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.

Sorry, we posted at the same time, if they say he has capacity and he doesn’t want the care then he doesn’t have to have it- they can try to show him it’s a good idea but they can’t make him, she’s right.

If he's no longer under a section and he has capacity he can just walk out of hospital whenever he likes. They don't have to agree but it's not a prison. I wouldn't be debating it at all. Just tell him he can leave whenever he likes but he'll be looking after himself

Then wait until crisis hits.

We had to do this with a relative who refused any care or support. We had to wait until crisis hit and sort it out from there. He ended up under protection of the local authority who sold his flat to pay for his care and made decisions for him. Luckily he was in an excellent care home at the end of his life but it was hard knowing he had to hit such an awful point before he could be helped

Did your friend grow up in a household where it was her dad’s way or the highway?

It sounds a little like she is so conditioned to going along with his wishes that she feels she has to let him have his way even if, objectively, it is not acting in his best wishes. She might be scared of confronting him herself.

She also may have some resentment if this dynamic has been going on for a long time. Instead of concern she might feel frustration if she can see an impending crisis but not feel like she has any control to prevent it.

Absolutely. If he doesn't pay, the taxpayer does, and many of those taxpayers will be less well off than your friend.

Well her options are : care for him herself (and en can claim attendance allowance and she can claim caters allowance if she earns less than £165 a week after costs) or he pays for care until his savings (or assets in the case of residential care home-they Count the house) get down to £23k.

Or she does a bit herself and gets a dom care company to do the rest.

Obviously if she does it herself she saves her inheritance but by the sounds of it she will be working hard for that money.

I'm in the same position except I'm not money grabbing

My Mum's money is there to be spent on her . We have already spent £100k and will no doubt spent her whole estate on her care but so be it . You cannot get round it unless her dad has put it all in trust .

Tell her to suck it up like everyone else has to .

So this friend of yours is apparently desperate not to use her dads money for his care when he obviously needs it because she wants to protect the money because dad doesn’t want it spent? Call me cynical, but she sounds a grasping type with one eye on that big fat inheritance.

My parents were not wealthy, but owned their own house near London etc. so far, between them they have needed over 15 years of residential care (DM is still alive). I did some of it myself for a while (for love, not money!), but it nearly broke me and damaged my relationship with DM, who doesn’t have dementia and with whom I have always had a close relationship. If my parents had not needed residential care, I would have inherited over half a million pounds (only child). All of it has gone on care, except the last £15k which they let her keep. And both parents have been pretty miserable, too, despite getting and paying for good care homes.

It’s never an easy situation, and can feel unfair, but it’s a lottery how much care is needed. And paying for care can be a lot less costly than giving it oneself, money or no money. This lady has to come to terms with a difficult situation and find the least worst way through it, unfortunately, because there’s no such thing as a good option here.

Going through a similar thing with a relative at the moment- it's a throwing money situation I'm afraid. If they've got it, it has to be used. The whole system is insane.

If he has mental capacity to decide where he should live and what care he should have then he will be able to go home, however unwise this decision looks to others. Social Care will arrange any help he is assessed as needing, whether he accepts it, if he has capacity, is his choice. That is tough on your friend though, because it puts her between a rock and a hard place - if he goes home with inadeqaute support she will have the worry of this and all the phone calls etc. She is not legally obliged to look after him but real life is not this simple.
People saying he should just go into a care home may not realise that the law is (rightly) on the side of the liberty of everyone, including unpleasant and difficult people of any age. If he does not want to live in a care home the circumstances in which he would be compelled to are very, very limited, and people who make these decisions have to ensure that individuals they deprive of their liberty have speedy access to courts.

O and there will not be a way to avoid paying for care (presuming the mental health act detention was S2) unless she provides the support he needs herself.

It’s a horrible situation to be in but I’m afraid he will have to probably use his money to pay for care whether at home or in a care home setting. My mum who died in January paid over £250,000 in care home fees as she was there a long time. Obviously no one wants to spend their money on care fees but I was relieved she got to be in a nice care home and was looked after properly. It is what it is I’m afraid, inheritance is never guaranteed and no one wants to spend their hard earned savings on care but lots of people have to.

