Where to look for medical home care

[DorsetCamping]

Not sure where to start...
DM has several complex health needs and is becoming increasingly frail. Her house is on the market with a view to moving into sheltered housing, however she needs hands on help now.

She has a leg ulcer that refuses to heal, coupled with chronic lymphedema which requires regular attention and strapping. However because she also has RA she doesn't have the strength to pull the strapping on properly. The lymphedema service has given all the advice they can but with the best will cannot offer a home service.

I live 45 mins away and work FT so can't help help on a daily basis (which is what she needs). Most home care she has looked into doesn't included medical care and so we are at a loss.

Even when she moves house she is going to need ever increasing help and so I am desperately trying to help research options.

Any advice gratefully received.

I should add that although she owns her own (very modest) home, she is in receipt of several different benefits so not sure if she would be e titled to any social care?

Sorry you are going through this. Its very stressful and frustrating. i'm sure others with more experience will reply, but I thought adult social services was where you start?

I'd be looking at moving her straight into somewhere with more care, not a sheltered accommodation! Sounds like she already needs further care beyond what a sheltered accommodation provides- which is basically none! In my area, they essentially only have a warden if the person pulls their alarm cord in their room. They dont provide any personal or medical care, help with cleaning or cooking etc. The person is expected to do all that themselves. (might be different in other areas though).

I worked for a private home caring agency, and we had a massive range of clients. Some were for social contact, housework or shopping. Other clients were quadraplegics and had total care - from enemas, to hoisting, bathing, catheters etc. We were fully trained in all. We often had bed bound clients with complex medical needs.

The agency also had nursing staff, and we often worked directly with district nurses. You could try your local social services helpdesk, or your GP to point you in the right direction, but it doesn't sound like something that can't be managed at home.

As an interim she should be entitled to district nursing services to address the leg ulcers, don't be fobbed off.
I'd look at moving her to a care home or nursing home if she's willing, as pp sheltered accommodation won't be enough for long if she is deteriorating.

have you asked the gp whether a community nurse could visit daily too deal with the nursing needs?
Extra care housing is better than sheltered as the care is on site and they usually have communal meals and other bits they help with.
Care agencies vary considerably in what they will and will not do but most people will have 3 to 4 care calls at home before they go into residential care. If she has not seem a community occupational therapist yet I would suggest you request she see one again via go who can make sure she is as safe and independent as possible and advise re care needs too.

Call adult social services for an immediate assessment and her dr should arrange with the district nurse for medical care.

Thank you all so much for your wonderfully helpful replies; sat here in tears.

I won't deny I am exhausted worrying about how to help her. My DB lives miles away so is unable to offer much support.

I am also embarrassed to admit I know very little about the various levels of care homes available. Just assumed care and nursing were one and the same thing (thinking 'Derek') . She is only 72 and seems way too young for a 'traditional'
Nursing home.
Is there a halfway solution? Places where a level of independence is maintained but medical support is available if needed? I am all too conscious that she needs to move sooner rather than later whilst she still has the strength to cope with the change but she is frustratingly stubborn and accuses me of pressurising her when I try and discuss the matter.

She also said the GP told her no community care was available to look at her leg but by the sounds of what you are saying, she is being fobbed off. I will ring the surgery tomorrow and put my foot down.

Contact age uk and look at your dms county council website which should have info. Does she have a social worker? They could assess and advise.
Do not feel embarrassed- it’s something we only get to find out about when necessary!
Loads of wisdom on these threads- no question daft. Ask away. Someone will have been there before! 🌺🌺

She's never had any social worker involvement. What exactly would they assess/be able to help with?
Is it straight forward to contact them?

Sorry, so many questions

If your DM has care and support needs the local authority should provide support to her or you in finding a suitable care service. I would also visit www.cqc.org.uk and put in your postcode and search for care services near you. The CQC are the regulator and inspect and rate all services, like Ofsted.
They publish the rating and report on their website to help you make choices. The reports usually describe the type of care provided. Residential care is lots of support from carers but no nurses. A nursing home provides treatment from qualified nurses. A retirement village provides accommodation and you can purchase carer visits on top. Staying in her own home and getting carers in is another option and you can use a care agency.

