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Where is the line between a care home & nursing home regarding needs?

(38 Posts)
OoooOoooOoood Sun 28-Oct-12 21:21:41

Grandad is currently in hospital following a chest infection. He's almost back to himself except it's left him weak and they feel he won't be walking properly( been in a chair for going out for years). There's no medical issues except the medication( which hasn't changed ) and a problem with his hand ( which has been an issue for 20 years).

He moved to a care home in the summer and they are currently holding a downstairs room for him as someone else is moving to a nursing home.

Hospital are now saying he will have to go to a nursing home, they've not got as far as discharge meeting so no idea what the home think. We are a bit confused as his needs haven't changed apart from he will be in a wheelchair most of the time. He can move between bed & chair with support. He only went to the home in the summer( very much against his will initially but has loved it since) and it seems a shame to go through the trauma of another move.

He's also self funding , not sure how that works with nursing care? Especially as my parents are paying until his house is sold.

Oodthunkit Tue 20-Nov-12 19:38:22

We had a lot of queries re other stuff though so would have been useful to meet SW ( who came to the ward but not to see Grandad /us, we didnt even know her name) and questions for ward staff.
Plus he's been on ABs for 3 days and my mum got a call this am to check if she was still ok for meeting!

Bad communication and not impressed with SW not at least saying hello.

iliketea Tue 20-Nov-12 19:06:32

One of the problems with CC funding is that before it's agreed, staff need to prove that your grandfather has something whch will not change with medical intervention. So submitting the assessment now would mean that he was turned down (as they panel could argue that the infection was reversible and could be treated). Have been in that position (as a nurse trying to get CC funding for a patient) - it's so frustrating, even when you know the antibiotics aren't actually going to change care needs.

Oodthunkit Tue 20-Nov-12 19:00:38

Cancelled again. After we arrived. Nurse refused to do assessment as he's on ABs. He's on them pretty much alternate weeks so surprised she was surprised.
We had a chat with ward sister re his drip/nursing home. Assuming he doesn't suddenly start drinking he's got it for the king term so nursing home has to be able to do that.
She's not expecting the infections to stay clear while he's not drinking, so not likely to stay off ABs long enough to get out.
Staff on the ward are v good though so happy for him to stay there for now. One nurse had sat and spoon fed him a cup of tea , took an hour.
He was refusing to eat for us today but he often refuses out help.
Think his sight has pretty much all gone now didn't seem able to see shapes/colours like before.

Oodthunkit Mon 19-Nov-12 16:57:07

The CC assessment. Financial one was updated last week as it was done last year and all that's changed is his savings are gone so waiting on house sale.

Thymeout Mon 19-Nov-12 11:42:10

Oh what a pain! So sorry you're having to cope with all this when you want to be concentrating on your grandfather.

Can't help with your specific enquiries, but worth a try. Medical issues will carry more weight than inconvenience to the family wrt to travel time. Was the assessment about CC or your grandfather's finances? An external PCT assessor came to see my mother and I was able to be present. (All of 2 mins looking at my mother. The rest of the time was taken up with her going through the ward notes with me and explaining why she didn't qualify for CC.) The LA told us to appeal the verdict, even before we'd been officially given it, because they didn't want to pay the full costs, tho' they'd be getting the money back on the sale of the house.

My mother was classed as 'self-funded', as opposed to someone with no assets, and the PCT assessor gave me a list of possible nursing homes for patients with dementia, so there was, in theory, a choice of homes for self-funded clients.

But when it comes to availability of beds, I don't know how long you can hold out against the hospital wanting to discharge. The problem is you're fighting on so many fronts, and the alliances keep shifting.

If you end up with a dispute with the PCT, the LA will be on your side. But if you are having problems with the LA, it's worth getting the local councillor/M.P. involved because they carry a lot of clout. Have you had any luck with Age Concern? They deal with a lot of cases like this.

Good luck!

