helping elderly relatives with health issues - lessons learned

bunnygo

excuse if in wrong place, but I've learned a few things recently which might help someone else, especially if you are doing things from a distance:

Health and Welfare LPA - if you have one, tell your relative's GP that you do and ask them what their procedure is to record its existence. It doesn't have to be activated, just so they know it is there.

'next of kin' (regardless of proper legal term) - again, tell the relative's GP and ask them to note. Also make sure they have your contact details. This data is copied on to the hospital system, which means if your relative gets admitted they know who to contact. It is no good if the contact details are for someone semi-conscious in the acute ward, especially if it is the landline in their house! There's no point giving details to the hospital if the GP holds different ones, as the database will just get overwritten again that night. If your relative is widowed, check that the details aren't those of the deceased spouse.

This will also allow you to request a GP appointment for your relative, or at least a phone call.

medical insurance: if they have it, get 'consented' on the policy both to make a claim and to manage the policy. Same reasons as above; if the policy is needed, it's no good if the only person who can talk about it is sick.

if the hospital has a 'patient portal', get login details so you have a chance of seeing what is going on.

discharge help/re-enablement; probably no chance if your relative has savings over the threshold. Don't waste time asking or discussing, it won't happen. Refuse discharge if unsafe.

look for any local agencies that provide things like keysafes, fall alarms etc; Age UK are a good starting point. The keysafe code should be lodged with the relevant ambulance trust, remember to tell them if you change it.

HTH.

elsien

Next of kin doesn’t allow you to make any appointments for anyone. It is a point of contact, that is all. Without the health/welfare LPA then any health decisions are best interests ones with the  medical professional as decision maker in consultation with relevant friends and family. 

Hospitals do like a NOK but in legal terms it is meaningless.

Reablement beds if health funded are not chargeable so your relative’s finances are irrelevant unless any care is being provided via the local authority rather than health. Just for the sake of clarity.

You need to be careful not to generalise one experience to everyone. 

And although you appear to be referring to relatives who lack capacity, people may have capacity in some areas but not others. It’s not a blanket presumption. So for example you can’t refuse discharge on behalf of someone able to make that decision themselves, however unwise the professionals consider it to be. 

Ditto accessing confidential patient information without the person’s consent,  if they are able to agree or to withhold. 

bunnygo

experiences do indeed vary - but I'm afraid that despite initial promises of reablement regardless of finance, it just isn't there. Social services are in collapse, which is why so many are in hospital who need not be. Good luck, Sir Keir...

I agree that NoK has no legal meaning. Except that the hospitals don't know that.

and you can say 'unsafe discharge' if there's no help at home.  Doesn't stop the person leaving if they are physically capable.

the experience is that the system is wobbly and chaotic (as we know) so these are some advocacy hints.

Bossyboots

I have never known anyone be charged for re-enablement in the home following discharge from hospital so it does happen. Like everything I suppose it depends where you live.  A financial assessment is undertaken if there is still need at the six week mark.

Likewise the fitting of keysafes is automatically undertaken at no cost.

It pretty much all goes downhill from there though.

p00hsticks

bunnygo said:

experiences do indeed vary - but I'm afraid that despite initial promises of reablement regardless of finance, it just isn't there. Social services are in collapse, which is why so many are in hospital who need not be. Good luck, Sir Keir...

I think as Bossyboots says, it must vary greatly throughout the country. I'm currently in what sounds like a similar position to you , but I really can't fault the reenablement team currently looking after my relative - they've been absolutely fantastic in providing care, physio, assessments etc in the weeks since leaving hospital.

Fingers crossed we get similar support from social services when the six weeks is up (self-funding).    

sheramber

When my husband was admitted to hospital the question was not "who is next of kin"  but was "who should we contact if ncessary?".

Sea_Shell

Generally, does anyone have any experience of the timescales involved between trying to arrange a basic care at home package, between going via the LA (but assessed as self-funding) and going direct to a private care agency.   Not a hospital discharge.

Does it usually take days or weeks?

DevilsAdvocate1

My dad's partner is currently in hospital after having a stroke.  She was doing well, but had another, minor stroke, yesterday.  Her grown up children have power of attorney and are down as the next of kin.  However, neither of them live locally.  The nurses have been handing a laptop of the notes to my dad saying "Don't read this, but can you hold it for me for a moment" and then leaving him alone with the notes.  I guess this is their way of making sure he has all the relevant information as he is the one being asked to make decisions as they can't get hold of her "children".  Bytheway, her children are both retired !!!  Dad is there all day during visiting hours.

They've also been getting my dad to help calm her down as she has been violent several times at night and they've had to call security.  She always calms down if my dad is there without him having to actually do anything.  I think she becomes violent when she is scared. and it only happens at night when dad is not there.  They ring him, he goes there, she calms down.

elsien

If the children have health and welfare LPA then the hospital must contact them or raise concerns with the OPG. They can't just ignore the LPA and ask other people to make decisions.  Not living locally is not good enough reason not to make proper attempts to contact people. Covid has shown that phone and teams consultations are equally valid ways of involving families and friends. 

ETA - your dad's partner might want to ask about why they are not finding better ways to manage the night time support needs than calling security. If all she needs is reassurance then most hospitals have a team (the title varies) who provide 1/1 support on the wards for just these eventualities. But it can take a lot of arguing about the necessity. I'd be asking questions about how calling security is the lesser restrictive option?

elsien

Sea_Shell said:

Generally, does anyone have any experience of the timescales involved between trying to arrange a basic care at home package, between going via the LA (but assessed as self-funding) and going direct to a private care agency.   Not a hospital discharge.

Does it usually take days or weeks?

We weren't given the option of going via the LA for a self-funding relative. Just given a list of care agencies and left to get on with it. 
If you are waiting for the care act assessment first from the LA then where I am you will be waiting a minimum of 6 to 8 weeks and probably longer unless it's so urgent as to hit the safeguarding threshold. 
Private is likely to be quicker although the good agencies may also have a waiting list. 

Rusty190

I found your post very helpful @bunnygo.

In my case, I am "the elderly relative", albeit currently hale and hearty!

I'm in the process of organising my lasting power of attorney and am finding that the "doing things from a distance" issue, is a major stumbling block.

Sadly, some of us have no other choice.