ACAT ASSESSMENT

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ACAT ASSESSMENT

How do you get an assessment on a parent who is cleary suffering from a form of dementia but whom refuses to talk to anyone...?

agedcare101

Hi Fiona,

Thanks for your question.  Your mum would not be the first person to put off ‘delicate’ conversations.  The best way for your mother to have the most control, the most input and have the best result is to discuss these things early.  These conversations are difficult and are best seen as a series of smaller conversations.  Anyone would be overwhelmed by the idea of sorting it out in one sitting.

You need to have legal permission to act on someone's behalf so unless you have an enduring guardian or enduring power of attorney, you won't be able to do anything without her consent.

If you want, you can read more about different legal permissions here and here.

If your mother is suffering from the beginning of dementia, you are best to have conversations about legal permission with her in her lucid moments before her dementia worsens.  If her dementia is too advance, getting legal permission at any point will be difficult/ if at all possible as it may be argued that she does not have capacity to give it to you.

Another thing to consider is maybe she doesn't need to go into a nursing home.  Home Care is a really plausable option which would keep your mum at home and maybe an option that is more palitable to your mum.  There is government subsidised home care at 4 different levels and dementia care (to a certain level) is certainly part of it.  Both home care and a nursing home start with an ACAT so you still have to have this conversation.

So how do you start this off?  I have copied and pasted some pointers we have on our site that you may find helpful.

Tips for making it the best it can be:

However you choose to approach the topic, there will be complex questions and emotions to deal with - for you, your family members and others close to you.  Nobody says it is easy, but here are our tips for giving everyone the best chance at a good outcome:

DO:

Remember, everyone has the right to take risks and make decisions about their own life 

Even when someone is very ill or has early signs of dementia, everyone needs to be able to express their opinions and preferences and have them respected. The exception is when someone is unconscious or has severe cognitive impairment from dementia or other brain disease or injury.

Think of it as an ongoing series of conversations

Don’t think of it as one ‘conversation’.  Ideas can evolve and opinions change over time. Available options can change as well.  Unless the situation is critical, there is no need to finalise any decisions in a single conversation.

Start talking sooner, rather than later. 

Allow time for several discussions with minimal pressure involved. Don’t wait for a crisis. It’s the popular wisdom but there is a good reason for it. 

Be open, honest and respectful – on all sides

Be sensitive to everyone’s needs and concerns but don’t avoid being truthful either.  This isn’t a time for emotional games.

‘Walk a mile in my shoes’

If you are the person who needs to think about aged care, even if it’s just a possibility, remember to consider the impact that your attitudes and decisions can have on family members and loved ones.  What if you were in their shoes?  While you may be determined to stay living in your home at all costs, what impact will this decision have on your loved ones?  They might be sick with worry or stressed and over-stretched with trying to help you.  How will your loved ones be affected?

If it is your parent or another loved one who is having to consider the future in these terms, avoid the trap of the role reversal.  They may be in a difficult patch of life but they are not children.  Remember that they are adults who have led full and meaningful lives and now they are dealing with complex emotions and feelings of change and loss.  Ask yourself: ‘what would I want/like/demand/hate if it was me in this situation’?  How would you like to be spoken to?

Mind your language

No matter how smooth and understanding the process has been or how appealing the aged care home (nursing home) might be, these are difficult conversations.  Nobody likes to be ‘moved to a nursing home’.  It implies total loss of personal power which should never be the case.   Be positive and considerate.  Avoid language that implies the person is a ‘problem’ to be solved by others.   Acknowledge that every person is different and there is no generic ‘one size fits all’ response when it comes to aged care.  Find common goals and work together as much as possible.  Focus on getting the right care and support, retaining control and retaining as much independence as you can.

Listen – don’t make assumptions

Sometimes people can be surprised by the way others behave and respond to things.  It works both ways.  Don’t assume you know what your parent or loved one will think and feel.  At the same time, don’t assume you know what your adult children or other loved ones will want for you. Listen to each other with an open mind and be prepared to accommodate surprises. 

Make it a collaboration

One of the new policy mantras in aged care is to ‘do with’, not ‘do for’.  It’s an acceptance that most people hate to have their sense of choice and control taken away, even when they know they need other people’s assistance.  It applies in all situations.  However well-meaning it might be, it’s never a good idea to simply ‘take over’.  If you’re looking at care options, do it together.  Sit in front of the computer together, make phone calls together, keep lines of communication open and transparent. If you want to hand things over to someone else, that’s fine as long as it’s your decision, on your terms.

Get outside help if you need it

Everyone is human, all situations are different and sometimes communication breaks down or becomes too difficult.  Others can often help.  Consider seeking advice or assistance from a trusted friend or other relative, the GP, a counselor, or a member of the clergy, for example.  You can also contact the National Aged Care Advocacy Line on: 1800 700 600.   The My Aged Care contact centre can also help: phone 1800 200 422 or visit the website.

We know how challenging this can be.

We really hope this helps,
the agedcare101 team

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