Cost of care home for elderly parent with Dementia

[fieldhouse]

This might be upsetting for anyone with elderly parents / experience of dementia. I don't mean to come across crass discussing the costs of it all but I'm just looking for honest answers as it's something my family is navigating at the minute. Can anyone explain to me the way that funding social care for the elderly works in England please? It's all new to me. I've looked it up online and know that new legislation is (possibly?) happening in October this year introducing a cap, but I'm really unclear about how it all works at present and would value hearing others experiences.

My father is 86 and has Dementia. He's been living at home with my 82 year old mother but has had a number of falls. The most recent one resulted in a hospital stay where he caught Covid and as a result of the Covid and the upheaval he's now deteriorated to the extent that he doesn't know where he is or what is going on. He's threatened to kill himself, and be violent, and is unable to take himself to the toilet so it is looking like a care home with proper care will be needed as soon as his hospital stay ends.

My parents own their own home which is worth around £400k (South East) and have a bit of savings - not sure how much.

Will my mother need to sell their home to pay for care home? Apparently the local nursing homes in their expensive part of SE can cost up to £2000 per week which sounds extraordinary!

Let's say they have £20000 in savings (I'm guessing) that will be used up pretty quickly.

I know they are in a very fortunate position compared to many in owning their own home in the first place.

Can anyone tell me how it all works?

I'm not for one minute thinking about our inheritance or anything, but my mother has said she thought there'd be nothing left for me or my sisters and she was very sad about that - having worked their whole lives.

I know the system is shit and successive governments have done nothing. I'm just trying to advise my mum as best I can.

Anyone else found themselves in a similar position and how have you accessed the care needed financially?

Also, on a broader note, my husband and I were discussing it and saying it makes us think is it really worth it working hard all your life? Is it better to end up with nothing or be a billionaire?

This from ageuk explains it well.

And yes, dispose, spend, pass on your assets when you’re likely to live at least another 7 years.

However, if the government deems you have intentionally deprived yourself of assets to avoid care costs, they have recourse, I believe.

My Grandma’s care home was £1500 per week (SE). There are cheaper ones but not as nice. She did get some help towards it I believe, which brought it down to about £1200, but yes she had to sell her home to fund it.

Social worker can advise
basically council pay for care and they put a charge against your dads share of the house nothing happens till your mum dies

yes spend spend spend my dad was in same position ended up no benefit for all the extra graft and topping up private pensions

A slight tangent but do be sure that care home not nursing home is appropriate, not all care homes offer nursing; if nursing needs present later, the person with dementia might have to be moved to a home that does provide nursing. A move can really unsettle and destabilise a PwD.

So sorry, dementia is an absolute horror show.

My friend’s dad is in a care home as he has dementia. It’s a council run one, so it’s cheap compared to private. But it’s still an eye-watering £1400 pw. The savings are now gone, so the house is being sold to fund the care.

Good care is expensive, my dad was in an excellent nursing home which cost almost £2000 a week and he died over three years ago so I’m unsure as to what the costs would be now.
All the information for the financial side of care should be on your local council website under elderly care.
Deprivation of assets is something that would be looked into.

As your mum is living in the house it doesn't need to be sold. On their savings, half of anything joint, and all of anything in your dads name only needs to be spent on care until £16k is left. But when the state starts paying, its not at all guaranteed that someone can stay where they have been before - for instance my friend who has both parents in residential care has been told that although the home says her mum is best in the dementia unit (where her dad is), the social work assessment is that she doesn't need to be in there, just normal care. And as that home only has x slots in the regular care bit for funded places, she could be moved when all their money runs out.
Saving through your life means you can make decisions about your care, stay at home longer, and choose somewhere you and your family like at the end of your life. My parents could buy in care that suited them rather than getting 3 x 10 minutes a day and my mum being put to bed at 6pm and got up at 10 as happened when they had 'free' carers after a health crisis.

If they have more than £23750 in savings ( I think that is the correct figure), then the local authority will do a financial assessment to work out what they need to pay for care.

There is funding available via the NHS and it's not means-tested. However it's extremely difficult to qualify for, most dementia patients will not get it.
If your dad becomes violent and shows challenging and/ or unpredictable behaviour then that is sometimes enough to receive at least a small amount towards nursing care, if not full costs.
It's called NHS CHC.

I was told recently that there is no time limit when it comes to care home fees that they will look back to if for example assets are given away. Not sure how true this is.

There is no time limit, I think people get confused with the 7 years regarding Inheritance Tax

Insist on a CHC funding assessment be completed, depending on his needs and type of dementia he could be funded by the NHS for his care.

@fieldhouse
you might find this link helpful, as the guidance stands for all English local authorities and you can also use the online calculator at the end to work out how much your father’s contribution could be.

www.surreycc.gov.uk/adults/paying-for-care/residential-services

The revisions to the cost of care funding due to come into effect later this year that you mentioned earlier in your post have been kicked into the long grass for at least another 2 years.

