Care Homes

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  • Care Homes
  • Premier Icon granny_ring
    Subscriber

    And payment for a resident.
    Has anyone had any experience of how the system works when someone has to go into care and how the finances are sorted?
    I don’t want to go into too much detail
    detail on the forum but if anyone can help with advice can they send me a message please?

    Many thanks 👍

    Premier Icon midlifecrashes
    Subscriber

    My dad moved into one two weeks ago. He is dying. Before this he has had repeated short admissions as an inpatient to James Cook Hospital for various crises and blood transfusions. As part of his exiting hospital care package he has previously had carers 3x to 4x daily and community nurses twice a week, together with weekly GP home visits. He has been provoded with a hospital type bed and air mattress at home too. All this wasn’t enough to kep him safe at home as he began having falls on the way to the loo and just generally not having the strength to do anything for himself, so he very reluctantly agreed to move. Because of the hospital admissions and the GP and social care people signing him up for end of life care, every penny of this has been covered by NHS/social care funding, he gets 3 months funded at the care home. If there’s an after that, then we need to look at funding from his/our pocket.

    Premier Icon cinnamon_girl
    Subscriber

    You may find this link useful. The NHS will pay a contribution for nursing care only, have you spoken with Adult Services? The hardest part is getting the NHS and Adult Services to communicate and for Adult Services to understand what the health condition is and how it affects the patient especially if it’s a rare disease.

    Home

    theboatman
    Member

    I’ve sent a PM as I have a working knowledge of this, so PM if you think I can help. I would say to anyone that if they are talking large sums of money, get some independent financial advice.

    Premier Icon maccruiskeen
    Subscriber

    I don’t want to go into too much detail

    whether you are north or south of the border is an important detail

    Premier Icon granny_ring
    Subscriber

    Thanks for replies so far, I’ll read them when I get a chance.
    Location is Wales.
    Cheers 👍

    fossy
    Member

    MIL in nursing home. Costing a grand a week. Some cover from the NHS as she has disabilities, but it’s like £200 a month, the rest comes from a deferred charge on the house via the Council (they pay the rest) – we’ve had to setit up.

    We looked into selling the house and paying directly to the home, but that would have cost an additional £18k per year to deal with the home direct as fees are capped via the council.

    Looked into renting out, bu the house would need extensive work to bring it upto standard – new kitchan/bathroom, and then the council would take 90% of the rental income. Just not worth the extra hasstle.

    At this rate, the house’s value will be gone in 4 years. She will then get her place fully paid for.

    It’s crap if you are old and own a property, this then all goes on care fees.

    poolman
    Member

    I was in this situation 3 years ago, if you re paying you choose the home. We saw some awful ones and chose one that best met the needs. You then have to pay, so look at income and all allowances, then the cost, to identify the income shortfall.

    Sadly the gap is open ended, it could be 1 month or 10 years. Some residents slot straight into care home life, usually ladies, men tend to give up. Clearly if the resident slots straight in then you could be looking at say 5 years, or 7…starts getting a bit frightening.

    As above you can pay by a deferred charge on the home, plus interest, all rolled up to pay on the asset sale.

    Premier Icon granny_ring
    Subscriber

    Fossy and poolman I’ll msg you later many thanks.

    poolman
    Member

    Please do, it’s a horrible time for everyone and the care home is a business so need the money. I ll be slow to respond as travelling but no worries I will get back. Sorry for your situation btw.

    fossy
    Member

    No problem.

    We still have some issues with care. The home itself is lovely, modern and like a hotel. MIL goes in a lounge on her own (she doesn’t like the other ‘old people – explaining her that some folks minds fail, and some people’s body fail – she is intollerant of mental disibilities and a stubborn old battle axe). We’ve bought her a special chair (£2.5k) as she spends many hours in it, then into bed – she’s hoisted. She’s all there mentally, but body has fell to bits, strokes and heart attack, heart failure. She’s quite big too, so no chance we can look after her – we managed to keep her in her own home for 5 years after FIL died, but car became more and more as her mobility went – she got very afraid of falls, then fell ill last Feb (we thought end of life) but with care, and moving to insulin injections for Type 2 (badly managed before), she bounced back as her organs improved.

