Tag Archives: Dementia Awareness

Managing the affairs of someone else – A professional appointment – Health and Welfare Decisions

25 Oct

 

Managing the affairs of someone else – A professional appointment – Health and Welfare Decisions

 

There are two ways in which a person can be appointed as an ongoing basis to manage the affairs of someone else and this is by appointing them under a power of attorney or the Court of Protection appointing them under a deputy application.  A person can appoint their loved ones or a professional whilst they retain the capacity to do so.  The Court of Protection will appoint someone if this has not happened, they lose capacity and need someone to support them or take over. Health and welfare decisions can only be made when that person lacks capacity to make decisions for themselves, so they are always relying on the decision making of the attorney to make decisions that they would be happy with.

 

In general, a professional appointment of a solicitor tends to be for finances only, as it is generally accepted that loved ones would know the person well enough to make health and social care decisions, but it would be hard to make decisions against medical advice for a professional who doesn’t know what the individual would want.  It is for this reason that the Court of Protection would be very unlikely to grant a health and welfare deputyship order to a solicitor.

 

So, there are limited circumstances in which I will agree to act as either deputy or attorney for health and welfare.  The circumstances are either when they have no suitable family member to act and I have had an opportunity to sit down with them and go through their medical history and have an in-depth discussion about their care priorities.

 

The other circumstance that I will act is where I am co-attorney with a family member who lives further away and needs someone to be “on hand” to deal with the issues that arise.  I would always defer to the family member who knows the person better, however with my experience, I can make suggestions to the co-attorney about how the persons care can be best managed.  This arrangement works well, I stay in communication with the family member and they are able to effectively support their loved one from a long distance away.  The attorneys and the person themselves know that the role will be undertaken professionally and that their distant loved one is supported in their attorney role, which can be distressing with an added element of feeling helpless through the distance in which they live away.

 

This is work that I love, I get to meet the person and make sure that they are cared for in a manner that is best suited to them and that their loved ones are informed, but still able to maintain their own lives.  It is a great outcome for all!

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Managing the affairs of someone else – A professional appointment – financial affairs

11 Oct

 

Managing the affairs of someone else – A professional appointment – financial affairs

 

Following on from my last blogs about managing the affairs of another person, what should the person do if they have no-one to do that or if they don’t get on with their family?  They can appoint a professional like me and I act for a number of individuals in some cases for both the finance and health and welfare.  I can also be appointed by the Court to be deputy (which is similar to the authority of an attorney), but these appointments are usually for financial affairs only.

 

My appointment is no different from the appointment of the family member, with the one exception that I charge a professional fee for the work that I do.  How much the fee is, depends on the complexity of the matter and in particular where they live, as if they live in care and they require the payment of their care fees and an annual welfare visit, the cost is far less than someone who lives in the community and due to issues arising I have to visit every few months.

 

I have a duty to maximise the estate for the benefit of that person, which means that I have an obligation to ensure that the funds are appropriately invested to ensure that there is an income.  I need to give consideration to the income and how the money is being spent, as someone who has only a couple of hours care a week or even a day, will spend less money than someone who has a full time live in carer.  How the estate should be managed has to have all the relevant information taken into account so that a bespoke strategy is achieved.  I even have to consider how much money is kept in one bank, as if the bank goes bust only the first £85,000 is insured and the rest could be lost.  I have to consider moving the excess to protect the client, if the worst happens.

 

I might be asked to make gifts and I have to consider whether that is reasonable.  I might have to take control of high value assets, so jewellery might need to go into a safety deposit.  If they have a safety deposit box, then I will need to know what is in it.

 

It is also useful to know what is in the Will, so that I don’t sell anything that is specifically gifted in their Will, such as jewellery or property.  If the donor leaves their house to someone and I’ve sold it, the disappointed beneficiary will not be happy with me and this is a circumstance that a statutory Will might be appropriated, so that the Court of Protection will grant a new Will giving a share of the estate that equates to the value of the property to that beneficiary.  So if there is a house worth £200,000 and cash worth £100,000, when the property is sold, whoever receives the cash will get £300,000 if there is only cash, but the Statutory Will would give 2/3 to the person who would have had the property and 1/3 to the person who would have had the cash.

 

My overall aim is to ensure that the wishes of the person are carried out as far as is possible to achieve, so if the client doesn’t want to go into care and it is possible to arrange their care in such a way to achieve that, then I do so.  If their primary concern is to be safe and cared for, then admission into care in some circumstances might be the right decision for them.  How I deal with their money depends on what their financial needs are, what their income is and what their capital is.

