any help or advice? re discharge from hosp to care home, and a meeting with social services etc

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hi there, my 89 year old father had a stroke a couple of months ago and has been in hospital since. Spent quite a bit of time in the stroke unit having rehab, then moved to community hospital for further rehab. Now reaching the point we need to decide what happens next.

We the family are sure he isn't safe to come home, as his mobility is very poor and it would only be my 79 yo mother at home. Even with carers coming in twice a day his risk of falling seems huge. He also has dementia. The social worker has asked us to attend a meeting next week to put a plan in place. About 9 months ago the local authority said they would part-fund a care home place, but only up to £499 a week (£200 of which is taken from my dad's pension and other benefits, so they're only putting in £300). This isn't enough to get him into any of the better care homes - in fact I'm not even sure it gets him into any of the ones with dementia units.

Also the hospital want to discharge him asap, and obviously we will be limited to homes where there is a bed free.

I am really worried he's going to end up somewhere miles away, where my (agoraphobic) mum won't be able to visit, and where the care is poor.

Has anyone been in a similar situation or have any advice? thank you x

I don't know loads, but has the hospital done a continuing health care assessment? If he is eligible for CHC funding, then this might help with the costs?

Also I think if there is a shortfall between what your parents can afford and the fees for a home that meets his needs, I believe local authorities can pay the difference but will put a "legal charge" on your parents home (if they own it).This means that your mum can stay there, but when it is sold, the local authority get the money they paid up front.

I would advise you to get visiting some care homes with vacancies ASAP and go to the meeting saying where you want him to go, don't wait for the meeting. IME Hospitals will often keep people if they can see the relatives are being proactive so keep the ward informed.

Also his needs have changed massively since social services did their assessment, so the £499 a week will have to change too, so don't take that as your baseline.

thank you. Yes I agree we need to be proactive - am going to ring round tomorrow and see if there is anywhere with any vacancies that has a dementia unit.
I wondered about CHC - is that where the NHS fund it? It seemed that they only fund up to £105 a week or something, but I agree that would help.
The house thing is worth looking into - I think that's called deferred payments? The problem is that my mum has already taken out equity release on the property and I don't know how that affects things. Also that would presumably leave my mum with nothing to pay for her care from when the time comes?
The whole thing is making me sick with worry.

thanks, you've been really helpful. I thought that - they should reassess his needs, as he needs nursing care really now, not just residential/dementia. I don't know how much that will raise the money they contribute, but I will ask.

Is your dad "pleasantly confused"?, if so a general nursing home might actually be better for him. The EMI units tend to be for patients with behavioural problems - lashing out at other patients, staff - they have higher staff patient ratios to cope, but he'd be a bit vulnerable if he is very immobile.

Def get a list of all the local homes with a dementia unit, and then start researching their CQC inspections, visit them, ask if they can manage your dads level of mobility, and think about whether places will suit him (what does he like to do, if he wanders can he do it safely, can he access places or would he be confined to a few rooms etc), get costs for the ones you like best, and then get on the waiting list for them.

Def get a CHC assessment, and look online for advice on what the criteria are and ensure that the assessment captures your dads needs accurately.

I hate to say this, but while your dad is in hospital, you are in the strongest place for getting him the right help. So the hospital can want to discharge him all they like, but unless you are totally happy with the arrangements for discharge don't accept it. Its hard to tell them that, but honestly, its the time you get the most attention to care needs and things that can take months to organise when someones at home (8 weeks for an urgent ss assessment for my mum when one hospital discharged her with no care) can be somehow sorted out in days when they are bed blocking (last admission they wanted to send mum home on a Friday afternoon, being picked up by dad, with no firm care sorted I refused her discharge, twice daily carers for a month started the afternoon she was sent home on transport)

he is sometimes 'pleasantly confused' but also sometimes aggressive and demanding. The nurses have noted this and mentioned it to me.

I think they are going to assess his mental capacity on Monday, in relation to possible admission to a care home, as he will be vehemently opposed to it (he refused to go into respite earlier this year to give my mum a break).

Is my mum able to refuse his discharge?? Presumably if she says she is not able to care for him, they can't send him home?

Am going to look into NHS continuing care.
I am also feeling angry with my mum, which I know doesn't help, as her poor financial decisions, and unending capacity to stick her head in the sand have made it even more complicated. But will have to just get over that as it's not helpful! thank you all

Yes, your mum can refuse his discharge - especially if she is unable to keep him safe, and herself safe doing so. If you can arrange to be in any meetings about his care it would be good. I find my dad is so desperate for things to be 'normal' that he won't argue for what he needs to care for mum, and is of an age to assume that those in charge know what they are doing.

Good luck with it all redundant.

thank you x

You may find it helpful to get in touch with Age UK - they can inform you of the NHS's and Local Authority's legal obligations. It's good to have a handle on you rights so that you do't get talked into anything if there are other options.

Visit as many homes as you can - you'll know the right place when you find it. Social Services often try and push a certain option on you - usually the care home with vacancies so they can get the person moved in and cross you off their to do list. Don't be pushed into a decision if you're not happy with it. If you need to go on a waiting list for the right home, stand your ground. Sadly, waiting list places come available quite swiftly

there is a home 5 mins from me, (but different county/LA) that I have visited that would be perfect, but they have a long waiting list, so I don't know what we would do in the meantime.

Will have to look further afield and at other options. Thank you all for taking the time to post, it has been so helpful. None of my friends have had to go through this yet as their parents are younger. Yes I have been looking at Age UK and the Alzheimers Society's websites, which have been v useful.

If you have a local carers centre, they may be able to give you some advice on local homes and tell you what to fight for.

Get on the perfect homes waiting list now - these things can move quite fast as people stay on the waiting list though their needs have changed, they've found other care, or have passed away so a long waiting list may be worked through quickly when a place comes up. But talk honestly to them about your dad as some places won't take anyone aggressive for the safety of the frail residents

Get a list of homes from Social Services that they are willing to fund. Make sure his assessment for care and nursing is up to date and accurate, as he is now probably entitled to more funding. Look on this web site for reviews of homes near you. www.carehome.co.uk/care_search.cfm
You can choose a home in a different authority. We have. Get on their waiting list asap. We had to refuse to have Mum home because I could no longer care for her.