    But, she wouldn’t try and walk, even just to a commode, so she has had to go into a Nursing home. She doesn’t have incontinence, but for loo trips, no.1 are in an a ‘nappy’ and they hoist her for number two. Unfortunately, they havent been using the ‘nappies’ (MIL’s own term) that were for her (on water tablets, lots of water), so she’s been getting ‘wet’. Had a fair few complaints about this. It’s down to staffing shortages – always difficult retaining staff as pay isn’t great, and it’s not the nicest of jobs cleaning up poop etc.

    Otherwise, she is like lady muck. Fairly good health now, much better than before, so we can see her being here for some years – big difference from everyone, including doctors thinking she was a gonner a few months ago.

    It’s been a no brainer doing the deferred charge, as the direct option is a ovr a 1/3rd more expensive, and will cut a year off her ‘funds for the home’.

    mooman
    Member

    Social worker here – feel free to email me any questions.

    I practice in Wales. I assume you will know there are differences to funding care costs in England and Wales.

    cinnamon_girl

    Subscriber
    The NHS will pay a contribution for nursing care only, have you spoken with Adult Services? The hardest part is getting the NHS and Adult Services to communicate and for Adult Services to understand what the health condition is and how it affects the patient especially if it’s a rare disease.

    Health and social services communicate very easily when it comes to who has responsibility for health or social needs. Getting health to agree to CHC is often a tad more difficult though.

    Premier Icon timbog160
    Subscriber

    Speak to social services – once in the system I found them helpful and efficient. My mum went into care home 3 weeks ago. She has no mobility, is incontinent and no longer capable of taking care of herself. She was previously living on her own but had 4 care visits a day, but these have become increasingly inadequate for her needs. She’s now safe and looked after and is eating better and is closer to other members of the family, although she is a bit miserable about leaving the house she called home for 74 years. The local authority pays the bills (c£500 per week) and this will be recovered from whatever equity she has when house is sold.

    Our only regret is not doing it years ago when she had more mobility, but at least we no longer get 3am calls from her to say she’s on the floor and can’t move having fallen out of bed!

    Good luck – it’s a worrying thing!

    Lionheart
    Member

    System is pants but not sure how the system could afford or manage it any other way. We currently have power of attorney for two relations. Both are in homes, both were beyond homecare even with carers. Both with severe dementia, both deaf, one blind, both immobile.

    Both now over 4 years in care homes, having pretty much spent all of their savings and remaining value of their houses. The government, contributes a small amount as both are deemed to be in ‘social care’ and not in need of full medical care which would get full support. They need 24hr supervision, neither can do anything for themselves and need more than help to do anything, for example they need to be fed. Both are on quite a few meds.

    As a nudge to the powers that be, we ask for an assessment of them every 6 months, takes 3 months for one to come through. Two assessors then visit for two to three hours and deem them to have 20 points on the need scale, they need 21 points to get financial support. If they needed more medical care or were more ‘difficult’ then they apparently would score the magic 21.

    Going into next year they will have to have gov/council support as they will have run out of Savings, equity, funds etc.. though ‘you can’t take it with you’!

    My thoughts,
    1. worst bit is having the homes as commercial entities that are trying to save costs, make a profit, this does not seem compatible in my head or our experience.
    2. The care home management and ownership seem very different, have very different agendas to the care staff.
    3. Have no idea how this (Big picture) can be resolved other than everyone paying an extra sum every month of their working life into an extra government pot.
    4. If you think you are going to last a long time and want to leave your money to anyone, do it early, probably earlier than you think.
    5. I really hope I don’t last as long as they have.

    Premier Icon granny_ring
    Subscriber

    Thanks again all, only skim read at mo.
    Mooman will msg you too.

    Premier Icon davosaurusrex
    Subscriber

    Watching with dismayed interest as my Mum has fallen 3 times in the last fortnight and my Dad has just had a stroke whilst in heart failure waiting for open heart surgery

    Premier Icon granny_ring
    Subscriber

    Thanks again, I’ve yet to message people but maybe I should give some more info here as it might help with more appropriate advice..
    The person involved has been diagnosed with alzheimers I believe and it looks like the hospital team are recommending some sort of residential care I think for the persons safety.
    I think it’s the start of a long difficult winding road unfortunately..

    tjagain
    Member

    I have worked in care homes and a lot with people with dementia. I also have some knowledge of how the systems work. Looks like you have good advice coming but PM me if I can help

    Premier Icon granny_ring
    Subscriber

    Cheers tj 👍

    fossy
    Member

    THe No1 priority is the person’s safety. Like others have said, we held off as long as possible (at great family stress) for her to be in her own home, but the last illness sealed the decision as she point blank refused to even try and get up – at home, she literally moved from the chair to the commode next to her. Wouldn’t walk to her bed in the dining room, so as soon as she couldn’t move to the loo, we had to put her in a home. She was in hospital for around a month, then into respite care until we found a nursing home.

