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Elderly parents

To ask what options are for elderly mother coming out of hospital, having lived independently but now needing more care

5 replies

loveyouradvice · 20/08/2019 10:42

Hi all

This is a new world for me.

Elderly much-loved mum has been living independently, with us popping in with food and drink three times a week, though in early stages of dementia. She has now just had a big operation and been in hospital almost three weeks.

She is clear she doesn't want to go into a home but does want to live nearer to us. She will need carers going in, as well as us and ideally someone on site who checks if things are okay. She hasn't been spending any money for ages so has enough to fund whatever is best for her and could buy or rent.

I imagine this is sheltered accommodation - or something else?.

I've no idea how this works - can anyone who is more knowledgeable give me an outline of how the system works, whether there are other things I should be looking at and where I look. And what sort of levels/options there are

Basically - anything you think would be useful to me, as a total innocent who's about to plunge in fast! All advice very gratefully received.

(I have posted this in AIBU as well, to reach more people, but suspect I will find far more knowledgeable people on here - thank you so much)

OP posts:
MereDintofPandiculation · 20/08/2019 13:16

First thing to sort, while she's still in hospital, is a "re-ablement package" - up to 6 weeks of carers, funded by NHS, whose job is to get her back on her feet and able to look after herself. Ask to talk to the hospital Discharge Team. Remember in your dealings with them, their focus is to free-up hospital beds, so be very firm in your advocacy for you Mum.

You can have carers in whether or not you're in sheltered accommodation. So you might want to scrutinise carefully any sheltered accommodation that is available. Firstly, there's very little sheltered accommodation available for rent, most of it you have to buy. Secondly, it seems expensive for what it is - a flat in a private sheltered accommodation block isn't that different in price from getting a fairly standard small house, at least in our area. On top of that there is a weekly or monthly charge for services (even if you don't use them); and finally there are services whose costs aren't included, so you have to pay extra. Thirdly, once the flat is no longer needed, it may prove difficult to sell. So do your research very carefully!

Assuming your mother is moving into a standard house (not because I'm advising this, but it's what I know with my father) - you ask for an assessment of needs from social services. They decide what she needs, then assess her financial means, and ask for a financial contribution (up to and including the whole cost). The value of the home isn't taken into account in the financial assessment, but savings are.

It's worth doing this step, because it also gives access to advice, and things like grab handles, pressure cushions, zimmer frames, "perching stools" are on loan, and come at no cost. You may also have a meals on wheels service in your area (40% of councils still have these) which will deliver a hot meal daily at lunch time (with choice of menu) and optionally a sandwich pack for tea. Or you can buy in re-heatable meals, there are several specialist suppliers besides the obvious supermarkets.

As far as the house itself is concerned, make sure that, if needed in the future, you can have bed, kitchen, and shower/toilet all on the same floor, preferably ground floor. So make sure that if there isn't already a ground floor wet room, you can put one in.

If she can still get out and about, it's good to be near a bus stop.

If you go for a stairlift, consider a reconditioned one. Most stairlifts aren't used for more than a couple of years, so a reconditioned one is a good option, and a lot cheaper.

There's a lot of useful technology about. LAs usually operate a alarm call service - elderly person wears a pendant, if they fall, they press the button, call centre talk to them, find out what's wrong ... but it still requires you to be on call to help them get up. I haven't found any service willing to pick up fallen elderly - except 999, for whom it is a low priority, so expect a wait of many hours.

You can get devices that check for movement - sudden movement as in a fall or collapse, whether someone hasn't moved for many hours, or whetehr someone is about to head out of the house at 2am. Movement detectors near front door can remind person to lock up as they go out. Security cameras, so you can see what's happening, Look into the whole "internet of things" for what would be useful in your case, eg remote turning on of central heating.

If you have carers coming in, easiest is to have a key safe, so carers can type in code, release front door key, and let themselves in.

If medicines are a problem, they can be delivered already sorted into daily doses (originally in a dose-ette box, now pronounced and often spelt dosset). Talk to the pharmacy.

If you haven't already, get Power of Attorney for Financial affairs, and for Health and Welfare. Has to be done while she still has capacity. You can't use the H&W one while she has capacity, but the Financial one can be set up so that you can use it - Dad manages his daily bank account, and I manage his savings account as his attorney. And if she's OK about it, write a letter for her GP (also dentist and optician), signed by her, saying they can talk about her medical affairs with you.

Finally - about yourself. You have no idea how difficult this can get - it's the relentless, on-call 24/7 aspect, you never have any down time to completely relax. So you need to protect yourself and your own sanity, else you'll be in no state to help anyone else, Save yourself for the things that only you can do - help with decision making, researching options, emotional support, and just being a loving daughter. Everything else can be outsourced. So don't say "Oh, I can easily push a lawnmower round her lawn once a week, and it won't take me long to mop the kitchen floor and run the vacuum cleaner around" - it all adds up. Get a cleaner and a gardener. And a hairdresser who will visit the house so you don't have to take her. And so on.

Your aim is to postpone as long as possible the time when a visit to your Mum is simply a chore.

thesandwich · 20/08/2019 14:00

Brilliant advice from dint hospital will have a discharge team and social worker who will facilitate moves. Step down care to a rehab type hospital may be an option- try and find out what options are available from hospital. Or temporary stay in a care home- do look at what options are for physio, key to restoring independence.
Age uk are a great source of advice. Our local authority website was v useful. Carers uk are v useful too.

hatgirl · 21/08/2019 22:24

Agree with MereDint on pretty much everything.

It's rare a move to sheltered accommodation is a positive step for someone on their own with dementia. It can work well for couples where one part of the is much more able than the other, or for people who don't have dementia, but in your kind of situation it just becomes an expensive (and disorientating) sticking plaster.

Far better to adapt their own home as much as possible or make the tough decision to look at 24 hour care whilst she still has some say in what she likes and dislikes. The second option is only possible if she has funds available to choose somewhere earlier than the crisis point social services will agree to fund at.

SnuffleBadger · 21/08/2019 23:08

I work in elderly care for the NHS.

Great advice from the previous posters but I would be wary of too many moves between settings as this can be detrimental to someone with cognitive decline.

Definitely ask about services available in your area to support your mum to transition back into the community. Provision is different depending on where you live but push the discharge team to outline all the options available.

As far as accommodation I would explore whether there are any extra care settings local to you. Extra care bridges the gap between the community (either own home or sheltered) and 24 hour care. These settings consist of apartments that are often rented. Your mum would have her own apartment but there is a care team on site 24 hours a day. Care input is care planned in the same way as in the community where carers visit a set number of times a day but a higher level of support can be offered than in the community and many are able to offer some support overnight. There is also usually a full programme of social activities and amenities such as shops, restaurants and hair salons on site. In my experience these settings support people to keep a home of their own with access to support as required.

Please try and push for a timely discharge for your mum to give her the best chance of regaining her independence. Prolonged hospital admissions for patients with dementia cause functional and cognitive decline that can be difficult to overcome.

loveyouradvice · 22/08/2019 13:38

thank you - and wow what useful advice... really appreciate all your time and trouble to share your voices of experience with me.

Now off to do my research!

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