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» Ship of Fools   » Community discussion   » Hell   » Whoever is responsible for the inability of the NHS to keep old ladies safe (Page 2)

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Source: (consider it) Thread: Whoever is responsible for the inability of the NHS to keep old ladies safe
Ethne Alba
Shipmate
# 5804

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It's hell, so we can use bad language right?

Roughly put:

In the UK, our National Health Service (NHS) deals with matters relating to health concerns. And at the moment it remains free at the point of use for UK residents.

Whilst our Social Services covers Social Care, with is all about retaining independence and Social Workers get involved at the Deciding Stage is someone is vulnerable or that person needs additional help. This provision comes through the local authority councils and is also free.

( as i type this i just KNOW that someone is going to jump in and disagree. Go ahead,....this is just starting the debate!)


The overlap between these two provisions has always been blurred, but of late each side is attempting to get the other to take the lead.

Add to that, the NHS is currently collapsing under diktats concerning waiting times + maximum bed occupancy.

Whilst the Social Workers (unless they are in private hospitals )are funded through local councils, who are under operating under serious cut backs.

In short?
It's back to Rook's language, it's all fairly fucked.
Unless there is a serious crisis.

And for serious read
" Left outside A/E"
...or...
" Next of Kin
informed Social Worker that they refuse to have Mr K ...aka Grandad.....living back with them"

It is all a very serious mess and Social Workers deserve far better. They are caught between a rock and a hard place.

The UK is going through massive change and no one really knows what is going on right now.

If someone....anyone...puts their heads above the parapet and says that they will step in and help, most social workers would seriously consider accepting that help.

Then again. most people would not do what Penny has done.
No judgement....just facts....
.
.
.
.

[ 14. April 2017, 23:15: Message edited by: Ethne Alba ]

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Penny S
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Most people have common sense.

Today, she wants to go home.

I am considering dobbing her in to the Environmental Health Officer.

We are considering leaving her at A&E, or refusing to take her back when she has been to Guys for physio.

Her son is considering suicide.

At the beginning of the year we thought she was going to die before April.

I think St Thomas' has done such a good job she has several more years. The hellish bit of me is feeling this is grossly unfair.

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Penny S
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And I feel for the social workers - not only between a rock and a hard place in this case, but with a scorpion in the gap striking at them with complaints.
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Doublethink.
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If her son is considering suicide please take him to a doctor/A&E.

If you don't want her back in your house, ring social services and tell them, give them a deadline 24 48 hours - whatever - if the worst comes to the worst they can put her in a hotel, but they need a few hours notice to organise that.

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AndyHB
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The problem, to my eyes, is that our Health and Social Welfare provisions are still based on a mid-20th century model, even if a few tweaks have been made to them over the years.

The NHS was designed to ensure that everyone's basic health needs was catered for and treated. It wasn't designed to cater for some of the highly complex and expensive procedures that are now available. That isn't to say that those procedures oughtn't to be being carried out, but - like so many other social provisions - realistic funding must be put into place before they become standard provision. As someone who, in the last 6 or 7 years has been put onto a number of medications for life, such as statins and blood thinning tablets, I find the Welsh Government's (health is a devolved issue here in the UK) approach to prescriptions (free at point of delivery) rather questionable, especially for those who are quite capable of (and in many cases willing to) paying.

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Tubbs

Miss Congeniality
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quote:
Originally posted by Gee D:
Trying to wrest this thread back to the topic, we find it extraordinary that the social workers could just foist this very elderly woman upon Penny S - who tells us that she herself is getting on. What is the power that permits that?

Pretty much. If you tell Social Services that you can cope without support as you have so and so to look after you or refuse it, then then you're left to it. It's not like they don't have lots of other work to do.

It might be useful for PennyS to ring Age UK or look on the CarerUK forum as they will help PennyS and The Son navigate the labyrinth that is the UK Social System. Unfortunately they don't do assertiveness training.

