88yr old DM with Dememtia wanting to leave carehome to go home as being pushed by my Dad - what can I do?

[Secondtonaan]

DM is 88, has vascular dementia, I'd say middle stage. V bad osteoporosis and mobility, incontinent and very confused. My Dad was looking after her at home for 3 years with one carer visit a day but it was going terribly, she had a lot of falls and A&E dashes... his health was declining too as getting no sleep and struggled with household tasks he'd never had to do before. He clearly couldn't cope but refused any more help from carers or anything I set up - day care / lunch clubs / meals on wheels etc etc.

Start of 2025 she went into a lovely care home for respite care - although I thought this would be long term as it was clear she needed this level of care. She is very happy there, well looked after and thriving doiing the activities compared with being stuck in one room all day at home. My Dad had some health crisis and ended up in hospital for a few months so DM has stayed until now.

However my Dad is now home and "better" and is desperate to get DM home. He could not cope in any way and she is so much better off where she is. I'm terrified what would happen if she went home. It's all about what Dad wants - he is lonely and feels abandoned by DM and as she hasn't lived at home for a year is totally ignorant of her care needs and seemd to have totally forgotton the state they were both in when she lived at home.

My Dad is about to give notice to the home for DM to leave. She has been appointed a social worker but is telling her she wants to go home so the social worker is supporting this. DM has no idea what's involved or any concept of how to cope at home... I don't even think it's what she actually wants. My Dad goes into the care home 3 times a day and tells her she's coming home so this is what she's telling people. I'm at my wits end, trying to explain to social worker the disatster that would unfold but they are saying they have to support DMs choice.

I'm trying not to drip feed but also not make this too long! I have POA for both financial and health as does my Dad. DM had a DoLs assesment recently when they said she lacked capacity (the care home say she lacks capacity) but then it was reveiwed at the last minute and they changed their mind and didn't sign it so there is no DoLs in place which I cannot understand as she clearly has no idea what is going on.

What can I do to keep DM safe / in the home?

That’s a good suggestion . All you can do is write and express all your concerns and send it to both the care home and the SS. Then wash your hands of it all. If it goes tits up SS will have to sort it out.

Court of protection would be last resort and is a long winded process, you need good reason to remove the POA’s as not acting in best interests. The OP answered me and said DM was self funding so it all hinges on capacity. If the funder was ASC or CHC NHS and the DM is not deemed to have capacity they would make the decision based on the best interest meeting with all POA’s involved, which could be challenged but in my experience this is rare. If the DM is deemed to have capacity and as she is self funding she can choose to go home or stay where she is without a Dols

Do you think your DF’s capacity is beginning to go?

Can you get an idea from your DM what home she is talking about? As others have said she may be talking about a different home, or different time.

i cant see that there has been a formal best interests meeting with all relevant parties just individual conversations.

It also relies on a good quality capacity assessment carried out by a competent professional.

Lots of professionals throughout health and social care still don't grasp that capacity isn't just being able to communicate a decision. It has to be an informed decision based in reality and coming from an informed rationale.

It sounds like OP isn't convinced that the capacity assessments have been completed robustly. She might be wrong, but ultimately her role as LPOA is to act in a way that she believes in in the person's best interests. She is disputing the decisions of other parties involved and the outcome of the capacity assessment. That means the COP need to make the decision.

Funding arrangements don't override the duty of the LPOAs to make the best decisions with what they believe to be the welfare of the person at the heart of them.

I don't think the COP is a last resort, I think local authorities just avoid it if they can due to the paperwork and the scrutiny involved.

If their capacity assessments are sound they have nothing to be worried about.

Which is perfectly acceptable. It's not always appropriate to get everyone in the same room at the same time. It often can prevent some people from being able to voice what they want to say.

A series of conversations regarding a best interests decision with all the relevant parties is just as valid as a single round table discussion.

@hatgirl hence my original post that OP requests another capacity assessment and a formal best interest meeting to lay everything out with all relevant professionals.

i didn't say anything about funding over riding POA welfare duties just pointed out that ASC/NHS can and do make best interest care decisions without it going as far as CoP if they are funding

@hatgirl I'm going to leave it here as it’s not my post to have a debate in and derail. It seems we both work in health or LA with experience of commissioning/MCA etc so we could go on forever.

This is awful, and surely adds another element to the discussion about what is in the OP's DM's best interests.

It's not simply about her capacity to make a decision, but about the reality that she has suffered actual physical harm while previous being "cared for" by her husband. From everything that the OP has said, it seem that her mother has been at best dominated, at worst, abused, by her husband over the course of their marriage. This poor woman is probably now, in the grips of poor health and dementia, having a more socially fulfilling and secure life than she has had for many decades.

Has anyone asked the husband why he wants his wife back home? In what way does she benefit? And does he acknowledge that his actions caused her physical injury in the past?

Aren't there also long delays in the COP? I don’t know what they’re like now but the last time I heard it was 18 months to get a Court Hearing.

I brought this up further up in the thread. I would certainly be raising this with the SW that his cognition seems to be in decline as part of the reasons that it’s not a safe place for her to be.

I’m also appalled that she broke her neck! That must have been awful. How can he possibly say it’s safe for her at home?

And telling her she’s not good enough is awful. Sadly it’s our experience that abusive men can and do get more abusive when they actually have to give care to their DW. DSIL said that she she thinks FIL viewed DMIL as the “Wife Appliance” avd once she developed Dementia and could no longer do everything for him he became embarrassed and angry.

I still think part of his reasoning to refuse Carers at home was because he felt embarrassed, it was nothing about making her life better and providing what she needed.

