At home, no capacity and no deputyship - access to money

[roundaboutthehillsareshining]

So my elderly relative is being discharged home with a care package. Fine, it's what she wants and it's the least restrictive option, so it's got to happen this way (even if it falls apart in a few months and she ends up back in hospital for 6 months). Anyway, there's nothing physically wrong and no dementia. Her team believe she has a new functional MH condition, but that can't be diagnosed in hospital and she won't engage with community care, so that's a dead end.

However, it's likely she's going to be found to lack capacity to manage her financial affairs. Her bank account set up is hopelessly complicated (at her choice) and can only be administered in branch, which she's not going to be able to access.

So if she's at home, and unable to access money, how does she pay for food etc until the deputyship comes through? The family can't afford to subsidise her, she isn't eligible for benefits as she's got money coming in, she just can't access it. So what happens? Anyone been in this situation before?

What a strange thing to say

You don’t necessarily have to put a key safe on the wall. You can get ones with tether cords (made of woven strands like bike locks) you attach to drainpipes or-door hsrdware. They are really tough to remove you’d need bolt cutters and a lot of determination.

This reads like something from the 19th century where the abusive husband tries to have his wife committed to an asylums.

This woman appears to being hounded and bullied by everyone involved.

What do you suggest then?

I quite agree. The poster isn't even her closest relative. The woman doesn't have a single diagnosis, has got tons of money, is living her life as she wants it. They claim she is mentally ill but who are they really

Few months ago someone shared in a group about their relative who she thinks has something but not diagnosed, took her off her being next to kin < and possible poa , observe > and completely demonised the woman in this group. I told her that perhaps she suffers from rejection dysphoria, not that her relative has got something.

The thread to be closed off
These are only claims, not a single medical or social proof and I can imagine why the poor person has taken this stance in life knowing what her relatives think of her

Capacity needs to be assessed first. It’s assumed she has capacity until she has been assessed to lack it.

she can make choices - even if unwise or not in her own best interests.

I won't comment on the analogy, but I do feel like the OP has had lots of very sensible advice, and shared experience and seems to be going round and round in circles until they find someone who will answer the question like they want it to be answered (which won't happen because the MCA and SS have a due process to follow). Which to me hints at wider familial dysfunction. In the eyes of the law an adult, deemed to have mental capacity, is allowed to live how they want to live until such time they become a danger to themselves or others.

A lot of us have experienced situations with elderly parents that are clearly not going to work and are going to blow up big time ( and, not without reason, expect that they will need to sort it out/get the blame for not preventing it). Not everyone feels able to sit back and wait for the inevitable disaster and some will desperately cast round for the nonexistent solution. I suspect that is the OPs situation.

OK, this thread has taken a weird turn.

For clarity: It is the assessment of the MCA assessor, who has found this individual lacks capacity to manage decisions relating to their health and wellbeing. It's anticipated that the same assessor will make the same findings relating to financial management, but that hasn't yet been confirmed.

Social Services have confirmed the plan (as the "least restrictive option" under the MCA) is to discharge home with care visits.

Without capacity, this person will be unable to access their own money or manage their financial affairs. Even with capacity, they will find accessing money extremely challenging due to the logistics of accessing a bank. At the moment, there is around a 6-8 month delay in issuing deputyship orders, so the purpose of the thread was to find out what happens during that period in terms of necessary household expenditure - food, oil, insurance, council tax, water, electricity, etc. As it's not possible for anyone to take on the expenses of another household on top of their own - especially as it's unclear whether there will be any funds to rebate once deputyship is granted.

I will take advice on attendance allowance, though having read the form, I'm not sure this person will be eligible, as they have not required care for the past 6 months.

All I can say to the people who have posted most recently is that I hope you never have to deal with elderly mental illness, and never find out for yourself just how Kafka-esque the various systems are. I wouldn't wish this on my worst enemy....

Good luck OP. I have no doubt you are in for an exasperating time. Based on experience I recommend a good stick of gin.

@roundaboutthehillsareshining https://www.gov.uk/emergency-court-of-protection

I started to look into this and apparently you can apply for an emergency deputyship.

Has she had her problems for six months, ie needed carer support even if she didn’t have it?

But this is where I can't understand who is advising you or what is going on @roundaboutthehillsareshining. Tjese things take time, as do all the assessments. Even doing the assessments now is risky, as in a few weeks at home your relative's condition may improve (ie no hospital delirium) and they may be found to have more capacity than any one thinks. However you have now listed some specific queries, so I will do my best to answer them.

