Care home fees

[Dementiadad]

I want to preface by saying I have no issues about paying care home fees...

however...

my dad has dementia and until a year or so ago was just about managing to cope at home with carers coming in three times a day for an hour a time. He lives alone as my parents are divorced.

Last autumn he started wandering and getting lost. We got a tracker and for a long time my sister and I would find him and bring him home. We kept on at social services for help as we were exhausted from it - his last care call was at 9pm and often he would go out again afterwards. No help was forthcoming, we were told just to call the police. The police were involved on numerous occasions, each time they refused to take him home as he would be alone and they deemed him at risk and so we would have to go get him/ have him dropped to our houses (where he cannot stay long term for several reasons). Social services still maintained he was capable of living at home and would not agree to him going into a home unless he agreed (which he would not as he has no clue what is going on). We were basically on our knees begging for help but got nowhere.

It has just got worse from there culminating in him getting lost in torrential rain in May, no tracker on, social media, police all looking for him - he was found bloodied and bruised from an apparent fall 6 miles from home a day later and taken to hospital.

The hospital refused to release him home, he was kept in for a week before it was decided to move him into a home. Social services found a place and he has been there 5 weeks.

He now moves into self funding as he owns his home and has some cash savings. His income is £18k a year pre tax.

I have just received the form re financial assessment. The letter attached says the home has been charging the council £650 a week. My dad will be charged £1,700 a week as a self funder.

I asked why the difference and the home basically said that is all the council will pay and they charge self funders more to make up the difference.

We looked around at other homes, pretty much all in the area charge the same and he is settled now and so I don't want to move him.

I am disgusted by this. Not only will all his savings and home be gone within 2 years or so we then have to hope that the council will let him stay there - the care home says it will all depend on whether they have any council places when the money runs out. I hope that because the council moved him here that they will agree he stays here (the risk of moving him is that they say we chose to go elsewhere).

I just don't feel it is right - that dad is not only paying for his own care but also doubly subsidising those with council places (he still pays tax)? If the fees were £1,200 a week (which is probably nearer the true cost) there is a better chance of him outliving his money.

AIBU? The council should be paying the true cost and not making the unlucky ones pick up the tab?

To employ a person you need to pay employer NI etc and to provide 24 x 7 care of 1 FTE you need to employ about 5 people to cover shifts and holidays, sickness etc.

So one person who is paid minimum wage quickly adds up when you x 5

You raise some interesting points OP. Many people will say they want the option to self fund so they have a choice in the care they get. But as you point out, what happens when the money runs out? And it does run out quickly.

Might be better to just go with what you can get from the council at the start and not have the stress of a move. Which then makes you wonder why all but the very rich even bother?

There's an elderly couple next door to me. Won't go into it all but they absolutely should be in a care home. But the daughter and SIL are clearly keeping them in their own home as it's worth £££ (we're in London) and they don't want to lose their inheritance. I tried to raise some of my concerns with the SIL when I saw him outside once. He didn't want to know. I didnt do it out of any nosey or mean way, just that I was really concerned about them. But I was basically told to mind my own business so what could I do. But this is where some relatives don't do the best for the elderly person because they're more concerned with their inheritance.

I don't know what the answer is. In an ideal world we would care for our old people at no cost to them. It is totally shit that assets that took them decades to build can be gone in a couple of years. But there's no money to fund it.

Self funders don't howl and refuse. They pay up because they have no choice. £7K a month on a teacher's pension, for example, is extortionate. Particularly when you consider that a family member, often elderly and unwell themselves, has to visit daily, organise transport and accompany their relative to every single hospital appointment, organise and pay for private chiropody and physio (home doesn't provide those), replace the glasses and hearing aid every time they go missing or get broken, check that food, fluids and meds are being given, grapple with the invoices, check that paperwork, particularly around DNAR documentation, is correct. The list is endless and exhausting.

