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Help needed re elderly care. PLEASE

(38 Posts)
Mynewmoniker Mon 03-Dec-12 17:47:59

Mum in law sent home from hospital but unable to walk due to possible 2nd stroke! Sister-in-law brought her home in her confusion and is now having to sleep at her sheltered housing home to help carer CARRY her to toilet.

Mum, 90+years, living in sheltered housing with a high dependency on others with regard to raising from the bed, dressing, walking, toileting and feeding has come out of hospital after a suspected 2nd stroke and is now unable to walk at all. The previous care was provided via Age Concern (feeding) and privately (all other needs).

I have many questions but our main one is about carehomes and are as follows:

1. Who decides that the sheltered housing is not a suitable place for mum anymore?

2. If a carehome is seen as the best option now, could this be provided by the council out of county and nearer daughter?

3. How much in savings is mum allowed before care is funded by the local authority?

3. If mum has savings and is able to be funded in a private care home, would she have to leave that home and find another one once funds ran out?

4. When they go for the assessment to the hospital tomorrow would there be some kind of social worker to guide them on such questions?

Complete newby to all this but wanting to help.

RedHelenB Mon 03-Dec-12 18:54:58

All I know is that the answer to no.3 could be yes - care homes are expensive places.

RedHelenB Mon 03-Dec-12 18:55:16

Oh and yes to question 4 as well.

Mynewmoniker Mon 03-Dec-12 19:45:38

Thanks RHB. I'm not understanding the 'yes' answer to Q3 though.

Are there any books/websites leaflets out there anyone? The Age Concern doesn't have info on this particular thing...well..not that I can see anyway.

ginmakesitallok Mon 03-Dec-12 19:47:55

Dear God! Wasn't she assessed before discharge?? Where I am she would never have been discharged into unsuitable accommodation.

didldidi Mon 03-Dec-12 19:49:44

Our local council has a section on charges on its website - might be worth checking there?

MisForMumNotMaid Mon 03-Dec-12 19:50:59
YulePutTatOnMyChristmasTree Mon 03-Dec-12 19:53:21

If she is settled in a Care Home and privately funded it wouldn't be in the best interests of Social services to move her if the funds run out, unless you have chosen a really exclusive, expensive one.

When choosing a care home bear in mind that her needs might change so chose one that can offer nursing care if she deteriorates, so you don't have to move her move than necessary.

IME Social Services are less than interested with self funding patients. Which is not what you want to hear, sorry.

SkivingAgain Mon 03-Dec-12 19:54:45

May depend which part of UK your MIL lives/wants to move to. From what you say it doesn't sound like she was fit to be discharged home. Ask Social Worker at local social services department for an urgent assessment and information about funding of home care and residential/nursing home care. Local Age Concern, CAB etc should also be able to advise on funding issues locally.

ChippingInLovesAutumn Mon 03-Dec-12 19:55:18

Just lurking as asking the same questions ourselves sad My friends Mum is in the same situation.

KirstyJC Mon 03-Dec-12 20:06:26

Well, I don't know all the details but it sounds like she should have been assessed by an occupational therapist, physiotherapist and seen by the Medical Social Worker when the results of those assessments were known, or at least that is how it is done where I work (OT in Care of the Older Person ward). Unless she self-discharged before they were able to do this of course, or refused to be seen.

Savings - in our area SW England it is £23,250 - over that, she would be expected to pay some/all towards the costs. She would be assessed by the Social Workers to work out what contribution she would need to pay. If she owns the home outright in her name only and no other person (ie husband) living there then she would be expected to sell that to pay towards the costs, but this doesn't need to happen before a care home is found - she could move into one and then sell her house with Social Services paying until she sells and pays them back. I think it is called the 12 week disregard although whether a house would be sold in 12 weeks is another matter! For remaining in her own home and getting carers in to help, again if she has over the £23,250 she would need to pay a contribution up to all dependent on savings, but the cost of the house wouldn't be relevant then. (I think, I am not a SW myself so please check!)

