Advice really care homes

[Applepudding2018]

For the last 6 months my parents have been supported at home by. 24 hour live in care (day carer, night carer, and drop in to. Cover day carers breaks). Cost approx &3,000 per week.

DM has fairly. Advanced dementia but her mobility is good, dad has poorly mobility and vascular dementia which is advancing rapidly. Cost is due to there needing to be waking mights due to my parents both requiring a lot of attention overnight, and as this has pretty much equated to 2 placements I a decent care home has been fine.

My problem is that due to my dad deteriorating as he has it's not really safe for him as he keeps trying to get out of his chair but can't stand and the carer can't be in two places at once. Additionally if he is going to need lifting this will require 2 carers and the cost of this is not sustainable long term. Mom is fairly healthy apart from the dementia and her care may need to be funded long term. Whisky my parents have savings - I have none and need to be considering my own retirement (50s) so me paying any top up is not an option.

So Sadly it looks as if we need to be considering a move to residential / nursing home. My dad is currently in hospital and didn't acknowledge me yesterday so I don't know immediate outcome for my dad but ultimately I know I'll need to be investigating homes.

I've been on CQC website and searched those with 'good rating' in my area, looked at a couple of websites. But - what do I need to be asking and looking for in conversations and visits? I'm terrified of getting this wrong.

Example I looked at one on the internet , thought it looked lovely, although likely to be pricey, but then noticed another thread where this company was slated. But equally how much is down to the company that owns the homes and how much the individual staff? Another company that runs a few homes in my area, some have good rating, some not. I am at least relieved to see a couple if homes where my friend has worked and would not recommend to me have both got required improvement on CQC.

Any advice appreciated. Thanks

[HeGotManFlu]

Firstly do you think they both need to go into a carehome, some do have double rooms, others may have two single rooms. It sounds like your dad will need a nursing home bed, mum may be ok with a residential home bed, some of the larger homes incorporate both and there is a price difference between the two.
Secondly I would ask for them both to have a care needs assessment, dad can get his done whilst he is in hospital, mum can get one done at home via social services, they will also both needs a financial assessment. You dad should also,have a CHC assessment done whilst in hospital, you can access the paperwork online to see what it involves.
I would also ask for them both to have a capacity assessment, do you have power of attorney.
Do look on the c.q.c. sites, the best thing to do is see if there is one you like, ring them and ask to speak to the manager, explain the situation and they may well give you a discount for two people. Go and visit homes, ask about staffing levels, activities, meals, visiting, careplans, access to their own g.p. You will get a feel for the place, get to meet a few staff. They will want to know how it's being paid for and will go and visit your parents to see if it's suitable, your mum could also visit the home. CQC reports are not always up to date, read back over the last couple of inspections, where in the country are you.

[Applepudding2018]

Thank you. I think that my parents would like to be together. They would want separate rooms. - both are up several times a night. We also couldn't afford to continue paying for the current level of care at home if we were funding a care home for one of them. My parents are self finding - but as I said in my OP we may need to fund DM's card for several years and I wouldn't be in a position to pay top up if their money were to run out.

I have, in the past, found social services most unhelpful. Once they knew my parents had over £23,000 savings they wouldn't even come and do an assessment last year when I was on my knees begging them to get support in at home.

I have financial POA. I will look into the CHC funding as this may be helpful - thanks.

[thesandwich]

Age uk may be able to offer support. But local word of mouth is the best guide- how the place feels and the attitude of staff. Turn up without notice and see what you think. Do you have a local vicaretc who could advise? Gp surgery may also have ideas. Good luck. Press for nhs assessment

[Chocolategirl79]

Sending massive sympathy. It's a tough position to be in.
We found the hospital social services team reasonably helpful so don't write them off even if your parents are self funding. We looked for a nursing home that was able to deal with nursing care and dementia and although we looked briefly at the reviews, actually it was much more helpful to go and see them and meet the team. You get a much better understanding of what their ethos is in person. It's time consuming and inevitably during the working day but we ended up choosing one which had a bad rating - due to a few specific things which happened while they were being assessed which really didn't bother us. For example they got downgraded for taking a resident's whisky away - when he would get drunk regularly and fall over, causing damage to himself. Human rights and all but we didn't have an issue with that. But it's what feels right for you. The very expensive one we looked at (formal tablecloth lunches with silver service and an extra cost for being served in their room) wasn't for us - just too formal.
We went through the CHC funding route and got funding due to his severe needs despite having enough money to pay for himself (theoretically) so it does happen.
Good luck.

[ICouldBeSomebodyYouKnow]

Surely social services simply assess care needs - what you do about it, and how they pay for it, is another matter.

I'd press social services to assess your mother in her home. Make sure they know your father may need extra care if he returns to his own home on discharge from hospital (though, at this point, you clearly can' specify his needs).

When it's close to your father's discharge date, he should be assessed by social services. Make sure they know beforehand, possibly by writing to the consultant, how little your mother will be able to care for him at home.

It's a worrying time. Hope you get the outcome you want.

[NewspaperTaxis]

Social Services? Well, they do as they please. In any dispute between you and the care home, they will side with the care home and if you are self-funding, you are subsidising the Council-funded residents. So they will be taking you for a ride - one you can't get off.

