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

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!)

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.

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 :( )

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 :(

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 .

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.

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)

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.

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.

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.