Does she and her carer(s) have suitable moving and handling equipment? If she was unable to stand independently when discharged then it may be she needs equipment, although that would depend on how she moves - some people just need one other person to give them a little bit of assistance to stand or mobilise in which case she probably wouldn't need much - maybe just a zimmer etc. If she needs more help then occasionally equipment up to an electric hospital bed and slide sheets may be needed - it really does depend on her needs and what the carers need to safely handle her. Both a physio and an OT will be able to assess the best for her. I am concerned about you saying carrying her - NO ONE should ever carry another person, they either move them with minimal assistance (eg hand on her hip/back to help her stand or steady her) or they use equipment (hoist etc) or they leave her in bed.

Some people can stay in their own homes even if they are confined to bed if that's what they want. The equipment can be put in, and carers as well, although there is a limit to SS care provision and usually nights are a problem, especially if someone cannot move alone and is incontinent - this poses huge risks for their skin and it can easily break down. Nevertheless it can be done if that is what the person wants. If they can afford it, some people have 24 hour live in carers.

I think, given how it seems like she was discharged before this was all assessed (for whatever reason) and assuming you are in the UK, I would try and get a family meeting/case conference with the professionals. You want a social worker and occupational therapist as a minimum, and a nurse who looked after her in hospital would be helpful. You would all (inc her) talk about her difficulties, how she sees herself overcoming them and what the risks of her remaining at home would be. If she is cognitively impaired in some way and there is a question over whether she would understand the risks then the SW might do a capacity assessment, but if you were all in agreement with her then you would be able to get a plan for her. You want to know a) what are her care needs, esp at night b)can these needs be met at home and then c)what type of placement (carehome) would they recommend if not.

Very sad to hear she is struggling so much and I hope you are able to resolve this asap.

ilikefestivitea Mon 03-Dec-12 20:09:26

Was she sent home with no assessment? If the hospital discharged her with no extra care / equipment then it's negligent. There is no way that anybody should be sent home in a condition that involves a carer / family member having to physically carry someone anywhere.

ClareMarriott Mon 03-Dec-12 20:10:00

My new moniker

Are you asking these questions because it is only your sister in law and yourself that are family? If not, what are any other members doing regarding your MIL ?

KirstyJC Mon 03-Dec-12 20:10:16

It is true that if you are self-funding then you will get less help in selecting homes etc but all assessments in the hospital should be done before discharge, and discussions had with the SW, irrespective of funding status. How on earth are you supposed to know what she has to pay for if you can't rely on the professionals to tell you? That is what we are trained for, for goodness sake!

Lilymaid Mon 03-Dec-12 20:17:29

"Was she sent home with no assessment? If the hospital discharged her with no extra care / equipment then it's negligent. There is no way that anybody should be sent home in a condition that involves a carer / family member having to physically carry someone anywhere"
I don't think that scenario is uncommon - DMIL was discharged from hospital, after a fall, without any assessment or anyone to look after her and DH had to drive 100 miles to her house to look after her, including about 20 night time trips to the loo (she didn't even have a raised loo seat).
As for the questions raised by the OP - IME it is pretty well left up to family to sort care and keep things moving.

3littlefrogs Mon 03-Dec-12 20:18:15

If you get in touch with Age UK or look on their website you will find lots of information. Age UK will also put you in touch with a specialist financial advisor.

From my own experience:

If your mum has more than £23K including the value of her home, she will have to pay for her care.

A care home costs around £800 per person per week, less if you don't live in London.

A self funding resident pays about 30% more than the local authority pays for non self funding residents.

It is a possibility that the LA would move your mum to a cheaper home once her funding ran out.

I am not sure re the out of county question.

You would need to find out who is doing the assessment in order to find out if a social worker will be present..

IME social services are reluctant to do anything until they do a financial assessment.

Your mother should NOT have been discharged from hospital without a proper care package in place.

longjane Mon 03-Dec-12 20:19:00

One you never never never say to any hospital that you cope and that you care for anyone if you dont have the stuff at home.

now you phone the dr and get them to come out you say she cant walk and you have no way of moving her.
hopefully they might send her back to hospital
but if they wont
they will OT and maybe SS involved

Isabeller Mon 03-Dec-12 20:19:43

You might be able to ask for urgent reablement* help so that some immediate care would be provided including some assessment. This could buy everyone some time to look into all the options.