@Turquoisesea , exactly.
My DM and FiL, both of whom had dementia, were both self funded in their care homes. They had the assets with which to pay, and didn’t need their houses to live in any more, so why on earth relatives like we were should expect the taxpayer to cough up, I will never understand.

The key issue as PP have said is to establish if he has capacity to make decisions about his care. If he does and he doesn’t want any care, it can’t be forced on him

your friend will be picking up the constant crisis though

tbh it sounds like your friend would rather he stayed in hospital indefinitely because it’s free

An elderly man with mental health issues and possibly early dementia who insists on going home with no care? And a daughter who thinks that's ok? Social services are going to be quite quickly involved with a view to assessing his capacity.

If your friend has POA but won't attempt to persuade her father to not neglect himself I don't know what happens.

Once he is deemed to have lost capacity, if she still refuses to arrange proper care of him, I suspect there is a way for social services to take over the POA via the Court of Protection and force the money to be spent on his care. If there is no POA he will fall under the care of the Court of Protection anyway if he loses capacity and social services will effectively sieze his assets to ensure his care is paid for.

He won’t have to pay for the 6 weeks ‘re-enablement’.

And if he applies for Attendance Allowance he could get some card paid for from that.

I agree with Choux.
Social services need to be getting involved and doing an assessment of need, and probably an assessment of capacity needs updating too.
It sounds as though the daughter is still in the mindset of obeying her parent or facing the consequences, so very much controlled. She might not be being controlled now in the same way as when she was younger but it'll take a while to recover from years of trauma and get out of the mindset of the parent saying 'jump' and her saying 'how high?'

To reiterate PP, the first six weeks are government funded. I would recommend they go with the six week plan then decide further action

Maybe, but my parents are the same. Horrified at the idea that their money might be spent this way (or that there might be inheritance tax to pay) whereas me and Dsis, who it actually makes a difference to, are quite relaxed about it.

I don’t understand either. Sounds like inheritance is more important to your friend than dealing with family.

I hope to be in a position to help my parents practically. However some of that will be finding cleaners and other help to keep them comfortable in their own home.

If his condition is being managed with medication, how is that going to work unless he has at least carers coming in? Any degree of dementia will v likely mean that a person will not remember to take any meds. Or will take too many, or at the wrong times. And NB, writing reminders for them doesn’t work either, because even if they remember to look, they will v likely forget as soon as they’ve turned their eyes away.
Ditto phoning to remind them. I’m speaking from experience here!

Chuck in any degree of stubbornness/bolshieness (often exacerbated by dementia anyway) and the situation is likely to be even worse.

Very sorry for your friend, we were going through something almost identical last year.

There are two separate issues here, who pays, and how to get him to actually accept care.

I'm afraid that if he has means I don't see how he can avoid paying for any care he receives, and I think she will be wasting her time trying to argue against it.

To be honest that is probably the least of her problems at this point. Getting him to accept help is a whole other can of fish, how do you help someone who won't be helped. She will have to speak to everyone - GP, hospital discharge team, adult social care. None of them will ever speak to each other, or know what is going on.

IME the medics are very slow at diagnosing dementia and agreeing that someone lacks capacity or is unable to look after themselves. They seem to bend over backwards to let the patient do what they want and she may have to just stand back at some point and let shit happen.

She is in for an absolute shit show. I realise this is not helpful. If she is on MN she should go to the Elderly Parents forum.

If he has been deemed to have capacity to make such a decision, and has decided he doesn't want / need carers then I should think the hospital will simply discharge him home. There is no point in the hospital saying he has capacity but then not respecting it so I'm with your friend. He can self discharge.

The sad reality is he probably won't manage at home for long and will quickly end up in hospital again.

Tell her to suck it up like everyone else has to . This 100%. My two DDs know that I should I need care my flat will be sold to pay for it. I have already put LPOA in place long before it's needed.

My parents don't want their money spent on care either but, when the time comes, it's how it will have to be. If you have money you should pay for your own care. Inheritance is what is left over, if anything. If it's needed for the care, then there is no inheritance.

To not ensure needed care is provided to protect inheritance is elder abuse. If this father has capacity then he can turn down care, but it sounds like it's necessary. If not, it soon will be then he can and should pay.