    Go visit quite a few. She has already had respite care in a number of homes following falls over the years, so you get to know a few. Some weren’t that nice, old and drab, some quite modern. Oh and find one that is near most of the family – work out how long it will take to get there – we’ve had a few that were only just over the other side of town, maybe 3-4 miles away, but it could take over half an hour to get there. The current home is 5 minutes away from most of the family.

    She does regularly say ‘I want to go home’ but we remind her that she won’t get up, so can’t go – even that carrot doesn’t work. She’s quite happy being lifted. We een looked into a hoist for the house, but that needs two people at all times, and we couldn’t get two carers at once. Even in the nursing home, it’s two staff to do the lifting – quite resource intensive, so you realise that’s why they (staff) can’t be every where at once ! A toilet visit takes at least 15 minutes.

    Getting old isn’t great. See what activities are done for the residents. MIL is a bit of a stick in the mud and likes her own routine, but she does occasionally get involved – she likes things like Christmas Fayres (she supervises a stall), and they have animal visits and singers regular.

    dave661350
    Member

    I feel for anyone going through this, we did 3 and a bit years ago.

    Get a power of attorney sorted now, don’t wait.

    Get an assessment done for Attendance Allowance. https://www.gov.uk/attendance-allowance

    £58.70 or £87.65 a week.

    As above posts say, look at a few homes. Don’t make appointments, just turn up.

    If dealing with the council, be shouty but don’t shout if that makes sense. Know what you’re talking about.
    Get a Continuing Healthcare Assessment done. https://www.gov.uk/government/publications/nhs-continuing-healthcare-checklist
    For this you do need to know your rights or ‘they’ will ride roughshod over you. We had it done, knowing that mum would not qualify but it was to hold those in the industry to account and to let them know we had done our homework…it also prompts ongoing checks.
    There is loads of info on this website

    Home

    My mother had lived alone for 10 years and was lonely for 95% of the time. She simply did not want to go and meet people…lifelong friends etc. We expected big issues in a new environment, especially a care home….but she loves it. Company if she wants it, a bit of safe solitude if not. Our experience of the whole thing has turned out to be a very good one. Yes we won’t get any form of inheritance and it takes some getting my head round the fact that some of mums ‘friends’ in the care home are wealthy and their wealth is safely tucked away in trusts whilst others squandered any money through their lives on fags, booze and ‘life’. Heyho.

    Finally, forums are great for venting (and for other peoples experiences to come out) This issue will affect most of us in our lifetime. Get some form of plan in your mind while everything is going well…you tend not to think as straight when it is all going tits up!

    mooman
    Member

    dave661350

    Member

    Get a power of attorney sorted now, don’t wait.

    My own personal view on this is that an advanced statement is much more beneficial. As others have said – if person has assets then care costs will eat most of it, and best interests decisions are so much easier if a person has informed what their wishes are around health and accomodation.

    Get an assessment done for Attendance Allowance. https://www.gov.uk/attendance-allowance

    £58.70 or £87.65 a week.

    CAB or Alzheimer’s Society can help here.

    As above posts say, look at a few homes. Don’t make appointments, just turn up.

    And be prepared to be told they are too busy to show you around. Care/nursing homes are very often a tad busy to be showing unannounced people around.

    If dealing with the council, be shouty but don’t shout if that makes sense. Know what you’re talking about.

    Do not be shouty .. in any circumstances.
    Knowing what your talking about is vague if this is a new situation for you – Local Authority social care will have followed the process many many times.

    Get a Continuing Healthcare Assessment done. https://www.gov.uk/government/publications/nhs-continuing-healthcare-checklist

    Yep .. its that easy. Not a mine field at all …

    For this you do need to know your rights or ‘they’ will ride roughshod over you. We had it done, knowing that mum would not qualify but it was to hold those in the industry to account and to let them know we had done our homework…it also prompts ongoing checks.
    There is loads of info on this website

    Bit of a bizarre contradictory statement that!