I don't know if all councils have a social services access team but that could well be the most helpful phonecall you could make, if SIL agrees.

It probably doesn't need saying but SIL needs to make an active effort to tell all and sundry she sees at the hospital tomorrow that urgent help is needed and be ready to spell out the seriousness of the situation.

*(google reablement and your council's name)

best of luck with it all

Mynewmoniker Mon 03-Dec-12 21:04:41

Thanks to all who are replying especially KirstyJC.

MIL went into hospital in Yorkshire by ambulance as it was thought she was having a stroke. SIL and BIL joined her at the hospital. The Dr did a points score before she was deemed to be fit to return home. Did I mention she has dimenshia (sp?) and said "yes" to everything? She missed out by 1 point to being kept in! I don't bldy believe it!!!

I've told both not to take her back to hospital tomorrow (they've hired a special taxi that takes a wheel chair!) and say they can't lift her out of bed.

Mynewmoniker Tue 04-Dec-12 16:23:05

UPDATE. MIL was taken by SIL and BIL back to hospital for assessment. They are keeping her in for about 2 days to do an assessment for care needs. PHEW!

Isabeller Tue 04-Dec-12 18:11:51

Thank you so much for coming back, hope a good solution is found

KirstyJC Tue 04-Dec-12 19:28:26

That must be a huge relief, thank goodness. Hope all ends well.

Mynewmoniker Wed 05-Dec-12 18:02:24

All your help and advice was invaluable, thank you all very much. We're still having daily updates so we're crossing our fingers we can fight for DMIL's best interest. DSIL has done a fantastic job with her over the years. We haven't lived as close so lot's (if not all) of the care has fallen on her. We owe her BIG time.

ChippingInAWinterWonderland Wed 05-Dec-12 22:04:16

Nice of you to acknowledge that too smile

I hope they can help. Do let us know.

Kundry Thu 06-Dec-12 23:52:46

I hope things are going better this time round. You need to make it v v clear that as a family you cannot provide her care and think she should be in a nursing home. (On the information here, sheltered housing would not be appropriate)

If she has dementia she may meet criteria for NHS funding for a Nursing Home. The criteria are very strict but if it is agreed that she needs a nursing home, you should ask for a NHS Continuing Care checklist to be completed. If she fulfils the checklist criteria, then her care should be fully funded by the NHS. From the limited information you have given, I think she may well meet the criteria so you must at least insist it is checked.

However she is funded, NHS, Social Services or self-funded, it is completely normal for people to move to a nursing home in another region that is nearer their family so don't worry about that.

orchidee Fri 07-Dec-12 00:40:05

The Alzheimer's society has a forum called Talking Point that you may fund helpful.

The family can insist that the patient is not returned home without a suitable care package in place. There are special long-stay beds and dementia assessment wards where people are assessed before deciding whether they should return home or try a care home (or other option). If the family seem willing to deal with the patient themselves then the they'll likely nit go through the full assessment. Request that the hospital social work team are involved. They will perform an assessment based on the family's report as well as the.medical team's report. Think about and write down MIL's true issues. Be realistic about what the family can commit to long-term. What happens e.g. if SIL is ill or wants to go on holiday?

Mynewmoniker Fri 07-Dec-12 13:51:10

You lot are brilliant and it's made this 'problem' so much easier to deal with. We are taking all the advice on board...keep it coming.

Thank God for technology...and mumsnetters!

Dawnporker Fri 07-Dec-12 15:05:59

You can claim for medical care (which is distinct fron 'care' care) from the NHS in these type of cases which can go some way to reducing the care home fees.

Mynewmoniker Mon 10-Dec-12 16:57:32

UPDATE: SIL has accepted care package and equipment at home. She says although mum has dementia she says she wants to go home when she's lucid. This care package is yet to be set up and we're not sure how long this will take.

