What help is there for a 99yr old?

[tompointer]

Hello,
Can anybody please tell me if there is any mental health treatment available for my DH's Grandad?
My DH has always been fond of him but only really visited him weekly. He lived alone in his house and managed somehow.
Last Christmas he went into hospital for 3 weeks with a blocked bowel. My DH's dad (grandad's only son) died at the same time and DH took control of grandad's business.
When it was time for him to be released the social worker was talking about his options which were either a home or sheltered flat. Grandad didn't want either and just wanted to go back to his house.
Somehow we agreed to take him in until he got on his feet. I expected that in a couple of weeks he'd be well enough to go home.
It was literally the next day that a hospital bed was delivered and grandad was here. We had to agree to carers coming in four times a day.

Grandad is still with us. He hasn't even wanted to visit his home. He has a carer 1hr each day to help him wash and give him breakfast, he pays for this himself. I do everything else.
During the past 8 months, we have come to realise that this man is suffering from some sort of undiagnosed mental illness.
I hate to see someone suffer like this and tbh the whole household is struggling to cope.

He can't bear it when we go out (we are allowed to go to work but not do anything enjoyable)
He lies for attention and loves to cause a drama and see us all get worked up.
But I do realise that's just the way a selfish old man might behave and put up with it, however, I am really worried about his mental health.

He is paranoid beyond belief. He is waiting to be abducted and taken to the middle east where they will sell his organs.
He won't trust anyone and randomly refuses to let the carer in because they are 'part of the plot'.
He sits with scissors in his hands and is always going in the kitchen to look for knives (which I have to hide) I fear for our safety.
He thinks he sees spiders in his room daily, he hears voices, objects speak to him. He's always checking up on us and thinks we have been murdered.
He is living in constant fear. Won't let me open the window and even gets suspicious if a parcel my son's bag in left in the hallway.
He is also has a very nasty tongue and complains constantly. He refers to our children ( 8, 19 & 21) as if they are outsiders. He hits my little dog with his stick when we go out.
He goes into waves of depression where he 'wants to die' and literally sits with his head down all day.
He also has been seen throwing his heart medication in the bin.
We have taken him to the G.P 3 times who have been fooled by his charming side and put it all down to his age. He hasn't got dementia, he's far to manipulating and clever for that.
We took him to a different GP and she got him talking and he said some worrying stuff.
That night we had a visit from the Crisis team. I thought they were going to help him. They keep sending different people round and we have to come out of work and tell them the same thing.
Grandad has had urine and blood tests- all fine.
We have had 3 visits from a Psychiatrist who said: " he is suffering from psychosis but that diagnosis can cause lots of problems so we will call it delirium". He was prescribed Quatiapine ( which he refuses to take. I can't make him! )
All they want to do is put him in a home.
Fast forward to a couple of weeks ago and we have decided we can't cope and agreed to look into the 'home'.
They sent another social worker round who recommended a home,
I asked questions about this home and basically, she said it was not a specialist place which worried me. She phoned the home and the owner came straight round. He listened to us and spoke to grandad. This home owner managed to grasp Grandads personality/illness a spot on.
He suggested Grandad should be kept away from the other residents and locked in a room of his own.
Funny, because we have been told all along that he needs to socialise.
The owner also said that he knows the system and no other options are available to us.
I don' know what to believe.
I 've googled the home and was appalled that the CQC rating was 'inadequate'
I don't want him going there.

Does anybody have any advice?
Thanks for reading x

Well it sounds very much like an underlying organic or non organic psychosis, could be linked to depression or just age related. The paranoia is concerning as people who feel cornered can be unpredictable and sometimes dangerous. Before everyone leaps on me that's a clinical opinion widely held in risk assessing mental health rather than an opinion that all those with mental health conditions are dangerous

He suggested Grandad should be kept away from the other residents and locked in a room of his own.

This contravenes the MHA, the MCA and Article 5 of the human rights act. It's very concerning that he would recommend this and I would be tempted to let the CQC know. They monitor inadequate services very carefully and rely on intel like this.

It does sound like he needs specialist help and ongoing care and I would be pushing for a social worker to come and assess capacity under the MCA and consider a best interest assessment not only for him but for you as a carer. or ask for an Approved Mental Health Professional (AMHP) to come and assess under the MHA. Anyone assessing him should take a full history and current concerns from yourself. Social care should consider it a safeguarding concern for children in the house (the scissors incident) and therefore an inappropriate placement / living arrangement.

I wish you the best of luck. The system is slow and useless at the best of times. Keep hammering the social worker they really are the ones with the keys to the castle. Crisis can do little unless the person is detainable and that very much can be down to his presentation on assessment.