    The problem that often frustrates and makes an already difficult and confusing situation worse when a loved one has a long term illness is the conflicting and often blatantly wrong information and advise given out.
    From the nurse in hospital telling family a loved one can have 4 calls a day from the council when they go home … when in reality the nurse has as much authority in providing this as the car park attendant at the hospital has.
    Or when the social worker says CHC will fund the care package .. when its a Health decision to be made.
    Or reading well meaning but ill informed advise on the internet.

    fossy
    Member

    Don’t feel guilty about putting a loved one in a home – sounds horrible, but it’s for the person’s safety – wouldn’t be good to find the loved one had fallen and spent hours on the floor.

    My wife even thought about caring for her mum full time, but even with a hoist it would have been impossible, and often emotions get involved, so makes the job much harder. We feel better knowing that MIL is safe – we were always checking on the IP camera to see she was OK. Even with a redcare button and the camera, MIL had fallen fairly regularly.

    MIL’s pretty happy, nothing’s perfect, that’s life. She stil has her routines – i.e. don’t go on a sunday afternoon as she is watching her ‘movies’. She knits all day (one handed – one arm no longer works), has cuppa’s on demand, tonnes of chocolate (she has a fridge full), eats what she wants, sits in her favourite lounge with a big window on the garden (didn’t have that ability at home), bird feeders directly outside her room window, and most importantly someone to talk to and her ‘staff’. She still asks us to do ‘jobs’ in her room, nd we say, you’ve got a handyman for that, sure enough, if she asks, it get’s done.

    For the family, the move has relieved alot of stress and ‘caring demands’ from us.

    mooman
    Member

    Its also worth remembering the cared for person in this too. If they wish to stay at home then as long as they have mental capacity then the social worker will do everything they can to enable this. It is also worth noting that a diagnosis of dementia does not automatically mean a person cannot make their own decisions – this is something family seem to get stuck on.
    Falls again are a difficult area too. Unless a person is immobile then you cannot stop them having falls. They can have them in a care home as easy and as often as in their own home .. response times will be quicker in a care home of course.

    As previously said in regards to making an advanced decision about accommodation; thats where I would put my priorities before a POA. It is not that uncommon to see familys coerce loved ones into a care home, and then for the loved one to give up and deteriorate rapidly, for this reason the social worker will want to ensure its the loved ones own informed decision to go into a care home … hence the advanced statement.

    project
    Member

    From the experience of working in the NHS, having a dad and aunt in a care /nursing home, and having worked in a care home, theyre profit making enterprises, expect to pay for everything and anything, and also be a guarantor if payments stop, for whatever reason.

    If the relative owns a property then that will be assessed as income, and will need to be sold to pay for care costs, £1000 per week plus for nursing care,private and state and savings are also checked and used as a basis for income,have to much and you pay more towards the fees.

    Ring up and book a few appointments at various homes,have a read of inspection reports free on https://careinspectorate.wales/our-reports, shows where homes are filing or doing ok,look at a few rooms,check the radiators for covers,so if a patient falls and rests against a radiator they will not get burnt,happens quite often,ask about meals,add on extras, hairdressing,chiropody,trips out,religious activities,etc etc,does the home smell of urine, some do,is the decor ok,are there sufficient staff in evidence,is it clean,do wheel chairs have footrests,ask if all hot water has thermostats fitted to avoid scalding in bathrooms,is there level access to the grounds,with seats outside, whats the smoking policy, visiting policy for freinds and relatives,ask about activities planned and ongoing.

    Make notes,about who you spoke to, and contact details.

    Final question to ask yourself would you be happy to live out the rest of your life there.

    fossy
    Member

    As a reative, you are not a guarantor, the costs stop with the individual in care. That’s just wrong @project, certainly not in the England.

    project
    Member

    fossy it was Wales,care home demanded bank details of us,as guarantor,i refused, but my brother signed the forms,and when my dad moved home because of neglect,they threatened court action and bailiffs, we won eventually.

    tjagain
    Member

    THe No1 priority is the person’s safety.

    Nope – this I disagree with very strongly. The number 1 priority is the persons wishes. This is enshrined in Scots law on this which is some of the best and most clearcut law in the world on this ( along with some UK law)

    Competency ( in the legal sense) is key – and that means understanding the consequences of your decisions. ” If you stay at home you might fall and hurt yourself and you could even die as a result” “I do not care I’d rather die next week in my own house than next year in a care home” Competent choice, they should stay home

    Just because a decision is irrational to us does not mean it in not competent. Just because you have a dementia diagnosis it does not mean you cannot be competent to take decisions. Living with dementia you can still take risks and so on – so long as you understand the consequences of those decisions.

