What exactly is an NHS nursing home?

[Trebin]

Father, late 70's, has advanced dementia, fractured hip and having been in hospital for 4 weeks, 3 post op they have decided he is likely to never walk again. Physio has been almost non-existent. Mother cannot cope with him at home and hospital say they will discharge to an NHS nursing facility (not a covalescence home as no propspect of improvement). I am confused as to what this is exactly - and is there a cost implication here?

Ss will do a financial assessment, unless he is to receive continuing healthcare funding from the NHS which is like hen's teeth to get.

Do your parents have more than 48k between them in capital excluding their home? If so this will be used to cover the fees, half of occupational pension and all of state pension except about £25 a week can be used if there's no NHS chc funding.

Depends if he’s there’s for a medical reason - so NHS cover the costs
Or they may pay pet of the costs

Not sure I’d want them in a nursing home at present

There are still some ‘Community Hospitals’ run by NHS that take patients for care and/or rehab, it varies throughout the country. Also some areas have NHS care contracts with Nursing Homes to provide longer periods of care where necessary.

Sorry but at the moment the usual processes of financial assessment etc are not applying
Unless this has just changed as far as I know everyone being discharged from hospital is getting NHS funding (‘Covid funding’) to speed up the hospital discharge process. Then social services will reassess down the line and look at financial assessment etc.

Depends on area but relatively unlikely to be a home actually run by the nHs, more likely a private home with NHS contract beds.

So best to ask to confirm but initially no there should not be any cost implication but further down the line he will likely be assessed for contribution or have to self fund completely if he has property or savings over £24500.

(Property not taken into account if spouse is still living there)

Thanks. Obviously the hospital have spoken to my mother so I'm not sure of the details. Mother will be staying in their house, but savings will be above the threshold. He cannot dress, wash, take part in any meaningful conversation, is not continent and now cannot walk without the support of two people, and then only two steps. Is this a 'healthcare' reason?

In its basic forms the difference between CHC funding being awarded or not comes down to is it a healthcare need or is it a social need?

A healthcare need would mean that the patient requires skilled care due to complex health and/ or behaviour issues.
A social care need would mean a carer could learn what to do, but without specialist training being given.

Normally a checklist would be carried out, if your dad passed the initial checklist then within 28 days he would have a more in-depth assessment. The assessment process would look at your dad's health needs using evidence from his GP, hospital, rehab, Social Workers etc.

If you google NHS CHC you can see the checklist and also the DST document that is used during the assessment process.

Normally a checklist would be carried out, if your dad passed the initial checklist then within 28 days he would have a more in-depth assessment. The assessment process would look at your dad's health needs using evidence from his GP, hospital, rehab, Social Workers etc.

If you google NHS CHC you can see the checklist and also the DST document that is used during the assessment process.

Thanks. I've been looking at the CHC checklist over the last 4 years, it's difficult to interpret. I know it is very hard to get over the threshold, but then his ability to do anything for himself has diminshed so much...

I would try phoning up on Monday and asking what the current process is.
You might find that your dad will qualify for CHC without you having to look into it any further.

In my dad's case we had a spectacularly unhelpful Social Worker. I ended up doing hours and hours of research, collected evidence myself, phoned helplines, the whole nine yards. I've heard of other people being awarded it without any input from relatives at all.
It's not worth putting yourself through all the hassle only to find out he's going to get it anyway.

Just as a rough idea, during the assessment you would be trying to show complexity.
Your dad is incontinent, has communication problems and has limited mobility. That could mean he cannot tell a carer that he needs washing and changing, because he has had a bowel movement, so a carer would need to anticipate that. He would then be unable to climb into a bath or stand unaided in a shower due to the mobility issues.

The DST assessment has different domains, the complexity is how the domains are affected/ linked, as per my example.

Unfortunately no DSTs are taking place at present due to the pandemic. The Covid 19 Bill means that all placements (except if pre existing) are funded by the NHS. We are awaiting further guidance on when this will change, which is being determined by the govt.

As someone says above, no DSTs are happening due to Covid. Not sure when that will resume.

From what you’ve said I don’t think he would meet the criteria for NHS continuing care. Overall there has to be evidence of complexity, intensity and unpredictability and really quite severe needs. So perhaps prepare yourself for that but of course it’s impossible to know without knowing all the details and you never know!

But everyone should have the checklist done and DST completed if they score high enough on that.
So definitely insist on that before they say he should be self funding.
But I don’t think the councils will be super organised getting people off the Covid funding so I’m sure nothing will happen in terms of payment very fast.