Oodthunkit Sun 18-Nov-12 17:23:12

Meeting got put back until Tuesday (cancelled 2 hours before it was to happen as they hadn't done the assessment angry)

Have more queries!
Grandad is registered blind , he doesn't do a lot at the moment so people don't always realise. When we've looked into nursing homes, out of the 10 in our area only 2 put visual impairment as one if their specialisms, which also happen to be the two closest ones. Could this be used as a reason for wanting one of these? Only one home (also one of the two nearest) says strokes as a specialism and the majority of his disability is stroke related.

And shock at prices! £850+ a week on majority of the ones in our area, this includes nursing but SW told my mum aporox £190 from NHS for nursing part. Is this the usual cost ?

Oodthunkit Tue 13-Nov-12 19:26:27

Yes the LA have agreed to pay the care section until the house is sold.

Oodthunkit Tue 13-Nov-12 19:23:48

There isn't a choice in home so no option of choosing a more/less expensive home hmm

Thymeout Tue 13-Nov-12 19:17:41

Oh dear!

I was initially told it would be better for my mother for to be discharged to a nursing home as she would get better care while she was dying in a place where there would be someone to sit with her, as opposed to a busy ward. "Like a hospice?" "Yes!" she said. I then found out that for 'hospice', read 'any old nursing home where there was a bed'.

Re CC. The PCT refused it for my mother because she didn't have 'complex nursing needs', e.g. tube feeding, a tracheostomy, oxygen dependent. The LA won their appeal on the grounds that she needed a trained nurse to be able to interpret her wishes, should she change her mind about refusing food and water. But the whole thing was academic, given her age and mental state.

Everyone has their own agenda. The hospital wants the bed. The PCT and the LA don't want to be landed with footing the bill for care. It's only the family who puts the patient first. God help those who are on their own.

Btw, I don't think your parents are legally responsible for paying for your grandfather's care. It's the LA. (Tho' they can put a lien on your grandfather's house so they will be reimbursed when it is sold.) Topping up is voluntary, if you want a more expensive home than the LA will provide. I think, if you are paying, you do have a say in which home he goes into. But check with Age Concern. Ime, the LA can sometimes be a bit economical with the truth.

Oodthunkit Tue 13-Nov-12 17:42:49

Not so sure about the comparison with FC as I don't feel there is enough good places/carers not paid enough and care for those with SN is pretty sparse too my county not coming across well here is it but everyone should have a choice in their care . Lots of elderly seem to be paying for their care and still not getting any choice which must be the only area of life that paying for something doesn't give you an alternative.

I agree - care of the elderly is a tragedy. You can get paid two to three times as much to foster a perfectly healthy child, who will probably be at school all day. A twenty-something with a disability can get 24 hour care at home. As soon as someone's over the age of 65, it's scrabbling to find care home places an hour away when families can't cope. I know there isn't really money to throw at the problem, but a more equitable distribution of resources across the life-spectrum wouldn't go amiss.

Oodthunkit Tue 13-Nov-12 16:58:24

sad Thanks for the help.

iliketea Tue 13-Nov-12 16:37:14

Unfortunately, IME - it's typical of elderly care in the NHS. Hope your grandfather continues to get good care wherever he is.

Oodthunkit Tue 13-Nov-12 16:33:54

Hospice just round the corner from me but think its even less likely. Seems to be massive waiting lists for it.

This really doesn't show up elderly care v well sad

The hospital have been v good this time though after many bad experiences with my Gran and previously with my Grandad.

iliketea Tue 13-Nov-12 16:28:32

OP - I wonder if transfer to a hospice for end of life care might now be more appropriate for your grandfather. Especially as you said you've been told he is not likely to have long left. Might be worth discussing it with the staff on the ward, as if there is a local hospice it's likely to be altogether more pleasant for the last few days than the hospital. This could be a possibility if your grandfather isn't having any more active treatment to make him better, but only having medication to alleviate symptoms.

It's so difficult to know with elderly patients as it's difficult to project the trajectory of multiple illnesses. My thoughts are with you and your family.

Oodthunkit Tue 13-Nov-12 15:51:00

There isn't a nursing home on offer at the moment afaik. They are regularly offering the other bloke a home an hour+ drive away on v bad roads in an area my Grandad really dislikes. We would have no objection to the majority of our county except this area though we would prefer him nearer so we can visit regularly.

