Advice and help please regarding elderly Aunt and care

[Shakey1500]

Hi, hoping someone can answer some questions for me please or point me in the right direction.

I am my elderly Aunts next of kin (only relative). She is 76 and in poor health. For the last 4 years she has been living in a privately funded residential home. I think that's how it would be described but not sure? She has her own flat, inside a home, with carers that pop in and make sure she's ok. She goes down to the dining area for meals but also has a little kitchen area in her flat.

She has been in hospital for 2 weeks and her current residence have told me that, as much as they love her to bits, they will be unable to provide the care now needed. Her mobility has drastically decreased and she is doubly incontinent. I understand their descision, though my Aunt will be gutted :(

She has become increasingly confused. I am unable to visit as often as I like due to distance, work, childcare etc so I am going by what her current residence tells me after they have visited her in hospital. I am waiting for the hospital Social Worker to ring and discuss all this with me.

I have lasting power of attorney for financial affairs but have so far not needed to act upon it. The thing is, I have no idea how "the system" works. If she needs round the clock care will this be called a "nursing" home? Does anyone know how much they cost? Currently she pays £1000 (ish) a month. is it likely to be a lot more? What is the criteria for her to recieve funded care from the NHS and what does it entail? I have no idea of her financial situation but think I will need to use the power of attorney soon to be able to assess and make a descision on her behalf. Does a doctor have to sign something agreeing that her mental capacity is impaired before I can use it? I should add that, at best, communication is poor with my Aunt (not through any issues, just that she isn't very communicative anyway) so I haven't been able to ask her outright what her financial situation is.

Sorry for so many questions and know I will get some answers from the hospital social worker, just need some heads up where possible
Thanks

[peanutbutterandbanana]

Shakey, poor you! Residential care homes will not look after someone who needs nursing care and so if her health is not good she will need to go into a nursing home. I do believe that if she has health needs that are forcing her into the nursing home then the NHS should fund this, but I am not 100% sure.

The social worker should tell you what the situation is, but I've been told by my mum's care home that social workers are incredibly busy so you do need to be persistent. Also her current care home will know a lot more about this, so pester them too.

Just ask lots of questions of everyone: the hospital, the care home, her doctor.

Hopefully there are some social workers on this site who will be able to help.

Power of Attorney - needs to be registered with the court of protection. We did my mum's through a lawyer, but not sure how you do it on your own. It was registered beginning of March and we are still waiting (apparently it will be fully authorised by the court end of May) but ours was an enduring power of attorney (not lasting), which you can no longer get. Advice lawyer gave to us was to get mum to sign a cheque for as much as she could prior to registering the POA because the time lag would mean that nothing could be paid (due to bank accounts being temporarily frozen whilst waiting) and that was good advice as it meant we could pay some of the costs of moving her, initial deposit at care home etc. So see if your aunt can sign a cheque to you so that you have some cash to be getting on with whilst you get the POA into motion.

Good luck

[Columbia999]

Sorry to hear about your aunt. As she is in hospital, she will have a full nursing assessment carried out by ward staff, and with decreased mobility, a physio and OT should see her to assess this as well. Coupled with the social worker's assessment, this should ascertain her care needs. She may not need a nursing home, unless she has clear medical needs where a nurse would need to be on the premises. Otherwise a residential home should be able to manage her care.
You will need to speak to her solicitor about the PoA, if she is assessed as not having the capacity to manage her own affairs now.
If she has assets over £23,000 (this may have changed, I retired last year!), then this will be used to help to pay towards her care; you can also apply for Attendance Allowance, which can also be put towards this. If she is in a nursing home, then the nursing element of the charges will be funded by the NHS. If the nursing report finds that her nursing needs are above a certain level, she may be fully funded by the NHS, so won't have to pay anything towards her fees.
I hope this helps.