People moaning it's expensive. Have a look at their incoming and outgoings before you moan.
The cost of heating homes in the Winter will be huge and that's just one thing.
Person in there has no bills to worry about and everything is taken care of. Some have minibusses where you can go on trips and most have an entertainment programme going on. All these things have to be paid for. Not to mention staff, managers, cooks etc.
There is always someone around too if you slip or fall. It's a business, it's a service and we need it. Just like we need private landlords for people who can't afford to buy.
You can get attendance allowance sometimes, which is something you usually find out yourself. Care Homes don't normally tell you that.

You raise some interesting points OP. Many people will say they want the option to self fund so they have a choice in the care they get.

Its worth pointing out that you do have a choice. If you're council funded they dont just stick you in whatever home they see fit. You can pick any home that provides the care you need that has a vacancy and is happy to take you. If your preferred home is full at the time you need it then you can always move there at a later date. The industry isnt as restrictive as some think. As already said, the provider may prefer self funders as its more lucrative but thats not to say that only the poorer homes will take in council funded residents. Plus there's an onus not to have a 2 tier system, hence homes are encouraged to have a mix of council and private funders.

My father's situation is much the same as yours. When his capital fell to near 23k, I contacted the council, they agreed a rate with the home. At the moment I don't know the figure, I'm waiting for the council to finish the financial assessment. He will pay something towards this. His fees when self funding were £1550 a week. I had sleepless nights thinking he would be moved before this was sorted. This is his second care home as the first one could no longer meet his needs as he became aggressive towards the staff. The council funded this one until I got deputyship through the court of protection and sold his house. When we started self funding this one the home increased his fees. My dad is safe and well looked after and wherever the money comes from that is the most important thing.

You're quite right about how obscene the charges are. Barely any more staff then a regular hotel, tiny rooms very minimalistic, food is OK but not anywhere near the standard you'd get in a hotel restaurant. Yet living in a hotel would be a fraction of the cost.

The staff are typically on minimum wage and ratios are ridiculously poor. As a paramedic i see some homes have only 2-3 members of staff in over night for the whole building so all they can do is follow the buzzers should they go off. We get called when the day shift come in and find which residents have died in bed over night. Claiming they were sleeping peacefully an hour ago yet stone cold in rigor mortis clearly died hours ago - no buzzers to alert when a resident dies only if they've got out of bed. Im not suggesting they've caused the deaths, just how sad it is that it goes un noticed.

During the day they just rely on locked doors on the corridor to keep people wondering out ans the rest is crowd control doing their best to stop random residents having sex (dementia not consenting just doing what feels familiar really).

The owners of these businesses are taking the residents life savings/houses and spending the absolute minimum on care.

@SleepyRich Interesting to get a professionals opinion on it. Worth noting as well that there are no rules on staffing these places, so as you say, 3 staff for 50 residents isn't uncommon on 10-12 hour nightshift.

Minimum wage has rocketed in recent years though and is likely the main outgoing in care homes. Same for food and utilities as well so they're getting squeezed more and more, or rather its eating into profits more and more.

We do it for mum but that's for care at home. For MIL the council paid and we paid a contribution from her funds but she was partially funded.

I work in a care home and my dad has been on one .

If savings fall under a limit of the threshold forgot what this is than the council have to pay. If you are over the limit think it's 21,500 then you are deemed as over. The council will only pay a set amount and you are forced to pay the rest.

Once the savings have gone then you can apply for chc. It means basically they need personal needs met that need to be funded by council. This is means tested and can be done by social work

It is a crap system as they worked all their lives to fund there care.

The alternative, which just isn't practical for the huge majority in today's society/economy necessitating 2 full time earners to fund the household, is shared living with said elderly parents which is still done in some communities.

In an ideal world but I can't imagine it happens often at all. Most people in care homes barely get a visitor from one day to the next, even with family nearby. And if family live nowhere near then it's a very lonely existence.

