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This is a tale of woe! For want of a Health and Welfare Lasting Power of Attorney (POA) our family find ourselves with a Catch 22 dilemma in getting services for my dad. We are going in circles, believe me, we are going in circles! Please read, and take note, all you carers out there…

My sisters and I have long held an Enduring Power of Attorney, and later a Property and Finance Lasting Power of Attorney which superseded it. Thereby, sadly, lie many other woeful tales of banks, and companies, and even our own beloved (?) Department of Work and Pensions who, at various times, have been disinclined to act on this legally binding document. No, said our solicitor when we set this up (unwisely as it turns out), I don’t think you will also need the Health and Welfare one. Our solicitor must be the only legal person I know who does not take up the opportunity to unashamedly tout for extra work.

Why, you ask me, with your wide experience of working in the field of mental health and social care, did you listen to her? Why risk it?

I suppose the answer is twofold. Firstly, preoccupation with dad’s immediate needs and getting his finances sorted prevented me from thinking it through clearly. Secondly, my own experience is that the teams I worked in were very keen and pro-active in trying to involve family members and carers in a person’s care – of course we obtained the appropriate permissions to do so, and the individual who we were providing services to was the focus of our provision, but, unless there was a conflict of interest, having the family involved really helped us to give a better quality of service.

Does this sound obvious? Clearly not everyone agrees. No less than four different health/social care services or agencies involved in my father’s care have either:

a) refused to provide a service, or
b) queried a request or a care decision, because a Health and Welfare POA is not in place.

Recently I discussed this with my father’s solicitor. He was frustrated, but not surprised, at the problems we were experiencing. He pointed out that what the services are doing is completely contradictory – on the one hand they will take only dad’s instructions about his care needs which in itself assumes he has capacity, but on the other they want the family to have a Health and Welfare POA before they are willing to involve or consult us when such a POA should technically only be used if dad LACKS capacity. As I said, Catch 22.

So: establish whether he has capacity, I hear you say. If only it were so easy. On at least three occasions over the past two years I have asked the mental health team or social services to arrange a Mental Capacity Assessment in relation to dad understanding his care needs, but they have so far been unwilling to do this. Recently dad had a hospital assessment prior to discharge and the health professional who completed it said she was recommending that social services undertake a Mental Capacity Assessment, but still they did not act.

We may yet be able to set up a Health and Welfare POA if dad agrees and his GP acts as a ‘certificate provider’ confirming that this is appropriate and that he has an understanding of what this means. With dad’s diagnosis of Alzheimers this could go either way – but mental capacity decisions are specific to the time and task in hand, so the fact that dad lacks the capacity to manage his finances for instance, does not mean he lacks capacity in other areas.

In a way I applaud the services’ tenacity in querying our family’s requests on dad’s behalf. They are taking my father as their key priority and not falling into the trap of talking to other people over his head. Sadly, though, they do not take into account fully my father’s memory problems and that he immediately forgets information they have given him and cannot remember the many times he has failed to deal with things and got into a pickle. My father is happy for the services to speak with and be guided by his daughters, and will happily say so if asked. This is brilliant until something goes wrong and we have to deal with the services from a distance. You cannot put dad onto the telephone to tell them he is happy for help to be provided if he is sitting 200 miles away, and if they ring him separately he cannot understand what they are talking about and will tell them that he is managing fine when he isn’t.

The supposedly simple task of putting a handrail by the front door is a case in point. Dad comes out of hospital and is assessed at home by an Occupational Therapist (OT). The OT recommends a hand-rail is fitted by the front door and dad agrees to this. They send round a worker to fit the rail but he cannot decide from the assessment report what is needed. The fitter telephones me to tell me dad ‘did not understand what he needed’ so he did not fit the rail. I ring the OT to request that they clarify what they want the fitter to do and arrange a new visit for the rail to be fitted. They say that the fitter told them dad ‘refused’ to have the rail at all and that they won’t rearrange fitting at my request because I don’t hold Health and Welfare POA. Phew!

I have several other examples but my blood-pressure is rising just writing this. I think a meditation session might be in order.

And the moral of the story? Get those Powers of Attorney sorted out early on, while your relative or friend is still capable of making one and before the need for services makes things more complicated. Good luck, and may you have a fair wind behind your sails!