Elderly, frail parent refusing home help - can we use LPA?

Danien

Sorry chasingthewelshdream, it sounds like things are far worse than you thought. I hope you get it sorted so she is safe and cared for and her health needs are looked after.

It does sound like she requires a thorough capacity and needs assessment, and her health and safety needs to come first right now.

aliby21

With a sudden deterioration like that I would definitely want medical investigations, as mentioned a check whether she has a urinary tract infection, or a TIA possibly.  It is alarming how a UTI can cause confusion in the elderly, as I have seen. 

ChasingtheWelshdream

Yes, the LPA we have access and everything will be self-funded. We can pay from her account, but what we need is professional advice as to the type of care to commission. We have been told we can use the Social Services brokerage scheme to arrange carers so that is what we will be pushing for.

Danien

aliby21 said:

With a sudden deterioration like that I would definitely want medical investigations, as mentioned a check whether she has a urinary tract infection, or a TIA possibly.  It is alarming how a UTI can cause confusion in the elderly, as I have seen. 

So true, seen it so many times.

ChasingtheWelshdream

We have had to travel back today and the neighbours are going to be checking up on her. I am very worried.

So today has been endless phone calls, call queues and hitting dead-end after dead-end.

Social Services will not escalate or prioritise the needs assessment (at least 8 weeks) and told us to go and sort our own care. I explained about her vulnerability, it made no difference. The call handler actually said - verbatim - there are too many people in the community living too long. Nice! I get the sentiment, but still....

The recommended council brokerage service number was ringing out all day, and when eventually answered at 4:50, responded that they are not the correct service - try a different number.

The recommended Community Help Service were very nice but can't assist - they need initial contact from MIL or a GP letter confirming lack of capacity.

We couldn't get through to the Age UK support line.

We spoke to the surgery, who informed us that MIL had already rang that morning and sounded confused so the GP was going to visit. We asked the GP to call us when they arrived, which they did and said that they would check her over but we heard nothing more. We rang MIL who vaguely remembered someone appearing in the living room, but wasn't sure who it was as she had fallen asleep. Presumably the GP with the key-safe - we hope! MIL rang us later asking when the nurse was coming out......

Probably TMI but on arrival at the weekend we found diarrhoea across the carpet that she had no awareness of, even though the stench was overpowering. Ironically she had cleaned herself up and washed her clothes, but absolutely no memory of soiling herself. A huge, distressing red flag to us, but when we explained it to the GP, they didn't seem overly concerned.

We have asked for a telephone GP appointment to record our concerns and ask about a capacity assessment. The receptionists remember her calling over the last couple of weeks and know she sounds confused at times, but we are so far not getting any feedback that we ask for. They have had written authorisation to speak to us, which MIL agreed to after a fall a couple of years ago, but we seem to be constantly chasing.

The problem appears to be that when someone goes out to see her, she appears lucid and tells them things are fine. I had to help her dress as she was breathless from walking up the stairs and felt that even moving was an effort. I was on the point of calling an ambulance, but 5 minutes later she is telling DH to go away and that everything is fine. She insists there is no problem with her heart.

On a random note, her feet are shocking with toenails like dog claws - I couldn't cut the at all. She is diabetic and should have been having regular podiatry appointments as part of her diabetic care. I'm wondering if she hasn't been seen for ages. So we need to get a chiropodist in - again, she likely won't want it.

We are at a point where we are potentially going to be spending a large amount of her money - to some extent against her will -  without knowing what we are supposed to be arranging.  We assume it is self-funded but we are not actually sure. She was not too far off the threshold from last time we looked at her account (I recall about £30k savings a couple of years ago). Things may have changed, I know she once mentioned she was having to use her savings to pay bills. 

We need a financial assessment, but haven't been able to get through.

We have applied for online banking through LPA so we can see where things are from here (couldn't find bank statements in the house, although we know she usually keeps things for years).

DH has sent off the Attendance Allowance application, which in the end he completed and signed under LPA.


