A recent court of protection case has highlighted how positive social work combined with good legal support enabled a 92-year-old woman to be cared for at home in line with her wishes.
The case (Re: AC and GC) involved Her Honour Judge Clayton supporting a trial period of care at home instead of residential care for the woman, who had Alzheimer’s disease, alcohol-related brain damage and a compulsive hoarding disorder.
AC had been living at home in Coventry with her son, GC, who was also her carer and sole attorney for property, affairs, health and welfare.
GC had Asperger’s syndrome, anxiety, obsessive compulsive disorder, a hoarding disorder and depressive episodes.
Back in December 2021, the court had suspended the son’s lasting power of attorney for health and welfare but he retained attorney status for his mother’s property and affairs.
An order had stipulated that GC left the home while it was being made safe and clean.
GC had litigation capacity. However, he was assessed as lacking capacity to make decisions about his own and AC’s financial affairs and about his own and his mother’s belongings.
An order had stipulated that the son left the home while it was being made safe and clean
In February 2022, AC was taken to hospital by the emergency services, who were concerned about the state and poor sanitary conditions of her home.
She was discharged from hospital to a care home through a court order made in her best interests at Coventry City Council’s behest. The court made a declaration that the woman lacked capacity to make decisions on her care, residence and litigation.
The official solicitor – who acts for those who lack capacity and cannot act for themselves – represented AC’s interests in a challenge to a Deprivation of Liberty Safeguards (DoLS) authorisation under the Mental Capacity Act 2005. DoLSs protect people who cannot consent to care arrangements if these deprive them of their liberty.
Care at home trialled
AC consistently expressed her wish to be cared for at home. She had lived in her house for 40 years and wished to die there. She missed her son and her cat Jasper.
The local authority did not support a trial period of care at home because of the high risk of care breaking down and the likely distress that would follow.
The judge disagreed: “A trial of care at home is not without risk but, on the evidence before me, it is a manageable risk and one which should be taken to try to afford AC the opportunity of returning to her home, in improved circumstances, and with the hope and expectation that it will continue to improve in the coming weeks and months…
“I could not be satisfied that a final placement at the care home would be an appropriate and justifiable interference with AC’s article 8 rights [under the Human Rights Act].”
Those involved in this case looked at Westminster City Council v Sykes, which had considered the value of being cared for at home at the end of life to a person with a progressive condition.
The judge in Sykes found: “Several last months of freedom in one’s own home at the end of one’s life is worth having for many people with serious progressive illnesses, even if it comes at a cost of some distress.
“If a trial is not attempted now, the reality is that she will never again have the opportunity to live in her own home.”
Given AC’s and GC’s mutual emotional dependency, the judge concluded that a 10-week trial period for care at home was in AC’s best interests. AC would share the cost of retaining the care home room with the council. A self-funder, AC had £240,000, which would cover the care costs in either setting.
The new deputy who had been appointed would be empowered to remove items from the property whether they belonged to AC or GC. They would employ cleaners, which would improve the relationship with the care agency.
Conditions
Great care had been taken over the conditions needed for AC to take up this trial; the court found it significant that GC agreed to them all.
Conditions included that GC was trained on moving and handling, received ongoing therapy and committed to giving full access to care workers.
GC also agreed to vaping rather than smoking indoors, checking the kitchen weekly for out-of-date food, not drinking alcohol when expected to be half of a care team and cleaning the house weekly.
He also had to give notice of any respite he would take, agree to unannounced monitoring visits and not leave his mother alone for more than two hours.
Notably, the judge praised “the very fine work which has been carried out in this case by all of the professionals… [as well as] the high quality of the work undertaken by the social worker”.
The social worker had produced 10 witness statements, describing the condition of AC’s property and stating that some progress had been made with the lounge, hallway, kitchen bathroom and AC’s bedroom.
The fire service confirmed that the risks had dramatically reduced from when they were first involved. One care agency was happy for GC to be a second carer, provided that he received training, and said the hoarding would not be an issue.
The judge praised ‘the very fine work which has been carried out by all of the professional and the high quality of the work by the social worker’
Legal aid
It may seem unusual that AC got legal aid despite having access to £240,000. That is because any challenge to a DoLS authorisation under section 21A of the Mental Capacity Act attracts non-means-tested financial support as such cases are associated with human rights.
And, while the judge thought well of the efforts of the local authority in this case, the question remains whether a council would try quite so hard for someone it had responsibility for placing or if they were less wealthy.
This judgment is also notable for outlining the consequences of hoarding – information that will be useful in future cases.
This case resulted in a humane, civilised outcome for both the person support and the family carer who also had support needs.
As such, it will be of interest to anyone looking to support family carers and uphold an individual’s desire to be cared for at home.
Comment: sensitivity and therapy allowed son to keep caring
Good social and legal work meant an elderly woman was able to remain at home, cared for by her son, despite them both having hoarding disorders and support needs, reports Belinda Schwehr.
This case reflects that, while none of us imagines ourselves at risk of neglect or harm from those we love and who care for us, their own difficulties may affect their caring efforts and our wellbeing.
The woman’s son had given up his job to support her when her husband – his father – had died. However, his own difficulties eventually undermined his ability to continue caring for his mother alone.
The court showed sensitivity to the issues in this case. The judge visited AC, learning for herself the importance of her relationship with her son as well as her deep desire to remain at home.
It was significant that the son found the therapy worthwhile – the attention and help of a skilled therapist was possibly the only input he had received for a long time – and, because of this, could deal with the conditions required to get his mother home.
It is worth remembering that counselling can be bought under the Care Act if the NHS will not pay for it.
Cases
AC and GC (capacity: hoarding: best interests) [2022] EWCOP 39. https://www.bailii.org/ew/cases/EWCOP/2022/39.html
Westminster City Council v Sykes [2014] EWCOP B9. http://www.bailii.org/ew/cases/EWCOP/2014/B9.html
