Deprivation of liberties / removal of rights

[maddyhind]

I have been my Mum's registered carer for several years. Her mobility is worse now of course but I think that I could cope. I think that the standard procedure if I manage to get her home is to have carers pop in a couple of times a day and therapists twice a week. 

[honeybee13]

Would your mum be on her own during the day if you work?

 

HB

[Ethel Street]

2 hours ago, maddyhind said:

One more point that I had forgotten to include. Mum has been in hospital for a few weeks but no one felt a DoL was necessary until I said that mum's wishes were not to go into a care home. Within an hour an urgent DoL was issued without any discussion with me. 

 Is it any wonder that I am concerned 

 

I'm wondering about that too. You are right to be suspicious.

 

The hospital wants her out - "bed blocking". But they can't discharge her without a safe place to go. Hospital  wants a care home, your mother is refusing. 

 

So hospital whacks in a DoL and claims that lets them discharge to a care home whether she agrees or not. Which is mainly about solving the hospital's bed shortage problem IMV.

 

I'd consider that a misuse of a DoL.

 

[maddyhind]

That's very possible 

[maddyhind]

I plan to challenge the DoL. 

[honeybee13]

Good point, Ethel.

 

Please let us know how it goes tomorrow, Maddy, and ask any other questions you have over the course of today.

HB

[maddyhind]

I have been my Mum's full time registered carer for several years. That is my job. She will not be alone during the day. 

The couple next door are both trained carers and say that they would sit with mum if I needed a break. Mums best friend is a trained first aider who would sit with her. 

Several of my friends would help. In an emergency one of mum's friends is a paramedic. Subject to availability he would sit with Mum. 

 I think standard policy for the local social service is to assign therapists and carers to visit if I manage to get her home. 

[BazzaS]

1 hour ago, Ethel Street said:

The hospital wants her out - "bed blocking". But they can't discharge her without a safe place to go. Hospital  wants a care home, your mother is refusing. 

 

So hospital whacks in a DoL and claims that lets them discharge to a care home whether she agrees or not. Which is mainly about solving the hospital's bed shortage problem IMV.

 

I'd consider that a misuse of a DoL.

 

yet, pt’s in beds who don’t need to be in an acute hospital bed but aren’t safe to go home : equates to no beds on wards to get pt’s into from ED, so people on trolleys in ED / in corridors.

That too means ambulances stacked up outside ED’s, waiting to unload their patients.

That too means delays in getting an ambulance when you dial 999 / 112.

 

So, (and let’s move this particular  discussion away from being about your Mum),

So, in general, what should a hospital do for a patient who is well enough to be discharged from an acute medical bed, but isn’t well enough to go back home?

What should they do for that same patient, if that patient lacks capacity to decline going to a care home?

[maddyhind]

5 minutes ago, BazzaS said:

yet, pt’s in beds who don’t need to be in an acute hospital bed but aren’t safe to go home : equates to no beds on wards to get pt’s into from ED, so people on trolleys in ED / in corridors.

That too means ambulances stacked up outside ED’s, waiting to unload their patients.

That too means delays in getting an ambulance when you dial 999 / 112.

 

So, (and let’s move this particular  discussion away from being about your Mum),

So, in general, what should a hospital do for a patient who is well enough to be discharged from an acute medical bed, but isn’t well enough to go back home?

What should they do for that same patient, if that patient lacks capacity to decline going to a care home?

They shouldn't misuse emergency procedures to fraudulently put people who should be protected under the capability act in care homes against their wishes. That is abuse. 

[honeybee13]

Hi Bazza. I can see what you're saying about bed blocking and I know it's a problem, but this thread is about Maddy and her current problems and the meeting tomorrow at the moment.

 

My mother was lucky to go into a rehab unit at the hospital after she had a fall or we could have been in the same position. I'm guessing that Maddy's mum doesn't have that option.

 

HB

[maddyhind]

10 minutes ago, honeybee13 said:

Hi Bazza. I can see what you're saying about bed blocking and I know it's a problem, but this thread is about Maddy and her current problems and the meeting tomorrow at the moment.

 

My mother was lucky to go into a rehab unit at the hospital after she had a fall or we could have been in the same position. I'm guessing that Maddy's mum doesn't have that option.