I have started the application for a blue badge, and have had to order birth and marriage certificates as she has no other proof of ID. I suspect there will be many hospital appointments coming up, and we can get her as close to the entrances as possible. This is against her wishes though. When we mentioned it she instantly refused, shutting us down to even discuss it - as she is doing with everything-  even though it is purely for her benefit. I don't know if I am doing the right thing, but with a 12 week turnaround it seemed prudent.  

It just feels like we have been left on our own and is draining the hell out of us. I thought there would be concern and action for a potentially very vulnerable person but apparently not.

In Wales, our council are a single point of contact, with domiciliary care arranged directly through the council and capped prices.

England, it seems a minefield. 

elsien

When my grandmother needed care, as a self funder the power of attorney was just given a list of local agencies told to go away and get on with it.

The local authority won’t do a financial assessment until the care act assessment is complete because they need to evidence that the assessment isn’t impacted by funding considerations. Local authorities are under a huge amount of strain due to and are basically prioritising emergencies. 

So to bump her up the list you’re probably going to be needing to phone them every time something happens that is a safety issue for her and if the neighbours are willing to phone up and raise a safeguarding if they have serious concerns that would also help. 

I think at the moment trying to go via the GP is going to be the best way to try to get things moving. At least if the district nurse is going in, they can also flag up concerns if they see them because to a degree you being there has probably been masking what may really be happening.
 Is there anyone else involved in her life that she may listen to more with regards to getting her health checked out because there does seem to be more going on. My mother will sometimes listen to her friends when she thinks I’m fussing too much.

You can get an idea of domiciliary care agencies from the CQC website although personal recommendation is better if you do know anyone in the area. Any agency are going to want to do their own assessment though which obviously comes with its own problems given that she still saying she doesn’t need support.

 How often are you thinking she needs someone to go in, Because even if she needs more help having someone every day or every couple of days is enough to keep an eye on things while you are not there if she will let them in/allow them to stay. 

Worst case scenario for her but which can start to get things moving is that things deteriorate rapidly and she gets admitted to hospital, when you may find the systems kick in a little bit more if they are concerned about her safety with regards to going back home without support. 

Information about funding care at home here. 

https://www.ageuk.org.uk/information-advice/care/paying-for-care/paying-for-homecare/

I completely sympathise with your situation, but I think practically advice is of more use to you at the moment. 

Does she have any sort of pendant alarm system in place and is that something she would accept/be able to use as she is at the moment because that’s maybe something else you could look into as well?

ChasingtheWelshdream

I forgot to say there is no risk from ovens etc, she does not cook.

And in between the confusion episodes (in her own words, ‘all in a middle’, she is perfectly lucid. It sounds like I am painting a picture of complete mental incapacity, which is not the case.

elsien

Fluctuating capacity is very hard to deal with and assess.  

Is she Acknowledging any difficulties at all on a good day? Noticing the smell in the house, for example, after her accident?

elsien

FWIW My grandmother also was  against the blue badge Application initially  because she said she was taking parking spaces away from people who really needed them, despite  us pointing out she couldn’t walk Without getting very breathless. 

Until she got it, then she acknowledged that it had been a good idea after all.

KxMx

It is difficult and you are doing everything right. The more radars she is on the bigger picture those with the power to help have. Can you ask neighbours to also make safeguarding reports? 

I did safeguarding report for Mum recently via sheltered housing manager May 1st, after trying to deal with the situation myself for a fortnight. 

She now has equipment needed and morning care visits, but only because last week she was admitted to Hospital.

Harsh as it sounds, sometimes things need to reach crisis point then the help follows quite quickly. 

Similar to a friend, social services insisted grandad (dementia, not self funded) was fit to stay at home. Family, GP, care agency, police and fall alarm service all said he needed residental care.
He got 4 care visits a day for 3 years and family were pressured to call in on top. 

After he had a bad fall Hospital refused discharge to any other setting than a care home.