Tubbs

[ 18. April 2017, 09:56: Message edited by: Tubbs ]

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"It's better to keep your mouth shut and be thought a fool than open it up and remove all doubt" - Dennis Thatcher. My blog. Decide for yourself which I am

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Penny S
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Thanks. Son is in an up mood at the moment having got the house into bags suitable for allowing access to tradespeople and CloudsEnd who specialise in hoarders.
Mother is refusing to access the bedroom I have prepared for her by moving all my sewing stuff and clothes horses into my room, even to look through all the clean and cleaned clothes in there.
She is going to the surgery for her legs to be dressed tomorrow, and I am hoping the nurse will pick up that she has been unable to, as the hospital said she could, manage her toilet requirements. My providing personal care was what I stated clearly wasn't going to happen. I have provided pads, incontinence pants with pads, disposal bags and a bin to put them in, and explained them to her twice. firstly when she arrived, and secondly yesterday, when she asked, already obviously in need of changing. Its a delicate matter, and I don't know how to address it, but I also do not want to be accused of negligence by the surgery.
Her son says the hospital lied to us.

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Tubbs

Miss Congeniality
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quote:
Originally posted by Penny S:
Thanks. Son is in an up mood at the moment having got the house into bags suitable for allowing access to tradespeople and CloudsEnd who specialise in hoarders.
Mother is refusing to access the bedroom I have prepared for her by moving all my sewing stuff and clothes horses into my room, even to look through all the clean and cleaned clothes in there.
She is going to the surgery for her legs to be dressed tomorrow, and I am hoping the nurse will pick up that she has been unable to, as the hospital said she could, manage her toilet requirements. My providing personal care was what I stated clearly wasn't going to happen. I have provided pads, incontinence pants with pads, disposal bags and a bin to put them in, and explained them to her twice. firstly when she arrived, and secondly yesterday, when she asked, already obviously in need of changing. Its a delicate matter, and I don't know how to address it, but I also do not want to be accused of negligence by the surgery.
Her son says the hospital lied to us.

She might well have been able to do it hospital but isn't able - or won't - do it now. Call Social Services and tell them that you're not able to cope as mummy needs more personal care than you can provide, get her son to back you up, then ask them to come up with something suitable for mummy.

Whilst moaning at us may be helpful in the short term, it isn't going to serve you in the long term. We can't. as the lovely RooK pointed out, do anything.

Tubbs

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"It's better to keep your mouth shut and be thought a fool than open it up and remove all doubt" - Dennis Thatcher. My blog. Decide for yourself which I am

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Gee D
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quote:
Originally posted by Tubbs:
quote:
Originally posted by Gee D:
Trying to wrest this thread back to the topic, we find it extraordinary that the social workers could just foist this very elderly woman upon Penny S - who tells us that she herself is getting on. What is the power that permits that?

Pretty much. If you tell Social Services that you can cope without support as you have so and so to look after you or refuse it, then then you're left to it. It's not like they don't have lots of other work to do.

It might be useful for PennyS to ring Age UK or look on the CarerUK forum as they will help PennyS and The Son navigate the labyrinth that is the UK Social System. Unfortunately they don't do assertiveness training.

Tubbs

But to send her off to Penny S, no relation and obviously finding it extremely difficult to care for an elderly person? Surely all that Penny needs do is to ring the hospital, say that she can't manage and that the taxi, with friend's mother will be at the hospital any minute now?

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Not every Anglican in Sydney is Sydney Anglican

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Curiosity killed ...

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Hospitals here have had their funding cut to the bone. Little old ladies with no care options are bed blockers and prevent others from having urgent operations and stop admission from trolleys in Accident and Emergency / Casualty. Hospitals tour every day, several times a day, to find someone they can send home to create beds for others. If there is an option to move a bed-blocking old lady the hospital is going to be relieved that either the surgical team is not standing around because there is no bed for their patient's post-operative recovery or the fines are not coming their way for breach of waiting times in A&E.

Basically you don't say you can take a bed-blocking old lady because everyone will bite your hand off with relief and not look too closely at the option beyond the hospital gates.

