Where is the line between a care home & nursing home regarding needs?

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Grandad is currently in hospital following a chest infection. He's almost back to himself except it's left him weak and they feel he won't be walking properly( been in a chair for going out for years). There's no medical issues except the medication( which hasn't changed ) and a problem with his hand ( which has been an issue for 20 years).

He moved to a care home in the summer and they are currently holding a downstairs room for him as someone else is moving to a nursing home.

Hospital are now saying he will have to go to a nursing home, they've not got as far as discharge meeting so no idea what the home think. We are a bit confused as his needs haven't changed apart from he will be in a wheelchair most of the time. He can move between bed & chair with support. He only went to the home in the summer( very much against his will initially but has loved it since) and it seems a shame to go through the trauma of another move.

He's also self funding , not sure how that works with nursing care? Especially as my parents are paying until his house is sold.

Residential care is normally based on 'social care' e.g needing help with washing / dressing / meals / medication administration. The care is provided by health care assistants (normally trained to nvq 2 or 3), nursing care would be provided by the district nursing team as there is not a registered nurse in the home.

Nursing care is for people who have a higher intensity need than residential can provide (for example due to needing hoisted for transfers) or for those who have increased medical needs e.g more close monitoring of condition / complex medication / palliative care. Care is overseen by a registered nurse in the home, normally leading a team of health care assitants.

I have no idea about funding - best bet would be to ask the social worker who is dealing with his placement. Make sure to ask if he has been assessed for continuing care funding as if he is eligible, the NHS would pay for all his care (direct to the home).

Hope that helps a little bit.

Also, I think fees can be defered until such time as a property is sold (the ward social worker should be able to give you more info about that.

Thanks. You've pretty much confirmed my understanding. I'm still not sure how he fits. He's probably on the line at the moment.

The lines can become a bit blurred as some homes offer both residential and nursing care. In fact all the ones we have built (I'm an architect) in recent years offer lots of different types of care within the same home.

Have googled the continuing care funding and brief check through the decision tool does bring him out on a few moderate and at least one severe.
Plus he is likely to deteriorate.

Hospital told my mum it's going to be a week or two before discharge.

If he's on the blurred line, and likely to deteriorate, it's probably better if he goes to nursing straight off, rather than going to residential and having to move again in a short space of time (unless the home he moved too was joint registered so that it would be a case of moving within the building rather than home)

Yes that's what I'm thinking now. Shame as the home is lovely and nursing homes are nearly all the same company locally and we weren't impressed with my great grandmas care

Just to warn you that you may find it is v difficult to get continuing care NHS funding, whatever the criteria may appear to say. Especially in the current financial climate.

My mother, 94, with vascular dementia, was admitted to hospital because she was refusing to eat or drink. Up till then, she was being cared for at home by visiting LA carers, four times a day. (Partially self-funded, her attendance allowance covered the shortfall.) After some time on a drip to rehydrate her, she continued to refuse anything by mouth and was put on the Liverpool Care Pathway, with our full consent. She had made up her mind, what was left of it, to die. The drip was removed and she was given morphine to help ease any painful symptoms.

Even at this point, the hospital wanted to move her to a nursing home and the NHS and her Local Authority had a dispute over who would pay for her care. The Continuing Care assessor met me at the hospital and told me she did not meet the criteria. (She was bedridden, couldn't stand unsupported, sleeping most of the time.) The LA would be responsible for the cost of the nursing home for 12 weeks and then we would have to sell her house. When I said she was not eating or drinking and would die soon, she said, "But she might change her mind". The LA challenged the decision and 3 days after her death, I got a letter to say she would be entitled to Continuing Care. (All very distressing, because obviously I wanted to concentrate on my dying mother, not to have to have a row with bureaucrats over money.)

I have read of cases in the press where patients severely disabled after a stroke have been refused CC, or only received partial funding for strictly medical procedures, most of the bill having to be paid by the patient.

If he needs a nursing home, then that is obviously what he should have, regardless of finance, but, from what you have said, you're likely to have a battle on your hands regarding funding, which will be much more expensive than his current home. If they are prepared to continue caring for him, then that is what I'd push for.

If you think that his care needs have not changed you should ask the home to go and reassess him to see if they are happy to have him back .

The care home has now refused him back.
He has gone down hill from my last post, is refusing food/drink which results in urine infections, making him confused and then he eats for a day or two until he is less confused and it starts again. He alternates between refusing to put his feet down and trying to runaway (on weak legs that haven't been used for ages).

The Dr/nurses have noted he needs nursing care. Mum wants to stop his care home place now as its obvious he isn't going back. SW has said that that makes him homeless and they won't pay his fees if she does that ( social care don't pay at present -he is self funded but until his home is sold my parents(pensioners) are topping it up).
The SW won't meet re any of this as he's not ready to be discharged( we don't expect him to make it that far though :( )

Mum is now worried that if he is still like this in a month they will try & discharge him to a nursing home anyway.

Through discussions with someones wife on the same ward ( he was in the same home as my Grandad) the nursing homes coming up are not local and in an area v difficult to access ( rural county/poor transport linksetc). This is more an issue for the other couple as my mum drives but it's an area my Grandad would have very strong feelings against living there. We'd prefer to him to go further but a different area but places seem to be dependant on people dying :(

So sorry to hear this, OP.