And yes there has been no end date or time limit given yet on the special Covid nhs funding.

Not sure I’d want them in a nursing home at present Possibly safer in a nursing home with lower proportion of peripatetic Agency staff than at home daily receiving a variety of carers and District Nurses.

He cannot dress, wash, take part in any meaningful conversation, is not continent and now cannot walk without the support of two people, and then only two steps. Is this a 'healthcare' reason? Dressing, washing, walking are "social needs". But associated things such as skin care to avoid sores (if skin is in a bad enough condition), problems taking medication, would be healthcare, though it seems to hinge on whether he's in a stable condition or whether he needs daily nursing decisions.

The checklist just decides whether they'll assess. Google for CNC decision support tool - a large pdf download. You'll need a clutch of "highs" to get CHC funding. It's rather salutary, to see how ill people can be.

Possibly safer in a nursing home... For context, my large city Council says that 5 homes have Covid - this is out of a total of nearly 150.

(I am not an expert - just have experience of this) and from what I understand IF he needs to self fund the costs will depend to a degree on which part of the country you are in, but round here in expensive Surrey if he was fully self funding you'd be looking at £1500 - £2000 per week given the extent of his needs. That's the worse case scenario - the combination of Covid measures and CHC requirements will dictate whether he pays any or all of it, and whether that changes after a certain length of time.

If he does have to self fund anything, they will take into account any savings he has over £23,250 and his income: if your parents have shared assets (eg shared savings) they can only take into account his half of those savings and assuming their home is jointly owned that wont be taken into account at all.

My suspicion is that the 'NHS' bit might mean it is NHS funded with no fee involved and that it is basically a "discharge to assess" facility. This would mean he's there for free while they assess his long term needs and the financial issues are sorted. Sorry to ask this but does he have any underlying conditions? Have there been any discussions about his life expectancy?

Your dad is obviously very frail: how able is your mum to handle all this? Does she have formal power of attorney for his finances or health&wellbeing? Do you? (And do you have them for her?)

Hi OP

Lots of good advice above. We are same-but-opposite atm. MIL is currently in hospital: she has osteoporosis, Parkinson’s and dementia, but the acute illness that took her into hospital was a lung infection, a urinary tract infection and severe dehydration and delirium. That was 3-4 weeks ago. The infections are nearly cured, she is properly rehydrated - but she’s still incontinent and much more physically frail, can’t even lift her head to see people. The nurses are using hoists to move / bathe her.

They’ve said they will give it two more weeks then she will probably be discharged. Medically, they will have cured the things that they can. But they can’t cure osteoporosis, Parkinson’s or dementia. And the care she needs to deal with these is purely “social” - toileting, washing, eating and drinking etc.

Thanks all. The physio made it sound like it was an NHS facility, not somewhere you could choose to be sent iyswim, and he would continue to receive the minimal physio there. No different from the ward she said, so maybe it is a 'discharge to assess' place as suggested. No really major underlying issues. Was very frail before fracture, what he is like now who knows as no visiting allowed. POA sorted. I'm aware they will be liable for thousands and thousands of pounds for care.......but he seems so ill, but there we are.

if your parents have shared assets (eg shared savings) they can only take into account his half of those savings but once they've done their first assessment, it would seem prudent to split any joint accounts - someone described here how their Dad's contribution had been assessed on the basis of half the savings being his, so once they'd spent his share, they went back for reassessment, and the Council assessed half the remaining savings still being "his".

Trebin, it's so hard and such a complex situation.
The best thing that happened for my Nan was that she was referred for support under the local hospice. The liaison nurse there did the CHC form and it was approved.
She did have chronic kidney disease and heart failure in addition to her dementia but it might be worth seeing if that's something your Dad would qualify for. As it would be support for you and your mum too.
If he is very frail and unwell he might be entitled to this support.

My dm stupidly didn’t put df into a care home. She looked after him for three more years. He had complex issues with a break in his thigh bone which they (fucked up and put the wrong pin in) gave physio to him which didn’t work.
My dm refused to put him into a home, instead she had carers come in four times a day, which eventually fell to twice a day.
Df had vascular dementia, hence his original fall. My dB was living at home at the time, so he was there for the mornings and evenings too.
These care homes have ratings, just like schools have Ofsted.
We did think at looking at homes and every HC professional said we wouldn’t last long caring for df. How wrong they were.
I hope he is found a lovely home with great carers

There are nhs facilities that are like convalescence homes, run by nhs staff. Not to be confused with care homes or privately run nursing homes. After I think it’s 6 weeks it will be means tested though.