How easy or difficult is it to get an elderly person into a care home with no private funding

[Bellson]

DM is 91 and had a stroke about 2 years ago. Since then her quality of life has deteriorated a lot. She used to be independent and active and now needs me a lot more.

I'm her only DC. She lives independent in a council flat about ten minutes walk from me. We both live in very small flats. She has no savings and no property to sell. I am her carer but since coming out of hospital she has carers who visit her at home twice a day as well. I take her out for lunch once or twice a week and then to doctors appointments and pop in most days to check on her or take shopping.

I think she would benefit from going into a care home for company and stimulation. Her medical care needs are being met by me and the carers and GPs etc but it's a huge strain and worry on me. Often she will call me distressed and she doesn't like living on her own.

There is a really nice care home near us which I tried to get her in but it's so expensive. I have gone to her GP and he wrote a letter recommending that she go into a care home but that was weeks ago and nothing has happened. I'm wondering if it's because we can't fund it it isn't going to be a priority. What I'm wondering is from people in the know what is the threshold for a social worker deciding that someone qualifies for a place in a care home?

Since the council is funding for the care I imagine because you say she hasn’t got any money to fund for the care then unless she really needs it, they won’t do it and I certainly don’t think she’ll be going into one of the most expensive ones so you need to lower your expectations a little bit.
As they have a budget the council do. You know though there are volunteers that can come and maybe spend some time with her. You could look it up. I think maybe help the age has information about that.

You won't get the expensive one. Settle for cheaper option if council is expected to Pay.

The thing is if you don’t think that actually medically she’s getting the care that she needs then of course you can ask for an adult social worker to do another assessment but if they think that she’s managing at home with the carers coming in then they won’t fund for her to go inside a home because of budget restraints

I'm afraid the cheaper option is the only option. And be aware that you might be judging the expensive one on surface impressions - the cheaper one might be better for your mum in the ways that matter to her.

I think I was very naive at the start of this process and now I would be happy for her to go into a cheaper home as I know she won't get the expensive one. It's a struggle to get a social worker assigned at the moment and I'm worried they will say she doesn't need a care home.

Get in touch with Adult Social Care. Explain in clear terms why you think she is not coping - that she is getting distressed etc. Don’t downplay it.

Unfortunately it’s likely nothing will change unless you say you are going to withdraw your care. Ie that you cannot and will not continue to pop in etc because you have other commitments. You are likely to have to follow through with this to make a change happen.

You may find that you get more detailed advice by moving the post to the elderly parents board.

The next step is for a social worker to visit and do a needs assessment. They will want to try 4 care visits at home (much cheaper) before they move her to a care home. And if they are aware she has support from family (you) they will be very happy to let you continue doing it until you point blank refuse.

So it is unlikely to be a quick process, and you definitely will not have the choice of the care home she goes to. They will select the most cost effective placement that meets her needs (i.e. the cheapest).

We had a real uphill battle with regards to MIL. Similar situation to your DM, no savings and no capital. She was only deemed to be in need of residential care when she was no longer coping with the maximum number of carer visits per day (4). She had repeated falls and hospitalisations and the latest one triggered another assessment. Unfortunately we, as a family, at that stage had to say we could no longer provide care nor facilitate her at home so they then assessed her as needing a care home placement.

Sounds like you may not have asked for a formal assessment of her care needs from adult social services. So that's your first move. If she doesn't have property or savings then they will pay, but as @catofglory and @BodyKeepingScore said, they will go up to the maximum of 4 carer visits a day and it'll only be when that's not enough to keep her safe that they'll fund a care home place. However, there will be other options too. Contact Age UK and ask about support in your area. There may be day centres she could go to and these might have transport provided to get her there. Age UK have a befriending service where someone will ring her regularly for a chat. Local churches are also worth checking for coffee mornings and similar for older people and again they may have lifts available to get her there.

Getting into a care home while she is managing with a care package at home won't ever happen. I would suggest trying sheltered accommodation where there are staff on 24 hours a day and they usually have communal rooms for socialising.

Does she want to go into a care home? That's the place to start. You can ask social services to do a care needs assessment and they will find out what she wants.

Obviously if there a risks involved they can make a decision in her best interest for this decision if she lacks capacity for this decision.

If she is managing ok at home with a care package then it's very unlikely that the council will fund a care home place

Care homes are extremely expensive (£1000+ per week)

You can request an assessment and ask for her to be assigned a social worker but I dount they will recommend that she moves to a care home unless the situation significantly deteriorates (and rightly so!)