Penny volunteered to do this - or her friend volunteered her to do this on her behalf -
against all the warnings given on the Difficult Relatives thread when several of us pointed out that anything Penny did was not going to solve the problems but that it was going to patch over the gaps in the care and health services and leave them stranded with not a lot of help

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Gee D
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Are there no intermediate stay places for recuperation and getting skills to cope at home? These days, you hear that X has just had a week in the San, and then off to rehab at Lady Davidson or Mt Wilga for a fortnight's rehab. The treatment you describe seems inhumane.

Next question - what's to stop Penny taking the course I suggested?

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Not every Anglican in Sydney is Sydney Anglican

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Sarasa
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I'm with Tubbs on this one, we cam listen but can't do anything practical. I think your friend need to get some backbone rather than taking advantage of your good nature and start sorting things out for himself.
I do have sympathy, I think my mother is heading into difficult realtion territory , but I think that is to do with her failing mental powers exposing the less nice sides of her character rather than anything deliberate.

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Previously Gussie.
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Penny S
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Update. She wasn't bed blocking as far as we could see, there were whole groups of empty beds in the elder ward.
She tells us that she has changed her pads today, but I can find no trace of this. She has assured me she knows not to flush things as she had to teach mothers not to do it at the pre-school club she used to work at. She has also owned to finding adapting to using these aids difficult.
The surgery yesterday wasn't very helpful when I went across to prime them on the continence matter, but said I should contact social services. Who will want her to pay, which she will refuse. There are no intermediate care provisions without her paying for it. I thought there would be.
The house is getting better, but her son is not there today so he can go across to the surgery with her.
There is a mental health issue which has been ignored.
And I am an idiot.
Dropping her off at A&E remains an option.

[ 19. April 2017, 12:14: Message edited by: Penny S ]

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Boogie

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You are not an idiot, but you do need to make an important decision and stick to it.

This will take as much strength as caring for her did, but you will both benefit from it in the end.

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Garden. Room. Walk

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Golden Key
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Penny--

What Boogie said.

And I worry that your friend will either wind up in the hospital (for breakdown or suicide attempt) or simply leave. And you'll be stuck with his mom, alone, with no help, trying to figure out what to do.

Please take good care of yourself. [Votive]

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Blessed Gator, pray for us!
--"Oh bat bladders, do you have to bring common sense into this?"--Dragon, "Jane & the Dragon"
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Gee D
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Can we agree on this:

You made a decision that you were under no obligation to make.

Without casting any blame on anyone, that decision has not worked in the way you had hoped.

You remain under no obligation to continue with your original decision.

Having done what you did, out of your own goodwill, you may now without any feeling of guilt ring the hospital and say clearly that she cannot remain with you longer than today.

You are not required either legally or ethically to find her somewhere else to go.

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Not every Anglican in Sydney is Sydney Anglican

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Tubbs

Miss Congeniality
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quote:
Originally posted by Gee D:
Can we agree on this:

You made a decision that you were under no obligation to make.

Without casting any blame on anyone, that decision has not worked in the way you had hoped.

You remain under no obligation to continue with your original decision.

Having done what you did, out of your own goodwill, you may now without any feeling of guilt ring the hospital and say clearly that she cannot remain with you longer than today.

You are not required either legally or ethically to find her somewhere else to go.

Not really. When you're discharged from hospital, you're offered a free, six week care package. After that you pay. I'm assuming this was waved away. Like all the other advice given to Penny over the last few months. Including to not get so involved, ringing social services and doing what they say, grabbing any help offered and telling mummy where she gets off when she's being a terrible guest etc. Or simply telling the son that he needs to make other arrangements for mummy as the current one isn't working.

I'm failing to understand why these aren't options because mummy is too scary and won't have it... But dumping mummy at A&E and running away is. That seems more of a last resort rather than a first. Especially as it will make everything worse.

