When does a elderly relitive not have capacity to make choices?

[Lovemusic33]

Not sure if I'm posting in the right place.

A elderly relitive has been unwell on and off all year, several hospital stay, the last stay being 2.5 months. Social services are involved but they decided that he (my relitive) gets the final say and he returned home last week, despite being very frail and unable to care for him myself. He has carers coming in 4 times a day and has a emergency button (careline). Since being home he has used the careline 5-6 times a day, 3 times a ambulance has been dispatched to him but he has refused to go to hospital, the other times either me or another family member has been asked to go and help him, several times because he has messed himself or been unable to get to his commode. He cries and moans that no one is helping him but he refuses to go back to hospital or a home, he expects his family to care for him (we can't, we are doing as much as we can which isn't enough to keep him safe). He now has a bladder infection.

I haven't slept since he's been home as I get calls in the night to tend to him, I have to refuse as I am a single parent and can not leave my dc's in the middle of the night, if no one can attend then a ambulance is sent. I'm tired and mentally exhausted as are other family members.

I have called social services several times and they say they will call me back but they don't. Social services told us before he went home that it would only be a trial and that they would have a care home placement ready if it doesn't work but they are doing nothing to help. Elderly relitive is a mess, very underweight, doubly incontinent ( catheter has now been fitted) and too frail to move around. All I keep getting told is that he still has capacity to make his own choices and he refuses to leave his home.

When does a person not have capacity to make that choice?

I do not think this is a mental capacity case. It sounds like (very common) that adult social care has been placed as he has a care package and in many cases, there has been a discharge from hospital with no OT assessment on his living environment.

Mental capacity or the lack of can only be determined by the court of protection and is hard to establish. That would mean an application either from a family member or a LA representative were there no nearest relative available.

I would place your concerns in writing to the adult social care team at your LA. Lay out your concerns as a safeguarding issue in your relatives case. IT may also be worthwhile speaking to one of the carers so they can document your concerns as they will have a written audit trail of their visits in a file kept at your relatives home. Ask the carer to report into their line manager your concerns so they can activate their end also. Carers can be worth their weight in gold in reporting safeguarding issues. Can assist in pushing the information along to adult social care services.

HtH

His GP or the social worker can carry out a capacity assessment, they can assess his understanding of his mental and physical state and if he feels he is at risk, he is still entitled to express his choices. If he is deemed to have capacity to make all his own decisions, including not having help at home or going into hospital then you could apply for power of attorney if you feel this is something you'd want to do. You would then be able to make decisions on his behalf if he later lost capacity. All this info is available on the mental capacity act website. If you feel he is at serious risk of harm or neglect at home you can call the social services adult safeguarding team. Someone must have assessed him to get carers in, the carers can go back to their manager If they feel he needs more help. If an ambulance has been to the house there should be a copy of each visit at the house which would say why they came, what happened and what advice they gave. If you don't want to respond to the careline you have to ring the careline company and make sure your name is not down as a responder, they will have to find an alternative.
I would ask for a GP review, preferably at his home and a social services home environment and care needs assessment.

To have capacity he must be able to understand the information being given to him, weigh it up to make a decision and communicate that decision back. The fact that he makes (what most people would see as) the ‘wrong’ decision does not mean that he lacks capacity. And that can be very difficult to deal with, OP, I’m sorry you’re in this situation. Good advice above.