What do I do if she won’t go to bed?

[Facecream24]

So to try and cut a long story short but still give enough information for advice! DM had an operation on her brain, its left her with impairment/disability. Social worker has assessed as not having capacity and done a DOLs. She is to be discharged from the rehab centre she’s spent 3 months at next week to home where social worker has deemed she needs care from being awake to going to sleep as she’s a risk to herself in the kitchen/if she goes outside on the road etc.

I have a million questions and concerns but honestly the one thing that is bothering me most is what if she refuses to go to bed? Obviously the care package has a time on it (9pm) as the worker has to go home! But the care package says they need to make sure she’s in bed before they leave - she’s stubborn and grumpy with the situation as it is - what if she just refuses to go to bed? What happens then? I’m an hour away, work full time, primary aged kids etc etc and feel panicked there will be some expectation that I drive down there at 10pm to try and sort it! I know it’s hypothetical and might not happen but I’m already so stressed with trying to sort out finance and a million other things that this single thing is really bothering me the most. Thanks!

edited to add. She doesn’t feel there’s a problem and she should be allowed to spill boiling water on herself if that’s what she wants to do. She’s not happy at the idea of having someone there all the time which is why I’m worried there might be issues.

@sosorryimnotsorry thanks for taking the time to reply it’s good to hear from a carer’s point of view. This is part of what I don’t understand. No, she doesn’t need assistance getting to bed as far as I can tell. When the therapists etc where running through what she can and can’t do they didn’t raise any concerns around that. The social worker has sent me through the very long list of things they will do and ensuring she is in bed before they go is one of them because she’s been deemed not safe during the day but safe overnight 🤷🏼‍♀️. I think there’s no concern she might abscond and leave the house overnight. I don’t think she’d have any inclination for that. When I questioned it they said ‘on balance’ they felt the risk was much lower of her hurting herself overnight as the main risks are all kitchen related and I guess they’re assuming she won’t use the kitchen!!

We looked into a live-in carer for an aunt of dh, and TBH it would have worked out more expensive than a reasonable care home, plus you have all the expenses of running a home on top. The aunt (no dementia) would have needed help to some extent at night (needing the loo) which would have meant more than one on shifts.

She did eventually move to a care home.

If using the kitchen is the main concern then I would simply turn off the kitchen appliances at night obviously with the exception of the fridge. Have a master switch installed if necessary. That way she will not be able to do anything unsafe overnight. I’m a client I had years ago they did this. They had a lockbox fitted over the switch so only those with the code could switch the kitchen power on.

@sosorryimnotsorry hello, if you’re still around just wondering if I can follow up with you. I asked about the court ordered DoLs and have got a reply to say they only do them in care homes and not a person’s own home? I’ve googled and it seems this response is incorrect based on what I’ve found but I was just wondering what would getting one achieve? Would it change anything for my mum? I’m not sure I understand what having it be not having it would mean for her? Thanks if you can help

Hope you don’t mind me answering your last post. There is a Deprivation of Liberty in the Community (DoLiC)

This is applied for, and granted by the Court of Protection, when a person lacks capacity out of respect of their care and support needs when living in the community.

They still need to meet the three stage test-

Is the person under continuous or complete supervision and control by carers/staff?
This can include restrictions on movement, monitoring, or needing permission for day-to-day activities.

Would the person be prevented (physically or through arrangements) from leaving if they tried?

Does the person lack capacity to consent to those arrangements, or are they unable to give real consent?

The continuous supervision can include use of cameras to observe when a person is not physically present.

A DoLiC does not give the police or other people power to return the person. But they can intervene under their general powers — for example, if there’s an immediate risk of harm, or under the Mental Capacity Act s.5 (protection from liability) if acting in the person’s best interests.

Really not adding to advise already given just to say, to not be available after 9pm. If you do it once you will do it everytime. Sounds awful saying this. Its your mum and you love her dearly. But they will just say you need to deal with it if they know you can. Sorry to sound like a bitch, know this from personal experience

Thanks @Shallysally i think I’m just not clear whether having this court ordered DoLs makes a difference to her or not? From my understanding the social worker has said she doesn’t have capacity and that she’s a risk to go out alone so I guess her liberty is being deprived because the carers have been told not to let her leave alone but they are supposed to accompany her to where she wants to go to try and give a degree of independence. Does anyone know what a DOLs would do for her? Is this arrangement somehow illegal without one or something?

it seems to be going ok so far anyway. Only one 9pm call on the first date which I was rather unhelpful with! But another couple since without any calls.

So the DoLS order is to legalise what you've just described. You might hear a lot of references to the "Acid Test" or the "Baroness Hale Acid Test". This is the legal definition of a loss of liberty relating to capacity (as opposed to criminality). Basically, a person is considered to be deprived of their liberty if:

1. They are subject to continuous supervision and control and
2. Are not free to leave

If those conditions are met, then a DoLS order (in a care home/hospital) or Court of Protection order (if at home) must be obtained for those arrangements to be legal.

In your mum's case, she's subject to supervision and control from her care team, who are restricting the activities she can do and monitoring her. She's also not free to leave the arrangement, as she does not have capacity to do so.

Therefore, to make the arrangement legal, her Social Worker will have to apply to the Court of Protection for a DoLS order. Otherwise, your mother could be seen to be living in a situation of unlawful imprisonment.

There are some good resources on the SCIE website (google SCIE DOLS) that might help explain it with examples.

Does that help at all?

@Facecream24, good to hear she has been settled at night.

Re the DoLiC, it doesn’t affect the support that she receives, it’s a protective factor.
As social workers, we have to work within legal directives and if your Mum’s social worker has identified that one needs to be in place then they will apply for one under Best Interest as shown in the Mental Capacity Act.

I know there’s a lot to take in. It sounds as though the social worker is working to promote your Mum’s safety.

It really does @roundaboutthehillsareshining and thanks again @Shallysally this has really helped me get my head around it thank you. I’m not disputing she needs the care at all as I’ve seen myself she’s not safe at times but she’s really against it all and unhappy with the arrangement as she doesn’t see her own struggles a lot of the time,