I wrote a couple of weeks ago about a tentative hospital discharge that had been adding a few grey hairs to my head. I have, of course, followed this up with a number of visits to said man who I’ll call Mr A, but managed to squeeze another visit yesterday which confirmed what I had suspected all along – that basically with or without capacity (and through many assessments there wasn’t any doubt that he did not have the capacity to make a decision regarding his placement) , at home is most definitely where Mr A wants to be.
He has fairly advanced dementia and although there are reams of risks and concerns about him being at home – the pleasure he showed on his face when asked about being at home and the expressiveness he displayed when we talked about hospital confirmed to be that any doubts I’d had at the time about discharging home (and believe me, there had been many – mostly egged on by hospital staff and some by my more senior management) might have been justified – but the right decision was made.
Possibly the thickest risk assessment that I’ve written in a long time accompanied him home but the importance of home is never lost and lack of capacity does not mean lack of choice. It’s just that sometimes reading through the obvious risks can be a little scarier – as a professional.
When you read about ‘bad’ choices made by professionals (ok, who am I kidding – by social workers) it does promote an almost risk averse culture but without any elements of risk then an element of humanity is lost. Of course, had Mr A not expressed and consistently expressed for years, his attachment to his home and his cat a different decision may have been made. I still get that pitter-patter of concern when I knock on the door and an accompanied gulp when I arrive in the office after a weekend, or in the morning to a telephone flashing with messages.
I expect that before the end of the year, Mr A will need to move though. The situation currently is sustainable but I’m not sure for how long it will be. The concerns that exist still remain but I’m hoping we might be able to look at an ‘extra-care’ sheltered option where he can have access to 24 hour support but within his own flat and still have his own space – rather than a residential home environment.
I’m just not sure if they accept cats.
Still, I don’t want to get ahead of myself although sometimes it’s hard not to think in both long and short terms simultaneously..