[Columbia999]

Actually she should have been entitled to Attendance Allowance while she was still in the very sheltered housing, if she was unable to make her own meals and needed help with other tasks of daily living.

[Shakey1500]

Thank you both for replying, that's so helpful

I've been trying to look for help online but it's an absolute maze! She had a solicitor draw up her will last year, could I approach him regarding the PoA do you think? Still waiting for the hospital social worker to call, getting through to the hospital is a nightmare. Plus she's on what they call a "transitional ward" and there seems to be different staff on every day, no continuity at all.

I'm not sure she receives the Attendance Allowance as I've no clue to her financial standing whatsoever. It's been really difficult as we've only been in touch for the last 5 years or so (she's my Dad's sister, he died when I was 4), she's my only relative on my Dads's side and I'm her only relative. She never married or had children and I'm desperate to make sure she is happy and comfortable. BUT she doesn't communicate well at all, possibly had some learning difficulties, I really don't know. But I've broached the subject of finances with ther before and got nowhere. I find it arkward, embarassing. Trying to find out anything has been impossible and I really need to so that I can make plans if I need to start saving for her you know? Arrgghhh, it's so emotionally difficult! Thanks again, though, very helpful.

[YouveCatToBeKittenMe]

My dad is in a care home, although he is not in the 'nursing' section. I don't know why he isn't considered to need nursing as he is doubly incontinent and no longer recognises us. He is mobile but only just.

As he has a good amount of savings he has to pay for himself. The fees are about £900 a week. (yes that is a Week!, it is a bit horrifying how much they are)
As the others have said, your aunt will be assessed as to the level of care she needs. Unfortunately the original assessor of my dad was rubbish as he was thrown out of residential care after 2 days as they couldn't cope with him and had no spaces in the secure unit, which is where he should have gone in the first place, but thats a whole other story!

Do be careful to check out any home that SS suggest as you need to be sure they will be able to cope if her condition worsens, it can be a real headache, and confusing for them if they have to move to another carehome as their needs increase.

The residential place which is in the same grounds as the secure unit where my dad is is lovely apart from the fact that they originally kicked him out, they do loads of activities and have a Bistro and trips out, a garden area, barbecue etc. They have a lot more freedom than the secure unit and can go in and out as they please, they can't just wander off down the street though obviously

I hope it all goes smoothly for you. It is better to get the POA done while you aunt can agree to it and still understands what it is. It's much harder when you have to have a doctor certify that they cannot make decisions for themselves.

[Columbia999]

If you already have PoA, then that's half the battle, you just need to get in touch with the solicitor to let them know the current situation.
You can look at the inspection reports of prospective homes by going to //www.cqc.org and do a postcode search. It might be best to wait till the assessment is complete first though, so that you know what sort of home you need.
YouveCattobeKittenMe, double incontinence is not classed as a medical need, because care staff can deal with it. From what you've said, your dad is in the right place now. He can move around freely but is still safe from wandering out into the street.
When the savings of a person who is self-funding drop to around the £23k mark, then you can get help with funding from the local authority, because they don't use every bit of savings to pay for care.

[iseenodust]

As next of kin you should be invited to discuss the findings of the full nursing assessment. I would suggest you also make it absolutely clear that they do not discharge your aunt into a care home that you haven't explicitly agreed to (and visited). Erm, standards of care do vary. We started to notice that if you were lying in bed in some converted homes you couldn't actually see out of the window.

Doubly incontinent does not alone qualify anyone for fully funded nursing care. If a bit of nursing care is needed there is a middle level where you get about £100 per week towards care home costs.

If you think your aunt is only going to sadly deteriorate then your need a care home that provides both nursing & residential elements. This will restrict your choice but as poster above said you really do not want to have to move a poorly lady twice.

If there is hope her mobility may improve then you could try asking for a respite/rehabilitation package to see if you can go home say in 8 weeks after intensive support.

If your aunt has to go into a home the first 12 weeks are picked up by the system.

