Psyche evaluation

Moody_Mare

My grandfather is still in hospital, so far we have arranged his live in nurse and been granted through the social work department direct payments to help toward this. Up to now his needs have been considered as social i.e 24/7 supervision due to confusion although not diagnosed as why. I have just been informed that he can not leave hospital as yet because he has to get his own socoal worker to do a financial assesment? ( I thought this was only required when going into a care home?) and he has just had a psyche assesment which he failed badly and is classed as a danger to himself. I am never told about these things before they happen and never get anything in writing from them after all I am only a close relative and primary carer.

They now say he would need more than 24 hour home care and that a nursing home would be better although this goes against his written wishes. Does any one have a clue as to what is going on? as I am being stone walled at every turn and they keep moving the goal posts behind our backs.

They state he does not have the capacity now to make a decision but they want to go against his written and the families wishes. Can anyone advice please as my stress levels are through the roof:A

Savvy_Sue

I am sorry, but you probably need to at least skim this thread to find out about Continuing Health Care and the hoops you would have to jump through to get it. However I think you will also learn that assessments shouldn't take place without you being present, that questions about finances shouldn't be asked before the assessment has taken place, and useful things like that. But note that this is only my rough understanding as I have not yet had to go through this.

One thing jumps out at me: if he is confused and lacks capacity, how are they going to assess his finances without your involvement? You might ask them that, although you might want to resist giving financial information and repeat that your intention is that he should return home, with the following arrangements, and will they please involve you in an assessment of THAT plan.

PALS at the hospital where he is might be helpful - it's the Patient Advice and Liaison Service.

Counsel and Care and Age UK might have useful info on their websites.

BTW you mention his written wishes: did he grant Power of Attorney to anyone?

Moody_Mare

Thank you for taking the time to reply, his written wishes are in the form of an advance directive as he did not believe he would ever need a power of attorney. There is no PALS service at this hospital, they take the view I need not be involved except to hand out financial info and I would have the power to sign him into a nursing home! But not to help facilitate his wishes, I am furious that they did this psyche assesment without even telling me that they would do this let alone ask me to attend.

I have no confirmed diagnosis and they will not let me have one, I think I am just supposed to right him off. He is not eligable for NHS funded care as his problem is social rather than medical although I have seen no paperwork regarding any of these tests as I am not allowed too.

Savvy_Sue

Sorry, but I thought ALL hospitals HAD to have a PALS - it may have a different name, phone the switchboard and ask how you make a complaint, that will get you through to them ...

monkeyspanner

Moody_Mare wrote: »

Thank you for taking the time to reply, his written wishes are in the form of an advance directive as he did not believe he would ever need a power of attorney. There is no PALS service at this hospital, they take the view I need not be involved except to hand out financial info and I would have the power to sign him into a nursing home! But not to help facilitate his wishes, I am furious that they did this psyche assesment without even telling me that they would do this let alone ask me to attend.

I have no confirmed diagnosis and they will not let me have one, I think I am just supposed to right him off. He is not eligable for NHS funded care as his problem is social rather than medical although I have seen no paperwork regarding any of these tests as I am not allowed too.

Prior to discharge from hospital the PCT must at least do a Continuing healthcare funding checklist. If this gives a positive result (and it is designed to be lenient in its assessments) then the PCT must organise a full DST (decision support tool) based CHC assessment. You say he is not eligable for NHS funded care so I assume a checklist has been done. Under the National Framework for CHC, as his representative you should have been informed about the result of that checklist and have been given the chance to comment and challenge any of the results.

One comment I would make here is that if the hospital are of the opinion that he is a danger to himself then his needs are most definitely not social they are medical but the NHS may try to assert otherwise.
For more information on mental health you could try this fact sheet.
http://www.counselandcare.org.uk/category/advice/pdf/memory-loss-depression-confusion-and-dementia-guide-9
There are powers under the mental health act to have someone sectioned for 28days for a full mental health assessment if it is believed they are a danger to themselves or others.

I have no personal experience of this particular area of CHC funding and I am unsure if you will be able to ensure his wishes are complied with. CHC funding can however be provided for any care setting including ones own home and the assumption that care in this circumstance can only be provided by medically qualified people has been relaxed so that a mix of qualify and unqualified care is acceptable.

My advice would be to stand your ground and insist that a full CHC assessment be carried out. If you believe the PCT (via the NHS trust) is excluding you from the decision making process. I would complain in the first instance to the PCT and if you make no progress go to the SHA (Strategic Health Authority) who have the power to review the PCT's proceedure and enforce compliance with the CHC National Framework. It would probably do your case no harm to approach the SHA now and ask for your concerns to be noted. They may tell you they cannot get involved until all proceedure with the PCT has been exhausted but at least you would be flagging to them that the PCT is not following the correct proceedure.

I hope you make some progress.

monkeyspanner

I think you may find the NHS CHC Practice Guidance Notes document informative, here is a link.

http://www.adass.org.uk/images/stories/National%20Leads/Continuing%20Healthcare/CHC%20Practice%20Guidance%20dh_115477%20final.pdf

The relevant sections start at section 11.7 and it appears there may be some case law to support a patient's wishes to remain at home (see Gunter case) but the circumstances are different in that Gunter was a young patient who could still express a wish to remain at home.

Moody_Mare

Thank you Monkeyspanner for all your good info. I have put in a complaint to the PCT since speaking to then they too have been getting the run a round from the hospital and have discovered some lie's being told too.
Can you tell me if the strategic health authority applies to Scotland as well? as I can find no details from them here.

I did also try to speak to PALS at this hospital but they do not have this as I triple checked. Many help for all your advice, the fight has begun.

Savvy_Sue

Moody_Mare wrote: »

I did also try to speak to PALS at this hospital but they do not have this as I triple checked. Many help for all your advice, the fight has begun.

But they must have SOME system for logging compliments (if only!), complaints and comments.

sleepless_saver

Moody_Mare wrote: »

Thank you Monkeyspanner for all your good info. I have put in a complaint to the PCT since speaking to then they too have been getting the run a round from the hospital and have discovered some lie's being told too.
Can you tell me if the strategic health authority applies to Scotland as well? as I can find no details from them here.

I did also try to speak to PALS at this hospital but they do not have this as I triple checked. Many help for all your advice, the fight has begun.

Is your relative in Scotland then? The whole system is rather different from England. I don't think PALS exists for one thing. Have a look at the Age Scotland factsheets on care/hospital discharge procedures etc (number 37s on). They also have a helpline, but worth looking at the factsheets first as it's complicated.

This (government) site sets out your rights as a carer in Scotland, and this is a link to organisations in Scotland who may be able to help if you get stuck.

monkeyspanner

Moody_Mare wrote: »

Thank you Monkeyspanner for all your good info. I have put in a complaint to the PCT since speaking to then they too have been getting the run a round from the hospital and have discovered some lie's being told too.
Can you tell me if the strategic health authority applies to Scotland as well? as I can find no details from them here.

I did also try to speak to PALS at this hospital but they do not have this as I triple checked. Many help for all your advice, the fight has begun.

Sorry I did not realise you were in Scotland the documents I referred you to relate to England. I am unsure how the health system is structured in Scotland but will do some research and let you have anything I can find.

sleepless_saver

There is an Independent Advice and Support Service which is specifically for NHS issues in Scotland. They should be able to help you, and are contactable via CAB.