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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.

iliketea Sun 28-Oct-12 21:31:56

Residential care is normally based on 'social care' e.g needing help with washing / dressing / meals / medication administration. The care is provided by health care assistants (normally trained to nvq 2 or 3), nursing care would be provided by the district nursing team as there is not a registered nurse in the home.

Nursing care is for people who have a higher intensity need than residential can provide (for example due to needing hoisted for transfers) or for those who have increased medical needs e.g more close monitoring of condition / complex medication / palliative care. Care is overseen by a registered nurse in the home, normally leading a team of health care assitants.

I have no idea about funding - best bet would be to ask the social worker who is dealing with his placement. Make sure to ask if he has been assessed for continuing care funding as if he is eligible, the NHS would pay for all his care (direct to the home).

Hope that helps a little bit.

iliketea Sun 28-Oct-12 21:33:12

Also, I think fees can be defered until such time as a property is sold (the ward social worker should be able to give you more info about that.

OoooOoooOoood Sun 28-Oct-12 21:50:53

Thanks. You've pretty much confirmed my understanding. I'm still not sure how he fits. He's probably on the line at the moment.

wonkylegs Sun 28-Oct-12 21:54:06

The lines can become a bit blurred as some homes offer both residential and nursing care. In fact all the ones we have built (I'm an architect) in recent years offer lots of different types of care within the same home.

OoooOoooOoood Sun 28-Oct-12 22:01:48

Have googled the continuing care funding and brief check through the decision tool does bring him out on a few moderate and at least one severe.
Plus he is likely to deteriorate.

Hospital told my mum it's going to be a week or two before discharge.

iliketea Sun 28-Oct-12 22:13:52

If he's on the blurred line, and likely to deteriorate, it's probably better if he goes to nursing straight off, rather than going to residential and having to move again in a short space of time (unless the home he moved too was joint registered so that it would be a case of moving within the building rather than home)

OoooOoooOoood Sun 28-Oct-12 22:18:52

Yes that's what I'm thinking now. Shame as the home is lovely and nursing homes are nearly all the same company locally and we weren't impressed with my great grandmas care

Thymeout Fri 09-Nov-12 12:28:56

Just to warn you that you may find it is v difficult to get continuing care NHS funding, whatever the criteria may appear to say. Especially in the current financial climate.

My mother, 94, with vascular dementia, was admitted to hospital because she was refusing to eat or drink. Up till then, she was being cared for at home by visiting LA carers, four times a day. (Partially self-funded, her attendance allowance covered the shortfall.) After some time on a drip to rehydrate her, she continued to refuse anything by mouth and was put on the Liverpool Care Pathway, with our full consent. She had made up her mind, what was left of it, to die. The drip was removed and she was given morphine to help ease any painful symptoms.

Even at this point, the hospital wanted to move her to a nursing home and the NHS and her Local Authority had a dispute over who would pay for her care. The Continuing Care assessor met me at the hospital and told me she did not meet the criteria. (She was bedridden, couldn't stand unsupported, sleeping most of the time.) The LA would be responsible for the cost of the nursing home for 12 weeks and then we would have to sell her house. When I said she was not eating or drinking and would die soon, she said, "But she might change her mind". The LA challenged the decision and 3 days after her death, I got a letter to say she would be entitled to Continuing Care. (All very distressing, because obviously I wanted to concentrate on my dying mother, not to have to have a row with bureaucrats over money.)

I have read of cases in the press where patients severely disabled after a stroke have been refused CC, or only received partial funding for strictly medical procedures, most of the bill having to be paid by the patient.

If he needs a nursing home, then that is obviously what he should have, regardless of finance, but, from what you have said, you're likely to have a battle on your hands regarding funding, which will be much more expensive than his current home. If they are prepared to continue caring for him, then that is what I'd push for.

Floralnomad Fri 09-Nov-12 12:31:40

If you think that his care needs have not changed you should ask the home to go and reassess him to see if they are happy to have him back .

Oodthunkit Fri 09-Nov-12 17:42:31

The care home has now refused him back.
He has gone down hill from my last post, is refusing food/drink which results in urine infections, making him confused and then he eats for a day or two until he is less confused and it starts again. He alternates between refusing to put his feet down and trying to runaway (on weak legs that haven't been used for ages).

The Dr/nurses have noted he needs nursing care. Mum wants to stop his care home place now as its obvious he isn't going back. SW has said that that makes him homeless and they won't pay his fees if she does that ( social care don't pay at present -he is self funded but until his home is sold my parents(pensioners) are topping it up).
The SW won't meet re any of this as he's not ready to be discharged( we don't expect him to make it that far though sad )

Mum is now worried that if he is still like this in a month they will try & discharge him to a nursing home anyway.

Through discussions with someones wife on the same ward ( he was in the same home as my Grandad) the nursing homes coming up are not local and in an area v difficult to access ( rural county/poor transport linksetc). This is more an issue for the other couple as my mum drives but it's an area my Grandad would have very strong feelings against living there. We'd prefer to him to go further but a different area but places seem to be dependant on people dying sad

Thymeout Sat 10-Nov-12 00:19:03

So sorry to hear this, OP.

Nothing helpful to add except to ask if you've been in touch with Age Concern?
Sadly, they have a lot of experience with this sort of problem and I've always found them very helpful.

Best wishes to you all.

Oodthunkit Sat 10-Nov-12 08:49:01

No they are on the list! Mum had a strop yesterday at social care and said they can't afford to pay the home now until the house is sold ( nothing shifting here, few interested people who can't sell theirs). They offer a loan scheme until houses are sold so Mum is getting an assessment for that. We think they might not like paying for an empty bed and may let him officially move out ( also gives them a bed to fill!)

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 .

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.

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

Thanks.
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)

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

Case conference on Thursday if anyone has any tips!

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 19:26:02

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!

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 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.

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 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).

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 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 16:37:14

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 16:58:24

sad Thanks for the help.

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 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.

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 19:23:48

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

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

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

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 ?

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 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.

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.

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 19:38:22

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.

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