Nan refusing residential care and Mum can't cope - what now?

poorlittlefish

My Nan is 93 and has been diagnosed with dementia. Some days she is lucid and others she is extremely confused. She is also registered blind, wears a hearing aid, is unable to walk (in a wheelchair) and is sometimes incontinent. She and my Mum live together but my Mum is physically and mentally unable to cope any longer. Nan is currently in hospital but they want her out and have suggested residential care but she is refusing, saying she won't allow my Mum to "control" the house if she's not there. The house is in their joint names.

Nan currently has carers in first thing in the morning to get her up, washed and dressed. Mum feels like she has no life because she can't leave my Nan alone, but at the same time she hates the thought of asking for increased carer visits because she she'd still have to be around to have strangers in the house several times a day. Neither my Mum or Nan seems willing to compromise and I'm not in a position to help as I live a long way away. Nan is convinced that Mum "hates" her but this isn't the case at all; she simply can't cope.

If Nan refuses residential care can she be "overruled"?
As Mum can't cope with Nan can she be forced to carry on?
As the house is in joint names is there any risk of my Mum being forced to sell her home to fund residential care?

I'd be really grateful to hear suggestions from anyone who's been in a similar situation with an elderly relative - thanks.

thorsoak

First of all, hugs to you and your mum - it must be so hard for her - and for your Nan too really.

Has your mum looked at this website - it might be of help. It is http://www.carersuk.org/help-and-advice/who-do-you-care-for/item/958-caring-for-an-elderly-parent

Hope this is of some help.

HTB_newbie

Hi

I just wanted to say that I feel for you and know how difficult this can be. My Nan is in residential care following a stroke resulting in dementia. She is as you describe sometimes completely lucid other times not at all.

Perhaps your mum can speak with the hospital? They have a duty of care and I believe that they cannot release your Nan without an adequate care plan in place. If you Mum cannot provide the constant 24hour care (even with the help of careers) then the hospital may not be able to release her home and, unfortunately, your Nans choices are taken away. More so should (after assessment) it be decided that your Mum (or someone else with permission of the family) can apply for power of attorney due to your nan's incapacity. Perhaps you Mum can ask for an assessment of her mental capacity?

This is a horrible situation and your have my heartfelt good wishes. We found it terrible, my Nan just wanted to go home where she knew things and felt safe. She was frightened enough without being in unfamiliar surroundings. My Mum just wanted my Nan to be safe and looked after as needed. My Mum felt very guilty and my Nan would cry and ask her why she did this to her. But months on the residential care feels to Nan like home and she is happy there. Nan realises how much Mum does do for her and they have a very strong bond. There may be light at the end of the tunnel

My understanding is that you Mum will not have to sell her home to pay for care fees.

z.n

As house is in joint names my understanding is that it is ignored when it comes to calculating entitlement to homecare/care home fee assistance unless this was done recently in anticipation of avoiding care home fees.

When MinL was discharged home from hospital a care plan was put in place organised through the local council. We found that important decisions such as medication changes, when to call district nurse etc were made by carers independently- if a formal care plan is in place then from an insurance point of view they are very careful,have to record everything etc. They were very good actually and tried hard to work round FinL. There was inevitable disruption but also the comfort of knowing help was on its way. The plan meant four care visits a day ( a key was left in a hidden place so they could come and go without always disturbing FinL) and the supply of things like a hospital bed and hoists. The hospital arranged everything (a few hiccups but there is a well trodden system that gets there in the end.) It was not expected that FinL be on duty 24/7- the care package was assessed as if he was not there. Over time he felt able to go out and about for an hour or two as he knew carers would be in. When MinL became confused then the carers spoke to district nurses who in turn spoke to social services. A social worker was appointed although MinL went back into hospital before the social worker got properly involved.

It was a bit muddled as MinL did a power of attorney during a lucid phase and this was in place but basically the carers and district nurses took all the right decisions anyway. At one point when things at home were getting too stressful for FinL they organised respite care in a local home. I think the key was to be willing to cede some control and trust their judgement when they considered a change needed to be made- we still had to push a bit when we thought a change was due and they were a bit slow. FinL struggled with the regular invasion into the house by chattering care workers- they learned pretty fast to leave him alone I think. MinL was very grateful for their help though.

The bigger problem was the complete lack of integration between the local services and the hospital and the erroneous belief that MinL was 'rich' following a financial interview in hospital by some idiot who failed to realise she was confused and answered yes to every question put to her. Once at home the financial assessment process wasnt too bad in the end and carried out very sympathetically and fairly by the local authority (although the expense of the visits was significant they were necessary if MinL was to be enabled to stay at home and she did have some cash of her own.)