Unfortunately she declined massively during lockdown and we weren’t aware of how bad he had become.

You know how bad the situation at home would be, I’m glad you have the strength to look after your DM and go against your F’s wishes. It must be hard but it sounds as though you’re doing the right thing

Depends on the urgency - anything that is routine and non urgent (e.g. deputyship for selling a property for care fees) there are long delays.

Anything relating to a personal welfare application such as this will be heard much quicker and as required.

I’m sorry not to be able to give any advice but I hope you can find an acceptable solution to your parents current situation…wishing you all a good outcome.

Apologies if you felt it was a debate or a derail that wasn't my intention.

You are correct I do work in this area for a local authority and a significant part of my current role is supporting staff with these sorts of practice/legal issues.

The OP should have been made aware from the social worker (who has hopefully already run the whole scenario past their in house legal team) that if as the LPOA she disagrees with the capacity assessment and the care plan that approaching the COP for a decision is an option.

Not derailing at all hatgirl or madformalteasers - guess these things can take different routes depending on LA / urgency. This is all good knowledge to have so thank you.

As asked by some PPs, does my Dad have capacity?? It's a VERY long story so will try and summerise but I think he has severe mental health issues, he is very controling and has terrible OCD, eveything has to be done a certain way etc etc. He also seems to suffer from delusional thinking, he often does something or is told something then denies it afterwards or only remembers the bits that suit his argument. For example last year he discharged himself from hospital against medical advice then said the hosipital said it was fine to come home. He then nearly died and was in A&E the next day. But he obviously doesn't think he was lying iyswim? I was the one sorting all this and washing his blood off the carpet (which took all day) but then he complained when he got home the house wasn't clean enough!!!!!

He has always been like this - his rigid thinking lead to his violent outbursts in the past but it has got worse and worse in old age. Maybe I should persue this with the Drs as a reason it's unsafe for DM to be at home. He is, however, very plausible and could look like a loving husband if you didn't look too hard.

It’s one of those questions like how long is a piece of string. It depends how urgent the situation is.

@Secondtonaando tou think ot might be worth emailing his GP and outlining your F’s plans for him and your DM and say that you are worried ot might end in unnecessary Hospital admissions for both of them, given that the last time she was home she broke her neck? I would also say that you don’t want any information from them but you are worried about his cognition and the safety of both of them.

I’m so sorry to hear this incredibly stressful situation 😟. Reminds me so much of the time before my mum went into a home with dementia. I’ve never been more stressed!

Such good advice here. I would only add is there anything that could be done, -once this immediate crisis is hopefully averted- to help your Dad…? It’s so much on your shoulders 😭 but I just wonder if there are any companion schemes locally 😕. Sending strength and I really really hope she stays in the home (my mum has thrived with the social side of the home like you say too…) and that you get a break ♥️.

Suggest, keep saying

"Unsafe discharge"

@Secondtonaan would it be an option for her to go home for a few days “holiday”? You can leave them to it and see how your dad copes with caring / feeding / personal care etc. Maybe he’ll be happy to let her go back!

I think I’d be suggesting this to the social worker and care home, rather than risking her losing her room there.

Your Dad is determined. It’s a stressful situation, you’re going to have to be the bad guy, the social worker shouldn’t be supporting this or they’ll both end up in a care home, it’s dangerous.

Is your DM highly suggestable? If you got her away from your DF and reminded her how much she loves the care home and all the nice things about it and suggested she stay there, would she agree with you? If so, this needs to be factored into the MCA. Does she understand the implications of what she's agreeing to?

@Secondtonaan Have you thought about this from a different perspective? This all depends on whether or not your parents are fortunate enough to have the financial means to afford this.

Would an alternative option be for your Dad to also move into the care home? Some homes have residents with a range of competence I.e. from fully competent through to late stage dementia. My reasons for suggesting this are your Dad wouldn’t have to learn new household tasks, his basic needs e.g. food etc. would be catered for, he would have plenty of company and be able to spend his days with his wife, your Mum.

My Mum always said she lost half of herself when my Dad died and she was so lonely without him. She needed constant companionship which no one could offer her. Your Dad sounds like he is struggling and moving into the home might help him as well.

I know this is an expensive option but I would rather have happy, well cared for parents in their later years than an inheritance.

It would probably be helpful if the people replying on this thread read the OP's posts first.

Without wanting to 'derail' further but if you do work in this field can I suggest you check this assertion out with your legal team/ supervisor before using it in your practise.

The local authority are not the decision makers just because they are the funders of the care (and if you read the OP's posts aren't even the funders in this case). There are two LPOAs. Even if there weren't two LPOAs if someone disagreed with the best interests decision or capacity assessment made by the LA they would still be entitled to ask the COP to consider their concerns.

The LA CAN make a decision about what they will and won't fund. They CAN make recommendations based on their professional assessment of the situation and make a witness statement to the COP to this end. They CAN also refer to the COP if they have concerns an LPOA isn't acting in the best interests of the person.

They CAN also make a best interests decision if there is no other appropriate authority to do so, which if it is agreed with by all relevant parties as a sound decision doesn't require a COP application. If anyone does disagree then they should be given the information about how to make an application to the COP or the LA should refer themselves.

They CAN'T override an LPOA without applying to the court and they CAN'T make a best interests decision in place of the court to determine an outcome between two LPOAs who don't agree.

There is a dispute between the two LPOAs and the LA about both capacity and the best care plan. So it's off to court for a decision.

@Secondtonaan - if you are unhappy with the plan and do want further decision making on it, it probably will need to be you that either formally raises a dispute with the LA or refers it to the COP. The LA are going to avoid doing it if they can and it's not in your dad's interests to do it at all.