Refusing dementia screening

badmemory

There used to be a website that doctors could use to assess.  I'm not sure of its name something like GP assessment of cognition.  Maybe a read & a few discrete questions might help you get an idea of the situation.  A pity he is self funding because they seem more likely to put them in a care home if they are, rather than being dependent on the LA funding them.

T.T.D

You must:

• follow any instructions the donor included in the LPA
• consider any preferences the donor included in the LPA
• help the donor make their own decisions as much as they can
• make any decisions in the donor’s best interests
• respect their human and civil rights

The above are your obligations your legal obligations. What is in the LPA? Consider those instructions help him make the decisions by himself for his own best interest according to the human rights act. 

That’s your legal obligations, if dads capacity is limited or lacks understanding and is against his best interests (I.E he is his own threat to his own life being through lack of cognitive ability) then it’s the organisations that look to you to make those tough decisions, you need to share that LPA with organisations so they know what interests your protecting.

its tough position but abide by the above and you’ll be ok. 

tooldle

I was going to suggest focussing on benefits of possible medication. It does depend on the type of dementia, but Dad could be one of the ‘luckier’ patients and be prescribed meds that slow down progression of the disease.
My Mum’s diagnosis was a long time ago. I’m sure there was a brain scan although things might be different now. By the time she failed the ‘draw the hands on a clock’ type tests, she had moved into a care home. Everyone is different and dad’s experience may be nothing like his brother’s.
You could try being harsh with him I.e. go ahead and refuse the assessment but don’t except me to pick up the pieces versus, let’s work together and take the assessments/ tests so you both know how best to support his wish to remain independent. Being frightened by all this is natural and he might not have thought about keeping you onside as his champion for independent living.

OutdoorQueen

I think practically they can’t  force your Dad to have complete  an assessment.  You could both attend an assessment and your Dad may choose not to answer any questions.  They can’t force him to talk and answer their questions.  

The Alzheimer’s Society have a national helpline, perhaps have a chat with them.

 0330 333 0804

This may also help, and be similar to what was mentioned by @badmemory in another post:
https://cks.nice.org.uk/topics/dementia/diagnosis/assessment/

elsien

HeparGirl24 said:

Thanks for the replies.  I fully accept my father will end up in a care setting eventually and he will be self funding when that happens.  He already claims AA which helps to pay for his current home help and he has agreed to have the helpers come in 5 mornings a week to make sure he take his tablets correctly. This still leaves his evening meds and the weekends to manage with phone call reminders from me, but the health centre are still insisting on the assessments.  As he is very stubborn I think a better approach is for me to negotiate little steps to encourage him to take extra help using the people he trusts, but the health centre is set on this full steam ahead approach which will only make him dig his heels in further.

I say the health centre because he hasn't seen a GP in 5 years and I've spoken to 4 different members of the health team in the last week who pass me on to someone else or to tell me to speak to his GP (impossible!!! but even if I could his registered GP has never ever seen him), so I have have no idea who to try and negiotiate with.

His views on life or death haven't changed and he understands the consequences of not taking his meds correctly. He also understands that just because he doesn't want to know he has dementia, that doesn't mean he hasn't got it! As his attorney I believe he has the capacity to make the decision to refuse the assessments, however unwise, and I would not be comfortable using a health LPA to override that.

So back to my original question - can the health centre force him (or me via the LPA)  to have the assessments?

No. For a number of reasons.
firstly, if he has capacity, it is his decision to make even if it’s an unwise one.
Secondly , as his health and welfare power of attorney you need to be thinking about the decision he would have  made when he had capacity. Which is to decline all the assessments in full awareness of what they are, and the purpose. So you need to have a very good reason to override that which I would suggest you do not have as things stand, even if he lacks capacity, which from the information you’ve given would appear to be unlikely. 

Thirdly, would you be planning on trying to use restraint to try get him in to the health centre against his will; and when he gets there and sits there and says I’m not doing this, what would the plan be then? You cannot force someone to cooperate in answering questions. And a GP should not be going along with that - they really should know better. 

With regards to the local authority that will be a care act needs assessment. Again, if he has capacity, he has the right to refuse. Is he needing care and support at home at the moment because again you could explain to him that this is about supporting him to stay at home, and looking at what needs to be in place to do that in the future.
But if he has managing well at the moment, and he is fully aware of what the assessment is, the purpose and what it involves if he doesn’t want to go there then what do you want to achieve?

I get how frustrating it is. This is about addressing his fears, because it’s very likely that he thinks as soon as he’s diagnosed, he will be forced to leave his home and that really isn’t the case. I work with people with dementia -  some in denial who really don’t want to know, others are fully aware something is happening but are convinced that as soon as they get that label they will have to go into care. So that’s why they decline the assessment. Tackling that fear should hopefully be more effective than any form of coercion that just isn’t going to work. Maybe along the lines of there is medication that slows things down, but to use that the medical professionals need to be clear on what the type of dementia is. If that is what it is rather than just memory loss because of aging or infection. 

Your dad is not the only person who thinks that death is preferable to living in a care home with dementia. I’ve just read a blog by a doctor with dementia who chose to voluntarily stop eating and drinking, while she still had the ability to make that choice for herself. That is an extreme and unusual example, but it does show how strongly some people feel about their end of life care and support. And the decisions they make around that. 

elsien

badmemory said:

There used to be a website that doctors could use to assess.  I'm not sure of its name something like GP assessment of cognition.  Maybe a read & a few discrete questions might help you get an idea of the situation.  A pity he is self funding because they seem more likely to put them in a care home if they are, rather than being dependent on the LA funding them.

If the OP does have health and welfare power-of-attorney, the local authority has no power to try and put anyone anywhere.
And the Mental Capacity Act is always around, looking at the less restrictive option first, which is keeping people at home if that’s what they want as as long as as is practicable. 

lr1277

Regarding speaking to the surgery, as a family we couldnt speak to the GP or any of their staff about dad. Not even dad's wife was allowed to talk to the surgery staff about my dad.

Dad wrote a letter to the surgery giving permission for any of the surgery staff to talk to certain family members. This made dealng with the surgery a lot easier. And we got this in place before the LPA had been granted ie. LPA not required.

About a month before dad died, the surgery wanted us to complete some forms which achieved the same end, but we never got around to it.

You could see if your dad is agreeable to you speaking to the surgery staff on his behalf (be they doctors or other staff) then finding out what your dad's surgery requires for that to happen.