    Everyone is different and everyone has different needs and desires. But to take away someones right to self determination is a huge thing to do and not a step to be taken lightly nor should it be done out of a paternalistic desire to “protect” the person if they do not want to be protected!

    tjagain
    Member

    Couple of other things to look at to add to Projects list – are the mens shoes clean and shined and are they clean shaved?

    Premier Icon granny_ring
    Subscriber

    Lots still to read on here so thanks all for input.
    As far as I know the person doesn’t have mental capacity and they live on their own. Some good friends localish, 30 mins away and family 3&5 hours away. As much as we would love the person to stay at home with carers coming in, what’s to stop them going walkabouts in the middle of the night….it happened recently.
    There is a meeting this wk with hospital social worker and medical team so we will be updated as to their thoughts. Just hope to be armed with relevant info!

    mooman
    Member

    TJ – you are correct. Only thing I would add is that if the persons wishes put themselves at significant risk which causes risks to others then their wishes would not be adhered to. Appols if it appears pedantic.

    A person wandering can have a monitor that notifies an identified person if they leave their home; often a family member .. which is far from ideal at 11.30pm at night!

    Has the person expressed where they want to go, or previously discussed accommodation wishes? as far as having capacity to make decisions – the social worker will complete MCA assessments ensuring they do everything to enable the person to make their own decision.
    I am not sure what part of Wales you are from. But typically the hospital social worker will hand over to a community social work team when person is medically fit for discharge.

    Premier Icon granny_ring
    Subscriber

    That’s what the meeting is about this week I believe.
    We have been told about the monitor devices but how can they be of use in our situation?
    There will be some difficult and emotional conversations this week I think.

    Premier Icon granny_ring
    Subscriber

    Bit of a thread update and thanks for all your input, and of course a couple more questions…!

    After viewing 5 Care Homes (an eye opening and humbling experience in itself) wittled down from a list of 10 or so, we managed to get the relative a room in our favourite home. You obviously hope and prey that you’ve made the right choice for them and they seem to have settled in well.

    We also spoke to another visitor there who visits a relative almost daily and she said it was a lovely home, lovely managers, staff etc and she went to see many more than we did.
    AS we are not local to the home this reassured us no end I can tell you!

    So soon we have the 6 week review with the hospital social worker so this has raised a couple of questions for me – Payment for the care.

    We will be taking the deffered payment route for the care. As I understand it the first 12 weeks are based on income as savings are below the threshold. Thereafter the deffered payment kicks in.

    As I understand it, if a person leaves hospital and has carers at home the hospital pays for the first 6 weeks, do they pay for 6 weeks of residential care does anyone know?

    The person concerned is in Wales and has Dimentia.

    Thanks again for any input.

    fossy
    Member

    In England I think that happens especially discharge from hospital. MIL had a few months in respite care in a ‘community hospital’ first before we could find a nursing home. I think the first 6 weeks in the nursing home were covered (but not sure). Ask the Social Worker – drop them an email if you don’t have time to phone.

    theboatman
    Member

    As I understand it, if a person leaves hospital and has carers at home the hospital pays for the first 6 weeks, do they pay for 6 weeks of residential care does anyone know?

    The home care offer is different, paying for residential care is covered within the regulations of the Care Act and all local authorities have to abide by this. But home care and the charging off for that is up to individual authorities and health partners. For example, where I live you may be eligible for up to 6 weeks of care at home, but this is funded by the local authority who simply choose to waive the contribution they charge for long term home care. It’s nowt to do with Health. But the contribution usually charged can very from authority to authority.

    theboatman
    Member

    In England I think that happens especially discharge from hospital. MIL had a few months in respite care in a ‘community hospital’ first before we could find a nursing home

    Again where I am, this wouldn’t happen and I’m in England. Community hospitals are for therapy and treatment, and wouldn’t be used for respite care. Health and the local authority have some joint arrangements for therapy to be provided in residential care homes, but these tend to target discharge in under 2 weeks. There have been some quirks, like folk on ‘non weight bearing’ pathways where health have funded resi or nursing beds in private homes to clear out the acute hospitals where folk aren’t ready for therapy. But these seem to be being wound up. The local authority should cover the cost of residential care if they cannot source you a package of care at home. So given the different experiences of fossy and I, it would seem things might vary area to area.

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