Dad wants to live in my brother’s rental house. How realistic is this?

[Denimes5]

My father is currently living in my brother’s house, paying him the full government rent a room scheme amount of £625 a month.

As expected, after a short time, he’s now decided he wants Dad out in the next few weeks.

Dad uses a zimmer, has a full package of care, has a urinary catheter, wears slip pads, often doesn’t get to the toilet in time to open his bowels and so there are faecal accidents.

He gets up at night to use the toilet a couple of times and my brother has to help him.

He doesn’t seem to have much recent memory at all and yet his recent brain scan didn’t show any dementia.

My brother wants to move him into his vacant rental house and charge the full market rental value.

There is no downstairs toilet in this house and I, as POA, would be expected to put a stairlift in.

My father says my brother has shown him round and he would like to live there.

The social worker says it’s actually worth exploring the funding options for this as the council might decide to contribute.

Dad would need a live in carer with support overnight. The cost would be extortionate. Then utilities, council tax, a cleaner, food, no doubt.

I am taking Dad to see a care home tomorrow as I think it might be more realistic.

How likely is it that my Dad’s wish to live in my brother’s rental house will actually be fulfilled?

I have my reservations about my brother’s plans but as POA, I have to consider all views and options.

I’ve spoken to Dad about how quickly his own funds would run out but he forgets.

I’m finding the whole POA situation a stressful place, providing so much support without any support.

The first step is a formal capacity assessment then.
If dad is deemed to have capacity regarding where he lives, the poa for health/ welfare isn't in effect anyway.

I’m not clear on a capacity. You talk about holding poa, but aurely that isn’t relevant unless and until he is deemed to have lost capacity?

I agree with the home arguements but the thing which I think is wholly clear is that this property is not suitable for him. He needs a single level home, probably with a second bedroom for a live in carer, so your brother’s property is utterly unsuitable, so encouraging him to move there and pay full rent looks rather exploitative. Once his property is off the table, you may find your brother’s views are more open to a carehome.

If he has capacity he can choose where he lives, op doesn't need to do anything unless she wants to. I wouldn't be encouraging a stairlift or wettoom, op can only get involved in finances with his permission anyway

Nurses can't do capacity assessment for social care decisions either. It's social workers only.

Oh really, when I searched it did say community nurses can.

Wouldn't a better option be to find Dad an accessible place?

Yes I know they are as rare as hen's teeth because I live in one but there are some around, check with your council and housing associations.

A stairlift would be a risk if cognition isn’t good. You should look for extra care or even a bungalow. Your brother is struggling but you wouldn’t want to move your father into a home with no ground floor toilet only to move him again in a few months.

Not always, some have that route but others are apply directly.

Catheter? Continence issues? Problems at night?
Unless he's 100% on the ball - and you say he's not OP - sounds like it's time for a care home right now.

I may be slightly twitchy on the topic of infection as I know someone who went blind from one. So the thought of wee and poo not being cleaned up immediately...

And by contrast we knew someone in a care home (marbles still all there) who said he thought he was a goner when he went in, but the miracle of being given all his drugs on time and proper cooked meals three times a day meant he perked up a lot and lasted another couple of years.

He wouldn't last long in the rental. I know from the awful time I had in my dad's last year that not having a toilet that's easily accessible is horrendous. My DH was amazing at clearing up shit, but dad seemed oblivious. Dad eventually had a fall trying to find the toilet and never recovered. A care home is the only viable option OP. Sad that you have the hell we went through.

The SW has suggested that Dad might be able to manage with a commode downstairs in my brother’s house if he would agree to use a commode.

He flatly refused to use one in his own home though and preferred to walk the distance to the toilet at night.

I don’t think he would think it would be private enough either.

A commode didn't work for my dad. He felt humiliated having to use one and I didn't like having to empty it!

When Dad was in hospital over the summer, he was deemed as not having the capacity to decide on his future living arrangements because of his lack of insight into his vulnerabilities into why he couldn’t live in his own home. So a best interests meeting was held for the decision. He went back to my brother’s house with a full package of care.

Now that he’s back in the community, it’s as though that never happened and we’re back at the start of it all again with the decision on the next living arrangement looming.

Presumably there’s an element of fluidity with capacity for health and welfare decisions, so you have to know when to step in and step back from making decisions. POA is potentially quite a vulnerable situation to be in.

I don’t think things have really changed that much cognitively since the last best interests meeting though.

I don’t believe the SW has done her capacity assessment for Dad’s ability to make the decision about where he wants to live yet.

A 2 storey property even with stairlift is not suitable for your DF now or for the future.

A single storey flat, sheltered accomodation or care home would be better

Do not move your DF into a house with stairlift

From experince of knowing elderly

Nurses and doctors (and OTs etc) absolutely can do capacity assessments for social care decisions - not all care arrangements are made by the local authority. For example if someone is in a hospice, a nursing home or funded by Continuing Healthcare then it's highly likely a nurse will be the professional completing a capacity assessment about any changes to their care arrangements including any ancillary social care.