There's just no credible alternative when you need more round the clock care than the 4 x visits a day in your own home that standard domestic care provides. Hence care homes meet a need, at huge costs, but they're generally run on a shoestring.

@Dementiadad the UK care system is broken and the government have done very little (if anything) despite Boris Johnson promising it was a priority pre covid. If you can get him in to a charity or council run home rather than private than the it’s will be less. Private care homes have share holders and are profit making businesses.

Unfortunately not many people like to think about planning for later life and the realities that many people will face.

Not sure if it’s been mentioned but have you considered live in at home care? This is much cheaper than a care home and has the added advantage of your Dad being in familiar surroundings. Usually works on the basis of having two carers who would live with him alternate weeks. The downside of this is there is less direct oversight of the carers, no on hand back up if there is an issue that requires more pairs of hands and potential need to step in if carer leaves/is off sick but hopefully the care provider would be able to provide back up. The upside is it’s about a third of the cost of care home fees.

For those seriously worrying about getting dementia and not wanting to be kept alive by medical treatment, you can specify this in a living will or have a trusted relative given power of attorney for healthcare decisions. I have a living will (cos I don't want my relatives to feel guilty if I die of a easily treatable illness).

I don't have a problem with homes being sold to cover the cost of care tbh. Part of the reason I want to build up assets is because I want to be able to pay my own way when im elderly (exactly as I do now). Im also keen for tax to cover decent care for those unable to build assets. I don't really believe in inheritance though, so im probably a bit unusual.

The majority of money goes to share holders unfortunately. Unless you are in a council or charity run home they are a profit making business which means spending as little as possible and charging as much as they can get away with.

Advanced directive and make it clear to every relative/GP

compassionindying.org.uk/how-we-can-help/living-will-advance-decision/#make-a-living-will

My mum hadn't done one and despite me nagging my dad about POA, he hadn't done that either. Thankfully the hospital was sensible and when she developed sepsis from an infection we said no treatment

@JuvenileBigfoot if you're in England, Extra Care Housing might be more appropriate for your nan than a care home. She would have her own (rented) flat but have 24/7 care on site. Nowadays, residential care homes are predominantly for people with dementia so aren't necessarily the best place for people with full cognition.

It's not a lonely existence far from it. You have people around you all the time. There are activities going on.
Much less lonely than living on your own.

Problem is those types of places are expensive to buy and extremely difficult to sell.

This. I am a volunteer care home visitor and had a Mum and FIL who were in care homes - Mum went to 4 or 5 different homes for respite when we went on holiday, as she was living with us, and FIL was in a home for several years. I have yet to find one of these wonderful homes with wonderful staff, that you hear about. Hopefully I’ll end up in one, if that’s my fate!

How the he'll would you know all this. Not surprised they told you to mind their own.
Perhaps their parent wants to stay at home, and dosent want to go into a care home.
Not everyone does.

@PassingStranger I'm not talking about Assisted Living but about Extra Care. There's a huge difference. Extra Care schemes are rented flats with care on site commissioned by the LA. You don't buy/sell them, you rent them.

This is the sort of scheme I mean:
https://www.haringey.gov.uk/social-care-and-health/older-people/extra-care-alternative-residential-care#:~:text=Extra%20care%20offers%20very%20intensive,over%20your%20life%20as%20possible.

I think you're thinking of the MS type of model which is completely different

Would rent for about £1k a month (I think) which, after tax, wouldn't cover even a week of fees.

Sorry just jumping in here to say are you sure? My son & 2 friends are renting an ex council flat in Southwark and it costs them £3200 a month not including bills.

@EmmaGrundyForPM Those extra care schemes are the best of all worlds as well you know, but theres not that many about and if you've poor mobility then there's little point having your own kitchen if you cant safely use it. Ditto advanced dementia.

I agree with this.

No-one is addressing the elephant in the room.

I don't want to go in to a home ever and want the right to be able to end my life when I want to.