Using health LPA on a gradual basis

[sleepwouldbenice]

Hi all
My elderly father lives alone and has dementia. He can largely look after himself ( gets food, washes etc) and even drives for the moment
His day to day memory is shocking though so i deal with all his admin, reminders, finances etc.
From a health perspective he takes his meds etc and will go along to any appointment I arrange
Eg latest covid vaccine. He won't really recall why he's there but he can largely manage. I can also access his nhs app etc. I also check his post, emails etc

I also have LPA registered etc
So I would say he has mixed mental capacity?!

I just want to make sure I dont miss out on any info because he forgets things and cant attend all appointments

I was wondering what I could /should do with the LPA to keep in the loop. Should I issue to his gp, hospital referrals etc . Is there anything else I should do?
Thanks all!

You can't use the health lpa until he has lost capacity. It's still worth letting GP know you have it. Also get your number on his records so they can contact you. They often phone a mobile first these days. My dad's capacity is ok but he forgets things and gets muddled if harassed.

Capacity is judged on a decision by decision basis - your dad may have capacity to take his medication regularly, but (for example) not have capacity to decide whether to start or stop a new medication. So absolutely get it registered with his GP hospitals etc even if there are still decisions he can make on his own.

If ReSPECT forms are a thing in your area have a look at them and a proper think/talk about what he wants for his future and make sure you are listed on it.

Thanks. So this is what confuses me. Even though I know he has some capacity and would largely always do as doctor recommends, and talk to me
But I would just want him not to miss out on something simply due to forgetting!
So I still let both the gp and hospital know? But does that mean they'll want me to make every decision for him? Dont want to take over, just keep a watchful eye

A good example is when he got his dementia meds and was supposed to gradually increase them. He wouldn't remember to order increasingly higher dosages, then take them i sorted all this
He'll pick them up from the chemist and take them daily though
He also forgot to take them at night and didn't notice he hadnt, I picked this up and sorted it
But without some knowledge I wouldn't know
Thanks again!!

While the previous poster is correct in saying that you can only use the Health LPA to make decisions on your dad’s behalf if he lacks mental capacity to decide for himself, you can definitely register the LPA with health professsionals and GP/pharmacy and explain that due to his dementia, you’re happy to act as a point of contact and help advocate for him to ensure he’s able to maintain his health and wellbeing. You’re legally entitled to do this in your role and professionals should be able to share his medical information with you (either with your dads consent if he has capacity to give it, or without your consent if he doesn’t on the basis that you’re his attorney)

I’d recommend reading OPGs how to be an attorney guidance and skimming over the Mental capacity act code of practice as it really is quite useful for navigating situations like what you’ve described

Thank you all. Useful guidance. Hadnt thought about chemist!

I’d contact whoever you need to and state that you have LPA for him and that he only has mental capacity for some decisions. You may need to model this for them, eg say the bits you need to happen, but if there is a choice to make that you think he could make for himself, say that you will talk it through with him and report back.

@sleepwouldbenice Health LPA is usually for very difficult decisions. So not treating something because treatment would be too difficult, or agreeing to an end of life pathway when the person cannot agree to it themselves. If it’s just forgetting something, you can advocate without any LPA being in place. Many of us do. The LPA only comes in after capacity is lost and major decisions are made about care.

That is absolutely not true MeetMe. Capacity can fluctuate on a day to day basis and LPA does not have to be for all decisions and certainly does not only have to be for major decisions

The OP (and the medical professionals) need to ask themselves does the person have the capacity to understand each individual decision and the consequences/implications. Does the person have the capacity to carry out the decision. This ca be as simple as deciding whether or not to take tablets, having the capacity to remember to take them and having the capacity to organise ordering them.

They still have the right to diced NOT to take tablets, even if that is a bad decision, but only if they have the capacity to fully understand the consequence of that decision.

@Comefromaway No one asks for a LPA for health when an adult is confused. Obviously you activate the finance one. I’ve never been asked for one when I had to discuss dm. Never. Doctors just discuss what next and treatment. I’m not saying don’t have one, but you don’t get asked for it in the circumstances op describes.

My parents were attorneys for an elderly lady for several years before she died. She had fluctuating capacity. Right up until the end she was able to be involved in some decisions but she did not have the capacity to understand the implications of many every day decisions.

Her GP surgery absolutely did ask for a copy of the LPA and there were other health professionals too who made an assessment of her capacity. This meant they were able to help with things like organising appointments on her behalf, dealing with medication and they were able to request that all phone calls went via them as although she had the capacity to make some decisions, she did not have the capacity to remember a call from the GP or the advice given to her etc. This meant for example that appointments were not missed.

If he has capacity to do this, he can simply give permission to the GP to share information with you- no need to rely on the LPA.

You don’t need a LPA for appointments, collecting meds or even making appointments. What GP phones anyone? I never had LPA but did all of those for DM.

I got my DM to sign a form with her GP stating that DB and I can speak to them on her behalf and that they can share details with us. We have LPA but that has only been used once when she was delirious on morphine following a broken leg. Her GP surgery does sometimes phone me for clarification because Mum tends to wander in and start rambling on at the receptionist a bit, but she has definitely not lost full capacity at this point. I also phone them as I have no means of contacting them online (their system is for registered patients only).

I noticed in your first post you said your father still drives.

From what you say further on I think you should seriously consider whether this is still wise.

Regardless of anything else why is he still driving???

I wouldn't say that's a mental capacity issue, tbh. It sounds like he was happy to make the decision to take the medicines (which is the capacity bit) but found the execution of his decision more challenging.

Capacity has 4 elements:

Understand
Retain
Weigh/decide
Communicate

So if he can understand that his medicine is changing
Retain the information long enough to make a decision
Weigh up the options (to take it or not)
and
Communicate his decision to you (even if just a nod of agreement)

Then he has the capacity to make the decision.

If he then, having made the decision, can't remember what he was meant to do, or to go and get the medication, etc., you can help him with that.

Remember too, that steps such as breaking down information, giving pictorial information, giving information at a more appropriate time, or breaking the decision down into a series of decisions, can all be ways of helping someone make decisions that may at first seem beyond them.

An example from our situation, which might help, although more of a property and finance decision:

DD1 has mixed capacity. She has new carers coming and she doesn't like using the lounge to meet with them. We thought a log cabin in the garden might be a good use of her money. But, they are expensive, and variable in quality.

Understand - DD1 understands that a cabin would be good. She doesn't understand that some companies are passing off poor quality cabins as if they are good. She understands that you can buy cabins new or second hand, but she doesn't understand that an ex-display cabin might be better quality than a new one.

Retain - DD1 has variable retention. She retains the minor details but not the 'big picture'.

Weigh - DD1 finds weighing information very difficult and is very impulsive. She just wanted to go home because the road was loud.

Communicate - DD1 communicates that every idea is brilliant as long as we get it done.

Overall, we decided that she didn't have the capacity to decide what to buy, so we made the decision for her, but let her choose the paint colour.