Can Social Services insist an elderly person leave their home and go into a care facility?

There's no question but that the lady will be going home from hospital this time - the discharge team has already liaised with the adult referrals team, and the ART have passed her on probably to a service like ours which will provide either urgent care or reablement support free of charge for up to six weeks. If she's getting calls three times a day that will be the result of an Assessment of Need, so evidently that's already been done. They are taking her home.

What's distressing her is that her social worker is now leaning on her to move into residential care in the event of further problems, and if nobody else lives in her house and the move is permanent then she will be expected to sell up and pay for her care (there are caps on care costs, but not on accommodation costs; and I am sorry to say that it is routine for self-funders, as they are known, to get gouged because councils won't/can't/anyway don't pay the going rate for residential care). The social worker (or similar) has probably been getting it in the neck for landing ART with a revolving door client as well as placing a strain on the falls response team and the emergency services; and this is all *in addition to* whatever Safeguarding concerns have been raised over the last few months on account of the lady's safety and wellbeing.

I don't doubt that there are differences in emphasis from one local authority to another, but round here things have to get pretty extreme before social services will even attempt to influence a client's decision once that client has already made a preference clear.

I have lost count of the times I have had to listen patiently to clients who not only bitterly resent the very idea of paying for services (this is one problem with universal healthcare - you try explaining the technical difference between health and social care to someone who not only can't reach her own bottom but is also hopping mad and hard of hearing) but who if anything are even more resentful of being asked to make financial declarations. "What business is it of theirs how much money I've got?" is the refrain. Well. Madam/Sir, you are sitting on capital of some hundreds of thousands of pounds but expecting the taxpayer to cover your care and living costs because you don't want to sell the house you can't live in. That's what business it is of theirs.

But happily this is not yet a conversation I have to have with anyone, so I can continue to nod and make soothing noises.

Yes, they can determine that it is an unsafe discharge to allow someone to go home without care in place.

However, the person can contest that determination and go through the legal process to stop involuntary placement.

I would encourage her to get some PT to help her stay mobile, get an OT to help remove trip hazards and improve safety in the home.

I would also encourage her to look into assisted living, so she actually has a choice in where she is going if living at home alone is no longer safe.

At 94, things change quickly and flexibility is really in her best interest. A good facility can be a lovely change.

By and large local authorities will move heaven and earth to keep people living at home if that is what they want. There will have been a risk assessment, and there has probably been a formal mental capacity assessment. If the lady is deemed to have mental capacity, then the short answer to your question is no: social services cannot prevent her from returning to and living in her home, not even if she falls on a daily basis. That doesn't mean it's a good idea.

The red flag might be the serious fall while outside - what were the circumstances? If it was a standard accident that's one thing. If it resulted from her going outside unsupported and unaware of her limitations, possibly at a peculiar time of day, then what they're worried about is her orientation to time and place and the risks associated with that.

Whereabouts is she, roughly? Are you her formal representative, and if not does she have one?

These two answers are about different situations. One is about a ‘safe discharge’ from hospital, rehab etc, when they want to avoid any claims that they were negligent. The other is about personal freedom. You can discharge yourself against recommendations, and I did it once from hospital because I needed to be at home for children. The hospital then takes no responsibility. It isn't a prison, you can walk out.

Any entity like a social services one is created by the state legislature, and enabled as well as restricted by statute(s) which define the scope and limitations of its actions.

Researching this would be very tedious;  some of these enablement statutes are really boring and sometimes vague and difficult in terms of identifying parameters and limitations.

The easier option is to put the Social Services rep on the spot by asking what specific legislative authority has been granted to it, and ask for the specific statute, section, and subsections.  I rather doubt many SS workers know this offhand.

I've done that twice; neither individual (one medical, one social) had an answer.   And the issue has been raised recently in the family, at the rehab level and remaining at home level.  

It might be difficult for you to do this since you're not a family member.  Are there any who might be available to stand up to SS?   If not, an attorney would be appropriate, especially one familiar with creations of government entities.   I don't know though if that specific issue would be something an attorney would want to address, unless it was one who wasn't particularly busy, or a large law firm which could assign the research to an associate.  

Attorneys for placement facilities as well as the SS legal staff would be more likely to know, but they're not on your side, and you want an honest answer for your neighbor.

If she lives in the US, social services may eventually move to acquire guardianship of her, if her dementia increases (which it will, because that's how dementia works) or her immobility increases to the point of her needing LTC. And, at 94, she could have a stroke, or any other number of issues that make caring for her in her home a circus.

Lots of things about age-related decline and end of life issues are distressing. FYI if you are able to see that she has "slight" dementia, she probably has more than what you are aware of (also how dementia works). If she was catheterized in her last hospital stint, her dementia may actually be the symptoms of a UTI which often mimic dementia, which if left untreated, can turn into sepsis -- a very life threatening condition. Or, she could be diabetic, have a thyroid problem, a vitamin deficiency, dehydration or high blood pressure, all of which can also appear as dementia.

If she has actual dementia, she is losing her abilities to work from reason and logic, so trying to get her to make a rational decision won't be possible anymore. Eventually she will either die alone in her home or the county guardian will move her to a facility and manage all her assets.

Yes, Social Services, like APS, can take this woman out of her home if she is declared unable to care for herself. My GF was in Rehab for a broken femur and had stomach cancer. She was wheelchair bound and had no one to care for her when she returned to her apt. She had overdosed at least once from pain meds. She was told she was not being released to home. That she needed to stay in LTC. My daughter says this is not unusual.

Social Services has this woman on their radar. Dementia decline can happen over night.