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Elderly Aunt - Crisis - Carers UK Forum

Elderly Aunt - Crisis

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Good morning. I have been reading your excellent forum for some time and hope some of you may be able to offer advice to help my brother and I.

By way of background - our aunt is now 95 and lives alone in the house she inherited from her parents (she never married and has no children). The house, in my opinion, is really not fit for her to live in safely, and I doubt whether it would be possible for carers or even a cleaner to work there. The house was badly affected by mining subsidence not long after it was built (my grandparents got a few hundred pounds compensation in the 1950s) and the floors slope badly. She has no fridge so food cannot be stored safely (I have caught her cutting mouldy bits off food sometimes, and her solution to milk going off was to start drinking tea without milk). Her kitchen is so small (it is a 1930s semi and has never been modernised) so there is no room for any appliances other than her gas cooker, and she has no washing machine either. Her bath is unusable and she has no shower. She is very deaf and unable to use a phone (has never been willing to try although we have suggested getting one suitable for a deaf person). We eventually succeeded in persuading her to have a mobile phone just so she can press the emergency button to summon help, but it took years to get her to accept even that. She flatly refuses to consider having carers come to assist her, saying that she will not have anyone other than family, and has also refused offers from a Victim Support Scheme after she was burgled to have regular visits from a "befriending" service although she is very lonely. She does not have dementia or any other major illnesses.

For many years she had a lot of help from my sister who gradually took on more and more responsibilities until, after my aunt became totally housebound (she could move slowly around her own house but would not go outside and claimed she could not get into or out of a car) my sister was doing all her food and other shopping, looking after her banking and paying her bills, arranging all her medical appointments and whatever repairs or replacing household items became necessary, and responding to urgent callouts including numerous times when she pressed her emergency phone button "by mistake". My brother also arranged things for her such as having central heating installed finally when her old back boiler broke down and she was found to be living without hot water (if he hadn't forced her to instal it she would still be doing that). Tragically, my sister was killed whilst on holiday abroad at the end of June.

Since that time, my brother has kept things going as best he can (he has a very demanding job which means he works long hours, travels around the country and often has to stay away for days at a time). We have applied for and have in place POA for my aunt's finances now, and have applied for the health and welfare POA but that has not yet come through. I live abroad and have had health problems myself (open heart surgery in 2018 and a hysterectomy due to womb cancer at the end of October this year, from which I am still recovering) so am not able to do much to help, which is something I feel very guilty about. I know that the house is becoming increasingly dirty with bad smells (she will not let me do any cleaning when I visit) and she is obviously neglecting her personal hygiene, not washing or washing her hair.

Now things have come to a head as the kind of crisis we always knew would happen someday has arrived. Yesterday afternoon my brother arrived to visit her (having last seen her on Thursday evening when he delivered her shopping), found all the curtains still drawn and could not get into the house as the security chain was on. He called the police who broke in and gained entry, and called an ambulance. My aunt was found unconscious on her bedroom floor having pulled the bedhead down on top of herself. She was taken to hospital and my brother was still there with her at 11.00 pm, she had had a CT scan and they were waiting for an X-ray. Some kind of infection (probably her kidneys) is suspected.

I am aware from reading the forum that she should not be discharged from hospital unless she is considered safe at home, but I am worried that they will try to send her home as she will insist that she is able to manage and they will take her at her word as she has capacity. Frankly, neither my brother or I are able or willing to become her full time carer. He has to continue to work to pay his mortgage and support his wife and son, and I am not willing to give up my whole life, sell my home here (I could not afford to buy anywhere fit to live in in the UK and could not live in my aunt's house in the condition it is in).

What are our options? Can we insist that she not be discharged until a care package is in place or she goes into residential care (which she would refuse if it is put to her), and tell social services we are not prepared to provide the increased level of care she will need? Will social services visit her home and are they likely to agree that these conditions are just not suitable for a frail 95 year old to live in? With regard to my aunt's finances, she has just over 23k in the bank (she receives the Pension Credit minimum income guarantee) and owns the house, but because of the subsidence issue I understand that the property would be unmortgageable so I do not know how we would manage to sell it to pay care home fees, and even if it was sold to a cash buyer it would not fetch very much. We are not bothered in the slightest about any inheritance we might have received being used to pay for her care, we want her to be safe, but to be blunt she is not our parent, she is an incredibly difficult person to deal with who will not act in her own best interests, and we are not prepared to sacrifice our whole lives to be at her beck and call. The paramedic told my brother that he would have to make a referral to social services regarding the need for care, which we are glad about. I have considered contacting social services about her situation before, but felt that it would be a waste of time as she would refuse to co-operate with any assessment process and insist she could cope. Even when my sister has arranged home visits from her GP and the GP has ordered hospital tests, my aunt refused to go for the tests and made my sister cancel the appointments. I have been afraid the GP would consider she was wasting his time and strike her off his list. That is how difficult she is.
Hi Lynn.