If he becomes very acutely mentally ill some ambulance services have mental health teams either in control or in triage cars. A&E departments all have MH liaison teams also. If all else fails this could be a last resort.

I know how hard this must be, but I couldn't put a vile, manipulative man over my children, animals and entire life.

If he won't be physically or mentally abused, I would be putting him in a home.

I know that sounds harsh, and not what you want to hear.

Beccarocksbaby, thank you so much for your detailed reply.
I will contact a social worker for a second opinion.
I have been told by Crisis I need their permission to self refer but I shall go ahead regardless.
I got the impression the home is used by social services as somewhere they place difficult individuals because the owner can cope with challenging behaviour.
At first, the crisis team prescribed lorazepam and it felt very wrong just sedating him for what was basically our own benefit. I gather this is what the home would do though. He mentioned the use of chemical restraints.
It's an eye opener for me. What a sad system.

I've called 111 twice but Grandad turns into a good as gold sweet old man and ambulance won't take him
He puts on an act with everyone and he's very convincing.
I shall talk to the social worker frankly and ask exactly what are his options.

My mother has Alzheimer's and despite meds nothing would take away her anxiety. It was fight or flight with her and she would get quite aggressive.
The CPN suggested a very small daily dose of Lorazepam every morning and it has made the world of difference.
It's not a chemical cosh or sedating her to the point she's unaware of her surroundings, it's just taking the edge of her constant fear. She's able to socialise now and finds pleasure in things whereas before she was forever agitated.
In the right circumstances, and provided they get the dose right, Lorazepam can make all the difference. However if they're just going to pump the old man full of the stuff just to zombiefy him then yes, I would be very against it.
Best of luck.

MaxiPaddy
I completely agree but I do feel I have a duty to care about him too.
I thought when the first social worker was to hear what we had to say that they would section him and place him in a hospital.
Instead I've been told by crisis that "he hasn't stabbed anyone yet"
They told me i need to do some watchful waiting.
Basically they're just a fob off.

I forgot to mention that in 2016 he was broken into and held at knife point. This obviously has something to do with it.

I wish I had proper information to share, but all I can say is that there is no way in hell he would spend another day in my home. He is clearly unhinged and a very serious threat to yours and your children's safety. Scissors and knives? Jesus.

I got the impression the home is used by social services as somewhere they place difficult individuals because the owner can cope with challenging behaviour.

Sadly it doesn't sound very good at all. Challenging behaviour is one thing (I manage care in a CB MH unit for young people) but isolation has to be a very last resort not something suggested at assessment. Also isolation can't be carried out in a bedroom it should be in properly designed suites.

Don't be alarmed by the terminology around chemical restraint though. Any "as required" medication which aims to alter behaviour is considered chemical restraint now whether it's 1mg Lorazepam or full injected rapid tranquillisation. There's a wide use lol.

At first, the crisis team prescribed lorazepam and it felt very wrong just sedating him for what was basically our own benefit.

It's for his benefit to. Living in fear and paranoia must be awful. Constant state of fight or flight is horrific and traumatising for everyone and a strain on his vital organs at 99. Did they prescribe 0.5 or 1mg? Unless he's used it before start low and build up. Benzos depress the respiratory system so you have to watch breathing etc in the elderly.

I wish you the best of luck. It's not as easy as "put him in a home" as people may indicate. You've got to find one willing to take him that has beds which isn't awful.

I work in care, whatever else you decide please do not place or allow a family member to be placed in a home rated as inadequate by CQC.
In my county there is a hospital for older people with mental conditions, once there is a proper diagnosis and a pattern of care to suit established they then go out to a suitable care home or have support at home. Is there anywhere else like this your relation could go?

Thanks for your replies.
He was prescribed 0.5 lorazepam at night and in the morning if required.
His Quetiapine is 12.5mg.

I've contacted social services and they are getting back to me.

I was talking to a carer whom used to manage a home and she said they will not diagnose him with anything because they will have to start paying.
She said they state someone has suspected dementia etc and invite them for a scan but all too often they can't do the test because the patient won't keep still. I suppose this is why they are dragging their feet with us.
She said there are no specialist elderly mental homes around here and the people she's dealt with just get moved around.

I have contacted a 'nice' home this morning to see if they would accommodate him but they said they couldn't unless the delirium was being treated with antibiotics. She was asking what is causing the delirium!?
I think we're stuck with him.

Grandad was Suicidal yesterday for no particular reason. Threatening to take all his tablets and asking me to get him a lethal injection. Today he is agitated and pacing around. I thought about informing the crisis team but then didn't bother wasting my time.
I've been dealing with this for too long now and it's clearly getting worse.
All hope on pinned on social services now.
What an absolute joke that nothing is in place for the older mentally ill.

