Care home fees - really struggling to understand but want to support

[PurpleSteak]

My friend is an only child of parents who were absolutely complete wrapped up in each other. Her mum who died after a horrible period with dementia a few years ago was kind, but her father has always been nasty, manipulative, controlling (with a diagnosed personality disorder) , both to mum and friend.

Since mum died he's got worse and now appears to be starting with some dementia. He's had a period in hospital after being sectioned.

Friend loves her Dad and believes it's her duty to make sure he gets what he wants, which is to return home, altbough she knows this will be hard on her - neighbours were regularly calling the police for his threatening behaviour before he went into hospital and she would visit to find urine soaked furniture and no food in the house.

Hospital are looking at discharge and care packages. He has money he'll be expected to cover the costs.

She knows she can't care for him, she doesn't want to and he can be violent. However, she is fuming that he'll have to pay for the care. Currently looking at ways to get him home without paying for care.

She will inherit anything left and as an only child this could be substantial, but she and her DH have a good lifestyle and financial security. Obviously a bit more is always good, but it's unlikely everything will be spent and she doesn't "need" the money.

My view is that they should throw money at it to get him the support they need and take some pressure off her, but she will do everything to protect "his" money. She seems to think she's doing it for him, he's worked all his life etc, but he's never going to have any need of the money.

I realise her sense of duty etc is affected by the difficult personality/relationship, but I'm struggling to understand this and really only want to help.

He/she won’t be able to keep the money and they will find that out in due course. If he stays at home until he dies, she’ll get the house, but most of the other savings will go. If he ends up in a residential home, the house will go too. Those are the facts and she can waste her time trying to defraud social services as much as she likes but it won’t work.

If I were you, I wouldn’t even bother discussing it. You can make suitably sympathetic-sounding noises if you feel so inclined.

It's not that she's expecting him to have care and find a way to avoid paying for it, it's that he doesn't want care so she thinks the right thing is not to have any!

She sounds a bit bonkers.

Well, her DF is allowed to make unwise decisions, but only if he has capacity.

If she has POA, and he doesn’t have capacity she is legally obliged to make decisions in his best interests.

Why is she fuming? It's only right that he should pay for his care if he needed it and I'd above the funding threshold.

Has he got capacity to make this decision? That's the question that she needs to ask the health professionals. If he does then he's allowed to make it, whether it's something anyone else agrees with is irrelevant. You're allowed to make bad decisions about your own life.
If he has capacity it's just a matter of waiting for the next crisis when it sounds like he'll end up in prison or hospital. It's sad but she needs to find out about their view of his capacity to make this decision

So if he doesn't want care and she wants to facilitate that, then she has to accept the risk he will come to harm and that his basic physical needs l won't be met.

Is he deemed to have capacity and is making his own decisions? Or is someone acting on his behalf? Either way, if he goes home without a care package (or even with a care package) it will inevitably all fall apart again. It sounds like he needs care 24/7 which means a care home.

If she doesn't want him to spend his money/'her inheritance' on care, the price paid will be neighbours calling the police and urine soaked furniture. If he does have dementia the situation will get worse, not better.

I agree with those who have said spend the money on care, that's what I did for my mother, but it's up to the individuals involved to make that decision.

She wants to protect her inheritance, however she dresses it up.
My own dmum may well need care due to dementia. She is managing in a sheltered flat but it won't work forever.
All of the money she accumulated is at risk. But she kept it to pay for her old age. I have made peace with it. And no doubt I will be glad that she can go into good care.
Your friend needs to make peace with it.

The options quite simply are - pay for care, or he has no care. He clearly needs care. So they need to pay. Simple.

I assume hospital won’t discharge him without a care package in place? So they have to pay.

It’s not the case that care will be covered by the LA if you have savings under 23k. You will have a financial assessment by the council and they will ask you to contribute towards the cost. Even people on state benefits are asked to pay something from their benefits towards care in many cases. Nursing care is free but other types of care isn’t.

Quite agree. Why would she be 'furious'? Such a peculiar mind set.

A friend's mother was sent home from hospital with a care package for six weeks but the friend cancelled it after a week as carers were not turning up at the right time and once there they spent the time filling in the report sheet and then left so mum didn't actually get any care. The visits I believe were about half an hour.

