Palliative nursing care, elderly grandmother

[Plant2628]

Posting here for traffic.

Sadly my very elderly grandmother has dramatically gone down hill in the last couple of weeks. Whilst mentally with it, she's physically bed bound. The doctor thought she had days to live but she seems to have bounced back from that. She drinks tea but doesn't eat anything. Family have been with her 24/7. The concern is longer term though if she continues (which I think she might) to defy the doctors. Is nursing care available for these circumstances and would it be a nursing home or hospice? Would it be funded in full given she's at the end of life and for how long?

Anyone had this experience and can share info? Going to speak to GP next week when he visits but it's a minefield.

Thanks

It might be best to ask on the elderly parents board. Nursing homes do offer end of life care but I’m not sure on the funding aspect.

Adult Social services are the best ones to advise. You can ring them direct and make and ask for an assessment

Sometimes people who are close to death perk up for a few days just before they pass. If she isn’t eating and is already frail then she is unlikely to live much longer.

If she is in the last 3 months (which if she isn't eating she is) then she would get NHS Continuing Care funding - it would be very rare for this to be 24 hour, up to 4 visits a day is standard.

This funding would also fund a Nursing Home - although you may have to pay a top up.

Hospices are for very short stays - they work on the basis of 2 weeks or less and will seek to move people on either back home or to a care home if they aren't needing the highly specialist care of the hospice.

The hospice where I worked for many years would only generally take people in the last weeks of their life or where symptom control was very difficult to manage or quite specialist. I would say if she has no difficult pain management issues, then a Nursing home would be best. You can ask for an adult social care assessment through your local council and they will do a financial assessment also to see if care could be funded or whether she would have to pay herself. If she has no savings over £23750 then she may also be able to get paid help with home carers if she wants to stay at home with support.

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To qualify for NHS continuing care funding, is that something your GP would apply for?

Usually it is either district nurses or specialist palliative care nurses that apply for CHC.

Contact your local hospice directly, they will be able to sign post for you. Others are correct that beds usually are only available for a couple of weeks for end of life care, but many also have hospice at home care which is up to 6 weeks. If they can't help they will know who can. If you phone the main number and ask to either speak to their community team or referral and discharge team.

Funding varies by area, hospices are mostly funded by charity donations as opposed to other NHS services so the level of contribution they require varies. If there's a specific condition that she has, cancer for example, some places may be more appropriate than others. You could always contact directly to find out what their options are/needs assessment.

Most nursing/care homes will need to be funded privately if she has means of paying/property that will be sold. You could call around to look for a suitable and what their process of means testing is.

That said she may prefer to die at home as opposed to hospice/home. In this instance her GP would normally make a referral to a district nursing service whom will assess the needs/visits required and can be increased as her needs increase. They can also administer any end of life medications which have been prescribed to keep her comfortable.

It's can be very difficult to estimate how long someone has left. But sleeping more, eating less or not at all, then stopping drinking are normally signs of someone entering last days of life. If she's comfortable that's the main thing at this stage, if she seems distressed - either with pain or breathing then contact the GP/OOGP as for an end of life patient some very effective pain killers and other medications can be prescribed.

A Hopice cares for Patients with Specialist Palliative care needs, they are not necessarily involved with every Palliative patient in the Community, patients are generally referred and that referral is triaged to see if that patient needs a Hospice Service. Referral is usually by a Healthcare professional but every hospice has their own Referral criteria.
It sounds like she may qualify for Fast track CHC funding for either a POC at home with a max of 4 calls per day and max 3 night sits per week.
If A POC at home does not meet the care needs you would be looking at a Fast track CHC Nursing home placement for 24hr care.