Welcome to an extremely quiet forum and a difficult time of the year for far too many in the Carer Army.

First stop ... the BIBLE on hospital discharges :

https://www.nhs.uk/using-the-nhs/nhs-se ... -hospital/

In short ... by the book or ... NO DISCHARGE !

( Reablement care ... an odds on favourite ? https://www.nhs.uk/conditions/social-ca ... eablement/ )

The immediate future ?

First reply to a posting yesterday contains many links to AGE UK ... covering a potential move into a care home ... either nursing or residential :

https://www.carersuk.org/forum/support- ... sues-39346

In essence , a check list split across those links of all the questions that need to be asked when considering such a move.

Peruse those at your leisure.

In addition , I also included a section ... ANCILLARY / RELATED CONCERNS ... towards the end.

They will apply to your aunt's own situation.

Have a read ... and then get back to us.

Finally , a link to BB's excellent thread on hospital discharges over the forthcoming holiday season :

https://www.carersuk.org/forum/support- ... ason-39256

In short , do not allow the NHS to dictate terms ... you must be in the driving seat !
Do you have a key? Take some photos of the home and send them to the hospital and Social Services. Also contact the Housing Officer from the local council and ask him to visit to decide if it is fit for habitation.
Strange ... homes fit for habitation ... almost all legislation out there is directed at tenanted property ... not home owners.

Definitely one to be investigated by the LA.

Insurance policy ... could that be compromised ?

( " The policy holder hereby agrees to keep said property in a good state of repair " ... etc. etc. ... ? )


AGE UK ... again ... have produced an excellent guide for elderly home owners :

https://www.ageuk.org.uk/globalassets/a ... report.pdf

Pages 13 to 16 ... HIGHLY relevant in the situation as so described.
Thank you very much for all the information - sounds good on paper, doesn't it, but I know from reading on the forum about the dreadful struggles many carers have that the reality of what is on offer rarely matches up.

I feel a little reassured after speaking to my brother again this morning. One of the doctors he saw last night told him to more or less be prepared for the worst, and if our aunt does not respond to the treatment they are giving her, they will not attempt to resuscitate her - and we both think that is the most humane thing they could do, as long as she can be kept comfortable. She was admitted to a ward last night after having the CT scan and x-ray, so at least was not subjected to a lengthy wait in a corridor or many hours on a trolley in A&E. They have said if she recovers she will definitely not be discharged without support in place, which is good to know - that is what I was most afraid of. Everybody he speaks to is incredulous that she has not had any help at home before now, but as I said earlier that is because she has always flatly refused it, and got very angry whenever the subject was raised by me or other family members. He and my two nephews are going to make sure she is visited every day over Christmas, bless them. I already had flights booked to go over for a visit on 23 January, which is the soonest my doctors here advised I should travel after my operation, so who knows what the situation may be by then.
They have said if she recovers she will definitely not be discharged without support in place, which is good to know - that is what I was most afraid of.


Never a " Truer " word spoken ?

The BIBLE on hospital discharges ( Again ) :

https://www.nhs.uk/using-the-nhs/nhs-se ... -hospital/

By the book or ... NO discharge !!!

BB's thread on same over the forthcoming holiday period ... for some :

https://www.carersuk.org/forum/support- ... ason-39256

In short , do NOT allow the NHS to dictate ... you are in the driving seat !

It really would be a crisis UNLESS the NHS fire on all cylinders !

Don't lose sight of the other considerations in the short term ... following discharge and probable reenablement care.

And , just in case it's needed ... the main CHC / NHS Continuing Healthcare thread ( Question should be asked BEFORE any discharge ! ) :

https://www.carersuk.org/forum/support- ... read-35998

The section : FAST TRACK NHS CONTINUING HEALTHCARE ( NOT JUST FOR END OF LIFE ! ) ... odds on favourite ?
Hello and welcome!

Ask for a needs assessment. There are many good care providers out there. A social worker can do one with you. They should do a financial assessment as well to figure out payment options etc.
In this case , Thara , nursing needs appear to be more appropriate.

In which case , a Needs assessment would NOT identify them ... purely related to social care.
The problem is, though, what would happen if my aunt either refused to co-operate with a needs assessment (if she recovers from this episode, she is more than likely to refuse to speak to anybody from social services, she has done it before) or just tells them she can continue to cope on her own at home? She seems to have no appreciation at all of the stress she is putting my brother under by expecting him to continue doing all that my sister previously did before she died, or any awareness of the fact that the way she is living is so unsuitable. But as I understand it, if someone is judged to have capacity then they cannot be forced to do something they do not wish to do.
Hence the reference to SAFEGUARDING ... the father ?