 

HB

Thank you HB that's just what I was going to say. This is obviously a very worrying situation for me. I'm happy to discuss the matter in abstract elsewhere but please keep this thread for advice and response to mum's problem 

[honeybee13]

I'm sorry Bazza, but I agree with Maddy. You could always start a new thread about bed blocking and I would certainly contribute to it.

HB

[BazzaS]

I don't want to derail Maddy's thread, but it IS relevant to this thread.

 

What if the hospital raise it as "better for others that the acute bed is available for acute patients, and better for Maddy's Mum that she is not in an acute bed at higher risk of acquiring a healthcare associated infection" - in fact I think you've already said that this has been raised :

" hospital was "the worst place for her because of infection risk" "

 

So, I'd suggest that instead of trying to get them to keep her in hospital, that you aim for them to asses a package of care that enables her to go back home, that (with adequate support) being in her best interests. Start off with what support you, family and friends acn provide, and then what would be needed on top provided by care at home (rather than a care home).

Edited July 31, 2022 by BazzaS

[Ethel Street]

2 hours ago, BazzaS said:

 

So, in general, what should a hospital do for a patient who is well enough to be discharged from an acute medical bed, but isn’t well enough to go back home?

What should they do for that same patient, if that patient lacks capacity to decline going to a care home?

 

Keeping the thread to Maddy's mother, we identified earlier that these are key issues for tomorrow's meeting -

 

- does Maddy's mother in fact lack mental capacity and who has determined this?

 

- on what basis did the hospital decide Maddy's mother wouldn't be safe to be discharged to her home without discussing the support available with her registered carer (Maddy) or, apparently, the local authority?,

 

A 'best interests' assessment for Maddy's mother, for any patient, cannot by definition include what is in the best interests of other patients who might present in the future.

[BazzaS]

1 minute ago, Ethel Street said:

A 'best interests' assessment o Maddy's mother, for any patient, cannot by definition include what is in the best interests of other patients who might present in the future.

 

True, but the final outcome on what will be provided does depend on resources. Otherwise EVERYONE would be getting personalised nursing care in their own home with their home being adapted to their needs. That just doesn't happen: in the 'real world' it is "best interests' then those interests being seen through a filter of "what is realistically achievable / available"

[Ethel Street]

When I was fighting for the best interests of my parents and getting them the best resources they needed I felt under no obligation to help solve the NHS's structural and resourcing problems at the same time. I'd recommend Maddy fights for her mother and leaves others to worry about the future of the NHS. 

[maddyhind]

16 minutes ago, BazzaS said:

I don't want to derail Maddy's thread, but it IS relevant to this thread.

 

What if the hospital raise it as "better for others that the acute bed is available for acute patients, and better for Maddy's Mum that she is not in an acute bed at higher risk of acquiring a healthcare associated infection" - in fact I think you've already said that this has been raised :

" hospital was "the worst place for her because of infection risk" "

 

So, I'd suggest that instead of trying to get them to keep her in hospital, that you aim for them to asses a package of care that enables her to go back home, that (with adequate support) being in her best interests. Start off with what support you, family and friends acn provide, and then what would be needed on top provided by care at home (rather than a care home).

That's what I am working on. I think a care home is a massive infection risk and infection risk is one of the many things that being cared for at home by me would prove the safest option. 

 I think that the hospital is blatantly lying to get mum out. I realise that if she comes home changes will have to be made for her but I can accept that. 

I can offer a great support package and a network of friends. Mum is terrified of going into a care home and her spirit is already low because of the stroke. Going into a care home will be massively detrimental to her wellbeing and cannot be her best interest 

[BazzaS]

2 hours ago, Ethel Street said:

When I was fighting for the best interests of my parents and getting them the best resources they needed I felt under no obligation to help solve the NHS's structural and resourcing problems at the same time. I'd recommend Maddy fights for her mother and leaves others to worry about the future of the NHS. 

 

I don't disagree, but the "fight for her mother' is going to have to be realistic within the resources available.

 

A "best interests meeting" isn't about the best interests of a patient regardless of resources / realism.

It is about the best interests of a patient within what is realistically achievable.