 

The firm that I work for has to insure the client’s money as part of their liability insurance, so within the firm there are safeguards to ensure that the clients’ money is safe from fraud or theft, including from me!  It is for this reason that I would not act with a co-attorney for financial matters, as I remain also responsible for the running of their affairs, including the fraud by co-attorney.

 

Having authority over another’s affairs is a big responsibility, which I take very seriously to ensure that the person is cared for as best as is possible to achieve and in the way that they want.

 

How to communicate with someone who has a cognitive impairment – Part 5

9 Aug

 

How to communicate with someone who has a cognitive impairment – Part 5

 

I would again like to thank Kate Smith from Memory Matters some of the information for this blog.

 

It is important to remember that no two people with a cognitive impairment will communicate or present in the same way, but here are some more ideas that will hopefully help.

 

People with dementia are often very good at reading body language and at interpreting tone of voice, even when fairly confused.  It is more respectful therefore to tell the truth, rather than challenge their view of reality.  If the person with dementia is awake and wandering about in the middle of the night because they believe it is day time, rather than tell them they are wrong, it is better to suggest that they go to bed and if they don’t want to, then sit and chat about the weather or distract them in some other way and later suggest they go to bed.  It is far less confrontational than telling them that they have made a mistake about time and they should go to bed, it can lead to them feeling shame for getting something wrong!

 

When you are with a person with dementia and their carer, it is best to talk to the person with dementia and not their carer if that is possible and if talking about them, ask permission to talk to the carer.  It can just make them feel uncomfortable if they are being talked over rather than to.

 

People with dementia don’t like to be tested about things, the rest of us don’t go through our lives being tested, so they might not want to answer questions if a lot of them are being asked at once.  So make the person feel comfortable and if you need information, see if you can get it in a more conversational way, instead of lots of questioning.

 

If at all possible, it is better not to say “don’t!  As soon as anyone is told “don’t do that” or “you can’t”, people do exactly what they have been told not to, it is human nature!  It is much better to redirect to something else and only at the point their life is at risk should they be directly challenged, if not, then they can be distracted instead, it is a much nicer way to behave towards people with dementia.

 

Everyone is different, not everything that I have discussed in this series of blogs is relevant to everyone, but hopefully it will be helpful, if you ever meet someone with a dementia.

 

It is also important to remember that the skills that relate to dementia are transferrable to other disabilities and situations.

 

Be calm, be happy, smile and this will have an impact on the person with dementia, this will be perceived by the person with dementia and they will appreciate that you are a safe person for them to be around.

 

How to communicate with someone who has a cognitive impairment – Part 4

26 Jul

 

How to communicate with someone who has a cognitive impairment – Part 4

 

I would again like to thank Kate Smith from Memory Matters some of the information for this blog.

 

It is important to remember that no two people with a cognitive impairment will communicate or present in the same way, but here are some more ideas that will hopefully help.

 

People with dementia can have difficulties in planning, putting the plan into action is called sequencing.  The often-discussed task is making a cup of tea, there are lots of different stages to this task, which we take for granted and if we get some of them in the wrong order, we do not have tea.  So for example, if we pour the water on the tea bag and then boil the kettle, we have a wet tea bag, but no tea.  People with dementia can also have problems with other everyday tasks and this includes talking about those tasks.  A difficulty planning is around the abstract thought process, I once had a client who held out her hand to me with a 50p in the middle of her hand and she asked me “is this 50p worth a pound?”!  She was able to identify the piece of metal in her hand, but did not understand its abstract value and therefore how it worked.

 

People with dementia can have problems with spacial perception, they will struggle to understand what is close to them or the distance between things, which can impact on how they talk about things.  This will also clearly have an impact on how they move about, which will also have an effect on how people treat them (if they look drunk, they might be treated as drunk!).

 

People hold maps in their head of their environment, so if there is a problem with the map, people can have difficulty finding their way around, except in the most familiar of places.  People with dementia who have difficulty finding their way around can begin to go out less or not at all, if they are alone, which can lead them to become isolated and lonely.  If they don’t go out, they might need a companion, they need someone they trust and feel safe with and they will happily leave their known environment.  When asked about places, they can get confused or muddled and mix places up or have trouble talking about them.

