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Bit of a change from my previous thread regarding car purchase, but here goes.
goes.My 89 yr old father who has dementia had a fall at home on Feb 7 th.
He lives with my 85 yr old mother who has physical disabilities and is in the process of having memory assessed. I'm a retired nurse and pretty sure she has dementia , but the GP assessed memory and based on the 6 item memory test decided she didn't need a referral , however our local elderly psych team have told me that their only criteria is changes in memory lasting longer than 6 months. She previously had an assessment 5 yrs ago and even Mam thinks she has dementia, so pushing GP for a referral.
Dad had carers going in 3 times a day for personal care.
Previous hip fracture, history of several falls and he has osteoporosis and takes blood thinners.
Although he didn't have any obvious injury , he wasn't able to mobilise at the same level as before the fall , so, reluctantly, he was taken to A/E by paramedics.
After a 5 hr wait on a trolley in the corridor he was seen and diagnosed with a chest infection . Because of mobility issues and increased confusion he was admitted and found to have COVID .
4 days on the COVID ward ( no visitors or other form of communication with family) then ( when medically fit, but still not back to previous mobility ) sent to a COVID designated care home to complete his 14 days of isolation. Unclear whether the hospital assessed his mental capacity , but probably not. The ward sister told me she'd told him where he was going and why.
Prior to him going to the designated care home nobody had told us he would be in Isolation.
No meaningful nursing assessment of his usual abilities or needs in A/ E or on the ward.
QUESTION 1. Ref' the MCA, If there was no assessment of capacity in hospital, did Dad consent to going to the designated COVID care home for another 11 days of isolation, and if so , how did they assess that he understood the information needed to make that decision? If they didn't assess his capacity , then nobody could make a " Best Interest " decision.
Managed to speak to him once on the phone in the 11 days he was in the COVID designated home. No therapy, medical or nursing assessment or input in that time.
Still classed as being a hospital inpatient, but seemingly " under the care" of hospital Social services.
At Day 14, SW ( who's never met him or asked what he's usually like) did a MC assessment over the phone
One of the main reasons she did this was because we've expressed safeguarding concerns in relation to the dynamics of his relationship with my Mam, Mam's own needs and problems, the effect on our family relationships, plus his frequent recent falls and risk of injury.
We are of the opinion that he now needs 24 HR care.
Following the assessment the SW maintained that , despite the fact that Dad didn't know where he was , couldn't remember falling at home, didn't know the name of the area he lives in ( thight he lived where they lived 4 years ago) and couldn't recall his date of birth , he has the capacity to decide where to live.
QUESTION 2. How/ when should we challenge this assessment?
How long would it take you or I ( assuming we have capacity!) to weigh up all the pros and cons to make a decision about where we wanted to live?
The MCA seems woefully lacking in its guidance regarding " being able to understand and retain information ......" when people have memory problems.
IMO, those who know the person and the home situation and history the best should be involved in MC assessments when people have memory problems
Because the SW wasn't able to get anyone to carry out a proper assessment of his mobility whilst in the designated home, she decided to send him to an Intermediate care bed at another care home . Idea being that he'd get some therapy input and try to optimise his mobility . No occupational therapy input as far as I'm aware, so purely mobility focused rather than anything around dressing, managing at the loo etc
We were told that he would have to continue to isolate for another 10 days in the new home, however , before we could challenge this ( he'd been in isolation for 15 days already) the home locked down due to COVID
Dad has his mobile phone with him now, but he hadn't used it at home for well over 6 months, so getting in contact with him is hit and miss,especially as the carers don't seem to be very good at placing it where he can hear / reach it. We've managed to speak to him twice and he was very confused about where he was, the time of day and desperately wondering why none of us had been to see him
His actual words were " I thought I was dead"
QUESTION 3
Presumably, after assessing that Dad has capacity, she must have got him to agree to going into the Intermediate care bed, but did she tell him that he still wouldn't be able to see or speak to his family and that he would continue to be isolated in his own room?
Having spoken to the SW today it seems the physio is seeing him and he's closer to his previous mobility level, but I have no idea about toileting etc
She's also told me that the staff are taking COVID into the home.
QUESTION 4 Can anyone direct me to the most up to date government guidelines regarding visiting in care homes and " blanket bans", and/ or any examples of such being challenged?
They're supposed to provide " holistic, person centred care"
This situation is ludicrous . The SW ( who I would say is relatively inexperienced) is acting as a gate keeper and our worry is that they'll " suddenly " decide that they've optimised his mobility and want to send him home with carers going in 4 times a day .
With my Dad's only experience of a care home being kept in complete isolation without family visits for 21 days, we don't have a cat in hell's chance of trying to convince him that it might be more appropriate for him to be in a care home long term .
Situation made worse by the fact that my husband and I are both recovering from COVID which we developed about 2 days after Dad went into hospital , so we can't go and look at any residential homes while we're still testing positive
Despite the governments almost total relaxation of COVID restrictions in the general population ( as long as you've had the "magic" vaccinations) , we still have these very restrictive policies regarding visiting in care homes , including requiring a negative test at each visit, yet staff can go about outside work completely unrestricted ( as long as they've been vaccinated) and are only being tested every week or less unless they have symptoms.
goes.My 89 yr old father who has dementia had a fall at home on Feb 7 th.