They have also told the other family that there's no chance of a swap once he moves.

Both mum & I have PoA for him. He has no speech now, we understand him but it's not going to be enough for them to clarify his decisions plus he is getting infections/confusion.

We've had the 'he's not got long' conversation numerous times now and been called as he was unresponsive only to have him respond when we arrive. Can't see him living long anywhere but don't want him to be somewhere he would hate for the last period of his life ( especially if it's too far to visit easily).

Thymeout Tue 13-Nov-12 15:14:53

What do you actually want for him? Realistically, is there a chance of a vacancy at your preferred nursing homes? He's not happy where he is and the longer he stays there, the more likely he'll pick up an infection.
Could he be persuaded to regard the LA's choice of home as a temporary measure, a sort of convalescent home?
Does your mother have Power of Attorney? Is he capable of making his own decisions?
I had PoA for my mother, did not want her moved anywhere, because she was only days from dying, and when I asked the CC assessor if I could withold my consent, I was told it was 'a grey area'. Might be worth asking Age Concern about this. The next thing I knew, I had a phone call from the hospital telling me they would not be discharging my mother, when previously she'd said they would be carrying out the discharge up until Cheyne-Stokes breathing. shock

Oodthunkit Mon 12-Nov-12 20:20:17

No rehab hospital here. There's a unit for physical rehab but my Nanna was at their highest end with a bad stroke and non verbal.

I'm not expecting him to move from the conference but need clarification of what we should be expecting to happen ( continuing care assessment is a good one to remember)

The other bloke who's more medically fit but Alzheimer's has been there 18 weeks now. Only vague hints of a nursing home as there doesn't seem to be vacancies.

Just to warn you, then, the case conference might be a bit of a non-starter if he's not showing some glimmer of being medically fit for discharge. If he's in a general hospital they're more likely to want to turf him out for the bed without much notice. Is there a rehab hospital he could go to for discharge planning to make the process less touch and go once he has stabilised a bit? It might give your mum a bit more peace of mind if he's in a slower-stream setting. It's worth asking about this in the case conference.

Oodthunkit Mon 12-Nov-12 19:26:02

He's in a general hospital. Its a high need ward, like the next step down from HDU( msinly elderly ).
He's refusing food/drink then gets dehydrated, urine infection, confused, they drip him up, he improves and starts again with refusing food. He's refusing to put his feet on the floor to move but then tries to run away when confused ( hadn't walked for 2 months, do not v successful!).So they aren't getting him well enough for more than a day or two before the cycle starts again.

Assessment has been asked for but not sure on progress. I can't get to visit very often due to work/kids/SPD limiting my walking distance!

The social worker won't be the one to say whether he gets moved on - it will be his consultant and the nursing staff and how desperate they are for the bed. Have they done a Continuing Care assessment or did you ask for one? If so, keep on top of the nurses to make sure it's done in time for the case conference so there's no delays. How come he'll still be in hospital in December? Will he not be fit for discharge before then? Is he in an acute hospital or a rehab one? (Sorry - noseying smile)

Oodthunkit Mon 12-Nov-12 19:02:57

Case conference on Thursday if anyone has any tips!

Oodthunkit Sat 10-Nov-12 20:39:58

My mum is worried that they will try and send him out when she is away in December but they'll have to deal with me and I'm less likely to roll over for the SW than she is ( I work in children's services so used to dealing with professionals)

He sounds like he's qualifying more now for Continuing Care funding, given the current level of unpredictability he's displaying. You can request an assessment via the nursing staff or discharge coordinator/bed manager (if there is one involved). They're not allowed to refuse just the assessment, even if the upshot is that he doesn't meet the criteria for the funding. You're best requesting it sooner rather than later as the ward staff need to complete this fairly lengthy document so it can take a little while - it's not something they can do quickly once they decide to discharge him.

Floralnomad Sat 10-Nov-12 12:26:08

Personally I'd give notice at the home , your grandad is not homeless as officially he still has his own home , then start looking for nursing homes . If and when he is fit for discharge then start the procedure for getting funding for it . I see little point in paying for something you are not ever going to use , and he's no more likely to go back there as to go home .

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