashable, she'd be relegated to puree. As I've said, that 'moves her along' the spectrum for being frail and therefore, in Surrey's eyes, justifies her being on end-of-life care, ie covert enforced dehydration.

Jolly glad I was there to stop that, and to be able to communicate her wishes. Guessing it annoyed the Council who were hoping to rig the situation. Probably not 'appropriate' though.

With my Mum, I put it as a bit of help with the housework and employed a help at home agency. This moved from twice a week to 5 weekdays. An hour a day and 2 hours one day when she goes out with the carer for a coffee or to the shops.
They keep an eye on food, making sure she eats. For example, they will make her lunch with her and help her plan what she is having for tea ( meal out of the freezer).
It's not cheap but mum likes all the carers ( she has 3 regular ones) and it has added to her life.

Thank you for that suggestion @unsync

We had H&W PoA for MIL who had no capacity. This was completely ignored by both care home and hospital staff, with the result that she was admitted and then resuscitated against her express wishes, prolonging her inevitable death by ten days and traumatising the entire family in the process.

I'm sorry to hear that Northern Dancer.

It is unfathomable what is going on in this country. It seems many NHS staff just want to do the blind opposite of what the family wants.