Tubbs

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"It's better to keep your mouth shut and be thought a fool than open it up and remove all doubt" - Dennis Thatcher. My blog. Decide for yourself which I am

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Lyda*Rose

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As I recall, a lot of the general problem -but not specifically Penny's involvement- started with the fact that Mom has not been declared non compos mentis (mentally incapable of making her own decisions) and so she waved the help offered and she has been able to impose her own terms on her son who has passed them on to kindly Penny. In England is a child legally obligated to care for a parent? Maybe the son should start the process of getting a power of attorney from the courts to properly meet such obligations.

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"Dear God, whose name I do not know - thank you for my life. I forgot how BIG... thank you. Thank you for my life." ~from Joe Vs the Volcano

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Golden Key
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Penny--

FWIW:

I'm a little troubled about the A&E idea, too. I don't know the NHS, nor the culture about doing that. Maybe it's acceptable.

Here, I think the only times I've heard of it being done is when someone has a family member who desperately needs help for psych or addiction problems, who've fought for years to get appropriate treatment and funding, and who've finally been told that the only way through is to leave the person at the door of the ER (A&E), and drive away. The hospital is obligated to try to help.

But leaving an elderly woman there, even if you go in and explain to staff what's going on, would likely be seen as cruel...and might actually be.

Plus: how would you manage it? If you tell her ahead of time, she'll object, and you probably won't even be able to get her in the car. If you manage to get her to the hospital door and *then* tell her, she'll freak out. The staff probably won't be happy with you.

And, however much better you'd feel after relieving yourself of her...later, you'd probably feel bad about doing it that way. IANAL, but there might also be legal consequences, even though you're not a relative.

I wish I had a magic-wand solution for you. The only possibility I can see is to tell the social workers that you honestly can't do it anymore, it's crushing your own health, she's not a relative, and there must be another place for her NOW.

I think you've done some of that, though.

[Votive]

[ 20. April 2017, 21:18: Message edited by: Golden Key ]

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Blessed Gator, pray for us!
--"Oh bat bladders, do you have to bring common sense into this?"--Dragon, "Jane & the Dragon"
--"I'm not giving up--and neither should you." --SNL

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Gee D
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Tubbs, a lot of what's behind your comments goes through my mind also, as does knowledge of some syndromes.

I was not aware of the 6 week package, and if it's been mentioned on this thread I've forgotten it. It goes beyond the practice I know of here where so many seem to have their hospital time, then off to a recuperation/rehabilitation home, even those with spouses and families around and willing to assist.

Not sure that I understand your last paragraph.

[ 20. April 2017, 22:08: Message edited by: Gee D ]

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Not every Anglican in Sydney is Sydney Anglican

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MarsmanTJ
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IME, the six-week package often gets conveniently forgotten to be mentioned if there is even a hint that there might be family members who can help with care. And it can be phrased in such a way to make it sound a singularly unattractive option. Because they know that there is pressure on them to not refer too many people to it.
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Tubbs

Miss Congeniality
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quote:
Originally posted by MarsmanTJ:
IME, the six-week package often gets conveniently forgotten to be mentioned if there is even a hint that there might be family members who can help with care. And it can be phrased in such a way to make it sound a singularly unattractive option. Because they know that there is pressure on them to not refer too many people to it.

My experience is similar to yours. But I also know you've got to grab whatever help is available with both hands and push hard. Because if you don't, you get left to get on with it.

There are tons of issues with trying to take care of an elderly but uncooperative parent. One is that if they're competent, they can do whatever they like. However stupid and wrong headed. And you have to decide how you're going to handle it. Sometimes you may have to simply tell them what's what and insist that certain things happen. Other times you have to sit on your hands and let them get on with it. Whilst hoping they don't injure themselves in the process.

If someone asks for advice / help, ignores everything that everyone suggests, but continues talking about their problems even though some of the problems they're having now are a consquence of ignoring the advice they were offered, at what point do you decide enough is enough?

I'm beginning to wonder how much the lovely Ship community is actually helping here?! Or, as the Ship isn't a private space but a public one, the likelihood of someone who knows them spotting these posts and it all kicking off ...

