A lady sits alone by a lake illustrating the feelings of loneliness and fear around supporting a loved one in 24 hour care

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Accessing appropriate support via the Court of Protection

When a loved one suffers injuries that means they require 24 hour support, there is a difficult decision to be made. Supporting family members can feel alone and isolated, concerned at the quality of care provided. Michael's story provides an example of the steps that can be taken to improve the level and quality of care provided.

Michael* was left with multiple injuries, including an acquired brain injury following an accident. After receiving extensive treatment in hospital, he was assessed as requiring 24 hour support to assist him with all aspects of daily living and he was discharged to a nursing home. His care and placement costs were paid by his local authority after a NHS Continuing Healthcare assessment determined that Michael was ineligible for NHS funding.

Concerns about the quality of care

Michael’s wife became concerned about the quality of care provided by the nursing home. Amongst other matters, the home had a very high proportion of agency staff, which meant a high staff turnover and there didn’t seem to be one particular person with oversight of Michael’s care. During some visits it became apparent that Michael’s medication chart had not been completed correctly. Michael was spending the majority of his time in bed, with very little rehabilitative support. A recent investigation by the Care Quality Commission (CQC) had revealed some significant safeguarding concerns. Moreover, the nursing home was some considerable distance from Michael’s wife, which meant that she struggled to visit as often as she would have liked to. Michael’s wife felt strongly that the nursing home was not able to meet his needs.

Action about the quality of care concerns

The extent of Michael’s injuries meant that he was deemed to lack the mental capacity to make decisions about where he was living and the care that he received. He was also unable to communicate verbally his views about the home.

The nursing home had not applied for a deprivation of liberty safeguard (DOLS) authorisation, which would have given Michael a mechanism to challenge his care arrangements.

Michael’s wife attempted to discuss her concerns with both the nursing home and the local authority, but there were significant delays in the issues being addressed or an alternative home being sought. Michael’s wife was keen to explore whether Michael could return home to live with her, with an external package of support in place.

Application to the Court of Protection

When further attempts to discuss the matter with the local authority were unsuccessful, Michael’s wife brought an application to the Court of Protection. The Court would take a view as to whether it was in Michael’s best interests to live at his current placement. In doing so, she asked the Court to order the local authority to provide updated care plans for Michael. Additionally, the Court could also consider the support that could be provided if Michael were to return home and investigate the alternative nursing home options that might be available to Michael. The local authority was also directed to re-investigate Michael’s eligibility for Continuing Healthcare funding.

Once Michael’s updated care plans had been provided, it became clear that providing support in the family home was probably not going to be a realistic option for him or his family. As a result, the search turned to suitable nursing homes. Michael’s wife did her own research into nursing homes closer to the family home, which Michael might be able to move to.

Michael’s needs met as a result

Through this collaborative approach, under the scrutiny of the Court of Protection, the local authority agreed to fund a nursing home, which was closer to Michael’s family. The home was more expensive than the placement the local authority was previously funding because of the extent of specialist support available, but the local authority agreed that the original placement was simply unable to meet Michael’s needs.

Following his move, Michael was finally able to access critical rehabilitative support that had not been available to him previously. He spent more time out of bed in his wheelchair and began to access outside areas and to spend time watching football with other residents, which had been one of his favourite activities before his accident.

*all names have been changed

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