It sounds like a short stabilising admission to an elderly functional MH ward would really help but beds are very scarce and well protected. It's very frustrating for someone like me who works in that system so I can't imagine how hard it is from the outside.

Keep talking to as many people as possible. Have 111 send a doctor out to assess his MH and risk of needs be as they can start a mental health act assessment if they can deem it necessary.

Good luck x

Can you video him when he's behaving unpredictability? Just so that you can share it with healthcare professionals who only see the nice side of him?

It sounds tough and you're doing so well trying to explore the options for him.

Erm how's his weeing ? If he has issues or a blockage there it can literally poison them and certainly affects their mind ( had this with my usually mild mannered elderly Gandad, who decided his neighbour was trying to kill him which she wasn't )

Has his home been sold so he has funds to pay for a nursing home ? Or is it a case of social services finding him somewhere cheap as they have to fund him?

You sound lovely, and it's a hard decision but I think now is the time.

Yellowbeard; His wee has been tested at hospital- all fine.
He owns his own home which is a complete mess inside and out (picture a hoarders house) he thinks it's full of antiques and won't allow anyone in, nor will he part with anything.
His DD in-law will inherit it (DH mum) but she won't do anything to help and said "I'm not being his carer"

Margot; We have nest cameras throughout the house and have plenty of videos to prove his behaviour. We have tried to show the crisis team but they refused. It's as if they don't want to know.

Becca; So there is such a thing as an elderly MH ward then. Thank you for enlightening me.

Becca; So there is such a thing as an elderly MH ward then. Thank you for enlightening me.

Most trusts will have one for over 65s which covers either organic illness (dementia etc) or functional mental illness (depression, psychosis) but beds will be carefully guarded and delirium is considered temporary so can't be sectioned and detained unless extreme circumstances. The MHA will always have us look at the least restrictive option and that kind of ward is up there with the most restrictive.

He needs a proper diagnosis and a referral to secondary older adult mental health services. Your GP can do this. If they refuse I would want a thorough explanation of why not as he is presenting a risk to you and your family including your children. Most GPS are quite risk adverse so I would push that point home hard.

Oh no! I think we've just made a massive mistake.
I think we've been duped!!
A social worker phoned me on Fri morn and wanted to visit. I said fine and she arrived 30 mins later.
She wasn't interested in what was happening and just spoke about him going into that home. She suggested we 'pop' him into there for a week while we have a much needed break.
We agreed ( what was I thinking)
The homeowner came and took Grandad away.
I felt powerless. It didn't feel right.
We visited him on Saturday. He was locked in a room on his own. He was obviously sedated and quite content, but he mentioned an incident that happened last night where he was injected!!! and yelled for the Police.
We spoke to the carer and she said she wasn't on last night but she said she'd look in the book- but, nothing had been recorded. I asked if he is sedated and she said she doesn't know as she is just a carer and nobody else is available atm.
Its strange because they don't even have our contact numbers and nothing is mentioned about him coming home. We haven't told them anything about his likes/dislikes etc.
I remembered the home owner mentioned something called a deprivation of liberty order. I googled it last night and I am devastated.
Have I lost all say? Will they let him home?? Please say I'm over-reacting
I can see now it was just a huge scam to get him in this horrible home.
Can anyone please inform me if I will have any trouble taking Grandad home later this week?? I sense I will and I don't want to let them that I suspect this because I need a plan of action.

I phoned and asked how he is today but all they say is that he is doing really well and everything is fine ( lies)

Does anyone know what I can do?

@tompointer a DOLS is put into place when someone is unable to consent to the care that is being given, ie constant supervision, behind locked doors, the team are very helpful at giving advice and if there isn't a DOLS in place then they cannot lock him in a room legally. You can ring them and find out and also discuss his care. They will be under your local council if you google your area and DOLS.

Even with a DOLS they may be on dodgy ground.

If he was rapid tranquillised (given injected medication) then not only should there should be several records including

His medication records
His daily running logs
Incident form

Rapid tranq is a last resort for clients that cannot be safely managed in the normal ways. If he's secluded that would mean he would have to have been a serious risk to himself.

It's also essential after a rapid tranq that regular observations of his breathing are taken, along with BP and pulse. There should be a record of this. He should also be reviewed by a psychiatrist/doctor within 24 hours.

HOWEVER

It is not uncommon for psychotic patients to have these kinds of delusions. It's also not unusual for a patient who has an adjustment of medication to be more sedated than usual in the first instance.

Ask to see his medication records (MAR chart) and it'll tell you what meds they have him on. If it says IM that's injectable.

If you're concerned depending on severity

Social Care
CQC
Police (although they are limited in how they can respond)

Also only registered medical professionals can inject people, nurses and doctors or people specially trained to do so.