What happens if they are kicked out of a care home?

[loopylou459]

Just that really...what happens if a parent is kicked out of care home because they are being violent and the home can't cope with them? This being a home that deals with advanced dementia. Where on earth do they go next? And who is responsible for finding it and paying for it?

The local authority has to find a placement, which may be funded if there aren't sufficient assets.

It's not down to you to sort and pay for - and do not allow them to coerce you or a spouse into having them at home for even a couple of days.

Friend of mine his dad had dementia and psychosis. Was violent.

NHS locked ward.

Poor poor man. And I bet in his younger healthier days he would be mortified at the mere idea of such behaviour which he now can’t help.
Cruel disease

Oh god. This is heartbreaking.

Im sorry that you’re having to contemplate this, OP.

I can’t speak for all locked wards. But I volunteered in a local one and for the most part it looked like any other care home. It had cosy rooms with residents sitting together and watching tv or doing activities. The bedrooms looked like regular bedrooms. Residents were able to move around. There was a small but nice garden. The only real visible differences were that the corridors were even wider than care home corridors, there were panic buttons throughout and yes it was locked but you had to be allowed in and out of the nursing homes I volunteered in too.

In these circumstances the NHS containing care funding should kick in which isn't means tested, takes some form filling but they should guide you through, this is NOT the same as social services funding and there's no funding cap etc so they can pay whatever it takes for the level of care needed. My ex grandmother in law was in a secure ward at a specialist nursing home with 2:1 care at one point.

There are places that take those with more challenging behaviour - a former colleague of mine aunt was unable to stay at the dementia unit (that heartbreakingly her sister was also in) due to violence, but the LA worked to find a suitable place and she is happily settled there now.

Happened with my mum. She was sectioned after care home couldn’t cope with her violence. Spent 7 months as a psychiatric inpatient. It was brutal and heartbreaking time but the staff were amazing.

Thank you that is some consolation at least. I suppose there aren't that many of these kinds of wards and they may have to go where there is a space which could be far away and may make visiting difficult. But getting ahead of myself now. It sounds like it is over to Social Services for the next steps.

That's useful thanks. So in theory it could be fully funded by the NHS? I suppose that is some relief as this kind of care sounds like it would be very expensive, even more than the care home fees which were huge!

Thank you. I'd assumed we'd exhausted the care home options so this is good to know.

I've been in the situation twice now and it's awful to go through but to reassure you there are actually lots of high quality options and in some ways it was better than when we struggled to get help for a relative who had high physical care needs but was sweet and cooperative. I found as soon as the police got involved things happened very quickly and without the usual barriers. The secure unit my relative is in is a lovely place actually. And it's only secure from their point of view, relatives can still visit freely.

Had this with dad last year.
he has Lewy body dementia , with horrific delusions and was at time violent. Certainly disruptive, difficult, and unpredictable. Extremely distressing for family to go through. He was mostly terrified frankly and his behaviour was fight and flight.

If not already, your parent will need to be on a higher level of support anyway and observed all the time, deprevation of liberty and all that. So first thing is a full reassessment by teams to agree formally his needs. Don’t hold off about sectioning under mental health act if that transpires- BEST thing that happened to dad as was immediately transferred to a specialist nhs dementia assessment unit who did wonders for him in determining his needs and helping him re establish REM sleep. Also, with sectioning they’ll be eligible to 117 funding thank goodness. Even if not sectioned, if they need nursing care and or deprivation of liberty, higher care ratio, they will qualify for substantial partial funding. So, Make noise, push hard etc to ensure assessments done on bad days, are fair etc., make friends with their care coordinator , refuse though to be labelled as “carer” and keep a step back from active involvement in the care assessment and finding of homes. Make sure you challenge funding assessments too. Stay on it constantly as they go through process.

this process is very different then when they maybe first went into a care-home with minimal needs that most dementia units in care homes have. It has to be driven by mental health teams and social care now.

so we were in your situation, he was already assessed for care needs, and deprevation of liberty, but not nursing at time. Care home couldn’t cope, wanted him out ( in fairness to them I don’t blame them given his aggression and violence). BUT they couldn’t merely chuck him out, no matter how difficult it got for them. Council and mental health team needed to reassess dads needs first. They didn’t exactly rush 🙄🤬 Then dad got infection, went into hospital and home refused to have him back. He was then bed blocker for some weeks in a really crappy hospital ward for men like him who needed deprivation of liberty and 2:1 24/7 care ratio. It was bloody awful frankly, but he needed medical care so needed to be in hospital. His needs were finally reassessed to qualify for full nursing care, and council had to find provision and pay full cost ( partly due to the 117 order) . Only 1 place in whole of local nhs region could meet his needs, way out of his local area . For a time social care were looking in other local authorities even. We didn’t have a choice for him.