As I said I have been through this recently. You can't apply for Deputyship without a separate MCA for finances and, they will most likely turn it down without a diagnosis. To get a diagnosis we had to push for a D2A place otherwise we were back in the while GP/memory clinic doom loop which takes months unless there is a further deterioration and admission to hospital.

When we were at the stage of applying for Deputyship it took 3 months from admission to hospital to work through all the paperwork for Deputyship for DM. It was then about 4 months for emergency Deputyship to be awarded. You either need to make alternative provisions for her or let the system try, fail and pick it up again in the meanwhile.

However (and this is a big however), smeone who is deemed to have capacity - however limited - is allowed to make their own decisions. And you may find your relative hasn't got capacity for decsisions around her own care but does over financial decisions, or certain types of financial decision. The reason these are separated out legally is so that it reduces the risk of abuse. This is assessed at the Care Act Assessment, the Deputyship application and again during the DoLS process on admission to a residential setting. It will be reviewed via DoLS regularly (or should be).

In the case of my DM we were awarded partial Deputyship because she is deemed to be able to decisions about certain things. And then, and only then, if I involve her in all decisions. Yes it is a nightmare. Is there anything I can do about it, no. Her MCA found she was able to articulate her wants and wishes when it came to managing her finances, even though she can't access her finances without support.

In the meanwhile, SS are legally bound to try the least restricive method of care first. This means supporting your relative to remain at home, until such time they have enough evidence to show she needs additional support. Am sorry this isn't what you want to hear, but they will discharge with no access to funding and apply for food bank support if no one from the family is willing to pick it up. We couldn't pick it up in DMs case. Running two households wasn't feasible at short notice. DM was back in hospital within a week having refused carer support. It was awful but it was the only way the system would pick her up, by then her care needs were too great for us to support. The system is horrendous.

In terms of the Deputyship in all, it has cost us in the region of £6K over a 9 month period to sort it all out. (DM is now in a care home but only after a very prolonged stay and deterioration in hospital). If DM had been at home I would have expected double that just on household management. However formal care costs are "loaned" by the LA until such time as the Deputyship is in place.

As long as you keep all your receipts all funds can be claimed as expenses under the Deputyship (including those associated with the application) but it is a lengthy process to put it all in place and manage the reporting etc. If no one in the family wants to / can afford to apply, the LA will apply instead and appoint a solicitor to oversee the Deputyship on behalf of your relative. Why won't immediate family pick this up? It is unusual for extended family to apply. And you will have to get support from the family to apply for Deputyship which could delay the application. If you don't, it will almost certainly be turned down.

My final advice is phone Dementia UK helpline or try their specialist forum. And if you can afford it, use a solicitor to do the application - it takes some of the sting out the nuclear button.

Also to add @roundaboutthehillsareshining we were advised not to apply for Deputyship until DM had been settled into her care setting for 6 weeks. This was to allow for any hospital delirium to settle and ensure that any diagnosis and MC assessment was accurate. Again, the Court of Protection is quite wary of taking away someone's right to autonomy too quickly. Go too soon and you are liable to fail on your application.

can I just thank you for posting your experiences @Thingamebobwotsit , very interesting.

No worries. And I am happy to answer questions. But someone else mentioned it up thread, chaotic people tend to be more chaotic as their dementia/frailty progresses. And there is very little anyone can do to stop it, until such time someone is deemed a risk to themselves or others.

Someone not being able to access their money, is not the the same issue as being able to manage their money or being able to choose how they live.

(Also from experience) unless the whole family is on exactly the same page on what happens next, unless there is PoA in place you will struggle to get much traction from the formal services until such point in time it reaches the threshold for them to step in (which is high, complex needs). Even more so where it is extended family members trying to push this. From what the OP describes there is a strong chance that 80% lucid will be assessed as having capacity to manage finances, if given support to access them.

I do understand that capacity means the right to make poor decisions. Poor decisions have been being made for the last 8 years, and now we arrive here.

I was actually very surprised that the health and wellbeing came out as lacking capacity. I expected, after having seen how much recovery was made in hospital without any medical care, just meals, access to washing facilities etc, that the person would be capacitous. At the moment, they are refusing to participate in the financial capacity assessment process, so capacity for finances can't be gauged. I don't know what happens when they consistently refuse to engage? Can a decision be made if they outright refuse to engage in any discussion of the subject?