And just to give an idea of the situation we were in for around two years prior to funding for residential care being granted... she has Parkinson's. Advanced enough that there are frequent falls. Also hallucinations and delusions. A fall in January preceded a broken hip and hip replacement, a few weeks of rehab followed. She was still discharged to home with four carer visits daily. She was doubly incontinent and we as a family on almost a daily basis were facilitating full showers in between carers to clean up after accidents. We had frequent phone calls as she'd fallen and we'd have to rush round to assess whether hospital was needed and to get her comfortable etc. She was completely incapable of leaving her home alone, in fact, incapable of managing within the home without our support. Relied on us fully for grocery shopping etc as she could neither leave home to do it nor bring it in or put it away had we arranged an online delivery. This went on for a couple of years until she had another significant fall resulting in hospital admission. At which point we told the consultant we could not provide any care at home nor ensure her safety any longer. This triggered another assessment and as she already had the maximum level of home care ie four visits a day and was unable to manage it was deemed she needed a residential placement

Sometimes the fancy Nancy care homes are not always the best. Quite often the no frills options have the kindest staff and other visitors can be wonderfully supportive

Baaaasically as said, she needs an assessment of needs from your local council. If she receives 2 x carers per day already and is funded either in full or part by the council then she will already have had an assessment. But if you feel needs have changed then you can bring the next review forwards.

You will probably be aware that the thinking nowadays is that people stay in their own homes for as long as is physically possible with up to 4 x visits per day maximum plus say extra visits for laundry, shopping if needed.

If you need more than 4 x visits per day from a carer then chances are you need residential care which is a care home 24/7 staff on site. Nursing homes are the same but with a nurse on site 24/7 but I dont think she needs that.

So basically, you do only tend to get into a care home if you cannot cope at home e.g. you cant make it to the toilet/commode, you're high risk of falls, it is unsafe to be home alone.

Many elderly go to hospital then get discharged to care homes as they have had a serious seizure/stroke etc and its unsafe to be left alone at home.

Age doesnt really come into it, its down to personal skills and abilities.

But sorry, coming back to your question, the basic threshold is someone needs more than 4 x visits by carers per day. Thats the threshold.

They might up the visits to four a day

but does she "need" a care home? You specify company and stimulation but mum's been in one twice for respite. The residents weren't in a condition to be company, (which was irrelevant to us because of mum's health).

if there's no other factors, you might find sheltered accommodation better for that. Also look at what's in the area as per pp suggestions.

Government policy is to support people to remain living in their own home in the community for as long as possible. All the time your DM’s needs can be met by having carers visit, and making use of community provision such as day centres this is what will happen. A residential care home placement would only be considered if her needs could no longer be met at home even with multiple visits from carers and familial support . Care home placements are not provided because someone is lonely or anxious. You could find out if there are any extra care facilities (flats with carers on site) that your DM could move into.

If you think she needs more company and stimulation, look at her attending local Age UK day centre. They will usually collect for just petrol money. She will get a bit lunch and plenty of company and can go several times a week if she chooses. As mentioned, for SS funded care home she would need to be unsafe with maximum daily care calls. Maybe enquire about extra care housing flat where the care is on site day and night and there is usually a dining room with communal meals and social activities during the day, but you get your own flat and can do your own thing if you don't feel like socialising. They are a good halfway house and some have care homes attached which you move across to when you cannot cope.

Also in my county at least, all care homes are open to Private as well as council funded residents so there is no 2 tier system. If they have a room available they will generally let anyone in as empty beds are bad for business and turnover is generally high if you get my drift.

Look on CQC website for supposed independent ratings. The same inspectors who review your dentist, hospitals and doctors also inspect care homes and all info is published on website. You want a Good or Outstanding home ideally. Requires Improvement or Inadequate run a mile. The inspections arent great but they are better than carehome.co.uk which is utterly meaningless.

Isolation and loneliness wont really count also. It comes down to physical abilities and mental capacity but thankfully your mum seems to be quite compus mentus.

SS here would not even assess my 98 year old mum and we had to find and pay for care. The last resort is a home and they won’t assess here even though they have a legal responsibility to do it.

It might be worth exploring sheltered accommodation or possibly "extra care" accommodation. These tend to be individual flats that you rent but with communal spaces, and I believe some may have communal activities and a restaurant too (there's a lovely one in. Exeter that does for eg). I don't know anything about criteria for eligibility but you could inquire. Tend to be council run, so same landlord.

If there are any near you there may be a waiting list - but worth investigating?

I assume the carers simply visit you in the new home, rather than being part of the accommodation, again youd need to ask 🙂

Please also be aware that, if the council do fund her care home, any pension will be put towards the costs apart from a token amount eg £15 a week for spending on toiletries etc.

If social services think she is unsafe with visits four times a day they may arrange residential care. They'll choose the home. From your description she doesn't sound anywhere near the threshold, sorry.

It’s basically impossible unless the person is at risk of harm by living at home. It’s normally only if a care agency are saying they can no longer keep the person safe and 4 visits during the day aren’t enough.

if the person can’t be left safely between care visits or needs help through the night, or needs help from 2 people at a time eg. Because they have a hoist (because then depending on area, 4 double up carer visits can be more expensive than a care home).

You wont get council funding for a care home for companionship sadly.