Involve carers in older people's care for the best outcomes

Older people with dementia are often living with frail husbands or wives; sometimes both have dementia. A Local Government Commissioner's Report (done with the Health Service Commissioner) on a case in Kirklees (in West Yorkshire, it covers the towns of Dewsbury and Huddersfield and smaller towns in between) shows how difficult it may be to deal with such situations, but how supporting the family's involvement is crucial.

In 2009 the husband (with dementia) was admitted to hospital with acute glaucoma, probably caused by a blow from his wife, whose dementia was also showing up. There seems to have been a safeguarding investigation, but it was never followed up, and the husband was shot out of hospital with no protection. This is not a big surprise to anyone familiar with health and social care: hospitals dealing with in-hospital decisions, especially if they need a bed for someone else, often know nothing about and therefore take no account of the home situation in their decision-making. If they employed or even liaised with social workers, they might know more about what's going on in their patients' lives.

The wife's symptoms worsened, and she was admitted to hospital: her husband went into respite care. Their son, a doctor, fixed up a private care arrangement for a nurse to provide home care, but the health trust and the local authority decided this was inadequate (without consulting him) and issued a Deprivation of Liberties order to authorise themselves to keep the husband in respite care without his consent. The health trust also took it upon themselves to write to the son telling him he should put them in separate homes, and sent a copy of the letter, presumably following the usual transparency guidelines, to the mother, causing her great distress.

The Local Government Commissioner said:

...the couple were denied the chance of living at home together in a settled lifestyle for longer than they did. The couple suffered a needless loss of dignity, while their son felt ignored, undermined and excluded from any decision about their care.

and the Health Service Commissioner said:

Involving their son could have led to better outcomes for the couple. Families and carers can have the key to understanding the needs of their loved ones. That’s why public services must, in law, involve families and carers in making life changing decisions for vulnerable people.

Utterly reasonable, and in addition to apologies, reviews of their practice and financial compensation, the trust and the local authority also agreed to review how they implemented their complaints policies, so presumably they told the family to buzz off when they complained, too.

Link to the Local Government Commissioner's (Ombudsmen) Report.