What is the process for determining that a nursing home v. residential home required,?

When we needed a care home for my parent not that long ago, the explanation I was given by the homes we spoke to was the level of medical nurse care needed. My recollection was that the nursing floors had a nurse there at all times, residential floors did not.

My parent was on various tablets, has some dementia, had a catheter but otherwise care needs were really personal care so residential was fine.

We were arranging and funding ourselves so I was keen to pick somewhere that also had a nursing wing should the situation change, to minimise impact on parent of having to move homes.

Just out of interest, what was the reason for her readmission to hospital?

Hoists are NOT a nursing needs!

This is literally my job, I'm a nurse working within a hospital discharge team, I work along side a social worker. The social worker will decide if the patient can safely go home, if not I assess the patients and decide if they need resi or nursing level care, social workers aren't trained to assess for nursing needs.

We then use the 'discharge to assess process' usually 28 days placement in appropriate facility, then patients are reassessed to determine longer term needs. If they have improved they can sometimes be discharged home. Fundingbis decided then asset depending.

After a failed discharge, the hospital may want - or could be persuaded - to go for an intermediate care/discharge to assess care home placement rather than discharging straight home again.

This would mean 4-6 weeks NHS-funded stay in a care home (from the hospital's standard list) so a more detailed assessment of her needs is made. This would give time to look around for a permanent placement.

If she's self funding, there's no benefit to going for a nursing home if she only needs residential. The FNC funding (even if she gets it) won't bring the fees down between those of a residential home. Although as others have said if she's likely to progress to nursing needs in time, it's useful to have a home able to offer both in the same.site to minimise the disruption of a move.

A PP mentioned hoists as one of the reason for needing nursing rather than residential. That's not been my experience. Many, if not all, residential homes have a variety of stand assists and hoists available and staff trained to use them.

@limetrees32 I’d add that diabetes can be what means nursing level care is needed. For example, if nurses need to monitor blood sugar readings and adjust injectable insulin, if regular wound care is needed. Carers couldn’t do this for DF who was having nurse visits to home - he didn’t qualify for CHC, he did qualify for FNC (funded nursing care) - because registered nurses working in the nursing home could take over what the community nurses were doing.

I think a lot of moves to care homes and nursing homes are initially on a respite/trial basis and then become long-term.

If your relative is self funding then it's between you and the care home and they will assess and say if they can meet needs or feel that nursing care is needed.

If social services are funding or it's a hospital discharge it will be up to the funding body who will determine the right level of care.

There isn't a separate assessment for the funded nursing element really.

After one failed discharge, they should be reassessing capacity and may refuse to discharge her home again (you or the other relatives should definitely be making a fuss about unsafe discharges), which would mean finding a nursing or residential home.

Even if they decide she needs nursing care, that doesn't mean she would qualify for CHC funding - as others have said, you have to be extremely ill and incapacitated to qualify, hardly anyone gets it until they are at end-of-life stage - so she would still be self-funding. That means it will probably be up to the relatives who have PoA to find a suitable home, whether it is near them or near where she is now.

But if she still thinks she has capacity, actually getting her into a home may be quite a delicate operation. With my DF, who had fluctuating capacity, and really, really wanted to go home, but could not be safely looked after there, I made a point of having a conversation with him while a nurse was in the room, and got him to agree to go into a care home to recuperate after hospital, until he was well enough to go home. Of course he was never well enough to go home again, and bounced back and forth between care home and hospital until he died a few months later.

Capacity is very tricky. It can fluctuate so it depends who assesses it and when. With most care homes, you move in on a month's trial (check, of course, when you speak to them) so perhaps that would be an approach you could use with her. She could go in and see how she fares.
The care home will still assess her needs and decide what level of care they think she needs. Whatever you do, it isn't cast in stone. One of my relatives started on residential but they realised very quickly that she needed more support and moved her to a higher level of care, where she did very well.
I will say that I've been lucky and I've had only positive experiences with care homes. Some of them are amazing - warm, loving and full of laughter.

I've learned that "I want to go home" is often their way of expressing that they feel uncertain/worried/anxious. "Home" is a feeling, not necessarily a place. It's very hard to hear them saying it but I wouldn't give it too much weight. My relative used to say it while they were at home.

I've done this a few times...
The only difference is the level of care that is needed. The care home will assess your relative to determine the level of care they need. As your relative will be self-funding, you don't need social services and they probably won't help anyway. All you want from them is a list of care homes in your area that accept LA funded residents, just in case funds run out. Find a care home that offers residential, dementia and nursing care so your relative can simply move within the home as their needs evolve.
As for NHS CHC funding - this is almost impossible to secure. There needs to be a very real clinical need for care that can only be provided by nurses/doctors. It's often only awarded for the last few weeks of life.
Join Safeguarding Futures, a Facebook group. Excellent info there. Age Uk are great, too.

Will the person need the sort of regular care/treatment that must be carried out by a qualified nurse? If so, they need a nursing home.

If they only need what is called ‘social’ care - help with washing dressing, ‘toileting’ as they like to call it, maybe help with eating and drinking, then a residential home is called for.

People often refer to any residential care home as a ‘nursing’ home, which can often cause confusion.

If she is self-funding, your relatives can just ask a care home near them if they have spaces, arrange an assessment (ours was over Zoom, followed by a trial period), prove she has access to the necessary money (eg two years worth) then move her in. It is easier if she agrees to it, then you don't have to get into the capacity/ no capacity issue. Has she expressed any wishes, however muddled?

That is presumably possible because there is a nursing unit on the same site (often care homes have a residential and a nursing wing). If they don’t have nursing (many dont as it’s expensive to employ nurses) then she would have had to move.

1. The discharge planning team makes an assessment of need and of finances (or determine if self funding)
2. Care homes with vacancies then make their own assessments of whether they can meet the assessed needs before offering care. The care homes usually have their vacancies on a system (brokerage) that discharge planning can access to match vacancies to patients. Patient will not be allowed to wait in hospital for a specific care home to come up. They will have to take whatever comes up to a large degree especially if LA funded.

My mum is in a residential unit of the care home and they still have a nurse on 24 hours. The carers don't give medication the nurses do. We were recomend that as mum was deteriorating she may benefit from going to the nursing unit but they think as she is settled there and the staff know her well they think that moving her would be too much of an upheaval for her so she is staying there.

NHS continuing care funding is a whole separate issue from whether the person has nursing needs and is very rarely awarded. It will be screened for but hardly anyone gets it.

If the person has nursing needs they get a nursing contribution (FNC) but still have to pay the rest of the fees if self funding or the council pay if not self funding. The NHS would very rarely continue to pay only for terminal illness or a very high level of need much more than this sounds.

The distinction is whether a nurse is required to be on duty at all times rather than just care staff. Care staff can give meds, assist with personal care and do most stuff. Nursing needs are usually things like catheters, feeding tubes, needing hoisting, having medical needs like having seizures. Some temporary nursing needs like a wound dressing can be managed by district nurses coming into the home.

If in hospital the discharge planning team will assess with input from the ward nursing/ medical team

Were you hoping for a particular outcome?