Hospital Nurses and Hospital OTs also frequently complete capacity assessments that result in patients being discharged with care packages at home or into residential or nursing care under discharge to assess arrangements.

It's not profession specific it's about who is the best person at that time best placed to make a judgement about the person's capacity about a specific issue.

Capacity can fluctuate and is time and decision specific. Every new 'meaningful' decision for someone who might lack capacity needs a new assessment, no one can rely on a capacity assessment completed a few months ago for a different decision.

Even if the outcome is likely to be the same.

You've tried your best but it hasn't worked out, he wouldn't be having "round the clock care", it would need a full time carer plus someone to cover their time off, plus the house is not suitable and the whole set up would cost a fortune before he even starts paying rent. If your brother is so keen to be involved why doesn't he leave things as they are and employ a full time carer there and keep the current care package, take the rest on himself. I'd push for a capacity assessment and start looking at carehomes.

From experience, my parents had a stairlift and it was brilliant for my mum who had no cognitive impairment at all.

My dad with mixed dementia on the other hand was a nightmare with it, he barged in to it and would stand on the footplate would forget to keep his finger on the controller so it would stop constantly. Would ignore the automation and try to force parts to move.

Stair lifts are incredibly slow and bathroom breaks need a bit of planning, when a person is loosing control of their toileting needs a stairlift is the worse thing possible

It doesn't sound feasible and from experience social services expect the family to step in far more than is reasonable.

I think people get quite confused about capacity. It sounds from what you have said that his cognition could be definitely affected, ( poor recent memory, pulling catheter out). The care home manager who said she thought he might have capacity to make a decision.....remember she absolutely does not know your dad at the level you do. The point you made about his memory and whether he can be supported to retain the information for long enough and show he understands risks and positives, that is the key here as it is evidence of him weighing up the decision.

Things to consider:
Finding a decent care home while he has the money to select a nice one rather than have him fall over and break a hip in an unsuitable house where carers visit four times a day. There will then be less control over where he might be moved to, (its then about finding which care home has a space available to free up hospital bed and all of these moves are traumatic for someone with compromised cognition.) . Someone i know whose dad had limited funds was able to get him into the luxury care home on the basis he had two years of fees and then they will agree to accept council payment pending sale of his house.

Your idea of poa meaning you have to discount your own needs is all wrong. The duties of poa and carer should not be mixed up, but i know they often are. Best interests of your dad does not equate to you having to do the care because he doesnt want to spend the money. Thats unfairness . In fact it is your DUTY as poa to use the authority your dad gave to you, to make the decision to choose safe and sustainable care using your dads funds and PRESERVING your role as daughter and poa, rather than carer. I hooe this helps.

One point to consider that I don’t think has been mentioned is accessing medical care.

Our FIL’s GP practice had an exceptionally poor reputation which it fully lived up to. There was no prospect of a home visit even when ultimately our relative became bedbound. Getting prescriptions etc was extremely challenging despite best efforts of us, fabulous visiting carers and local pharmacy. In contrast nursing home had visiting GP and nursing staff on site so FIL was well attended to and not left in unnecessary pain.

Your situation may be different of course, but don’t discount the merits for your relative of having ready access to expert geriatric and dementia medical care. If in a good facility of course ..,,

Nothing about the current setup with my brother was ever going to work, but he insisted on having Dad at his place with the full package of care.

He is quite selfish and is mainly concerned with what he’s willing to put up with and less so what is best for Dad.

He is fed up with ‘the constant stream of people’ into his house and so on…

He supports Dad at night time, isn’t happy with the situation, but won’t agree to overnight care in his own home for Dad which is why we’re at this point now.

Its not really up to your brother, if your dad has lost capacity then you act with your poa. The 4 visits a day isn't enough, the sw needs to do the assessment ASAP, in the meantime I would seriously think about arranging emergency respite care in a nice residential home, even just for 2 weeks while he settles. Are you managing his finances at the moment. Him moving to the rental house doesn't solve the situation, someone still eeds to offer overnight care. Him not wanting people coming in and not agreeing to overnight care is not in your dads best interests and that has to be the priority.

Your dad needs to be in a care home - don't co-operate with ANYTHING else. Your brother wants him off his hands (and to make money off him!) and for you to do all the work of keeping him safe, fed etc in the new home (it will be a huge amount of work and will only increase, and he'll never be as safe as he would be with professionals on hand round the clock). You'll probably end up spending your money too, when the benefits he's entitled to don't cover all his needs.

If your dad WAS going to rent privately, it should obviously be in a place with no stairs. DB is not putting your dad's needs first. Tell the both of them that dad can stay put or you'll arrange a home - no other options. I reckon DB will get on board with the care home pretty quickly - and if he doesn't, tough.

Sounds like he needs to be in a care hone

OP.
If he is getting up at night to use the toilet/need care then be aware that live in carers have a limit on how many times they are woken. Around where I live it tends to be 1x15 min wake up. Anything else in terms of frequency of waking up or amount of time spent awake and it then becomes waking night care. Which is £££££. Do you have an accurate figure of how many times your dad is awake at night and more to the point how long he is awake for? Are social services even aware of this?