Read this
www.nhs.uk/chq/Pages/2392.aspx?CategoryID=68&SubCategoryID=681

Age Concern also useful resource. They now have drop in advice centres in many towns.

[Columbia999]

Sorry, the website for CQC is www.cqc.org.uk/. The first link is for some golf website, that'll teach me to check first!

[Shakey1500]

Thank you all.

She was (up until being in hospital for 2 weeks) an extremely heavy smoker (up to 40 a day). Her current home manages this as she is in her own flat within the home. She has needed oxygen before and had the cannisters etc in her room but insisted that they be removed so she could smoke (I'm aware that she can't have oxygen while actively smoking). One of the reasons she was admitted to hospital was because her oxygen levels were really low. They have increased now. I think the hospital are classing her as "medically fit" because the oxygen has increased. But without it they will drop again. Sorry, I'm waffling. My point being, is her need for oxygen support classed as "medical" needs? As opposed to the incontinence not being (for purposes of NHS funding)?

Still no news from Social Workers. Trying to gather as much info before I speak to them. Terrified of being fobbed off and given mis-information.

Thank you all so much

[Columbia999]

Don't take any "medically fit" threats from the ward. She has nowhere to go at present and her full needs have not been assessed. You could ask them to start the nursing assessment, which also needs input from the doctor on the ward, and OT and physio; mental health team as well if they're involved. The social worker needs chasing up now, as they should have allocated a worker to carry out an assessment.
Keep checking back here too, I'm sure I'm not the only (retired) social worker on here. I worked with elderly people and also an over 65s mental health team, so hopefully most of my knowledge is still intact, although things are changing so fast now!
Good luck.

[iseenodust]

Another thought - it does not have to be a care home in her current town. Do you think she will receive lots of visitors? If the harsh fact is that after a couple of weeks it might just be you dragging yourself up the motorway once a month then consider a care home in your home town? (Being blunt once you are in one, have lost your independence and friends are dropping like leaves then it doesn't matter where the home is.) The funding would not be affected by this.

[MoaningMinnieRisesAgain]

You can ask them to assess whether or not she needs oxygen available when she is discharged - some people have tanks or something called an oxygen concentrator. Oxygen has to be prescribed and I would hazard a guess that may tip her towards nursing rather than residential, but plenty of people in their own homes have oxygen too so I can't be certain.

She will not be allowed oxygen at home if she is still smoking because of the massive fire risk. She could be 'medically fit' as in she is stable and would be able to leave hospital right now if she had a suitable placement to go to. Don't worry about the 'medically fit' part, she won't be going anyway until she has a place to go.

[Shakey1500]

Columbia Yes, I have the impression that the hospital is saying she's fitter than she is. Her current home's carers have been to see her and their description of her medical state/general dispositon is completely different. And I trust them, they are lovely and have a genuine soft spot for her. They are also gutted that she will be leaving them. I believe them over any amount of transitional staff at the hospital.

iseenodust Yes, I've thought about bringing her closer to home. She adores where she is now and will not take the news well that she will have to leave and I'm so sad for her. This is horrible to say but in a way, it will be a slight blessing if her mental abilty has become more impaired as at least she may not be aware of it happening. That sounds awful :(

Right, I'm going to attempt to ring the hospital. I will update if that's ok. Thanks again, bit teary now

[Shakey1500]

Right this gets weird. Aunt was having her medical assesment yesterday afternoon with the Social Services team and medical staff. I haven't heard anything else as yet. Been told to wait for them to call.

So I was thinking of getting my practical head on and start looking for places for her, thinking ahead. I realised this morning that I didn't know (in her current room/place) what was hers and what was the home's regarding furniture etc. So I rang and asked. The manager asked me why I was asking and I replied that I was trying to be proactive in light of them saying they could no longer care for her. She's then backtracked and said that this isn't the case and it will depend on the outcome of the assesment?!

