I notice from searching the postings here that any reference to Scotland and the Scottish system hasn't thrown up many responses, but I am ever hopeful of any enlightenment some of you may have. My story is a long one, so I'll abreviate as much as possible. Probably not that uncommon so please bare with me.

1. Mum, 73, lives alone (In Scotland). Diagnosed with Vascular Dementia in 2008 although we feel she has been suffering since 1999. Closest relative lives 200+ miles away. Still active and gets 2 buses to attend bowling twice a week.

2. She had been visited at home by a support worker once a week for the last year - 18 months. Seeing slight decline in eating habits, decision taken to provide Wiltshire Food ready meals, with a carer going in once a day to heat up the meal.

3. 4 days prior to the carer commencing, mum had a "presumed" fall, (she has no recall of falling). Was taken to A&E by the support worker, who to be fair went beyond the call of duty and stayed with mum until 9pm. Mum has a stable fracture of her upper arm near the shoulder.

4. Mum stayed in A&E ward for 2 nights and was then transferred to another hospital. Admitted to the acute admissions ward where she remained for over a week. Decision taken on the 1st night of admission to this ward to sedate mum with guidance from the geriatric psychiatrist for agitation and aggressive behaviour (something which has previously never been an issue). Mum was then moved to another ward in the hospital, where it was felt she could be better managed, however in her time there she "Escaped" on 4 separate occasions. She has now been moved again to a nursing home for temporary / permanent care.

5. Whilst the saga at point 4 was going on, a single shared assessment was carried out, which states that whilst mum was managing in her routine at home it was felt that her short term memory is no longer functioning, that following her stay in hospital, she would no longer be able to relearn the routine which was keeping her functioning at home even with full support, and a recommendation of 24 hour nursing care in a care home was recommended. It was also presumed that she would be at risk of other falls, with further admittance to hospital, and she was at risk of wandering; this was her 1st fall, and she had never previously wandered.

6. We request a continuing healthcare assessment from the hospital, with reference to the coughlan case. Response came back stating that mum had no requirement for further care as an inpatient, nor did she required ongoing medical interventions. Her dementia requires supervision which can be made available through Social Work, and if need be they can arrange a permanent care home which would be subject to means testing.

7. We decide, that mums agitation and aggression is a direct result of her wanting to go home, and feel that if she has no requirement for medical intervention then she can be "supervised" at home by social work. They also stated that coughlan and other subsequent cases have no leagal bearing on NHS Scotland, but procedures following on from Coughlan were put in place in the form of a MEL/CEL 2007 which they follow.

8.Following (off the record) discussions with other professionals who work in this area, a strong suspicion grows that if mum did not own her own home, then placement in a care home would not even have entered into discussions.

9. We request that mum comes home. We are then summoned to a meeting with the care manager and CPN. CPN was more supportive than the care manager to "Give it a try". Care manger suggested it may take some time to arrange 4 carers a day.

10. We are concerned that mum has now had 4 changes of environment, over 5 weeks, and are concerned that the care manger is dragging things out as she is considered to be in a safe environment. We feel the longer mum is out of her own home the less likely she is to recognise her own environment.


Questions:

1. If the Social work care manger does not provide carers within the 12 weeks respite care allocation, who then pays the care home fees.

2. If mum does come home after a prolonged period out of her house and does not recognise the house, can we suggest that her inability to readjust to her own environment was as a direct result of the delay in getting her home, and should social work then pay for her care? (as it was their delay which would contribute to mum being permanently placed in a nursing home?)

3. Presuming mum does come home and everything is ok for a while. How do we prepare for the eventuality of her going into care and avoiding the means test. Can we say that a means test is in direct contravention of Article 8 of the Human rights act? Is there something else which gives social work the right to means test over and above this law?

4. Have we missed something entirely? Why can we not find a single case in Scotland where a patient or there representative has taken NHS Scotland or the local authority to court over this?

Any advice greatly appreciated, and anyone who has experience of this in Scotland, I would love to hear from you.