Dementia patients are usually only fully funded if they have been detained under the mental health act and get 117 after care.
As mentioned by others, even when their money has been spent, the council will only pay a certain amount towards care so there has to be a top up paid or they will need to move somewhere cheaper.

Your parents home will not be used to fund your dad’s care whilst your mum is still living there. ( unless they have a second home too)

As mentioned, CHC funding (Continuous Health Care) is extremely difficult to access. CHC is where the NHS pays for care due to the person being deemed to need medical care (I think). However, my MIL is 95, unable to feed herself, unable to have a conversation (she just babbles) doubly incontinent, doesn't recognise us AND ALSO HAS BREAST CANCER and she still has to pay for her care. She's not far from end of life, but it's not imminent. A CHC assessment should be carried out by an external qualified person, but her home won't get someone in, they just say she doesn't meet the threshold. I don't know how ill you have to be to meet that threshold.

The whole system is hideous, dementia is heartbreaking and you have my every sympathy 💐

Age UK can advise on this but in the simplest terms - As long as your mum is living in the house it will not be counted (and nor will a charge be put on his half). If his savings (and joint savings will have half assigned to him) are above £23,250 then he is responsible for paying for his care. Under £23,250 and above £14,500 the local authority will begin to contribute on a sliding scale and then under £14,500 they will fund but he will make a contribution.
Things to be aware of are not all homes take LA funding so if your father is likely to need funding soon ask them as you probably wont want to move him. Also if he is funding make sure he is claiming Attendance Allowance (he loses this when the LA start paying). Also in regards to your parents house talk to a solicitor about whether they are joint tennants or tennants in common. If they are joint tennants and she dies before him all the value of the home will go to him and therefore could be spent on care fees. Tennants in common his half would go to him but she could leave her half to you and your siblings.
All situations are different so I would get some advice on your fathers exact situation and what is best.

From looking at the range of problems that he has it sounds as though he would qualify for NHS Continuing Health Care Funding, which is not means-tested and is based on health needs rather than assets and income.

www.beaconchc.co.uk - you will find advice here.

Hi OP, sorry that you are going through this. I have been there and navigating the system is a nightmare at a very stressful time. I hope sharing some of what I learnt may help. Try age concern for advice.

1. As long as your Mum lives in the house, it can’t counted in the means test for your Dad’s care.
2. Do you or your Mum already have lasting power of attorney for health and finances (these are two different forms). If not, this complicates matters, something to come back to, but it’s now too late to register for your Dad but essential that you do this asap for your Mum if she will agree. You can do it online yourself which is much cheaper than a solicitor.
3. You will need to work out what savings your parents have as any assets above £23,250 in your Dad’s name mean paying for his care. Note the house does not count as per point 1.
4. Do not get your hopes up re NHS continuing health care (CHC). I went through this with Mum and no chance despite her being completely bed bound and having dementia and a whole host of other issues. I am not saying don’t try, just don’t get your hopes up.
5. You should be able to qualify for NHS funded nursing care which is a much lower amount. Many care homes apply for this on your behalf.
6. You should qualify for attendance allowance, although there’s a six month period where you need it before you get it. However, you can backdate the six months to when you can prove your Dad needed the care (doesn’t count if in hospital).
7. You can apply to get your Dad’s state pension paid to you (to go towards your Dad’s care) instead of direct to him (if you haven’t go power of attorney already).
8. If your Mum doesn’t have a will, or has one that leaves everything to your Dad, get a new drawn up asap. She can leave her assets to you instead of your Dad if she wants. If she then predeceases him, it won’t all get spent on his care unless you choose to use the money for this.

Good luck OP.

Be aware that not all care homes offer nursing care. My dad has dementia and is in a residential home. They will not apply for the nursing element because they don’t offer nursing.

His is £800 per week for residential.

My granda pays £3000 every 4 weeks for EMI residential.
I know some nursing homes are starting at £900 per week.
Your view re the point of working hard and earning money..... you get to choose where you want to be cared for.
My grandads care home have no top up fees meaning that they match what the council fees are and don't charge more.
Care homes I've worked in their starting charges are more than what council fees are meaning if they are fully funded by the county they have to come up with the rest of the money to top it up per week.

Also as long as you mother stays in the house it's not counted as his assets but if she decides to sell her home to move somewhere else half of the home sale will have to go towards fees.

My dad is in Wales, which is a cheaper part of the country than SE. Hence £800 per week for residential.

Your dad probably had a wider choice of home for being able to self pay. Some care home costs are equivalent to personal costs - room rent, utility bills, cleaning, three meals a day, activities - these would all have charges even if a person stayed at home.