FIL going wandering

[Fairyflaps]

FIL is in the process of being assessed for dementia, and is living in his own home with carers coming in 4 times a day, as well as a district nurse once a day. This is all fairly recent since suffering a series of health issues earlier this year including repeated UTIs and several hospital admissions. He wants to remain in his home and Adult and Social Care are doing what they can to facilitate this.

He has not found this easy, which is understandable, and has been resisting every intervention. He's always been a difficult person, but this is now manifesting in unpleasant ways, like deliberately emptying his catheter bag onto the (carpeted) floor, or taking off an incontinence pad that he has had a shit in and just leaving it where it is, saying the carers can deal with it. He has done this in front of visitors. The carers do deal with it, but they have to do this in the time they have available, which means they have to rush to get the essentials done. The few friends he had have stopped visiting.

DH has power of attorney, so he can make decisions, but cannot overrule his DF. They have never had an easy relationship, and FIL is unpleasant to DH, and will accuse him of controlling him, and ordering him about.

The latest problem is that FIL has started wandering off. Previously this wasn't such an issue as he wasn't physically well enough to go anywhere beyond his immediate neighbours. But twice in the last few days he has been missing when the carers have arrived and the police have had to be called. He has been found both times and has luckily not been hurt. But he lives in a rural area with no streetlighting or pavements and especially now the days are getting shorter and darker, the risk of him coming to serious harm are more likely.

Although he is apologetic to the police for putting them to any trouble, he still takes the attitude that he can do what he wants and people shouldn't try and stop him. There is no way he would agree to any sort of tag or tracking device. He already refuses to wear his help button or use his mobile phone. Adult and social care are looking at options for paying people to take him out, so he doesn't feel so stuck indoors.

The carers say they can't lock him in, which we understand.

What are the other options for keeping him safe if he is unwilling to cooperate?

For the wandering - things like a video doorbell which would track who is leaving the house. You can also get sensor mats for the doorstep, or magnetic alarms which will alert someone to him leaving.

But all the other stuff does sound like he is struggling in a lot of other ways. I don't really understand what you mean about the Attorney not being able to "overrule" your FIL, that is what POA is for, being able to make decisions for people who are not able to make those decisions for themselves. I think it would be wise to speak again to social sevices and social care and explain what is going on, and that things are deteriorating.

Fill in a form called the Herbert Protocol and let the police have a copy - it gives them all FIL’s details if he goes off again.
Keep spares for local shops, etc..

Get a door alarm that streams to your phone so at least you know which direction he went.

Pin the tracker on the back of his clothes so FIL can’t take it off.

Yes, POA is exactly for overriding decisions made by anyone without capacity. That doesn’t mean DH can somehow stop his father bolting, though.

Don’t mention the wandering when FIL needs to find a care home. They don’t like it.

If he’s only being assessed for dementia and hasn’t got a diagnosis of it or a provisional diagnosis of it, then capacity has to be assumed to be there. Therefore your DH cannot use his PoA. That only kicks in when capacity has been lost and some sort of assessment has been done about that.

@lovelycattus yes, that's the situation with the POA. Currently DH is doing things that FIL is unable to do/ has no interest in doing (managing the bank account to make sure bills are paid, SORNing the car, applying for attendance allowance). But he can only make decisions with FIL's agreement. E.g. he can't stop FIL making large bank withdrawals. Maybe this wandering will encourage them to speed up the assessment.

Thanks for the Herbert Protocol suggestion @Supersimkin7 we'll get him signed up on that.

We could do a doorbell to alert us when he left the house. It wouldn't tell us where he went. It's quite rural so his only options are the immediate neighbours who know him and the situation, or a national speed limit road with no pavement.

Regarding not telling a care home about the wandering, it is already going to be difficult to find one due to his deliberate soiling. If he continues to leave urine and excrement everywhere (this goes beyond incontinence), not many care homes will want him, and any that do take him are likely to keep him isolated from the rest of the residents because he is a biohazard.

