Care home fees and top ups (dementia)

@WhatwouldJessicaJonesdo, I feel your pain. Whilst the SW? dealing with the social care side of the financial assessment application has been lovely, he can't get through to the Finance dept either. So I just have to wait Its a rabbit Warren of confusion.

What malfoy says sounds about right. It's easy to find lists of care homes by googling, my df could have moved to a lightly larger rabbit hutch in the same home, and that would have put the price up by almost £100 per week, and decisions are made very quickly, just like in hospitals.

Do MiL & FIL own a property? FIL would not be eligible for a Deferred Payment or Resident's (First Party) Top Up, because the property would not be included in the Financial Assessment in his circumstances. However, you could seek some independent financial advice on releasing equity from the property to enable MIL to pay a Third Party Top Up.

It would also be worth asking the LA if they would be prepared to allow MIL to be a Third Party Contributor by agreeing to a Voluntary Legal Charge on their property to secure the debt. The answer will probably be no, but worth an ask. - Contact the Financial Assessment Team with these questions, rather than the SW.

And there is no such thing as a list of current vacancies. Do you not realise that the nature of the business is that it's unpredictable and someone will die and the room will be immediately filled- there are rarely empty rooms for long and certainly not in a banding rate bed.

Homes don't list their fees as they can vary from bed to bed and giving you a rough price would be misleading.

You can request a copy of the assessment.

Have a look for one of these for your county:

www.carechoices.co.uk/publication/gloucestershire-care-services-directory/

I'm a social worker dealing with cases like this every day.

I don't have time to hold your hand especially not as you're capable of looking for yourself. I only have to meet the eligible needs of the person and for the 'best value' possible. We are so busy we cant do the 'nice' things. If I was to spend time with every family as you seem to be complaining you're not getting then another five urgent cases would've come into my work list.

I so nearly called in sick today because I can't cope with my workload and feel so stressed that I'm drowning. I couldn't though as I had six urgent cases of carer breakdown awaiting a placement.

I'm so fed up of hearing 'the social worker didn't do anything' or 'social services are useless' and the like from people who have no idea how much we are doing behind the scenes.

As for top up- is increasing your hours sustainable? Do not commit to any top up if it can't be sustained as that could result in a move.

Apologies if my post was not clear I did say DB DM and I paid third party top ups as it was cheaper than moving him further away
There were other extras which came from savings
I did exactly what the financial assessment team advised and have all the break downs in writing from them

You say he needs to go into a home in a few months. Then go on to say two homes have been offered within the budget.

It could be different at your local authority but where I live they can't search for somewhere until the time comes he needs to go and his needs have been assessed at the point. They then have to make 'best value' offer which is the cheapest placement available that meets the needs at the point of the search.

So their banding rate is £500 but the cheapest available place is £650 then they have to use that option and pay an above banding supplement of £150. They can't then force a new search if suddenly a cheaper bed comes up.

Essentially the search needs to be done at the time of his needing to go in to care and you could be lucky at the time of that search.

Have just noticed he is still at home currently but his wife is struggling. At this point I would really push to make sure they get all the support possible. In an ideal world he would be attending a dementia friendly day centre several days a week to give his wife a break. He should be having a regular week in RH every 6 weeks or so which mum can look forward to. Night time toileting will probably be the crunch as even if a convene worked, he might forget he had it and still try to get up at night.

I would look at other options for the toileting. In a decent care home he will only be in his bedroom at night and maybe for a siesta. He might manage a convene catheter at night or a bottle beside the bed. During the day, if he is in the lounge area there should be a toilet nearby and if they know there is an issue here could choose to sit near to toilet. Maybe he could wear a tena pad for emergency back up so as not anxious. I would second the idea of blunder transport for mum to get there. Find a local carer support type organisation who will be able to advise mum how to find resources like this. Maybe ask if he could join a waiting list for somewhere closer to home and if a place comes up you can decide if the other plan is working or whether to move him.

Actually there isn't much secrecy seek advice there are very good legal and long term care advisers who can help negotiate the system

The whole process would be much better if there wasn't the secrecy around finances - care homes do not publish their fees, councils will not say which homes are on their lists for when the money runs outv and do not let you know about top ups and what can be done.

(You can pay your own TPTU if it's a 12 week property disregard or a deferred payment and the LA. agrees. They might not agree if they don't think you'll have enough to last you.)

