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Ask Dr. D. Love Your Own Question

Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17659
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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My mother suffered a stroke on April 10th leaving her paralysed

Customer Question

My mother suffered a stroke on April 10th leaving her paralysed down her left side. She was subsequently put in a residential home, where for the last month maybe two she has been having "Fits". She has paralysis in her throat whereby she can no longer eat, only Complan, she always maintained she does not want to die in a hospital and has made a living will and also a DNR notice.
This morning we have been told she is refusing food and medication and they are phoning their doctor to try and have her put back in hospital. This is entirely against my mother's wishes and going from a reasonably active woman for 96 she does not want to live any more like this. She is bedbound only has the use of one arm, luckily her "main" arm.
My question is can the Home force Mum into hospital?
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. D. Love replied 2 years ago.
Is the home saying that they can no longer care for her?
Is there an option for the mother to go to a house within the family?
Customer: replied 2 years ago.

They are saying that they do not have the capacity for intravenus feeds nor injections. Unfortunately Mum does not want to come up to Norfolk and my Sister isn't up to looking after her, she goes to pieces in a crisis.

Expert:  Dr. D. Love replied 2 years ago.
Thank you for the additional information.

Ethically, no patient can be forced to receive care, unless they are considered to have a medical or mental illness that hampers their ability to make appropriate decisions (which is why a suicidal patient can have care provided against their will). If your mother is competent and not considered depressed/suicidal, then she cannot for forced to receive any care, including hospitalization, IV fluids, or injections.

One of the key issues, then, in someone that is refusing care, is an assessment of whether she would be considered to have a mental illness of such severity that it is impairing her ability to make proper decisions. If so, then they could justify admitting her to a hospital against her will. There are also many people with mental illness in whom it does not impair decision making, so it is more than simply whether mental illness is present.

If she is considered competent and does not have mental illness of such severity, then she cannot be forced to be admitted against her will or to receive IV fluids or injections.

However, there also may be an issue of whether the home can provide the supportive care that would be necessary. If your mother does not want IV fluid or injections, the fact that the home cannot provide them is not relevant. However, there should be consideration of what care she does need and agrees to receive, and then whether the home can provide that care. If not, then there would need to be discussion of what site of care would be able to provide the care that she is willing to receive.

If I can provide any further information, please let me know.
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17659
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
Dr. D. Love and 6 other Medical Specialists are ready to help you
Customer: replied 2 years ago.

I am worried that, as at the moment there is not a family member present, there is nobody to ascertain what decision is made by the doctor if he says she is mentally incapable of understand that she MUS have medication and/or food.

I am willing to stand firm against the home and stand up for my Mother's wishes but I am concerned that they might take a decision to pack her off to hospital with no come back from the relations.

It's not that we would complain if they didn't keep her alive, she no longer wants to live like this, in bed all day long (apart from bathing and essential services) but we don't want her forced to live when she doesn't want this.

Expert:  Dr. D. Love replied 2 years ago.
I understand your concern, and it may be more effective for you to phone the doctor directly to assure that the doctor is hearing your mother's perspective. The doctor will better understand your mother's wishes if you express it to him prior to performing the evaluation. If the doctor receives a call from the home with a message that says that they can no longer provide sufficient care, the doctor will consider hospitalization before realizing that she is refusing hospitalization. He will then understand that he will need to consider the assessment noted above.
Customer: replied 2 years ago.

Sorry for delay, I have emailed the Home to reiterate my Mother's wishes, as yet they have not replied to me.

I suppose the Home will release the Doctor's phone number, he is not resident at the Home?

What do I do if they refuse to let me phone him?

Expert:  Dr. D. Love replied 2 years ago.
If you cannot contact the doctor directly and the home is not willing to provide his number, then the other option would be to contact the hospital directly, both to emphasize that she is refusing hospitalization and to request that the doctor contact you for discussion of the situation.
Customer: replied 2 years ago.

OK that seems pretty comprehensive, I would like to thank you very much for helping with a very upsetting situation, I do appreciate the time you took to help me.

Expert:  Dr. D. Love replied 2 years ago.
You're welcome. I hope that you are able to get resolution for your mother.

Customer: replied 2 years ago.

Unfortunately I was out when the Home phoned my Sister she didn't have the gumption to stand up to the Home and Mum has been carted off to Poole Hospital, which is the last place Mum wanted to be.


