What does "care package" actually mean?

They are being vague because it is an individual thing.

There will be an assessment of his needs and any equipment eg for my mother it included installing a chair lift. That my mother broke her wrist from jumping of to answer the phone.

It can mean carers in several times a day, meals on wheels, equipment or it can mean a care home.

the hospital discharge system has changed vastly recently and a lot of the advice above is well meaning but out of date.

in many areas the hospital rather than social services now arrange discharge. This is under a system called discharge to assess and there are a number of different pathways - the two most relevant to this situation is the pathway that is a discharge home with a care package and a discharge to a care home.

in both scenarios the hospital are responsible for funding it and arranging it and social services will have an agreed timescale to become involved after discharge. This is usually around 4 weeks if the discharge is to a care home and a few days to a few weeks if the discharge is home.

the discharge home pathway will involve a team of OTs/physios/carers etc doing a rapid assessment of the person at home to ensure it is safe for them to be at home. If it isn't they get returned to hospital.

the discharge to a care home pathway is basically the NHS moving people from acute hospital beds into 'rehab' beds in care homes to await the assessments.

this will look at if they are eventually returning home with a social services package of care, or if they are eligible for NHS funded care or social services funded care in a care home permanently. They officially remain NHS patients during this decision making period, they just aren't in the hospital any more.

if OPs aunt says she can't have him home it's likely he will go to a care home on a discharge to assess pathway and it will all be worked out in the longer term from there,

the house is safe for as long as aunt is living in it.

Your aunt needs to make clear she cannot assist with his physical care anymore and needs respite from it all sometimes.

I would leave the ‘sometimes’ out, if it were me.

PinotPony, there are things called cannula sleeves. They cover the cannula but have safe things to fiddle with and they work well for people with dementia who tend to pull their cannula out. I make them and donate them to the local hospital where the nurses are always pleased to receive them.
When my mother had dementia, I had a dreadful time with SS. They had someone go to her house to assess if she was well enough to be discharged from hospital. The test was that if she could make a piece of toast and a cup of tea, she was well enough to be discharged. She couldn't do it so the assessor helped her and then said she was fine!

This is in contradiction of the usual advice, for example Age UK:

“Will my home have to be included in the means test?

In some situations, your home won't be taken into account in the means test. There are a few circumstances where this applies:

If you need short-term or temporary care in a care home, your home won't be in the means test.

If your care home is permanent, it won't be counted if it's still occupied by:

your partner or former partner, unless they are estranged from you
your estranged or divorced partner IF they are also a lone parent
a relative who is aged 60 or over
a relative who is disabled
a child of yours aged under 18”

Care is horribly expensive, and local councils are massively struggling due to a lack of govt funding, so there's not always much social services can do. Your aunt needs to prepare for a large bill, if she refuses to let him move back home with carets coming in. Friends paid upward of £1000 a week for a subsidised place in a church care home about 10 years ago. I have no idea how much it is now, but I know we were shocked by the fees. Social care is on its knees.

It can be carers, physios, ot, district nurse, equipment etc depending on his assessed needs. Sometimes called an interim community care or Reablement team. It may be that a care home is a better environment short or longer term to provide this but the assumption is typically a return home. You need to be assertive as to the limitations of any support his family can provide. There should be a discharge coordinator or sw at the hospital who will assess needs and provision who you can speak to.

Unless it's changed in the last 10 years if they are joint tenants then I believe they can take more than half. My dad did a lot of research about it and ended up getting my Nan and grandad changed to tenants in common so if one of them went into care SS could only take 50% (minus the £21k or whatever it is they're allowed to have).

I think the value of half the marital home, but not more than half . From my understanding. And any savings are also used for care, until savings go below 21k

I forgot to say about this, unless things have changed in the last couple of years depending on how the property is owned (joint tenants vs tenants in common) they could potentially take more than half of the marital home.

This.

Being unable to walk OP won't normally qualify you for a care home place though. SS answer will be to move the bed downstairs, supply a commode and then send carers in 4 x a day.
I'm not saying it to be snipy, it's just about managing expectations. Prepare for him being sent home with carers and if he does get offered a place then treat it as a bonus. IME my DH nan was refused a place in 2019 and she was far worse than my Nan was in 2015 when she was given a place quite easily.