 

When talking to someone with a dementia, it is more respectful to accept their understanding of their world than correct them, unless it is not possible to do that.  So when someone in their 90s talks about their parents as though they are still alive, unless there is a risk to their life, it is better for that person with dementia to also talk about their parents as though they were living.  I had a client once whose husband had passed away and she thought he was having an affair and that was why he hadn’t visited, even though she had been told and had attended the funeral, she just couldn’t retain that information.  So her family told her lots of different things, but not that he had died, as she just got upset each time, as she re-grieved for him.  The family said that he had a cold and didn’t want to pass it on, that he would come next week or that he had come a few days ago and due to her confusion, she accepted all of these excuses and wasn’t upset at either his death or perceived affair!

 

When talking to someone with a dementia, if you do nothing else, but the kind, safe, smiling person.

 

How to communicate with someone who has a cognitive impairment – Part 3

12 Jul

 

How to communicate with someone who has a cognitive impairment – Part 3

 

I would again like to thank Kate Smith from Memory Matters some of the information for this blog.

 

It is still important to note that no two people with a cognitive impairment will communicate or behave in the same way, but here are some more ideas that will hopefully help.

 

People with dementia can have problems initiating something, they just can’t seem to get started.  A couple of years ago, I went on a dementia experience, when I had my hearing, vision and sensitivity affected by various pieces of equipment and was then told to do three things all at once, none of which I could hear properly.  It was an information overload at a time when I had impaired senses and it became too much for me.  I just sat down in the chair in the corner and waited for someone to come and tell me what to do next, as I had no idea what I was meant to do!  This is apparently a common thing that people with dementia do, when they don’t know what to do.  So, I sat waiting patiently and watched what was going on, as best as I could see.  People with dementia might need help to get things started, as they might not know how to in that moment.

 

The next issue that they may have is called perseveration and this is when they do get started they cannot stop.  I have had a few clients that walk, all the time in a care home.  They cannot even sit down to have a meal for any length of time and often have food that they can carry with them and eat on the go.  Even going to the loo can be challenging for these people that walk a lot, as they have trouble sitting for any length of time, which might not be the same time frame that they eliminate in!  It can be repetition of any action though, including moving their hands, feet or arms in the manner that they did for work years ago, if their work tasks were repetitive.

 

People with dementia can become bewildered with choices, so keeping the choices down to very simple ones can help.  Instead of asking if they want beef, chicken or fish for dinner, just start off my asking if they want beef, yes or no and if the answer is no, ask about chicken etc.  In this circumstance it is useful to know what their general preference is, so as to ask them about what is likely to be a positive choice for them first.  The person talking to them should keep the language simple, to ensure that they are as empowered as possible to make as many decisions for themselves as is possible.

 

People with dementia can have problems making good decisions, as they can have an impaired judgement.  When faced with the choice about going into care, often they say that they don’t want to and believe that they are caring well for themselves, but are remembering a time in the past when that was true, which then affects their ability to make a good decision now.  There are lots of different reasons for impaired judgement, this is just one example, however the person’s judgement might be impaired, so they might need support to make decisions.  It is important not to interfere with an unwise decision, as people with dementia are allowed to make unwise decisions, like we call do from time to time.  Impaired judgement is about exactly that, rather than about imposing on the person a different choice their loved one or family would rather they made.

 

The ability to make an unwise decisions is one of the five principles of the Mental Capacity Act 2005.  The issue about protecting them from an unwise choice is around their right to life, when a decision is so unwise it puts their life at risk, then their other rights can be overreached, such as the right to a private and family life or the right to free association.

 

If nothing else, but the kind, safe smiling individual for the person with dementia.

How to communicate with someone who has a cognitive impairment – Part 2

28 Jun

 

How to communicate with someone who has a cognitive impairment – Part 2

 

I would again like to thank Kate Smith from Memory Matters some of the information for this blog.

 

It is still important to note that no two people with a cognitive impairment will communicate in the same way, but here are some more ideas that will hopefully help.

 

People with dementia can retain some motor skills that those around might have thought that they had lost.  In general, people lose their fine motor skills, so their dexterity becomes impaired for wide-ranging things, however they still might retain muscle memory for something that they did a lot when they were younger, which is why people can play the piano, even if they have trouble getting dressed and doing up buttons for example!  This can be helpful with doll therapy and pet therapy, as the person with dementia is used to rocking a baby or stroking a pet.  The moments are familiar to them and feel safe, so they will relax.