 


Oh honestly, some people are frightened of their own shadow.


 


Many thanks.


Pauline

Expert:  Dr. D. Love replied 2 years ago.
You're welcome.

Customer: replied 2 years ago.

Could I just ask is it normal in Nursing Homes that nurses are not permitted to give patients injections for pain?


 


My emails to the Home have resulted in them cancelling the ambulance to Poole Hospital and I will have a discussion with them in a minute.


 

Expert:  Dr. D. Love replied 2 years ago.
It is good that you were able to get the transfer cancelled.

All long term care facilities are designed for various levels of care and are designated for the level of care that they can provide. The design is not just what each staff person is qualified to do, but also the staffing pattern and what monitoring and support services can be provided. It is typical that the lower level homes are unable to provide parenteral services, including IV interventions and injections.

Customer: replied 2 years ago.

I have had a rather heated conversation with the Nurse at the Home and I have told her firmly that she is in no way to send my Mother to Hospital and no further action is to be taken by the home until I have spoken to my Mother tomorrow afternoon.


 


She said she had phone their doctor who said he didn't think that what is wrong with Mum isn't reversible but again I told her that she must not take any action until I have spoken to Mum and obviously them. Mum wants to die now this is why she is refusing treatment she's 96 and has had enough. My feeling is that not enough care was taken in chosing a home for her basing that decision on how close it was to my sister's bungalow the home being literally 3/4 minutes away.


 


Am I permitted to take this step in refusing Mum to be taken to hospital, obviously I will need to pay you more than the basic amount.

Expert:  Dr. D. Love replied 2 years ago.
To be specific, your mother has the right to refuse to be taken to the hospital, and you have the right to insist that your mother's decision be respected and followed and to serve as her advocate. They can rightly raise the issue noted above about whether she has a mental health issue that should be assessed, but in the absence of such an issue, she has the right for refusal.

Customer: replied 2 years ago.

Goodness me what a day, the Home tried to find out where I got my information but I have not disclosed this, as it is nothing to do with them.


 


Everything is being left now until I get there tomorrow and I have told them I want a face to face consultation with someone in authority.


 


Thanks again for your help in this very upsetting time.


Pauline

Expert:  Dr. D. Love replied 2 years ago.
You're welcome. I hope that everything goes well.

Customer: replied 2 years ago.

Had another phone call from the Home who have contacted their doctor and he has given them instructions to send Mother to hospital after all. He says its because she has an urine infection, but let's face it drugs can be given for that sure in the home. It seems they are unwilling to do anything at all but are not prepared to say they can't look after her, they are covering themselves by saying "They have a duty of care" to make sure she is comfortable and they cant do that because Mum keeps throwing her arms up so they cant get near her. Unfortunately, this is how Mum behaves if she doesn't want to do something or be examined she acts physically. I have gained the name of the person sending her against my wishes andmy Mothers and her position in the home. I am assuming if Mum refuses treatment at the hospital they cant force her am I right with that?

Expert:  Dr. D. Love replied 2 years ago.
Yes, but she needs to be clearly expressing that. It may be necessary for you to serve as her advocate with the hospital, emphasizing that she is refusing admission and is refusing to provide consent for care. It will usually be more effective if the family member is present, rather than discussing this over the phone, but if the only option is to communicate by phone, that is what you must do.

Customer: replied 2 years ago.

Oh dear, as I am going down to Bournemouth tomorrow I had better do this personally at Poole Hospital.


 


Can we keep this q&a open until I return home on Wednesday, please?

Expert:  Dr. D. Love replied 2 years ago.
Yes, even if it times out, the customer can re-open a question.

Customer: replied 2 years ago.

Can the home get away with sending mum to hospital just by saying the doctor told them to do it, or do they have to comply with the patients wishes? I'll leave you alone after this until Wednesday when I will have the complete picture.!!

Expert:  Dr. D. Love replied 2 years ago.
No, every caregiver has a shared responsibility to follow the requests of the patient. The doctor has a higher level of responsibility from the perspective of being the individual that would be performing the various assessments noted above, and if the doctor asks that the patient be sent to the hospital to perform that assessment, the home would correct in following his order. However, once there is no longer any question about the patient's ability to make the refusal, every caregiver has the responsibility to follow that request.

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