Separately, there isn't a diagnosis, nor is there going to be one. CT scans have come back clear, there's no neurological sign of dementia or other brain conditions visible on the scan. Psychiatry don't see elderly patients in hospital for diagnosis not associated with dementia, that has to be done via the community team. They've already tried, but as with the financial assessment, if the person is completely refusing to engage with them, they can't make a diagnosis either. For this reason, we don't think a D2A place is the right answer - she's not receiving any medical care in hospital and has no ongoing medical needs, so she gets a few more weeks of being fed, warm and washed, but it's not solving any of the problems that prevent those things from being done at home....

All we get from social services is one line email updates, no answers to questions or any further information. We've asked for visibility of a care plan for the care visits, for information on what happens if the financial assessments aren't done, but get nothing back. I'm expecting that one of those one line updates will be "she's home now", but it would be really nice to know what to expect if and when that happens.....

This reminds me of a situation regarding my friend's DF. It was obvious he was suffering from some form of dementia/Alzheimer's, but he refused to engage with the authorities and wouldn't answer any of their questions. As a result, she didn't bother to claim Attendance Allowance on his behalf as it would have been very hard to prove without a formal diagnosis.

A few years later, her DM had a fall and had to have a hip replacement followed by a stint in rehab for her mobilisation. Her DF went into a local care home as there was nobody to look after him, and he stayed there until he died about a year later. His care was funded by the local authority, so he wouldn't have been eligible for Attendance Allowance anyway.

These situations are always incredibly difficult to navigate.

@roundaboutthehillsareshining As frustrating as it is, there is literally nothing you or the SS team can do in this situation. Until your relative reaches crisis point and is admitted to hospital and found to be "at risk" they are allowed to do whatever they want. The bar for being deemed "at risk" is exceptionally high. It sounds like also applying for any sort of financial intervention at this point in time is pointless and likely to be turned down. No decisions can be made if they refuse and are deemed to have capacity to refuse to participate in financial discussions.

This may go on for months or days/weeks. There is no way of telling at this stage.

Also sorry - am working so having to respond in fits and starts. SS have no requirement to update the family, particularly if your relative has refused to give them permission or there is no PoA.

This is likely to be why no response.

The best bet would be for their immediate siblings or children to step in. Or their closest living relative. If this isn't you, you will be deemed too far removed in the event of a crisis to be involved.

I wondered previously whether OP was DDIL. But she probably doesn’t want to say.

We now have a mca booked for Friday afternoon. How do they run, anyone who knows? I’m not directly involving myself but am interested.
My relative has suddenly got to the ‘asking the same question about five times an hour’ stage. Exhausting.

We've just been through this with my mum and then my dad. Both refused to even consider power of attorney. My mum was assessed as lacking capacity for financial decisions last year. The assessment was done by a senior social worker. She asked questions to my mum and my mum sat there laughing and calling my dad a thieving b. So, after the assessment, social services seemed to think that my dad would pay. He flatly refused to give mum any of 'his' money (married for 64 years, great hey) so we arranged a monthly standing order to cover food costs. Care costs were social services problem and they allowed me to complete the financial assessments. Mum was moved into care late last year because she decided she hated my dad so much he 'deserved to die', Sister applied for deputyship, 8 months later it was granted and she then paid the contribution to care costs. Obviously it meant that money built up too as my mum had not been accessing anything.
We continued with the standing order monthly for dad, it covered newspapers, food etc. Toiletries we used amazon. If there's a way of setting up online shopping for food or meals on wheels, then this can be legitimately charged to their account. The other thing social services did was tell us to put a safe in the kitchen and money was put in there and the carers had to go and do food shopping once a week (appreciate this may not work in your scenerio) If none of this is possible, then you have to start chanting 'unsafe discharge' at the discharge coordinator because the basics aren't in place to sustain life. If they aren't listening then you need to ask to speak to their manager and make it clear that this is an unsafe discharge
Where there is no power of attorney or deputyship, social services can appoint the court of protection.
It's extremely difficult because social services will always try to get family or friends to do things like shopping.

She has been found to be at crisis point. This isn't the first rodeo, this will be the fourth time carers have been brought in following an extended hospital stay after a crisis - each of which have involved police and ambulance. The difference is that, without capacity, this time SS have assured us she won't be able to "fire" the carers or refuse them access.

It's a slightly complicated situation, I would be considered an immediate family member and have acted on behalf of the person before in the previous crises. I'm so involved now as I have PoA for another relative (unrelated to this person) and was a SENCO for several years, and so I'm used to "speaking social services" language. The problem is SS aren't telling anyone anything.

I guess we just have to ride it out. It's just so frustrating, as her previous social workers were very good at communication and updates, whereas her current worker just ghosts....