Scotland; Is social care means tested? Confused after assessment.

[WallyWallyWally]

We're in Scotland.

I have posted about my PIL before. My MIL has osteoporisis, Parkinsons and is en route to a dementia diagnosis. She is very physically limited in what she can do, and mentally she's getting more confused daily. She' starting to struggle with personal care and keeping herself clean. My FIL is her carer - to the best of his abilities, which TBH isn't great. There is no way she can be left overnight or organise food / showers / shopping etc for herself. I understand there is a distinction between personal (showering, toileting, taking medication, getting dressed) and other (cooking, shopping, cleaning). I don't know where overnight supervision comes into this.

FIL needs to have a hip replacement. This will mean him being in hospital for a week, plus at least 6 weeks recovery. I contacted the local council about getting a care assessment done for MIL for the time when he is unable to provide care. After umpteen weeks they have come and done the assessment. According to my SIL (DH and I live abroad) who was there with them, the assessor agreed that my MIL is unable to care for herself but "there's no money to pay for carers" and gave them leaflets for private care companies.

What does this actually mean? Is there an income limit for this kind of social care? My understanding was that in Scotland personal care was free, while things like shopping, cooking, cleaning are not - but they could be provided and charged for.

Unfortunately I don't know what was actually said at the meeting, but I've asked SIL if she can share the report with us.

Anyone got any experience of this?

TBH I suspect that during they (FIL and SIL) have glossed over the fact that MIL can no longer clean herself properly or take her medication correctly, and they've focused on the shopping / cooking / cleaning side of things.

Any advice on any of this?

It is free but the individual needs to be assessed as needing it www2.gov.scot/Topics/Health/Support-Social-Care/Support/Adult-Social-Care/Free-Personal-Nursing-Care. The assessment is key as that determines the packages size which she is eligible for (you don't have to take carers the council gives you btw- you need to read about self directed support when you get to this stage).

It sounds the council ( its actually most likely a new health and scocial care partnership - a mix of NHS and council) have decided she doesn't meet the threshold for a care at home package - i would contact them again to ask.

You FIL also needed to be requesting and getting a carers assessment from the local carers team. This can open the door to things like respite care for him.

It’s free. Get back in touch with the social work department and ask. A sum of money for her care can be calculated that you can use to pay for a private company, if you prefer that to council care which may or may not be available in her area.

I’m going to have to get the report and see what it says. It’s difficult... SIL is possibly the least assertive person in the world. PIL are trying to minimise the extent of MILs decline, and she goes along with it as she doesn’t want to speak out in front of them - while accepting more and more of the burden of caring for them.

If there are able family members around, is the expectation that they will do the care? SIL has her own family and ft job.

Me again.

It turns out that the social care assessment was never actually completed so there is no report. MIL can - barely - go to the toilet, wash herself and feed herself. In reality she struggles with all these things. She can't manage her medication at all. The assessor agreed that she needed general care but that she didn't meet the bar to qualify for funded personal care: the bar must be set pretty low, that's all I can say. SIL asked whether there was any help for when FIL is in hospital and recovery after the hip op: the response was that "there isn't any money for frilly things like that".

So it's privately-funded care or SIL doing it all. The SS woman did say they should apply for attendance allowance (I though they already had) and carers allowance to help pay for private care.

Realistically this is going to involve respite care in a nursing home for at least a few weeks while FIL has his operation and recuperates, isn't it? SIL doesn't have a spare room to move her into and her house is not access friendly at all. He will need carers and will get physio visits as there will be no-one to help him at home. But they won't do anything for MIL I assume.

Any advice? I'm having to tread so carefully here. DH has a very stressful job, and is a bit jolted having spoken to his mum on the phone and she just talked nonsense the whole time. Then FIL basically asked him to "come and help out" while he goes into hospital - we don't even live in the UK and both work / have family. SIL is lovely but so unassertive and passive, and she has her own MH problems to deal with as well as her own family. I am - by nature - an assertive and organised person, but I'm over here and they are over there! Argh.

You're in a bit of a limbo. I'm not in Scotland so I'm talking generally. Either they've done the assessment, in which case you/your mum needs a report and a letter stating the result, so that you can appeal; or they haven't, in which case they need to do it.

To describe care when your main carer is absent as "frilly things" is outrageous. Get advice from Age UK as to whether it's worth complaining. Make sure you keep a record of all conversations - this applies to everything from now on.

Assessments are pretty undignified for the person being assessed. They will usually try and present themselves in the best light and claim to be able to do things better than they can. Family find it difficult too - the way their elder is managing is the new norm, and it is too easy to say "yes" to "can she use the toilet" when what is meant is "she needs assistance. She needs mobility aid/support to stand [which may be provided by the wash basin/toilet roll holder], she is unable to reach behind to wipe herself properly, she cannot pull her pants up properly, she does not always reach the toilet in time, without assistance it may take up to two hours".