the good news was that this nursing home was bloody fantastic, purpose built modern designed for dementia patients , owned by GPs, lovely nursing and care staff. Dad went onto end of life pathway shortly after he arrived, going downhill fast as is often case with LBD. he actually lost a lot of his aggression, and as his frailty increased he couldn’t inflict sort of damage he had when mobile! He died last autumn. I genuinely believe that he was better looked after here than in his previous care home, so it all turned out well for us all. But, in practice it’s horrible that care homes can put relatives through the “ he’s not welcome here/ we can’t cope” milarky. Remember, it’s not your personal problem to solve; it’s hard to process that, but think if they had cancer- you’d not be deciding where they were treated would you? it’s better if you can take a step back and let social services, nhs mental health teams and care coordinators do their bun fight and come up with the list of places that can meet their needs. you can then visit and state a preference . In practice you might not have much choice, as even nursing homes aren’t always equipped to deal with patients like this.

get the assessment first. They need much higher ratio of care, probably deprivation of liberty ( think it’s called something else now). Go from there.

id also, once they’ve moved, ensure you get a Respect Form done and held with home. Absolutely vital to agree what sort of interventions you, as family, feel are best now. We were slow off mark with that, and it really mattered in last few months, to ensure they didn’t drag him back to hospital for infections etc causing him more distress. Also to ensure he stopped meds that were “ keeping him well/alive” like statins, hypotension type stuff.

It is common. Sadly dementia , especially Lewy body dementia, causes delusions and hallucinations.
I called it a grotesque disease when dad went through it
that seemed a good word

yep,he was on nhs locked wards, but mostly because nhs mental health teams were pissing around for months saying it was delerium due to infection…then they thought he’d developed psychotic illness…just why? Dad was 88 and after 9 months on nhs mental wards being treated with antibiotics more likley to have dementia with psychosis than the other 2.
bizarre frankly
but it did get him sectioned - and that does have benefits oddly
once they’d agreed that it was dementia he was finally moved to a brilliant dementia assessment centre- that really helped dad

people react in horror to idea of locked wards. In good places patients won’t know . And they really do need it for their and everyone elses safety. Just like anyone of any age sectioned under mental health act. It sounds horrific, but it’s necessary and doesn’t make them prisons or a vision of bedlam. It is dependent on hospital and wards. As I say the specialist dementia assessment unit dad went too ( still a locked mental unit) was blinking marvellous and a lovely place.

Just standard nhs mental wards can be dreadful for dementia , imhe. That’s mainly because they don’t have a lot of very elderly patients in then, and don’t know how to treat them. The worse for dad was isolation- staff didn’t have skills to keep him occupied, distracted from his delusions, and give him human contact. Which dementia patients need. He was bored, frightened, and eventually depressed by time he left for dementia specialist unit.

Not necessarily full costs. it will depend on needs. But it shouldn’t cost more than current care home, as nursing element now needed potentially will be covered

f they have a 117 order in place or have been put on “ end of life” , then more likely they’ll get both nursing and care elements covered.

but you need to push. During full re assessment. As I said in other post - make sure it’s fair on not just a single “ good day” assessment…they need current care staff input etc.

There are actually a lot of places, even care homes ( vs nursing homes) with locked units. Just you wouldn’t know ! That’s because so many even gentle and calm dementia patients will wander off ( try to go home😢) and be a danger to themselves. It’s quite common for dementia patients to be on a deprevation of liberty at some point- but they’re constantly reviewed, and have to be removed as soon as risks go down. Which sadly they do often as illness progresses.

the issue for your relative, is more the aggression, and need for units that have 2:1 Care ratio needed for violent and aggressive patients. It’s kind of separate issue, and only affects a smaller number of patients . Yep, they need locked ward too, but it’s the care ratio mainly . That’s why your current home doesn’t want your relative- they don’t want to, or can’t, provide that level of staffing and costs. Your relative will need 2 people for all care tasks.