I've told SIL to ask what her plan 'B' would be if it didn't work out but although I feel the decision was made on guilt I feel I have to back SIL as she is the main carer. Am I right?

orchidee Tue 11-Dec-12 14:17:26

Ok. To a person with dementia, "going home" means being back in my safe place. This could be their recent home. Or it could mean "I feel unsafe, I don't like it here, I want my mum, I want to go home." Do you know what I mean? "Home" isn't a building, it's a state of mind.

Families are under no obligation to provide care, social services are. Families can provide no care and spend time with their relative just visiting. If they commit to providing care then each person must be realistic about their ability to make an ongoing commitment. Also, the family as a whole must be flexible about reevaluating the care package as each persons needs and abilities to care change. And they will. Please don't commit to X because others commit to Y.

Does that help?

Mynewmoniker Tue 11-Dec-12 19:02:32

I agree about the thoughts about what "going home" means.

SIL feels she can commit to the care and after hearing other patients shouting out in confusion and trying to get out of bed in the hospital thinks that this is what mum would have to put up with 24/7 in a care home.

"The lady was very nice and seemed to know what she was talking about" She would be nice wouldn't she ?

I'm still sitting on the fence as I feel I have to back SIL even though I don't think it may be the right thing.

Husband agrees with me re backing his sister.

3littlefrogs Tue 11-Dec-12 23:00:54

Bear in mind that 24 hour care is the equivalent of 3 shifts per 24 hours, 7 days per week, 52 weekws per year, with no day off. Have you got enough people lined up to cover that number of hours?

Exhaustion sets in very quickly when you are caring for someone with dementia.

MamaMimistletoe Tue 11-Dec-12 23:22:12

As Kundry mentioned your MIL should have been assessed for NHS Continuing Care in hospital and if she wasn't then the hospital/social services staff have failed in their duty.

You should insist on this assessment, even though you shouldn't have to as it should be done automatically. Primary Care Trusts will do what they can to try and avoid paying for continuing care even though people should be eligible for it

Please look into it and gather the facts - google 'Pamela Coughlan'

Mynewmoniker Wed 12-Dec-12 18:23:05

MIL is unable to walk. They are not sure why she has suddenly lost the use of her legs although they know it's not a stroke. At least she wont be wandering out of the door and into the street.

3littlefrogs SIL says she can carry on visiting as she does and leave the majority of the care to the new carers at home.

Mama I'm still not sure what assessments were done but SIL/BIL seemed happy.

I was sending them the advice updates the end of the day...
-GRRR!- -inside-

Mynewmoniker Sun 06-Jan-13 20:25:38

Update: MIL home, bedbound in living room due to being unable to weight bare. Calling out for SIL as partially sighted and confused. Is on antibiotics and the rest as they think she may have water infection.

She has 2 carers a time for 4 times a day.

When review is done in 2 weeks time, in your experience, what are the chances they will continue advising the care at home or advise a care home.

What is the hourly rate for a carer and does this double if two carers are attending?

You have all been so helpful lately. I'm really grateful if you can help this time.

Mynewmoniker Tue 08-Jan-13 18:08:13


struwelpeter Tue 08-Jan-13 18:58:55

Talk to Age concern as a priority as to how to get the maximum funded care. You can pay for whatever you like if MiL has the funds i.e. a full-time nurse or 3 nurses for shifts and laundry service and whatever is thought to be necessary but funds soon disappear - also does anyone have PoA and thus access to MiL's accounts and pension etc? If not you need to do that too. However, what NHS will pay for is difficult as NHS and SS continually bat back and forth between who does what and seeing as both services are stretched then they try to lean on relatives as much as they can and avoid over committing, but to be fair in some instances it is hard to distinguish what is nursing and what is care. Encourage SiL to go for maximum help possible as sadly condition is only going to deteriorate and all carers need a break. And do what you can from afar, perhaps don't ask what you can do but rather do some research yourself and visit and then simply say you will do x or y whatever appears to be easy to do from afar.
Good luck, it's a very hard position to be in.

Mynewmoniker Tue 08-Jan-13 19:21:39

Thanks for this info, struwlpeter thanks

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