It sounds as if your husband is using financial POA to help your FIL, but unless he also has health and welfare POA he cannot make H&W decisions on his behalf. The way round this would be a best interests meeting between the family and social services to agree the type of care your FIL needs. His wandering is a safeguarding issue.

In terms of tracking him, you probably can't. My mother had a tracker bracelet but removed it as soon as the carers left. And there was no point trying to conceal a tracker because she wore a range of different clothes, and often failed to take a coat or handbag with her. Paying people to take him out is not likely to help, because when he wants to go out, he'll still just go anyway. My mother had a daily carer who took her to the park/shops etc, but as soon as she left mum would launch out on her own anyway.

Care homes will not be concerned about wandering, it is extremely common, it was the main reason I moved my mother to a care home and they were not at all bothered by it. Dementia care homes have a locked door policy so no wandering was possible.

The deliberate soiling is an issue but the time is approaching where the only way to keep him safe will be a care home, so Social Services will need to find a solution.

You can only be honest with the care home. For the right home, he won’t be the only one doing this.

Has your F had a mental capacity assessment about any particular decision such as where he wants to live, whether he wants carers coming in etc? The decision in particular on whether he wants to be kept safe or to keep making his own decisions even if it means he dies of exposure or being run over? If he’s being assessed for dementia then there is at least a question mark over whether he has a disorder of mind or brain, so a capacity assessment could well be appropriate. Check with his GP?

Has he had a capacity assessment done recently? Sounds like the local authority need to assess whether he has capacity to make decisions about his residence/ going out by himself etc. If he lacks capacity your DH can make decisions on his behalf. If he is a danger to himself (and potentially others, depending on awareness of road safety) then secure accommodation or a care home may be preferable to the current package of care in the community

DH has both financial and health and welfare LPAs for FIL, but while FIL is judged still to have capacity, he can only exercise the financial one with FIL's consent and the health and welfare does not come into force.

A demential assessment is now underway, so I suppose that will include a capacity assessment. He has been showing symptoms of dementia for several months, but as he has also been having repeated UTIs, it wasn't possible to determine whether it was the result of the UTI, so not necessarily permanent, or dementia. He's now gone a couple of months without a UTI so an assessment is possible.

FIL didn't want carers coming in. He only accepted them as he wouldn't have been discharged from the hospital without a care package in place. Out of carers or staying in hospital, he chose carers. He now tolerates them, though he is not nice to them. He has refused occupational therapy. He wants to stay in his home.

He is now the healthiest he has been since he was first hospitalised earlier this year, but he is still very frail and prone to falling. Up until now he wouldn't have been able to make it any further than his neighbours, though there was a disastrous outing by car. Luckily nobody was hurt though several vehicles were damaged. He no longer has access to his car keys and has surrendered his licence under police advice.

If he is assessed as having capacity, I think he would choose independence, and not being told what to do over being kept safe.

@catofglory you're right. There is nothing we could do to track him.
And while paid people to take him out would improve his quality of life, it wouldn't stop him wanting to go out whenever he felt like it.

A Life360 sticker is small. If he has something like a particular pair of shoes he wears you could attach the sticker to those quite discretely. They don't have GPS but will ping a signal when close to a Bluetooth device. I'd say that was an acceptable way of trying to keep a vulnerable person safer.

Believe me, there are many other residents in care homes just like your FIL. His behaviour is as a result of his illness - I’m pretty sure his younger self would be mortified if he could see some of his behaviours now.

I would suggest contacting adult social services again and ensure that they are aware of the wandering and danger situation, as soon as this occurred in my situation they authorised respite against her will and sorted the paperwork, took 48 hours though already had the diagnosis from the gp

@Fairyflaps it is possible that his assessment will find he doesn't have capacity, in which case SS can go ahead with finding residential care for him and your husband can use his H&W LPA.

But failing that, in this type of situation what tends to happen is that you have to allow the at-home package fail. Which it will do one way or another. He will have a serious fall and end up back in hospital, or he will put himself in danger in some other way. And at that point SS will decide he does not have capacity to make decisions and a care home will be found.

It is very hard on the family in the meantime.