He lives with my 85 yr old mother who has physical disabilities and is in the process of having memory assessed. I'm a retired nurse and pretty sure she has dementia , but the GP assessed memory and based on the 6 item memory test decided she didn't need a referral , however our local elderly psych team have told me that their only criteria is changes in memory lasting longer than 6 months. She previously had an assessment 5 yrs ago and even Mam thinks she has dementia, so pushing GP for a referral.
Dad had carers going in 3 times a day for personal care.
Previous hip fracture, history of several falls and he has osteoporosis and takes blood thinners.
Although he didn't have any obvious injury , he wasn't able to mobilise at the same level as before the fall , so, reluctantly, he was taken to A/E by paramedics.
After a 5 hr wait on a trolley in the corridor he was seen and diagnosed with a chest infection . Because of mobility issues and increased confusion he was admitted and found to have COVID .
4 days on the COVID ward ( no visitors or other form of communication with family) then ( when medically fit, but still not back to previous mobility ) sent to a COVID designated care home to complete his 14 days of isolation. Unclear whether the hospital assessed his mental capacity , but probably not. The ward sister told me she'd told him where he was going and why.
Prior to him going to the designated care home nobody had told us he would be in Isolation.
No meaningful nursing assessment of his usual abilities or needs in A/ E or on the ward.
QUESTION 1. Ref' the MCA, If there was no assessment of capacity in hospital, did Dad consent to going to the designated COVID care home for another 11 days of isolation, and if so , how did they assess that he understood the information needed to make that decision? If they didn't assess his capacity , then nobody could make a " Best Interest " decision.
Managed to speak to him once on the phone in the 11 days he was in the COVID designated home. No therapy, medical or nursing assessment or input in that time.
Still classed as being a hospital inpatient, but seemingly " under the care" of hospital Social services.
At Day 14, SW ( who's never met him or asked what he's usually like) did a MC assessment over the phone
One of the main reasons she did this was because we've expressed safeguarding concerns in relation to the dynamics of his relationship with my Mam, Mam's own needs and problems, the effect on our family relationships, plus his frequent recent falls and risk of injury.
We are of the opinion that he now needs 24 HR care.
Following the assessment the SW maintained that , despite the fact that Dad didn't know where he was , couldn't remember falling at home, didn't know the name of the area he lives in ( thight he lived where they lived 4 years ago) and couldn't recall his date of birth , he has the capacity to decide where to live.
QUESTION 2. How/ when should we challenge this assessment?
How long would it take you or I ( assuming we have capacity!) to weigh up all the pros and cons to make a decision about where we wanted to live?
The MCA seems woefully lacking in its guidance regarding " being able to understand and retain information ......" when people have memory problems.
IMO, those who know the person and the home situation and history the best should be involved in MC assessments when people have memory problems
Because the SW wasn't able to get anyone to carry out a proper assessment of his mobility whilst in the designated home, she decided to send him to an Intermediate care bed at another care home . Idea being that he'd get some therapy input and try to optimise his mobility . No occupational therapy input as far as I'm aware, so purely mobility focused rather than anything around dressing, managing at the loo etc
We were told that he would have to continue to isolate for another 10 days in the new home, however , before we could challenge this ( he'd been in isolation for 15 days already) the home locked down due to COVID
Dad has his mobile phone with him now, but he hadn't used it at home for well over 6 months, so getting in contact with him is hit and miss,especially as the carers don't seem to be very good at placing it where he can hear / reach it. We've managed to speak to him twice and he was very confused about where he was, the time of day and desperately wondering why none of us had been to see him
His actual words were " I thought I was dead"
QUESTION 3
Presumably, after assessing that Dad has capacity, she must have got him to agree to going into the Intermediate care bed, but did she tell him that he still wouldn't be able to see or speak to his family and that he would continue to be isolated in his own room?
Having spoken to the SW today it seems the physio is seeing him and he's closer to his previous mobility level, but I have no idea about toileting etc
She's also told me that the staff are taking COVID into the home.
QUESTION 4 Can anyone direct me to the most up to date government guidelines regarding visiting in care homes and " blanket bans", and/ or any examples of such being challenged?
They're supposed to provide " holistic, person centred care"
This situation is ludicrous . The SW ( who I would say is relatively inexperienced) is acting as a gate keeper and our worry is that they'll " suddenly " decide that they've optimised his mobility and want to send him home with carers going in 4 times a day .
With my Dad's only experience of a care home being kept in complete isolation without family visits for 21 days, we don't have a cat in hell's chance of trying to convince him that it might be more appropriate for him to be in a care home long term .
Situation made worse by the fact that my husband and I are both recovering from COVID which we developed about 2 days after Dad went into hospital , so we can't go and look at any residential homes while we're still testing positive
Despite the governments almost total relaxation of COVID restrictions in the general population ( as long as you've had the "magic" vaccinations) , we still have these very restrictive policies regarding visiting in care homes , including requiring a negative test at each visit, yet staff can go about outside work completely unrestricted ( as long as they've been vaccinated) and are only being tested every week or less unless they have symptoms.