You will need to find out if you can visit at any times, to give your parents drink. For those with advanced dementia, there appears to be a covert pathway policy in place in care homes where they are fast-tracked to the morgue via dehydration, and you won't be able to prove anything. They regard the Council as the customer, not you, and dead bodies save the Council and the local NHS a fortune.

The CQC is a bogus organisation, I'm afraid. If it rates a care home 'outstanding' you may be on to something, but often it holds back on poor reviews for several months because they are carrying a torch for the care home. If the care home has on the CQC website that they are carrying out checks that is a bad sign, as it means the home has been reviewed and slated but they don't want to go public on it yet.

Be wary of big chain care homes, they are very corporate and even more only in it for the money. That means BUPA, Barchester, Caring Homes...

Maybe speak to the other families visiting... if the care home has no traffic that is a bad sign. That said, if their parents are not in the same state as yours dementia-wise, that might not tell you much. Don't get taken in by the sense of paying for the chandeliers. Have a look to see if there are any nice parks or cafes nearby if you want to take them out to. How easy is it to get to? Are you reliant on public transport?

The Care Plan is the Contract, so pay attention to that because otherwise you can't get them for breach of contract. It's like if you take a flatshare and didn't sign anything.

Though you may not want to top up, I can assure you you may be topping up in the sense of visiting and making up the difference, so try to pick a place you feel like you want to visit. Also Google to find out how well off/corrupt your local Council is, if they are not flush you may find all kinds of bad things will be going on.

Whatever place you choose, you may find on your first day you meet an utter cow of some importance you'd simply never encountered on previous visits.

[Bluelady]

We visited a number of care homes to find the right one for my parents. Forget social services if they're self funding, they won't give s shit. Forget assessments, the care home will do their own.

We looked for the following:

Staff engaging positively with residents
Staff engaging with us as we looked round
Residents happy and not left in front of a TV
Residents clean, well dressed and tidy - no food down fronts
Food and beverages on offer at all times
Rooms personalised with own pictures, furniture, etc
Clean, not smelling of wee

The care home we found was lovely and fitted all our criteria. My parents were very happy there and the care they received was exemplary. I will always be grateful to the staff who made my parents' last days so comfortable and happy.

[CMOTDibbler]

I'd add that it's important to look at care homes through the lens of your parents needs - I've noticed loads of them have lovely grounds which can't be accessed by residents as they aren't secure or wheelchair friendly. If your parents will spend a lot of time in a chair, are there different interesting places that they can be that isn't just looking at the TV or other people.
If they have some mobility, then safe places to potter round are great, especially if things are set up to enable them to do things

My mum had a respite stay in a home which looked pretty grotty from the outside, but had things like a lovely secure courtyard garden with level access, some flowers to water (with a small watering can) and some rabbits trundling round. That meant that she could access it herself, amuse herself (she's pretty much non verbal and doesn't like people in general) gardening or looking at the rabbits, and then wander off to one of the many other seating areas spread round the home.

[NewspaperTaxis]

You are right about Social Services not giving a damn if you are self-funding - up to a point. I mean, Surrey County Council quite brazenly admits to not informing self-funders and their relatives if a care home is in dire straits and had bad warnings from the CQC. It says it only has a legal responsibility to inform Council-funded residents (though in reality I doubt it does that either!). This was cheerfully asserted by the Local Govt Ombudsman, so think about that when your parent arrives at A&E at death's door and is in hospital for a month and a half and nearly dies because the Council chose not to inform you of any CQC failings - and nor did the CQC either.

Again, dead bodies save them a fortune.

On the other hand, Social Services can intervene to stop self-funders moving their parent from a failing care home - out of spite and also because self-funders are paying more for care and subsidising the Council. That is what you are dealing with.

That said, Social Services are tax collectors under a false flag - they will latch on to families who own their home and build a case - with the local NHS CCG - to push the elderly into the care system, because as stated it avoids bed blocking and also subsidises the system. But as with all modern privatisation and outsourding, someone else profits, we just get fleeced.

Back on topic a bit more, go to the local school outfitters to have name labels made up for underwear and clothing - you can get nice copperplated labels to make it feel a bit classier but it takes time to get the order in. Don't label up cashmere clothing as that will just go in the wash and get ruined - simply don't bring woollen clothes to the care home.

Also, one big thing - check the temperature in the place. Some care homes are just hot, and with dehydration a problem, it's awful. Some however are quite airey - to be fair the Barchester home which tried to fit us up and also Caring Homes did have a nice airey atmosphere. but others seem to have the heating on in a heatwave. Your parent will be trapped. Visit on a sunny day to assess this.

[Applepudding2018]

Thank you to everyone who has responded with advice. We were allocated a hospital aftercare social worker who seemed really nice and she has organised a 4 week respite bed for my dad - he's supposed to be on enhanced assessment but this seems to involve leaving him in his bed where he doesn't know where he is.

Have started phoning and visiting care homes thinking for the long term - and it's a minefield. Who knew all the different categories of care? So for example one home does 'dementia care' and 'nursing care' but it doesn't do 'dementia nursing care'!