 

You can push for an increased package of care, even beyond 'average' (you make the point that for every average there are higher levels and lower levels, to cause the 'average' to exist). Yet, they don't have to resource EVERY possible option, for every patient, only those reasonable.

 

Since I'm:

a) repeating myself, (so perhaps not making the point adequately), and

b) have already been seen to be 'derailing the thread' (never my intent: the point is about not trying for something unobtainable because it is "in best interests" but unrealistic.

 

So, I'm out, .......... with one parting observation.

I'm not suggesting Maddy has to "solve the NHS's resourcing problem", but instead needs to make any suggestion she puts forward reasonable and realistic .... or it'll get rejected.

[maddyhind]

49 minutes ago, BazzaS said:

 

I don't disagree, but the "fight for her mother' is going to have to be realistic within the resources available.

 

A "best interests meeting" isn't about the best interests of a patient regardless of resources / realism.

It is about the best interests of a patient within what is realistically achievable.

 

You can push for an increased package of care, even beyond 'average' (you make the point that for every average there are higher levels and lower levels, to cause the 'average' to exist). Yet, they don't have to resource EVERY possible option, for every patient, only those reasonable.

 

Since I'm:

a) repeating myself, (so perhaps not making the point adequately), and

b) have already been seen to be 'derailing the thread' (never my intent: the point is about not trying for something unobtainable because it is "in best interests" but unrealistic.

 

So, I'm out, .......... with one parting observation.

I'm not suggesting Maddy has to "solve the NHS's resourcing problem", but instead needs to make any suggestion she puts forward reasonable and realistic .... or it'll get rejected.

Mate, seriously, please respect my wish to keep the thread specific to my Mum's problem 

[Man in the middle]

Quote

So, I'd suggest that instead of trying to get them to keep her in hospital, that you aim for them to asses a package of care that enables her to go back home, that (with adequate support) being in her best interests. 

 

I absolutely agree. But in this particular case no consideration appears to have been given to that option. Instead the patient has been summarily deprived of her liberty - a course of action that should only be considered as a last resort when all other options have been considered and discounted. Furthermore there seems to have been no discussion with the patient's family (which is clearly seen as desirable if not necessary). At the very lowest there seems to have been an enormous abuse of process here. Nobody should be deprived of their liberty in these circumstances on the whim of a single person without suitable alternatives being considered. Even convicted criminals are entitled to have alternatives to custody duly considered by a judge or magistrates.

[maddyhind]

Man in the middle : obviously I don't know your background but you seem knowledgeable. Do you think abuse of process is enough to get the DoL overturned?

[Man in the middle]

It's difficult to say because we don't really know exactly what process was adopted! I suppose it depends on what the hospital actually tells you they did. But the fact that you were not consulted at all points to there being breaches of the guidance at the very least. I think you need to major on the reasons why this step was taken, Among the questions you should demand answers to:

 

• Why did they consider it was necessary to detain her (which can be done by force if necessary, so it's not something that should be undertaken lightly)?
• How will her treatment suffer if she is not detained?
• What alternatives were considered before the DoL decision was taken?
• Why was it deemed necessary to take that decision on Friday afternoon and before you had been consulted?
• Exactly what changed to prompt the DoL order being considered?

 

You should also get confirmation that this is an "urgent" DoL order (and thus lasts only seven days) and if so are there plans to seek a "standard" DoL order? Ultimately I think you need to make it clear that you are  prepared to have the issue considered by the Court of Protection (how to do this is in my first post).

 

Do let us know what happens. 

Edited July 31, 2022 by Man in the middle

[maddyhind]

Thank you everyone. I hope for the best and appreciate your efforts but I really fear that this is a stitch up and the fix is in. 

[maddyhind]

The bottom line is that if going into a care home was in my Mum's best interest - it isn't, she is terrified of going into one - then the hospital would have discussed it with me honestly. They didn't. They panicked as soon as I said that mum and I would refuse to go in, got an urgent DoL. In my opinion the DoL was obtained fraudulently. It will be challenged 

[honeybee13]

I wouldn't use the word 'fraud' though, Maddy, you want them to co-operate with you. Get as much information as you can, especially the answers to MitM's questions, before you start challenging anything.

 

HB