Not my parents! What happens if an elderly person refuses to pay for care?

We also got lucky and secured CHC which shut up my mother and brother who seemed more concerned about hiding money and working out what they would ‘allow Dad” out of a very healthy bank balance. Frankly his care seemed secondary to this. Appalling time to see the reality of our mother and brother. Anyway she is now utterly miserable but her bank balance is in tact so she can’t moan….but she does and lets people think she is paying because she’s wanting to be the victim and tell them she wanted him home but BlueLegume put him in a home. Bonkers…if you are still allowed to say that.

@SafeguardingSocialWorker on reflection I can see my mother was delaying making a decision for my father. He was discharged originally from hospital to a ‘reablement’ facility which was lovely but a very unsuitable setting for him. He got lucky because the lead nurse was amazingly compassionate and could see we had unresolved issues with our mother. Eventually though she had to sit us (well me and sister) down and explain the setting was completely inappropriate and we needed to find a home. DoLs invoked multi disciplinary meeting etc. Thankfully she gave us about a week to find somewhere and get his room sorted etc….BUT that was mainly because she had worked with and knew the manager of the home very well over many years so they did seem to understand my sister and I had taken control and stopped mother and brother kicking the can down the road to avoid making a proper decision. Incredibly stressful time. You think you can narrow down a series of homes you might prefer but once you start ringing round and explain the nursing requirements rejection after rejection, or they have no space. We rang upwards of 50 establishments in the area and only one came back prepared to take our father. Thankfully it is the right place for his needs - not all singing all dancing but the right number of staff and a pleasant environment. On reflection if we had been firmer with ur mother about the recommendations of nursing care being needed months earlier we might have had more options.

It's threatened regularly, mostly to relatives who think if they keep delaying choosing a care home they might be able to run down the clock without having to pay for care.

In reality most people get a shift on and get something organised once they get the first legal notice letter from the hospital.

I've seen the hospital follow through on the threat three times and on one occasion the police were called when the person refused to leave after all the legal processes to 'evict' them were complete.

It happens less frequently these days as the discharge to assess process used in many hospitals means that hospitals ship people out to care homes 'for recuperation / assessment' and pay for the first 4 weeks of care there without involving social care/families in that decision. It sorts the bedblocking issue but just pushes the difficult conversations further down the line.

It's so situation dependent it would be impossible to give a general answer as it depends on capacity and all sorts, but in answer to the question about if they could stay in hospital indefinitely the answer is no.

If they refuse to pay for care but also refuse to leave hospital (or the family refuse to make arrangements for them to move) because they know they need the care then eventually the hospital will take legal action and start to charge them the daily cost of an acute hospital bed which is more than you would pay per day in a care home!

going through similar with PILs, how did you manage to actually get them in the care home?

Yes, sometimes there is nothing you can do except wait for things to come to a head which is very stressful, epecially if they have been assessed as having capacity to make the decision to refuse care. There has to be a specific question to decide upon when making a capacity decision, e.g. 'is mr x able to understand the risks he is putting himself under'.

My mother had repeated falls and hospital admissions, incapable of doing anything unaided yet my father refused to fund carers, he held the purse strings. If the hospital set up a care package on discharge he would cancel it once fees became payable.
He had capacity, so did my mother. Absolutely sweet fa anyone can do about it. I instigated safeguarding and he lied to the social workers about how he could do everything to care for her. He definitely didn’t do a thing.
Nothing anyone can do. Eventually he was unwell so the situation changed and he couldn’t stop them going into a residential home.

Do they have to rely on it for living expenses? I thought 50% of shared savings were regarded as belonging to them, not their partner. There wasn’t a requirement to be spending it, they could still continue to save for their elderly needs

Funded nursing allowance and Attendance Allowance between them will still leave them at least £800 a week short of nursing home fees, not sure how easy it us to get funded nursing allowance if your needs aren’t sufficient to require a nursing home rather than a care home.

If it’s just the one asset that stops her being funded, should you not ask for a reassessment to stop the debt building up? And present an up to date valuation of the asset.

Only if they are assessed as needing to be in a care home. It's more likely they will be discharged to their home with a package of care.

They won't get to decide what happened financially.

They'll be discharged into a care home and the council will as a last resort take a charge on their house and get their money when they die.

A home’s value won’t be counted towards care costs if a partner or another adult over 60 lives there, if that’s what they are worried about.
Pensions/investments/savings that provide income are assessed at 50% if the partner not going into care relies on it for living expenses.

If they refuse to pay, they won’t get care, and eventually some sort of crisis will probably force the issue.

This. If both parents have to go into a home. The home gets sold and they pay for their own care.

@BranchGold
If they have capacity they do have the right to refuse care, but it does become a catch 22 where if someone continues to not meet their basic needs and refuses to cooperate, do they really have the capacity?
One of the principles of the mental capacity act is that an individual has the right to make an unwise decision.

They can ask social services for a care needs assessment which is free, home adaptations the council pay up to £1k and claim attendance allowance, if they go into a carehome self funding they may also get a funded nursing contribution which can all go towards the fees.

This I think.
If option 1 is most likely I wouldn't get involved. Can you see where that will end up, ie at your door indefinitely.
If you're already in that situation it might be advised to step away and let a crisis develop.

I'm sure the government could take it from a state pension or something, but it's more difficult to just take it from the estate of a deceased person.

State pension would be nowhere near enough. A debt against the estate wouldn't be that complicated. A debt against the assets of a living person is a little more complex, but if they don't have capacity and.nobody has PoA the court of protection steps in and appoints an attorney who can then dispose of assets. If they do have capacity then it would be treated like any other debt - with it eventually reaching the point of court appointed bailifs being able to seize assets.

They could pay for private carer.

I know a neighbour who was not coping at home, repeated falls etc, where the ambulance service was called out at least 3 times in as many weeks.

I think once the system is aware of an individual they’ll be assigned a social worker who will explain their options. Then it’s a question of capacity, but also what kind of needs they have. Certain health conditions will be funded by the local health board, particularly nursing care.

If they have capacity they do have the right to refuse care, but it does become a catch 22 where if someone continues to not meet their basic needs and refuses to cooperate, do they really have the capacity?

Yes, there's truth in that but OP does say that the people concerned are barely (if at all) coping. So just refusing to spend money. She even says that they want to live in a care home but won't pay for it as they think that the state should be funding them.

That can be considered deprivation of assets and is illegal.

They are going to come a cropper here and they just have to be left to find that out for themselves. The debt for their care will be registered as a charge against their estate and is likely to mean that as it accrues they leave little or nothing to their children anyway. So they might as well use the money to fund care. Hospitals are not long term care homes or hotels.

Adult social services are likely to become involved as safeguarding becomes more and more of an issue so these people might well find that their hand is forced.

Ideally, they should see a decent Independent Financial Adviser, but I doubt somehow that they will.