Dols

[hjor20]

Advice please.
Elderly grandparent in hospital. Deemed medically fit but unsafe for discharge due to needing carers x4 a day. Admitted 2 weeks ago for chest infection and vomiting blood. During this admission no investigations have been done to identify route course of the bleeding.
Social worker, physio and OT now demanding best interest meeting due to her not engaging in physio and refusing hospital bed and carers. She's accepted and agreed to full care and hospital bed, she just isn't happy about physio in the hospital due to having torn tendons in feet and in a lot of pain, and the fact she is blind. Happy for physio to attend at home in a familiar safe environment.

I feel like they're not listening to my grandmothers wishes and pushing for best interest meeting so they can put a DoLs in place. They have mentioned dols a few times.

What can I do? The nurse yesterday offered to get her a book to read because she's that bored- she's blind for god sake!

Where has patient centred care gone??

I do agree, the assessment will be very quick, there will probably be 2 staff and it will soon become clear that she cannot weight bear at the moment and that should hopefully lead to a more intensive and appropriate safe care package and funding.

Remind the staff that we are all allowed to make unwise decisions, regardless of if we have capacity or not!
imagine if we tried to stop people doing drugs that can kill them or sports/activities that are dangerous or staying in relationships that are damaging/harmful! We allow people to do all those ‘unwise decisions’ because we are allowed individual choice.

your grandmother has that same rights, she has been deemed to have capacity in the area and is allowed to make choices that some health professionals don’t like.

however- I would urge you to be involved in meetings, Pals is a good shout, and ensure her care package is in place with IT/Physio calls booked in etc.

Maybe auntie should be involved in any meetings as she lives with nan and cares for her. She should know the real home situation.

Kindly, if she's not engaging with physio in the hospital she's going to be massively deconditioned and will certainly struggle to transfer when she gets home. Is she allowing them any input at all?

@Louisetopaz21

Can you answer me a question please?

Is it standard to do a Dols assessment weeks after SS agreed DM should go to a care home?

We have poa and are self funding but dols have come out of the woodwork and are deciding if we have done against her human rights etc.

It feels like someone has contacted them although they have said otherwise ! 🤔

The process is that the home submit a form 1 to the local authority and they will triage it and decide when to allocate to a best interest assessor due to lack of resources it isn't heard for there to be a delay. A DoLs is to independent assessment to look at what restrictions are in place and if they are least restrictive, necessary, proportionate and in the person's best interests. The local authority have a legal duty to carry one out when made aware of the person and it isn't anything to worry about. They will not be criticising decisions you have made as you obviously had reasons to place mum just a safeguard as all families are not like yours xx

@Louisetopaz21 thank you
Yes she has dementia and lived alone . We were doing our best but she got lost , set fire to two microwaves , couldn't care for herself and the list goes on

It's been an incredibly stressful few years and frankly I'm cross because I thought the worst was over

I'm in the process of liquidating her estate and buying a care annuity so I'm astounded that it's happening when it's pretty much too late to over turn

Thank you for the info though .. as I said to the assessor why would I put her in a care home she didn't need and spend her substantial estate when it wasn't needed . I guess there are some strange people in the world but I can't imagine anyone doing that.

That. They're only wanting an assessment. Not treatment. Without that assessment she might not get the support and equipment that she needs when she gets home. And having nursed my late husband, having that equipment was a game changer, and what enabled him to be cared for at home.

I'd try to get a compromise from her. If she'll allow an assessment you'll enable her to discharge herself if need be.

Thankfully today she's demonstrated she can get out of bed and onto commode to do business. So feel like we're a step in the right direction now 

Sounds like you supported her to be independent at home as long as you could. You sound like a lovely daughter and i always say to families I am not here to change anything or criticise. Unfortunately they are who have different motivations sadly. Sounds like you made the best decision for mum xx

If there has been a capacity assessment done and it has been decided she has capacity then there is no need for a DoLs. She can make the decisions for the restrictions herself because she has capacity. She has capacity to say no. If the professionals then think she is placing herself in danger they will need to reconsider if she does have capacity. The 2 things are not exclusive of each other. It is possible for her to have capacity for some things but not others. It is not black and white.

@Louisetopaz21 thank you and yes I've done everything I can to enable her staying at home but she was becoming dangerous to herself and others .
It's so sad but I'm worried because she will tell the assessor she wants to go home even if she doesn't know where home is anymore

I'll deal with what happens and I get why there is a necessity for your position but it's added stress I could do without 🙈

just a couple of points that may help:

Capacity is decision specific. This means for example, she may have capacity to decide what to have for dinner, but not where she should currently live. Or capacity to decide whether she has a hospital bed but not whether she needs to stay in hospital or not. Therefor capacity needs to be assessed for each decision.

Secondly - if she is stating repeatedly that she wants to go home, and the staff are stopping her from doing so (or would stop her if she tried to actually leave the ward)then she would be deemed to be under constant supervision and control and not free to leave - and this would need to have a legal basis to it. The only way this could be legally enforced would be through a DoLS (or use of the Mental Health Act which would not apply here.) So I would agree that this would need a DoLS assessment - which should also include an assessment of capacity around her decision to stay in hospital. The outcome of this assessment could be that she does in fact have capacity to choose to leave hospital (even if this is felt to be unwise) and therefor she would have to be allowed to leave, or if she is deemed not to have capacity to make that decision then a DoLS should be in place. This would not be a bad thing as it offers legal protection and affords her certain safeguards and rights.

The decision about whether or not to engage in physio would again be seperate decision. DoLS would not really be relevant here, but again her capacity to make this decision needs properly assessing (ie is she able to understand, retain and weigh up the infromation regarding engaging with physio and then able to communicate her wishes)If she is deemed to have capacity to make this decision then she has the right to refuse - wether or not this is considered an unwise decision. If she is deemed not to have capacity then a best interest meeting could be held to decide the best way forward. However - I dont see how in any circumstance they could then "force" someone to engage with physio without them wanting ans this would be practically impossible and potentially involve very retrictive practice which would not be justified.