Tubbs

[ 21. April 2017, 18:06: Message edited by: Tubbs ]

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"It's better to keep your mouth shut and be thought a fool than open it up and remove all doubt" - Dennis Thatcher. My blog. Decide for yourself which I am

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Tubbs

Miss Congeniality
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quote:
Originally posted by Gee D:
Tubbs, a lot of what's behind your comments goes through my mind also, as does knowledge of some syndromes.

I was not aware of the 6 week package, and if it's been mentioned on this thread I've forgotten it. It goes beyond the practice I know of here where so many seem to have their hospital time, then off to a recuperation/rehabilitation home, even those with spouses and families around and willing to assist.

Not sure that I understand your last paragraph.

It sounds like things work differently here. NHS and social service provision is very localised. Some places will have rehabilitation centres and if you're suitable, you'll get a place. Other places won't have them at all.

Tubbs

[ 21. April 2017, 18:18: Message edited by: Tubbs ]

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"It's better to keep your mouth shut and be thought a fool than open it up and remove all doubt" - Dennis Thatcher. My blog. Decide for yourself which I am

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Gee D
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Thanks Tubbs, the health system here is very different to that in the UK. And I've just realised that the rehabilitation hospitals I've been talking of are private institutions and that those going there would have private health insurance to pay for it (private health insurance here is vastly cheaper than the sorts of figures spoke of in the US). What I still don't understand is why Penny S can't go back and say that she made a mistake, she can't manage the care of this woman as she had hoped she could, and that the hospital must make other arrangements promptly.

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Not every Anglican in Sydney is Sydney Anglican

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Curiosity killed ...

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It is no longer the hospital's responsibility when a patient is discharged. It then becomes the responsibility of social care (social services). And if social care has been rejected it is a long process getting them back involved. It's damn difficult getting them involved in the first place as they are hugely overstretched too. (We have to work very hard to get children social care support when the situation is horrendous.)

This financial year, local authorities have just been allowed to surcharge all local inhabitants for elder care as part of the council tax because homes for the elderly are going out of business as their finances have been cut to the bone too and that is a local authority responsibility too along with social care.

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Mugs - Keep the Ship afloat

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Gee D
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What id Penny just takes this woman to a local shopping center, leaves her in a coffee shop under some pretence, and just does not return? All the belongings moved back to the woman's home?

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Not every Anglican in Sydney is Sydney Anglican

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Golden Key
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Well, that would look very, very bad. Probable public scene, when the woman realizes what's going on. Concerned passers-by record videos and put them online. Viral. Imagine the comments. Imagine if social media tracks Penny down.

Maybe just take the woman to her *own* home, with calls afterward to her son and to Social services. (Write down all info about the calls, too.) Maybe make sure she has some basic food and incontinence supplies, a couple of days' worth, and let .the son and Social Services know that. (Keep receipts.) Let them know that someone needs to come and retrieve her things.

IANAL, but this is a really complicated situation.

[ 22. April 2017, 00:39: Message edited by: Golden Key ]

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Blessed Gator, pray for us!
--"Oh bat bladders, do you have to bring common sense into this?"--Dragon, "Jane & the Dragon"
--"I'm not giving up--and neither should you." --SNL

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Gee D
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I appreciate just how bad it would look, and was not being entirely serious in what I said. But it would be a good way of forcing those who are responsible for the provision of the relevant services to get busy and do what they should.

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Not every Anglican in Sydney is Sydney Anglican

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Curiosity killed ...

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The way to force the authorities to provide the support was, as Penny was advised repeatedly, not to get involved and leave the social workers to get on with their job when the woman was in hospital. Hospitals put pressure on social care to support patients into interim support or back into their homes with a support package.

There is a system in place at that point in the process. Creaking at the seams, overstretched and struggling to cope, but there are gears to grind into place. Trying to feed someone back into the system when the wheels have come off is much, much harder.

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Mugs - Keep the Ship afloat

Posts: 13082 | From: outiside the outer ring road | Registered: Aug 2006  |  IP: Logged
Gee D
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# 13815

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Thanks.

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Not every Anglican in Sydney is Sydney Anglican

Posts: 6055 | From: Warrawee NSW Australia | Registered: Jun 2008  |  IP: Logged



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