OP have you asked about the local authorities own homes? Can FIL go on waiting list for a place there? Is the care good in the other homes FIL has been offered, even if no ensuite? Can you ask again as those places may have been filled now and you might get offered different ones / different homes

mil travel is more important than en suite. en suite is nice but sadly may not be really needed for long as unfortunately with a deteriorating condition it is entirely possible that he will get to the point of even crossing the room to an en suite is too much. This whole stage of his life is unfortunately going to be messy and undignified at times and a £200 a week top up is not going to stop that from being the case. so much more important is the vibe and the ethos you get from the home. are the staff going to be kind and compassionate when helping with these messy and undignified inevitabilities or will they be too overworked and miserable for that?

hunt more along direct bus routes from MiL house and find more places that are accessible for her. there will be one which is within budget but which hasn't been offered yet as they don't have a vacancy. however if you check on their vacancy situation regularly it won't be too long before a room is available.

Please don't advise others to commit financial offences Jace

The rest of your advice is great but not this bit....!!!!! 😧😧
If under savings threshold and you have power of attorney you can use his savings to contribute
No you cant! Not to the fees outside of assessed his financial contribution that L.A. already take into account.
If you mean you used his savings when under threshold to contribute additionally to third party top up for his care home fees, then you acted illegally. Had that been discovered you would have been reported to court of protection , asked to pay it back, and likely had your power of attorney removed as it'd be treated as financial abuse (misusing a POA) under safeguarding.
If you mean you used his savings to buy him items he needed or pay for extras like hairdressers or physio whilst in carehome, or otherwise to to his benefit, then that's fine. If you meant the latter, be careful as your sentence could be misread!

In terms of recommendations check out CQC reports, some review websites out there and don’t forget Facebook and Twitter
Although Dad died recently I still get twitter updates from nursing home showing what they and the residents are doing 😊

First thing is to get a list of vacancies for homes that can meet his needs
Then enquire about top ups
En-suite and MIL travel will not be taken into account I’m afraid
DB and I paid nursing home top up between us with contributions from DM as it worked out cheaper than extra fuel to drive further
DM visited every day and DB and I alternated so every day between us
If under savings threshold and you have power of attorney you can use his savings to contribute
My Dad lasted a year in nursing home and at rate we were spending could have managed another 5 easily so not a problem but you need to work it out as worse case scenario would be to have to downgrade in future
I found my local authority financial assessment team quite helpful although I had to push for breakdowns and ask lots of questions

I would research all options and ask the nurses and social workers where they would and would not place their loved one

We aren't allowed to make personal recommendations like that really.

If someone frames the question to me in terms of 'which options out of A and B do you think would best meet my dads needs' though I'm more than happy to answer and give a bit of a nod and a wink if ones far superior to the other

FIL went into a home from hospital. His care home fees were paid by the NHS as continuing care. This continued for about 3 years and his pension went untouched. He did not have his own toilet as falling in this area was a high risk.

I would research all options and ask the nurses and social workers where they would and would not place their loved one.

@WhatwouldJessicaJonesdo, sympathies.
I would urge you/MIL to make a sensible long term choice as you don't know how long he will be in there.

My mother is in a non-ensuite room and has a commode, but as she has been doubly incontinent for years, I'm not sure how relevant an ensuite would have been.

She is in a Nursing Home with dementia. She has been in there almost 4 years having been unable to manage at home, even with carers (and is 88 now) She has self-funded so far, but we are now going through the council financial assessment. The process is as clear as mud. It seems that they have agreed to pay a set amount but it hasn't been put clearly in writing yet.

I am guessing that her pensions will be paid directly to the council who will then top up to their agreed amount. I have been told that the "top up" cannot come out of her account, so we will be paying that as if rather she didn't have to move at this stage.

I too wish that assisted suicide was a legitimate choice - my mother knew what was happening to her mind and wanted to pass away rather than have to move to a waiting room. I would feel exactly the same if it were to happen to me.

OK I just can't understand how anyone who isn't self funding is affording top ups!?
Most dont. People who are LA funded often don't offer to try to afford third party top ups and they accept the care home placements offered by the LA at their rates. Only those who want to choose more expensive 'their preferred' placement can choose to pay TPTU.
They must have some well off children..
Yes. Or rich siblings or grandchildren. General Public moan about people having to sell their homes to pay for their care home, "and what do they get for it? ", well this is what they get for it. A choice of care home, their children and grandchildren not having to pay third party top ups so that they can choose their home, etc..

As PPs said the LA have offered other suitable care home placements, an ensuite toilet is unlikely to be an assessed eligible need nor is 'must be in the same small town'. Even if you feel so. Those are niceties, fabulous if that's possible if there is suitable and enough care home provision in that area, with vacancies at a time they are needed, but meeting the clients needs is more important so it may need to be a care home bed offered that may be a bit further away.