 

One third of our brain relates to processing visual information, so if this part of the brain is damaged, then the person will have difficulty in some way process or misunderstanding what they see.  This can lead to what appears to be difficulty in walking, if for example they perceive lines in carpet as snakes on the floor or dark carpet / mats as holes, which they need to step over.  They might also have difficulty in recognising people visually, so a prompt, such as giving your name and relationship is helpful.

 

The person with dementia can lose insight into not just their condition, but lots of other things to.  They might act in a way that is considered socially inappropriate, such as greeting everyone like they are your best friend or spouse.  They might hold hands with someone, as it is comforting to them, without the insight into what is socially acceptable, they are behaving in a way that they want and is helpful or comforting to them.  In general, unless completely inappropriate, then it is easier for them if the people around them go along.  I have had clients who have hugged and kissed me like I was their child and have always appreciated that it was a lovely, warm and kind way to greet me!  It is nice to be liked!

 

Communication is relevant both ways, communication to tell someone something and communication when someone is telling you something.  The loss of the ability to communicate can be in both directions, but it could be worse in one than in the other.  People can have word finding difficulties, which can be frustrating, as they know that they know what they want to say, but have trouble remembering the specific word, so “pork” could become “bacon” or “pig” instead or they might use gestures to try to explain themselves.

 

Receptive language is about someone’s ability to understand what is being said to them and if this fluctuates the person can be thought of as having selective hearing!  It might simply be that their ability to understands fluctuates, like the rest of their presentation.  So, the person might need the carer to use simple language or different language.  They might need to use gestures or other nonverbal communication, anything that involves touching the person with dementia should be appropriate, usually touching their hand is considered appropriate, but what that is, depends on the perception of the person with dementia.

 

What is important is that the person with dementia feels safe with you, if nothing else, be the smiling safe person!

How to communicate with someone who has a cognitive impairment

14 Jun

 

How to communicate with someone who has a cognitive impairment

 

Firstly I would like to thank Kate Smith from Memory Matters some of the information for this blog.

 

No two people with a cognitive impairment will communicate in the same way, but here are some ideas that might help.

 

Memory can be unpredictable, however in general short-term memory tends to be lost first and long-term memory stays with that person for a longer period of time.  However, if something emotional or very unpredictable happens during what is otherwise a mundane situation, such as a huge surprise happening during breakfast, then the details about what you ate and drank for breakfast will stay with you longer than other breakfasts.  This surprise / emotional memory works like long term memory and can be retained.  What is important or emotional to one person, won’t be the same for another, which is why it can therefore be unpredictable what will be remembered.

 

People with dementia can have difficulty focussing, which can relate to their inability to filter their environment.  People without this impairment can focus and concentrate on the thing that they consider important and may not even hear people close by talking to them, if their focus is so strongly fixed on the task in hand, but people with dementia don’t always have this high level of concentration, so if there are multiple things going on in their environment, they might struggle to concentrate on any one of them.  This can also be a useful thing, if they become agitated or anxious, as the carer can do something that will distract their attention from what / why they are anxious and change their mood really quickly, such as dropping keys on the floor to create a sudden noise.

 

The areas of the brain that are affected by dementia are different in each person and if the frontal lobe is damaged, this can lead to issues with both planning and impulse control.  The family members of people who have issues with impulse control will be surprised by comments or swear words that can be used, that were never used before.  The filter that ensured that their interactions were social appropriate and measured has disappeared and they will both act quickly and out of character for them as they were before.  They might become more angry or tearful for example, the display of their emotions is unpredictable.

 

Another aspect of the loss of impulse control is the loss of ability to plan or manage their lives.  If they are thirsty at 10.30am, they might not be able to wait until 11am for their morning coffee, or plan a loo visit etc, so when they realised that they need / want something, they want it now!  They might ask for what they want and will have difficulty concentrating until they get it or they might get up and walk off to get it, which could be mid conversation!

 

Unless the environment is very familiar, that they continue to see / use daily, they could be disorientated, including to parts of their own house they don’t go in regularly, such as the spare room or family members that they don’t see regularly because either they don’t visit or live a long way away.  As far as people are concerned, everyone has a name, relationship and visual look and it is possible that they can forget one or more of these aspects, so they might know you are familiar, but not your name or what relationship you are.  This can create issues of inappropriate behaviour if the person thinks you are someone else, particularly when sons are misunderstood for husbands or daughters for wives!

 

What is important is that they feel safe with you, not the information about you that they can remember or not!