There’s such a shortage of carers and long term care places, he might well have at least stabilised post infection

As far as I know, your aunt could continue to live in the marital home, and the cost of your uncle’s care would be paid back to the council when the home is eventually sold.
I’m not a SW but that’s my understanding of the funding when you own an asset( like half the marital home)

Is the confusion a temporary thing? If he's had a fall I presume he's had a catheter fitted so is he also being treated for a UTI?
Realistically a care package will be carers 4x a day unless you're self funded. IME yes a few years ago they would get sent to a care home for 6 weeks where it would then be determined if they could go home afterwards. Nowadays though unless there is a high risk to their safety they'll be sent home with carers. Happened to my neighbour, she ended up leaving the external doors wide open and putting the oven on and forgetting it so it caused fires before she was given 'approval' to go to into a home. DH nan couldn't walk, she only ever got carers 4x a day - if she needed the toilet before a carer came she'd just have to soil herself. It's shit.

I feel really sorry for your aunt..what a dreadful and worrying situation to be in. We found ourselves in a similar situation several years ago with OH's mother, who was dementing rapidly, and falling over frequently.

He needs to be in a home....one that will meet his needs. If that happens, your aunt will not have to leave her home.

SS are absolutely hopeless. They will do anything to get people off their books. Do NOT be pressurised into having him at home with a so-called 'care package' (ridiculous phrase). It is clear that your aunt is not able to care for him. When dealing with SS, it's NO NO NO all the way. Then they will have to deal with it.

Maybe one of the children could offer for your Aunt to stay with them for a short time for some respite / rest. The hospital could then be informed there would be no one at home to care for him in between carer visits were they to discharge him.If your Aunt stated she couldn’t or was not prepared to carry on caring for him, I assume they would undertake a financial assessment regarding contributions for a care home.

Things that need to happen first:
Establish cause of his confusion: is this delirium or pre-existing cognitive decline?
Resolve delirium.
Ask your uncle what he wants.
Capacity assessment relating to residence and care needs.

Then your uncle, his family and health care and social care professionals discuss and plan from there.

Once his confusion improves the nurses and therapists will assess him on the ward. They will carry out a care needs assessment, looking at what he can or cannot do for himself like getting in and out of bed, washing, getting dressed, going to the toilet, walking. If he has capacity to make his own decisions then he has every right to return home with or without carers. Your aunt needs to tell the staff that she cannot manage and they are both at risk if things dont change. The staff will allocate him a social worker or a discharge worker, they should speak to him and your aunt. If he insists on going home the therapists may do a home visit, arrange equipment, move a hospital style bed downstairs, get carers in. If your aunt really cannot cooe she needs a carers assessment and just refuse to get involved. The staff may arrange rehab aftercare but nothing will happen while he is confused. Whats their situation with finances and poa.

The SW will assess his needs and what he wants and try to achieve the level of care that maintains the most amount of independence while keeping him safe. If they think he can be managed at home with carers visiting, that's what they will put in place. They will only place him in a residential setting if he actually needs it.

Your aunt needs to make clear she cannot assist with his physical care anymore and needs respite from it all sometimes.

As for where he lives ...the bottom line is that presumably it is his home too and he has a right to live in it if he wants to. It is never easy. Also wouldn't be easy for your aunt having carers in and out of what is also her home. Ultimately, if he isn't assessed to NEED a residential care setting, where they decide he lives is a relationship issue, not a care issue. It's difficult all round.

Oh yeah. As,soon as SS hear the words self-funding, you might as well be adrift at sea. You might get a phone call if you're lucky.
But I do know several people who would be self-funders if they were to go into a home, getting free weeks in a care home because they couldn't manage at home. Most then either stayed in that home or moved and self-funded after sx weeks.
Your aunt needs to describe the worst day ever with him, not an average day. If SS and the NHS can shuffle off responsibility onto a relative so they don't have to do anything, they will.

This is what happens in our Borough. The confusion may be delirium - social services will assess mental capacity. Your aunt needs to be clear with them that she can't cope.

When my Mother had a care package it was carers 4 times a day for six weeks
She didn’t like it said it was an infringement of her civil liberties!

at this stage it is hospital social work/discharge coordinator rather than local authority that you need to be talking to. your aunt needs to be clear that she can't manage him at home and that if he is returned home she will be moving out. as mentioned above 'unsafe discharge' are the magic words along with 'carer breakdown'.

It’s all about the funding

if he is funding, you have whatever you want to purchase

if not, he’ll be assessed and whatever needs offered. That could mean a trial at home with CP for a while- with long term 24 hour care if that fails. Depends on findings from assessment

good luck- sounds really difficult