Feeding, as in physically getting food from plate into mouth, comes under personal, but not the getting food on to the plate in the first place. But having to be reminded to eat, or to eat something other than chocolate biscuits, or to drink enough, does count as a need.

Try to get hold of the assessment guide/checklist and go through it yourself, preferably with the help of someone who knows the ropes, eg Age UK. Remember "a need that is met is still a need". This may give you enough for it to be worth appealing the result. But in any case will come in useful in a year's time when she has deteriorated and you ask for reassessment.

Councils can barely afford to look after everyone who needs it and it sounds as though the assessor has seen that your SIL is very passive and talked a lot of bullshit to save them actually having to provide the care. You do need to be assertive when dealing with them and brutally honest. I know its not ideal, but either you or your DH needs to take the time to come over and throw your weight around to get something sorted.

Thank you both.

@MereDintofPandiculation I agree that it's outrageous. I spent most of yesterday on a chatline to Care Information Scotland, and both their advisers were shocked at how dismissive the social worker seems to have been. They've given us lots of advice, including insisting that the assessment is done to completion, a report provided and complaining to whoever is senior to the social worker. They've also pointed out the key words to use - that MIL is a Vulnerable Adult who is at risk if left alone. It's fucking ridiculous actually - we, the family, are totally new to this . We don't even know what care MIL needs to keep her safe through this. Even if we have to fund it (and we probably will) - we still need someone experienced to say what kind of care she will need and how to source it.

You are totally correct: they will have presented it all in the best light, and my SIL will have kept quiet so as to not rock the boat or upset her parents. I'm looking at the attendance allowance form now, and I can just see them all shying away from the basic statements like saying out loud that MIL cannot wipe properly after using the toilet or cannot wash difficult-to-reach parts of her body.

DH is probably going to go over. Unfortunately he's a teacher, so his holidays are set and he cannot take time off otherwise. So we really need to get meetings etc set up for when he is there in person - otherwise it's pointless.

Onwards and upwards.

Incase you do find yourselves funding care, we had good experiences with private arrangements from both https://www.homeinstead.co.uk and then, when we needed someone to live in , from https://www.country-cousins.co.uk

The 'country cousins' organisation act as an agency, who put us in touch with people who lived in for a fortnight at a time. We had three who came in rotation so that holidays etc were easily covered.

The agency were pretty helpful in asking what help was needed and not surprised when we had at first significantly underestimated the level of help required

If you are likely to be self funding anyway, I would not spend too much time with assessments and focus on finding help.

Hope it goes well with you.

Can I just add, that even if you do end up self-funding, it is worth having the assessments done so that if things become worse (and they sadly usually do) you don't have to start at the very beginning once again. You need to constantly push to get the help you need.

Even if we have to fund it (and we probably will) - we still need someone experienced to say what kind of care she will need and how to source it. - Yes. It so annoys me when I read on here of Councils that refuse to carry out an assessment on someone who will be self funding. I guess if it goes wrong it's not the Council that picks up the pieces, it's the NHS.

In an ideal world, I would agree that an assessment would be helpful, even essential.

In our experience, though, the people sent to do the assessment just asked my quite deaf, keen to 'please and not be any bother' mother whether she needed any help and were perfectly happy to believe her answers entirely unchecked so that the assessment was not worth much.

Later, when her needs had significantly increased, it was much more obvious just how much help she needed, so that highest rate of NHS contribution and Attendance Allowance were granted on entry to a nursing hone. Cognition rated 10/30. It had honestly not changed since her previous assessment but was just that much more obvious.

It may not so bad to leave any formal assessment til it is absolutely. Paying for carers does have the advantage that you can get on and secure carers within days. Then adjust what us require from a position of experience and understanding.

All the best

So.. the mystery clears a little. It turns out that when the social worker came to do the assessment, she asked MIL and FIL if they wanted her to go ahead and do the full assessment... and they said no! God knows why, apart from their ongoing reluctance to admit that there is a problem.

DH had a good talk with SS this morning, they've agreed that they situation has probably moved on and they will try to get a date to actually do the assessment when DH is over. They'll try to do the carers assessment then as well.

Something that puzzled me though was that the SS said there isn't actually a "report" as such produced from the assessment, it's just an ongoing file that is held by SS. DH pressed him and he agreed that we could have something. Surely they need to give formal notification of their decision whether to provide care or not - or of the care that MIL requires whether it's funded or not?

So did you all get an actual paper copy of a report / decision after the assessment was done?

Cheers for the support, it is great having somewhere to come and offload.