All legal professionals working with elderly clients want to avoid negligence claims when working with elderly clients. Unfortunately we live in an increasingly litigious society and attorneys and professional deputies are coming under increasing scrutiny. The number of elderly clients is also likely to increase as we have an ageing population in the UK. There are now 14.9 million people aged over 60 and this is expected to exceed 20 million by 2030.
Whether you are Attorney for health & welfare, or professional Deputy for an elderly client, it is important that you understand what needs to be done so you can be confident of best practice when working with older people and avoid potential for a negligence claim or disquiet from the OPG.
It is seen as good practice by the Office of the Public Guardian (OPG) to apply a high standard of care by involving and getting advice from other professionals, for example a qualified independent care professional and requires deputies to work with third parties to achieve the best possible outcomes for clients. These standards require solicitors to:
- Ensure any level of care (including any supplementary therapies or treatments) is relevant to the client, good value for money and appropriate to the level of funds available.
- Review or commission a care plan or occupational therapy report and commission any aids/adaptations necessary to ensure that the client’s needs are met.
- Allocate a care professional when the client doesn’t have any family, carer or friend who could advocate on their behalf.
- Carry out a health review/assessment at least once a year to ensure the clients needs have not changed and are still being met.
My team of social work and occupational therapy consultants at Relative Matters support solicitors in Sussex and Surrey to meet these high practice standards. Occasionally we come into contact with someone whose needs and circumstances have been overlooked.
Example of the need to avoid negligence claims
Mr. Jones, an 88-year-old gentleman, had been placed in a high end residential home. His only relative was a nephew who showed no interest in him. His solicitor had a Lasting Power of Attorney for his property and finances. Following a hospital admission his solicitor referred Mr. Jones to Relative Matters. The care home had refused to have Mr. Jones back when he was ready for discharge and we were asked to find a suitable placement for him.
When I visited Mr. Jones in hospital he was apathetic and withdrawn. He was dressed in a hospital gown and had no personal toiletries. A glass of water was placed on his bedside cabinet but he was unable to reach it and appeared not to like water anyway.
We were advised that no one had visited, despite the care home being paid in full for the duration of his six-week stay. Hospital staff had no personal information about Mr. Jones so conversation between him and hospital staff was limited and treatment restricted to his medical needs.
Mr. Jones was only receiving the lower rate of Attendance Allowance (he would have been entitled to the higher rate for some time) He had not been assessed for NHS Continuing Healthcare.
When I went to collect Mr. Jones’ clothes and toiletries from the care home I found photographs of him looking at me proudly in a naval uniform and another in a family group.
This proud man who had fought for his country had ended up a virtually anonymous patient without the dignity of even having his own clothes and toothbrush. His income was also less than it should have been.
Visiting someone in hospital is important for someone’s well-being. It is also an act of kindness and compassion. If your client is admitted to hospital it is not necessary to go yourself, but good practice to make sure someone visits.
Here are the questions you need to ask yourself to ensure your practice is sound and person centred.
- Have their needs been properly assessed?
- Is there a care plan in place?
- Are they receiving the public funding/welfare benefits they are entitled to?
- Has a specialist independent financial advisor been involved in planning future care fees?
- Is their care and medication reviewed regularly?
- How are safeguarding issues identified and addressed?
- How are Deprivation of Liberty Safeguards (DoLS) monitored?
- Does an independent care professional attend Best Interest (BI) meetings?
- Do they have LPAs in place?
- Are their end of life wishes known and recorded?
Over the coming months I will consider each question in depth and will be looking at Needs Assessment very soon. In the meantime please let me know if you have an issue relating to working with elderly clients I can help you with.
We are often asked which the ‘good care homes are?’ in a specific geographical area. We cannot answer this as everyone has unique needs, preferences and expectations. Finding the right care home for someone takes time, expertise and the ability to see things from the person’s perspective.
Relative Matters were asked to assist with a Bob who had become concerned about his Mother, Barbara who had returned home after a hospital stay and it had become evident very quickly that she was not coping. Bob had found a care home willing to take her at short notice, however, soon after she had moved in, Barbara was demanding to go home, her behaviour had become challenging and the home were not coping with her. During this time, Barbara was being assessed for a diagnosis of dementia and the Deprivation of Liberty (DOLs) team had been asked to be involved as the home were concerned that they were holding Barbara against her will.
We responded swiftly and assessed the situation from Barbara’s perspective and it was evident there were some memory and capacity issues. A full holistic assessment of her objective needs, her perceived needs, and her home environment were completed and through this process, it became apparent that she lacked capacity to make an informed decision to return home and was not actually concerned about going home. Barbara simply did not want to be in the home where she was.
After liaising with Bob, the DOLs team and the care home, it was agreed that it would be in Barbara’s best interests to move her to a care home that could meet her needs, and through meeting her needs, promote better behaviour patterns that could be managed in a more person centred way. A carefully drawn up profile was developed with Barbara of what she wanted from her next move. Once research had identified a specialist care home that could meet Barbara’s needs and preferences, she was escorted for a visit, so that she was fully involved in the process and then supported with the actual moving process.
The move was a complete success. We had ensured that the new care home was understanding of the behavioural aspects of Barbara’s dementia and were willing to work with her so that her needs could be met in a cohesive environment where she did not feel institutionalised, activities were interesting and she felt valued.
Finding a care home is easy if you use a ‘one size fits all approach’ but just like you and I will inevitably have different needs, preferences and expectations about where we live, older people are no different.
This post has drawn on work undertaken by Liz Tremlett. Liz works as one of Relative Matter’s Occupational Therapy (OT) Consultants. OT’s work with people to identify the difficulties they are experiencing in every day life and to work with the person to find ways to overcome these, in order to promote health and wellbeing.