A further assessment has been ordered of the decision-making capacity of an elderly woman who was taken to hospital under High Court orders last month due to concerns about “extreme self-neglect” in a “squalid” home.
The woman has several physical health issues and a history of misusing prescribed drugs, and regularly makes numerous calls to ambulance and doctor services, sometimes 10 a night, often just seeking reassurance but sometimes wanting visits and painkillers, the president of the High Court, Mr Justice Peter Kelly observed.
A social worker told the court that, even if it was considered appropriate for the woman to return home, support care options for her had been “fully exhausted” as carers refused to attend at the house due to its condition and the woman’s past agitated and abusive behaviour towards them. It seems that situation will not change in the medium term, she added.
In the context of a HSE petition to have the woman made a ward of court, her GP of 26 years and a consultant psychiatrist both consider she lacks capacity to make decisions about her welfare.
Another psychiatrist, a medical visitor who assessed her at the request of the High Court, said, while her decision making and judgment are poor, she would not meet criteria for admission under the Mental Health Act.
The case returned before Mr Justice Kelly in recent days when he was updated on the position of the woman.
Paul Brady, for the HSE, said the case concerned an elderly person living in circumstances of extreme self-neglect with the issue being whether that was “an eccentric choice that should not be interfered with” or there were mental health issues.
The social worker said the woman remains in a residential hospital unit and had said on September 20th she is happy there as it was quite cold in her home and she had not much food, and she apologised for being abusive to carers.
The woman has on other occasions been abusive, saying she wants to go home, the social worker said.
Her court appointed guardian said the woman has told her she wishes to go home and her biggest concern is her cat, which is being looked after by neighbours. A further assessment of capacity would be “very helpful”, the guardian said.
Because of the conflicting medical views, Mr Justice Kelly directed a second medical visitor should assess the woman.
The first medical visitor had raised issues about whether the woman meets criteria for detention under the Mental Health Act. That Act does not apply in the context of intended wardships, he said.
It is “truly distressing” to consider the circumstances in which the woman was living before the court application was made, he said.
Her house was cold, damp and dirty, with a hole in the roof and the floors “saturated with urine” as the woman is incontinent of urine and sometimes of faeces. Cat food had been seen beside her own food on her bed and her food was sometimes intermixed with faecal material from the cat.
Electrical connections were in a dangerous state, with one socket servicing ten different plugs with urine seeping into it, he said.
He could understand why carers would refuse to go into such conditions, while the woman has also been aggressive and threatening towards them. She has a past psychiatric history, physical health difficulties including diabetes and hypertension and a history of misuse of prescribed drugs.
Adjourning the matter to next month, he was satisfied it was not in her best interests to go home at this stage for reasons including the “awful” conditions and it would only be a short time before she would have to be readmitted to hospital.