I said "But you explicitly told me that you could not provide the level of care needed, just two days ago"

"No i didn't" she said. Now I am totally confused. I know she said this, else why on earth would I be thinking/ looking at other homes, trying to sort things, looking for advice?? I've no idea what's happened to be honest. Baffling. So, anyway, I'm to wait for the results of the meeting. Confused.com

[MarySA]

It might be worth giving Help the Aged a ring. I think they might have a helpline you can ring for advice. Or even their website.

[fridayfreedom]

Just reading through your thread. Was she actually in a residential care home or was it sheltered housing? did she rent it from a housing association?
If it is sheltered housing then residents are supposed to be mostly living independently but they can also have help from carers with some self care and may have meals provided.
It sounds as though with issues around double incontinence, mobility and confusion that her needs may have gone what can be supported in this environment. The same would go if she was in a residential care home.
The ward team should be able to give advice following their assessment of her current needs plus her rehab potential.
I would be concerned that her oxygen levels may also be affecting her level of confusion.
re the Power of Attorney, have a look at the Court of Protection websites, can't remember the name exactly but something along the lines of the court of the public guardian. It gives advice re activating a PofA. You may not need to involve a sollicitor so can cut the costs.
There are procedures in place to make sure that the PofA is not registered fraudulently. Not certain if the Dr has to actually sign that she no longer has capacity to manage her affairs but they should give an opinion re your Aunt's capacity in this area. If she is able she may actually be able to give her permission for you to go ahead anyway.
Re NHS funding for care, this is called Continuing Health Care and is difficult to obtain, think blood and stone! However she is entitled to a screening assessment for eligibility. Previous posters are right, continence which can be managed, mobility which can be supported and confusion which does nt include unpredictable behaviour , hitting etc would not qualify for NHS funding.
re nursing homes, if she is self funding, has over £23,600 approx I think which may include property then she will need to fund her own care. The property may not have to be sold initially if she has assets to fund her in the meantime , some people rent property out to fund care. If she needs to sell teh property then Adult Services acn use what is called a 12 week property dis-regard giving time for it to be sold. The money wil need to be paid back at sale. Ask the social worker about this.
Hope this helps, just keep asking questions, and don't be pushed into moving her but bear in mind that NHS beds are scarce and waiting for a particular home may not be feasible if there is a long wait.
Good luck

[iseenodust]

It was over a week from assessment to call from social worker wwhen MIL was assessed in hospital. They do assessments and then take findings to a weekly meeting where decisions are actually made. (Red tape - In hospital the costs are the NHS hospitals, NHS funding full or part for care at home comes from primary care trust.)

[Shakey1500]

friday it was sheltered accomodation (I've since been able to put a name to it)

Have visited today, bless her she looks so frail :( Her bed was wet and I had to ask the nurse to attend to it GRRR.

According to the nurse she is not medically fit yet. AND she has written proof that the lady at the sheltered accomodation HAS said that they can no longer care for her. I'm really fuming now (see last post). She lied to me, as I knew she had yet she vehemently denied it and made out I had misunderstood. And the cynic in me thinks this is because they want the fees still to be paid whilst she's in hospital, knowing they have no intention of being able to care for her. But I haven't rang her yet, need to concentrate on sorting everything else out.

Thank you all for this, it has really helped me

[Shakey1500]

An update.

Aunt is still is hospital but a lot better or "medically optomised" as the hospital call it (!). The sheltered accomodation have confirmed they can no longer care for her, she has been assessed and requires a residential care home. The fab news is that she has agreed to move to my home town, I've found her a place in a residential home that will also extend to nursing care when needed and liased with the (rather lovely) social worker. They are going to assess her on Monday. She also agreed that I can now manage her affairs. I had a rather arduous task of sorting through two full-to-bursting bin bags FULL of paperwork that we removed from her sheltered housing. Paperwork dating back to 1979 and in no aprticular order

Thanks again