Funding 24 hour Care at home..

[20questions]

Hi wondering if anyone can advise..
My elderly uncle has dementia and has 24 live in carers which he is self funding (getting attendance allowance and other non means tested benefits). He has funds for around another 10 months before his savings fall below the threshold. He desperately wants to stay in his own home where he has lived for over 50 years. When his funds run out, does the council pay for 24 hour home care, or will they force him to go into a care home or will they pay for care at home and reclaim when he passes away and his home is sold? He lives alone with the carers and has no dependents.

Not 24 carers doh! Meant 24 hours a day carers!

The usual amount that social services will pay for is four care calls per day, single or double handling depending on the client’s care needs.

In some circumstances if the person has continuous health care funding (paid for by the NHS and not SS) there may be more support available, although 24 hour care is rare.

The situation you describe will require your uncle to have a capacity assessment to determine if he can make the decision to stay at home (with carers visiting up to 4 times a day) or go into a care home. If he does not have capacity then a best interest decision will need to be made, which you will be involved with if you are his next of kin, or very involved in supporting him at home.

If the decision is made that he needs to go into a care home environment then SS will review his assets and these will go towards paying for his care.

Best advice is to try to speak to a social worker or social care assessor now to start having conversations and making plans for the future well before it comes to the point where he can no longer pay for his 24 hour care.

As a social worker I have made a case for 24 hour care, - the local authority has to meet his care needs but can argue that they can do this more cost effectively in a care home. They are not allowed to base this on cost alone tho. I still think the 4 calls a day rule is illegal on it's own but there's not much case law. Sometimes an agency doing live in care costs not much more than a care home. If I was your dad's social worker I would first do a Care Act Assessment to assess/prove why he can't be left alone at all, then I'd take it to funding/decision panel and argue that it would cause distress etc if he had to leave his home. 'Which' and Age UK have good info sheets. Be prepared to challenge the local authority

Thank you both for your replies. Very helpful.

I'm afraid I got told clearly by soc services that while live in FT care was clearly needed, 4 daily visits would be acceptable. They give me a budget to cover that and I use it to pay for part of the FT care.

They have to cover what is needed, the minimum to meet needs. No frills but got to meet needs.I still think the 4 visits a day is wrong but I know some local authorities say it. My colleague in Wales has this too. My DF needed social care (Midlands) and I was quoted this by his hospital. But the law states people should be assessed on individual needs, this 4 x day seems to be unofficial policy, it's not law. In my area nurses quote it when people are assessed for Continuing Health Care too. Years ago we used to say people could have a budget for care up to the limit of a care home cost ( here we pay around £750 pw) called net cost budget, but then this was deemed illegal by the courts. Here live in care agencies charge around £900-£1000 pw. Doing it via a Direct Payment was cheaper but that changed after employment law - working time directive hourly rate improvements for care workers.

I'm a sw and in my authority we will search for a care home that will meet the needs and when a hike comes back to say they can meet the need that then becomes his personal budget.

It's based on best value at the time of the search so he could get £600pw or he could get £900pw. We will then fund that much and someone would have to pay the extra if the live in cost was more.

Assuming we assessed that his needs were high enough for a care home. Some people pay for a lot more care privately than we would assess they need.

I'm 38 & currently in a nursing home in the south west. I can tell you in my case my fees, funded by social care is £2200 a week (this includes 6 hours of one to one care daily). Next month I move back to a house, with care funded by social services, not continuing health where the NHS cover fees.

I was given two options, one, direct payments, where I'm responsible for finding staff & become an employer with all the responsibility. I'd have one carer live in 24hours a day, only providing care by day. Her two hour break would be covered by an another carer who would also provide waking night care. Cost, around £1900 a week. Option two, my preferred, is two carers each doing 12 hours, £2400, all organised by social care.

I didn't tell anyone about the domestic violence with my husband (that landed me here) for years for fear I'd be placed into a home like I have been. It's taken a fight, & three years but I almost there now! It's a case, usually I'm told of what's in the clients best interest & cost. The first care package they found came back home came in at £3000 a week & I got declined.

Sometimes, especially if needs will decline nursing is seen as best, but I find the whole confused residents trying to get in my room day & night, the screaming, crying, staff that speak such poor english (I cannot get my heating turned up by a few) so difficult.

I also know my age helped my case, as did me having to move two counties away for this placement, as finding a home to take someone my age without learning difficulties was impossible.

Don't give up, but see if you can cut any costs now without ruining quality of life too much.

I wish you & your family all the best with these difficult choices. K

Make sure your uncle is assessed for NHS continuing care before the local authority assesses his means.
It is possible he might qualify and the NHS would then pay for the cost of his care.

CHC are not going to pay for 24 hour carers if a care home can do the job for less!

We have had a carer for 8 hours a day for DD from 10 am to 6 pm; and that was on the assumption I was there too - it was what I wanted. I did not want people in the house before breakfast. If I had essential appointments, they provided two carers for as long as it took. DD also had 2 carers for four hours every week, to enable me and DH to go out on our own. That was funded initially by Social Services, and later by NHS CHC funding. I knew of people like DD, getting care 10 hours a day, 7 days a week. Someone else preferred carers overnight, so the rest of the family could sleep.

We could have had care at night, but DH wanted some privacy; not people in the house 24/7.

Even all that support was not enough, and we had to seek residential care - which costs far more than the care at home.

So, all this talk about 4 visits a day are just local policies; there is nothing in law. The needs must be met!

There is one other question. I don't know what the current case law is, but people have argued successfully in the past that under the Human Rights Act Article 8, they have a right to a private family life in their community - which means their own home, not a care home! I would say that is particularly true at the moment, where care home residents are subject to far more restrictions under government guidance, than they would be their own home or supported living.