Nothing helpful to add except to ask if you've been in touch with Age Concern?
Sadly, they have a lot of experience with this sort of problem and I've always found them very helpful.

Best wishes to you all.

No they are on the list! Mum had a strop yesterday at social care and said they can't afford to pay the home now until the house is sold ( nothing shifting here, few interested people who can't sell theirs). They offer a loan scheme until houses are sold so Mum is getting an assessment for that. We think they might not like paying for an empty bed and may let him officially move out ( also gives them a bed to fill!)

Personally I'd give notice at the home , your grandad is not homeless as officially he still has his own home , then start looking for nursing homes . If and when he is fit for discharge then start the procedure for getting funding for it . I see little point in paying for something you are not ever going to use , and he's no more likely to go back there as to go home .

He sounds like he's qualifying more now for Continuing Care funding, given the current level of unpredictability he's displaying. You can request an assessment via the nursing staff or discharge coordinator/bed manager (if there is one involved). They're not allowed to refuse just the assessment, even if the upshot is that he doesn't meet the criteria for the funding. You're best requesting it sooner rather than later as the ward staff need to complete this fairly lengthy document so it can take a little while - it's not something they can do quickly once they decide to discharge him.

Thanks.
My mum is worried that they will try and send him out when she is away in December but they'll have to deal with me and I'm less likely to roll over for the SW than she is ( I work in children's services so used to dealing with professionals)

Case conference on Thursday if anyone has any tips!

The social worker won't be the one to say whether he gets moved on - it will be his consultant and the nursing staff and how desperate they are for the bed. Have they done a Continuing Care assessment or did you ask for one? If so, keep on top of the nurses to make sure it's done in time for the case conference so there's no delays. How come he'll still be in hospital in December? Will he not be fit for discharge before then? Is he in an acute hospital or a rehab one? (Sorry - noseying )

He's in a general hospital. Its a high need ward, like the next step down from HDU( msinly elderly ).
He's refusing food/drink then gets dehydrated, urine infection, confused, they drip him up, he improves and starts again with refusing food. He's refusing to put his feet on the floor to move but then tries to run away when confused ( hadn't walked for 2 months, do not v successful!).So they aren't getting him well enough for more than a day or two before the cycle starts again.

Assessment has been asked for but not sure on progress. I can't get to visit very often due to work/kids/SPD limiting my walking distance!

Just to warn you, then, the case conference might be a bit of a non-starter if he's not showing some glimmer of being medically fit for discharge. If he's in a general hospital they're more likely to want to turf him out for the bed without much notice. Is there a rehab hospital he could go to for discharge planning to make the process less touch and go once he has stabilised a bit? It might give your mum a bit more peace of mind if he's in a slower-stream setting. It's worth asking about this in the case conference.

No rehab hospital here. There's a unit for physical rehab but my Nanna was at their highest end with a bad stroke and non verbal.

I'm not expecting him to move from the conference but need clarification of what we should be expecting to happen ( continuing care assessment is a good one to remember)

The other bloke who's more medically fit but Alzheimer's has been there 18 weeks now. Only vague hints of a nursing home as there doesn't seem to be vacancies.

What do you actually want for him? Realistically, is there a chance of a vacancy at your preferred nursing homes? He's not happy where he is and the longer he stays there, the more likely he'll pick up an infection.
Could he be persuaded to regard the LA's choice of home as a temporary measure, a sort of convalescent home?
Does your mother have Power of Attorney? Is he capable of making his own decisions?
I had PoA for my mother, did not want her moved anywhere, because she was only days from dying, and when I asked the CC assessor if I could withold my consent, I was told it was 'a grey area'. Might be worth asking Age Concern about this. The next thing I knew, I had a phone call from the hospital telling me they would not be discharging my mother, when previously she'd said they would be carrying out the discharge up until Cheyne-Stokes breathing.

There isn't a nursing home on offer at the moment afaik. They are regularly offering the other bloke a home an hour+ drive away on v bad roads in an area my Grandad really dislikes. We would have no objection to the majority of our county except this area though we would prefer him nearer so we can visit regularly.

They have also told the other family that there's no chance of a swap once he moves.

Both mum & I have PoA for him. He has no speech now, we understand him but it's not going to be enough for them to clarify his decisions plus he is getting infections/confusion.

We've had the 'he's not got long' conversation numerous times now and been called as he was unresponsive only to have him respond when we arrive. Can't see him living long anywhere but don't want him to be somewhere he would hate for the last period of his life ( especially if it's too far to visit easily).

OP - I wonder if transfer to a hospice for end of life care might now be more appropriate for your grandfather. Especially as you said you've been told he is not likely to have long left. Might be worth discussing it with the staff on the ward, as if there is a local hospice it's likely to be altogether more pleasant for the last few days than the hospital. This could be a possibility if your grandfather isn't having any more active treatment to make him better, but only having medication to alleviate symptoms.

It's so difficult to know with elderly patients as it's difficult to project the trajectory of multiple illnesses. My thoughts are with you and your family.

Hospice just round the corner from me but think its even less likely. Seems to be massive waiting lists for it.

This really doesn't show up elderly care v well :(

The hospital have been v good this time though after many bad experiences with my Gran and previously with my Grandad.

Unfortunately, IME - it's typical of elderly care in the NHS. Hope your grandfather continues to get good care wherever he is.