The other main issue was the delay between the care package being assessed and actual discharge meant that the package was inadequate at the point of discharge as MinL became ill again- but the hospital still discharged her (leading to stress all round as carers could not follow plan etc and medication was inappropriate, district nurses in meltdown and GP misinformed leading to an emergency readmission to hospital and having to go through the whole process again a month or so later. In theory they are only supposed to discharge if a suitable care package is in place.

So I would suggest your mother having a full and frank conversation with both the hospital and social services as necessary. Ultimately, if your Nan is confused they will take the decisions in Nan's best interests. The fact that Nan doesn't like it will be irrelevant if home is not the safest and best place for her. I have a friend who has just taken the decision to put an elderly parent in residential care and feels awful about it- but also knows that this is the safest place as confused parent was trying to get out of bed in the middle of the night etc and falling. The parent is not happy about it and access to the phone has had to be limited as the parent was ringing child to complain all the time. Sadly, sometimes one has to be realistic-the situation has no happy solution. It may take a few weeks to organise though and there will be pressure to discharge from the hospital.

Mayflower10cat

http://www.ageuk.org.uk/Documents/EN-GB/Factsheets/FS38_Treatment_of_property_in_the_means-test_for_permanent_care_home_provision_fcs.pdf?dtrk=true


Page 6 gives information about property. If your Mum is over 60 and/or the full time carer living there, then the house cannot be used to calculate capital.

We're facing something similar with my inlaws; they are both in respite care after my FiL fell, before Christmas, and fractured his hip. FiL has been 'attempting' to care for his wife for about 18 months. They both have dementia. He is worse than she is at present. Social services have assessed them both and FiL has been assessed by the hospital and mental health team. They are deemed a danger to themselves and need 24/7 care. Both are vehement they are 'going home' and don't need any outside help. They have turned away social services on many occasions. My sister in law lives an hour away by bus and has been visiting almost every day, cooking, cleaning, shopping and being abused verbally by her Dad. She retired last year and her husband retired just before Christmas. They have had no time to enjoy each others company or relax.

My sister in law simply cannot cope anymore. With both parents in respite care (and safe) it's become blindingly obvious that they need to be in a Care Home. They cannot even cook for themselves anymore, it's too dangerous.

We have found that you simply cannot 'force' anyone, even if it is THE best thing for their well-being and their safety, to accept care in the home, or to move into a care/nursing home. All you can do, is get as many experts to agree that it is in their best interests. That's what we've been doing, plus a few little white lies along the way. For instance, FiL's discharge from hospital was conditional that the recommended level of care was in place. We simply told him that he had to recuperate for 2 weeks minimum in the same carehome as his wife - or they wouldn't discharge him. And that the medical team agreed. He accepted this, which was a breakthrough.

I fear there are many more little white lies yet to come. The next step is persuading them to move into a very nice specialist dementia care home which is just a few miles away from us. My sister in law is at breaking point and her husband quite rightly is not going to allow the abuse and lack of any thanks or simple courtesy any longer.

I wish for the best outcome for you, your Mum and your Gran. It won't be easy, but cross your fingers behind your back as you tell one of those all important little white lies....

hippihaz

I work on an elderly care ward and from what you've said she only has carers once a day, usually the maximum care package provided is calls 4 times a day, so if she is refusing the idea of a residential home, I would expect this would be tried first. Only if she has such needs that it's deemed they cant be met by carers four times a day, would a residential home be considered in terms of her 'best interests'. Her capacity to make decisions would also need to be assessed - if she does have capacity, then she is allowed to make her own choices, be they unwise ones and having dementia does not automatically mean she doesnt have capacity. Hope that helps a bit.

Mojisola

poorlittlefish wrote: »

Mum feels like she has no life because she can't leave my Nan alone, but at the same time she hates the thought of asking for increased carer visits because she she'd still have to be around to have strangers in the house several times a day.

As Mum can't cope with Nan can she be forced to carry on?

Your Mum is going to have to be very strong and keep telling SS that she is no longer able to care for her mother.

If they decide to send her home, your mother should stay with someone else for a week. That will show whether the care package is enough support for your grandmother.

Prothet_of_Doom

Contact Social Services and ask to have a social worker appointed for your Nan.

jacques_chirac

Are there not other family members that can help?

poorlittlefish

jacques_chirac wrote: »

Are there not other family members that can help?

Unfortunately not. There's almost none of us left and my brother lives even further away than me.

Mojisola

Prothet_of_Doom wrote: »

Contact Social Services and ask to have a social worker appointed for your Nan.

As there are carers in place, Nan should already have a SW.