She has a leg ulcer that refuses to heal District/ Community nurses should be dealing with this in her own home if she can't get to the surgery herself to see a practice nurse.

coupled with chronic lymphedema which requires regular attention and strapping Again, this should be supported by the NHS - who does it currently?

However because she also has RA she doesn't have the strength to pull the strapping on properly. The lymphedema service has given all the advice they can but with the best will cannot offer a home service this is where social care may come in if it's a daily task she needs to do. Is it the only thing she needs help with?

When you ring care companies are you describing her as having complex medical needs like you have in your first post? Her needs aren't actually that complex, they are pretty standard health conditions that care companies will be familiar with amongst their clientele.

With budget cuts etc district nurses will sometimes only do home visits if someone is unable to get to the GPs themselves, perhaps that's what the GP meant (I.e she didn't meet the criteria for home visits, not that no one would dress her ulcers?)

Either way it sounds like a referral to adult social care would be a good idea for a social care assessment. They may be able to co-ordinate things a bit for her.

You can contact social services yourself through your local adult helpdesk at Shire Hall/County Council. They're really good at assessing needs - when my Nan was poorly, the Social Worker pushed her GP for community nursing, got several benefits we hadn't realised about (attendance allowance for one) and arranged care. Nan wasn't impressed, but I had a young family at the time and was running myself ragged trying to do it all.

It's so hard knowing what's the right decision

We live in a relatively rural area and management of the leg ulcer involves a half hour drive to a central health clinic twice a week. It is not managed by her local GP surgery.

Similarly the lymphedema involves another clinic even further away and her appointments are very random, often weeks apart.

She is in so much pain, that whilst she can still just about drive (although that's another worry) she literally can only walk a few steps.

She is also morbidly obese (which aggravates the lymphedema), has mild heart problems and diabetic to throw into the mix!

whilst she can still just about drive

That's probably why she isn't eligible for district nursing I'm afraid.

If she has diabetes then I'm surprised they aren't a bit more concerned about her leg ulcers though.

Sounds similar my diabetic, 98yr old nan who refused to move from her home, and expected my 70yr old, disabled mother, to visit daily and do everything! Its difficult, and people like their independence. Sounds like she could benefit from several services (I'm no expert BTW, and people might correct me):

Social services: assist with what care options are available, prevent social isolation by checking what clubs/social things there are locally, if driving is an issue now, are there any local transport services available, elderly care groups, get-togethers etc. Also check what benefits she currently has and what else she might be entitled to and generally put her in touch with various services.

Occupational therapist: looks at the function and helping her remain independent. Look at her walking and whether a stick, frame etc might be of benefit. Looks at things in the home and risks, such a rugs she might trip over, would a handle near the step make it easier to walk in, would a long handled shoe horn help etc.

Nutritionist/Dietician: not only to advise on diabetic friendly meals, but also advise on losing weight. Also might advise a high protein diet to help the leg ulcers heal.

District/community nurse: wound dressings, diabetic checks (among other things)

Does she currently visit a diabetic foot clinic for chiropody care? Our area has cut this service except for the most severe, but being a diabetic, she could be entitled to this service too.

Also seeing an optometrist, again, due to the diabetes.

If driving is a safety concern/visual concerns I'd be speaking to her GP if she isnt safe and a danger to others.

My DFs neighbour has similar problems. She gets four visits a day from the District Nursing team for her health care needs. These are funded by the NHS.

She has additional help with making meals and bathing which she has to pay for herself.

We’re going through this.

Contact adult social services. They should be able to help.

Also, look on the council website to see if they list homecare agencies. If not, look at yell.com.

Are you sure sheltered housing is what she needs? Most people in sheltered housing have much lower levels of need than this, even though they are older. If she moves into Sheltered Housing, it may not be long before you are contemplating another move into a Care Home. She is probably best staying where she is for as long as possible to make the fewest number of moves, especially as being morbidly obese she will need bariatric equipment wherever she goes.

You are describing quite an 'old' 72 yr old sadly. As a first step you need to contact Adult Social Services about care needs.

Finally if she is in that much pain, is it really safe for her to drive? Could she safely manage an emergency stop?

Where my dad is, the district nurses won't visit if you can get yourself to the surgery/health centre. However his leg bandaging for ulcers is done by the practice nurses and he keeps it on between visits. His carer will sort it out if the bandage end comes loose, and on the occasions he is down to a single layer, she'll redo that.