My mother is now in care home temporarily for past 6 months. NHS health practitioner/SW from same local mental health office (they have featured in the TV news lately) going in to see her in bedroom and pressuring her to do what they want. They have been in at least 5 or 6 times in past month or so, especially last few weeks.
Always say the same thing, tell her which care home she has to go to. She tells them she does not want to leave as she is quite happy at the care home she is in and is unwell at moment, in bed all the time, panicking with anxiety, unable to use zimmer and needs 2 people to use commode/toilet. The care home is a NHS/S117/LA arranged place which costs £570 week (to LA/NHS) but the care home they keep suggesting is private and costs £1400 week.
I have warned the Health practitioner to stop pressuring my mother in a lengthy email a couple of weeks ago but she has now resumed it by sending in a SW instead. My mother is bed bound and needs lots of help, 24 hour care, mental health problems of depression, anxiety, panic attacks, been sick for two years in hospital/care home after two periods on section 3 for ECT treatment, lithium, anti-depressants, anti-psychotics. She is very vulnerable and the health practitioner knows her health state as she is attached to the mental hospital my mother was in for 18 months.
I don’t know what to do about, I feel helpless to stop these people picking on my mother like this. Would this be a safeguarding issue?
It’s not appropriate to give firm advice on a public site and with limited information, but I think it is important to clarify with the care home or the organisation which placed her in the care home whether they believe your mother has the mental capacity to make the decision about where she lives. If the care home believes she does not have capacity for that decision, then they must make an application to the local authority for a formal authorisation to continue to care for her under the Mental Capacity Act Deprivation of Liberty Safeguards (commonly referred to as ‘DoLS’).
That will require an independent assessment of her capacity and will explore the current care she is receiving and the restrictions she is placed under. It also requires the independent assessor (called a Best Interests Assessor) to involve your mother in the process and to find out her wishes and feelings, and also to consult with anyone interested in her care, which clearly appears to include you.
It does not guarantee that she will get exactly what she wants, but there will be an independent assessment of her current situation.
From what you describe, your mother appears to be subject to section 117 aftercare, so the local authority and NHS must provide services to prevent deterioration of her mental state and readmission to hospital. She should be involved in the process of developing the section 117 care plan, and carers should be involved too, if the individual agrees. Where there is disagreement about the nature of the care plan and objection from the individual concerned, this would need to be negotiated further, with possible recourse to the court (maybe Court of Protection if you mother lacks capacity)
This is separate to your concerns about the behaviour of the professional. It is not clear whether this professional works for the NHS or the local authority, but either will have complaints processes which your mother could pursue, or you could with her agreement, if she is able to give consent. I don’t believe the local authority would treat it as a safeguarding issue.
Thanks for your quick reply and information.
My mother has capacity to make decisions although the hospital declared her to have no capacity after they carried out an in house capacity assessment using their ward SW, until I challenged it and they had to retest which restored capacity. She is under S117 aftercare funding and this is where the trouble with the NHS/LA starts. There is no COP involvement. I have EPA and nearest relative status but not welfare LPA. Because she has capacity the NHS/LA cannot make the decision for her but they can try and pressure her to do what they want instead. This pressuring is reaching a high and unpleasant level now which is affecting my mother’s mental and physical health. This is why I mention safeguarding. I understand that it is the NHS/LA that investigate safeguarding issues so they would be investigating themselves…
Could my mother ask the care home to not allow these unsupported visits by council/NHS officials?
It is up to her after all who she talks to…isn’t it?
She is perfectly within her rights to ask for someone to be present during a future meeting.
She could ask for advocacy support, but I’m not sure whether she may fall between the stools of statutory Care Act advocacy and mental capacity advocacy. She has mental capacity so an Independent Mental Capacity Advocate is not possible. She is subject to s117 so strictly speaking falls outside the Care Act remit, but the local authority may judge her to be within the eligibility criteria.
Alternatively there is non-statutory advocacy, but the availability of that depends on the services in the area.
But could my mother tell the care home she did not want visits from social services/NHS unless they were arranged in advance. ie by appointment. This way she could be supported during a SS/NHS visit?
If she says she wants someone present during a visit, then it seems to me that visits will need to be planned in advance. I would have thought this was no more than good practice in any case.
I think it worth reading through the Choice Regulations concerning accommodation with care that applies to both England and Wales. In England, the Regulations can be found here. https://www.legislation.gov.uk/uksi/2014/2670/regulation/4/made
In Wales, then you will need to go here The Care and Support (Choice of Accommodation) (Wales) Regulations 2015
Persons in receipt of Section 117 Aftercare, where accommodation is a central part of their care, ie, care is provided in the accommodation, then the person can activate their choice. In Wales and England, where this choice is declined, this refusal has to be provided in writing.
You could ask the Social Worker or the NHS worker if they have considered the Choice Regulations in light of your mothers stated preference. If they have not considered the Choice Regulations, there would be grounds for a formal complaint.
In my experience, funders/decision makers rarely consider choice, and as a result, leave themselves open to formal challenge.
Thanks again for answers.
Yes this seems correct and I thought they would have done it like this as good practice. But if the purpose of these repeat visits is to make my mother change her mind to do what the NHS/SS want then the presence of a witness or advocate at these ‘private’ chats would not be helpful.
There have now been 6 or so of these chats with my mother. I suspect that when a formal ‘proper’ review meeting is arranged, the HP will refer to these chats to confirm the ‘new’ choice my mother has made, even though she has not changed her mind at all. With two members of the SS team visiting (HP and SW), they can back up each other if challenged.
But from now I could request planned visits only…but they would not like it…
Thanks for your quick response.
My mother had expressed a preference, to be nearer her daughter who lives in a different council area. This was 6 months ago and her health is now worse and staying in bed all day, actively wishing to be left where she is, not moved about; now wanting to stay in present care home. Moving would unsettle her.
The care home they keep pushing is not in her daughters area but near to her original residence which she has not occupied for 2 and half years. My sister has problems with driving and can only visit once a week if the care home is far away. This has been communicated repeatedly to the Health Practitioner and her team over past 6 months but they will not listen.
As you mention the S117 preference regs, there is the issue of top-ups if a preference is exercised in this way. But if there are no other suitable places to meet my mothers needs then this would not apply. But if it can be established that my mother wishes to go to this particular care home (the SS/NHS selected one which they pressure her to pick), then because she has capacity, the NHS/SS, can say she has to pay the top-up. This care home costs £70k plus which is well over the local council rate (£29K), presumably meaning a top of £40-£50k a year or even the full cost. Alternatively the NHS/SS would have to pay (if treated as a need) until a cheaper place becomes available but by this time my mother may not wish to be moved again and would wish to stay there whatever the cost. But this care home is too far from my sister in any case.
Why can’t the NHS/SS just do what people and families ask them to?
Is your mother being asked to consider the other home as the LA and NHS consider the current home is not meeting her needs? Has there been a formal reassessment? If so, does the assessment identify specific needs that would require a change in accommodation/care?
No there is no mention of her needs as far as I know since the NHS/LA has not involved me in these chats with my mother. I have not been invited/present at any of them or been informed they were taking place. I only know because my mother told me. Her needs are being met in the care home she is in as far as personal care/washing etc is concerned. The only unmet need is to be nearer to her daughter so she can visit more often. The HP says the funding is running out at present care home as this was only temporary. 6 month review is due now.
It may be that the care home she is in is not being paid the full cost of meeting my mothers care needs because the NHS/LA were not honest when they sent her there and now want the NHS/LA to pay more.
So rathe rthan pay a higher rate under S117 funding the NHS/LA want to make a preference move which can be funded with a top-up.
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