She ended up going to a private agency and paying for the four visits a day, an hour each time, which although expensive, at least her mum was clean, fed and watered properly and things like putting on washing, changing bedding, washing and showering were carried out properly.

One of my friend's did care at home for the local authority and she said that some of the carers would do the absolute bare minimum for the client before rushing out the door leaving someone sitting in soiled clothing, not being washed or showered and no drink or food.

You really do get what you pay for sometimes. Anyone whose parent has the ability to pay should not cut corners with how they are looked after. Eyeing up your inheritance should never be a consideration but we all know that it often is.

Haven't read the thread after seeing this line in original OP However, she is fuming that he'll have to pay for the care. Currently looking at ways to get him home without paying for care.

Why the fxxk should anyone else pay for her father's care? I'd be fuming at her attitude!

That's why you should read the thread! She doesn't think someone else should pay, she thinks as he doesn't want any that's what he should get - none.

Ok - caught up with the thread. Perhaps you should have explained that in your original OP then. As it stands, your friend can't give her parent the care he needs - his neighbours have already reported him to the police for being violent etc. so she needs to pull her finger out and get him into a care home, possibly with the help of social services.

Ok, so she knows she can’t look after him because his care needs are too great but she doesn’t want him to have carers he doesn’t want. So it boils down to whether he has capacity to make that decision ie is he mentally capable of weighing up all the factors and making the decision based on those factors? If he does have capacity, he is allowed to make an unwise decision and care can’t be forced on him.

If he doesn’t have capacity and care is being put in place in his best interests then daughter can’t just step in and say he doesn’t want them unless she is going to find an alternative that is acceptable to him and meets his needs (which sounds as if it doesn’t exist) or she needs to challenge the decision about his capacity, if she believes that he is capable of making it and the capacity assessment is incorrect (or out of date, capacity can change)

The capacity issue is the key really.

If he's got dementia there's a real risk that he will decide to stop his medication and if he's violent with it then that's a real issue.

I really wouldn't advise it. I had a neighbour whose husband was like this, and eventually he pushed her down steps and she broke her hip. He held the ambulance service off getting to her for ages and it was really traumatic for all concerned.
He was a really gentle man before the dementia set in as well.

I agree, her argument is that "they" shouldn't be able to force him to pay for something he doesn't want. It's hard to argue against that balck and white view.

With his best interests st heart of course you'd be arguing that he might not want it but he needs it, but she's so conditioned to believe that what dad wants he must get and that it's her job to give it to him 😪

She probably does have some of his issues, if nothing else she's very damaged by them.

Forget best interests. That only comes into it if he doesn't have capacity to make this decision. He's allowed to make a bad decision if he understands and accepts the consequences.

https://olderpeople.wales/resource/mental-capacity-an-easy-guide/ here's a great guide to capacity

The law as it stands means that it is usual to have to pay for care in this situation unfair as it may seem.

Yes, that's her argument. He is deemed to still have capacity currently, although I don't think anyone expects that to last long.

The hospital want a care package in place for a safe discharge. Friend's argument is that it's their decision, which he disagrees with, so they should pay.

Reality is that if home care is put in place he's going to refuse them entry anyway, so why should he have to pay for that?

It will be awful and it won't be long before he's back in hospital, but arranging care won't make him engage with it.

It sounds like he has probably been deemed not to have capacity if these conversations are happening. Assuming this is the case then relatives can find this really difficult because sometimes they know that even if the relative did have capacity, they would make the same decision. The thing is, you can’t base a legal framework for making decisions on behalf of people who are unable to on what their relative says they would want. It would be so easy to abuse - even in this case you could say that she’s trying to stop her dad getting the care he needs. These sorts of decisions need to be more objective than that.

Does he own his own home? If so, and obv. he wouldn’t need it to live in if he moved to a care home, could it not be sold, and the fees ‘rolled up’ until such time as it’s sold?
Pretty sure I’ve heard of such an arrangement.

Similarly, at my DM’s care home there was a lovely old bloke who came every day to visit his wife with dementia - before she’d moved in he’d completely collapsed from the strain and exhaustion of trying to care for her - wet beds 3 times a night, etc.

They had no children and he told me he was perfectly happy that his wife’s fees were being ‘rolled up’ until their house was eventually sold - either because he’d died or needed himself to move to a care home.