Mental capacity contradictions

Can an old lady with a documented history of refusal of treatment with an anti-depressant really consent to treatment when she no longer even remembers who her daughter is?

Over the course of the last year Mum’s mobility has deteriorated so much that she essentially can only go out of the house if it is to get into a car and be driven somewhere. She also has a degree of dysphasia which frustrates her, as she loves to chat.

Unsurprisingly, she has become quite down in the dumps, but she has some old-fashioned views about mental health and doesn’t admit to depression although her GP saw fit to refer her to the Community Mental Health Older Adults Team. Mum got on well with the CPN and enjoyed her visits but did state unequivocally that she would not agree to be treated with antidepressants even if a formal diagnosis of depression was made.

So far, so in line with Mum’s categorical refusal to be agree to having carers at home. On that issue, even though lots of people think Mum would benefit from carers (including the Social Work key worker and her GP as well as family & friends), Mum has been entitled to refuse the carers – or so the social work people tell me.

Mum has been hospitalised for a nearly two weeks now, having been admitted with severe constipation. She is more confused than ever and cannot tell me when I visit what has happened to her that day (even though I know she has had physiotherapy, for example). The doctors have explained to me that this ‘delirium‘ is common when elderly people are hospitalised.

This morning the doctor told me Mum definitely can’t come home without an extensive care package. So how are they going to get her to agree to it?

After the first week, during which Mum was often tearful, she was put onto an anti-depressant without anyone consulting me, even though the doctors had had a full history from me in which I told them Mum’s attitude to anti-depressants.

Now, don’t get me wrong, if they had consulted me or my brother, we would have agreed that Mum should be treated, but they say Mum consented. She wasn’t asked in my presence, so I don’t know how the question was put to her. I don’t think she was fit to consent; she doesn’t even know who I am some days.

I think this is an abuse – albeit for the ‘right’ outome- of the capacity to consent rules, and as a carer it leaves me more frustrated than ever about what my role is. It seems that the medics can do whatever they like with impunity when they think it is the right thing to do, while the family carer cannot insist on anything at all – in this case a care at home package – even if it is obvious to all concerned that the person is making a really bad decision.

It never rains but it pours

Why does each new crisis arrive so soon after the previous one is resolved?

When I awoke very early this morning, as I usually do being a moderate insomniac, I was looking forward to writing a blog post about the really momentous thing that happened  yesterday.

Meanwhile, the news was full of information about the amout of rain that has fallen overnight, and sure enough, the usual deep puddle had formed on our driveway. I’ll come back to the rain later…

Yesterday, Mum’s GP decided it was now time to sign whatever the relevant paperwork is to define Mum as an Adult with Incapacity. The immediate first thing about this is that Mum can now be over-ruled about having local authority carers coming in. We have been in limbo for over four years, with everyone – OT key worker at local authority elderly care team, GP, Mum’s friends, me, my sibling, my friends, the church elder, Mum’s neighbours, Uncle Tom Cobley – thinking that Mum would benefit from these visits, and that she would actually enjoy having more people coming into the house as she becomes increasingly housebound.

But, the gatekeeper to this service, the OT key worker at the local authority, cannot (she says) provide it if Mum says she doesn’t want it. Which she does, every time.

In the last couple of months, though, there has been a dramatic step change in Mum’s condition. She is now confused and distressed upon waking. She is also wetting the bed, forgetting to take her pills, and a whole host of other behaviours that are not optimal for quality of life.

Yesterday, when the GP called me to say she was now content to sign the paperwork, I was happy and relieved; but when I awoke this morning I had other more mixed feelings:

  • sadness that my Mum should be categorised by officialdom like that;
  • rueful regret that Mum’s stubbornness about accepting carers should mean that this categorisation was necessary in order to get her what she needs;
  • worry that there will be some other consequences of this designation down the line that I don’t yet know about and which will be bad for Mum.

However, I don’t have time now to process these feelings any further, as it never rains but it pours.

_35The GP had visited Mum yesterday while I was out working, and among other things realised that Mum is constipated. Our whole family has lived with Mum’s bowels for as long as I can remember, and she was diagnosed donkey’s years ago with diverticulitis. Mum has always had to eat bran and perform various dietary rituals to ‘keep herself regular’. She almost certainly has sub-optimal gut motility. These days she eats Oatibix and prunes every morning and uses a product called Laxido. I think she has missed a couple of days recently¬† along with forgetting to take her pills, so today the chickens came home to roost.

I gave her a Laxido drink yesterday at teatime after speaking to the GP, and another one this morning along with her Oatibix. She then felt the need to go to the loo, but was in there for ages bellowing with great pain. It’s a ghastly situation. When she finished in the loo, she told me that her cleaner blocks the loo by using the wrong toilet paper. This is clearly nonsense, but after a few minutes I realised Mum was trying to tell me the loo was blocked. Sure enough, although there was no sign of anything she had passed in the loo, when I flushed it the bowl just filled up.

Bloody flipping feck feck feck!

indexMum lives in a very ancient wee cottage with very dodgy drains. It is possible that Mum has blocked the loo by accidentally dropping an incontinence pad down it. It is also possible that the sewers are backed up by the torrential overnight rain, or blocked by autumn leaves. I investigated…. stuck my hand around the U-bend, but couldn’t find any obvious block. So where we are now, is that I have called the relevant sewerage company and they will send someone within 24 hours!

She only has one loo, by the way.

So, I will have to spend as much time as I can at Mum’s house between now and them coming because she can’t even answer the door never mind speak to them! And it’s parents’ evening tonight and….. and I want a life!

Why does each new crisis arrive so quickly after the previous one is resolved?