Dementia care after hospital

[Hadalifeonce]

An elderly lady is diagnosed with dementia and severe mobility issues, if the hospital recommends a care home on discharge does anyone know if this is automatically covered by NHS funding?

With my grandmother she went straight to the care home from hospital (we were given a choice of 3 homes). She had her financial assessment done when she was already in the care home. She was liable to pay fees as she owned her own house, had savings, etc. They essentially ran a tab for her so she did not pay the bulk of her bill until her house was sold.

Same here: the Council funded my mother from the moment of hospital discharge, with the tab running up for a long time (over a year I think), while the paperwork and finances got dealt with. After the property was sold, the bill was paid off, but when the money ran out, she was funded by the Council. But as far as my experience goes, you don't have to worry about finding money right now if she requires a care home place immediately.

Thanks, we are getting conflicting info. Some say as the dementia is quite bad, she will be fully funded, others saying we will have to apply for funding, then finally that she will have to self fund. But there are all people who do not have 1st had knowledge.

A financial assessment will be done to determine how the care is funded.

I dont think her care will be fully funded if she owns a property and/or has substantial savings.

Usually adult social care pay for the bulk of care but she may also be eligible for Chc funding which is nhs funding and is not means tested. She should have a social worker allocated so you could ask them.

She doesn't have a social worker yet. FiL has been very reluctant to involve any outside agency thus far. Even the GP has-been very hands off!
It has all come to head today, she has been taken into hospital, so we are hoping this will force the issue with FiL.

It’s hard to say definitively what will happen.

Your mil will be assessed before discharge as to whether she can go home or not. This will depend on things like whether her physical needs can be met (with carers, equipment, adaptations at home) or not, whether spouse / family members are willing / able to provide care (organising medications and ensuring they are taken, providing food / drink etc, keeping them safe / fed / clean/ entertained etc) or not, and her medical condition whether she requires ongoing nursing care or not For my MIL she went into hospital with Parkinson’s, osteoporosis, dementia already diagnosed - but it was severe dehydration / infection / delirium that actually got her hospitalised. Her already poor mobility deteriorated greatly after a few weeks in hospital and despite the efforts of the physios to get her walking etc, it didn’t happen. She went straight to a nursing home.

However, be warned that if social services are told (by FIL for example) that he can / will care for her at home, they will likely jump on this. My Own FIL had to be coached to state clearly that he could not provide the care that MIL needed and that it would not be safe for her to come home, even with multiple carer visits and equipment etc. if he hadn’t done this, she would likely have been sent home - incontinent, unable to walk, completely confused - to be cared for by a well meaning but incompetent carer, and mY SIL running herself ragged to fill in the gaps.

A as social worker will be assigned at the hospital. Are you involved OP? One issue we had was that FIL was the main contact for the hospital and it was hard get info from him and to stop him making unrealistic promises 🙄.

Whether or not she goes to a nh or gets carers at home, a financial assessment will be carried out to ascertain how it will funded. Age U.K. has great info - remember that the situation varies btw England and Scotland. It depends on what assets (property, debts, savings, income) your MIL has.

For care in a care home if she has over £23250 (in her own right or double that jointly with her husband)/a high income and does not meet chc (ontinuing health care NHS funding) she will be self funding. If she owns a property or properties this may be taken into account if she is married it may not as I assume the fil is her husband unless they own other property they don't live in too. You can ask for a financial assessment from your local authority to see what she will contribute towards residential care (or care in her own home) which can be up to full amount and you can ask for a chc assessment - ward will not do this till she is infection free and unlikely to do if they don't think she will meet criteria (you can look criteria online)
Hope that helps

Thank you. They are both in their 90s FiL has a belief that it his his job to cope, whatever the situation, incontinence, waking several time a night, getting more and more confused.
We persuaded him he needs some help a couple of weeks ago, he finally agreed to some night time help as his sleep has been severely affected by her demands. She has now been hallucinating at night and getting very agitated, the carer said this is beyond her expertise acting on her own. This morning MiL could remember what the stairlift was and got so worked up she ended up falling.
Which us what has now caused the hospital admission.
We are reassuring FiL that she will be well cared for, but I am just trying to offer the experience of others re care home and funding, just in case.

Thank you Allie your responses.

All not Allie

Re funding they will take into account assets in her name and half of joint assets. As FIL is still living in the house it will be ignored until he dies/goes into a care home.
She may be released with a reablement package for a few weeks that is NHS funded.
Watch out for FIL and MIL cancelling carers if FIL thinks it's his job. Been there, got a wardrobe of t-shirts.

I don't know if it varies around the UK. We have been told that mum will be funded by the local authority (no property, no savings) but all her pensions will be taken and she will have a £ 30 weekly allowance.

Mum is on a rehab ward at the moment and has been approved for residential care - she has severe arthritis and the onset of dementia.

Oh poor thing, hope she is ok. When she is stable she will see the doctors and the therapists. She should have a capacity assessment to see whether she can make her own decisions about where she lives and agreeing to care or moving to a care home, does anyone have power of attorney. She should have a care needs assessment in hospital to see what she can do, cannot do, will need help with, her falls risk, mobility, everything really they might leave that for a while if she has injured herself. Once they know she will have a financial assessment to see who pays for what, the staff can Carry out a chc checklist but it's not automatic funding, it depends on what complex needs she has and how this affects her.

If she is not safe to go back home then she may needs to move to a carehome, even if she went home with 4 carers a day that isn't always enough. If the plan is she can go home the therapists will visit the house to see what equipment can make it safer.
Who arranged the current carer, is it privately funded.

Are they getting attendance and carers allowance or any other benefits. Attendance allowance is paid to the carehome if a resident is self funding, you can also apply for fnc funding if she has nursing needs which goes towards the carehome cost.

AgeUK have a lot of ionline nfo on caring for the elderly, funding, choosing a carehome, etc.

Hi, FiL has POA, but he just projects his feelings onto her, so he wants her home asap.
The hospital are referring her re dementia, they are working very quickly, which is great.
We are watching and waiting now, telling FiL that she is in the best place, and they will advise of the best way forward, even if that means having to go into a home.
He isn't happy, totally understandable, he wants immediate answers. Thanks everyone.

They get attendance allowance, FiL has funded the carer on a temp basis.
We will see what the hospital day tomorrow.

“Hi, FiL has POA, but he just projects his feelings onto her, so he wants her home asap.“

We had this too. I don’t know how well your mil is looked after by fil but my fil was just not good at it: he just didn’t understand her illnesses and didn’t put things in place to care for her. He would hand her medicine and leave her to take it - she’d hide it, or wrap it up to take later. He’d give her a drink and she wouldn’t remember to drink (which led to dehydration, infection, hallucinations and delirium. Ditto food. Their house was really cluttered and he wouldn’t think to move rugs / side tables / etc to make it safer and he expected her to know to avoid them. He bought a new car but didn’t check she could get in / out of the really low seats. He got a walk in shower installed but chose controls that mil couldn’t operate 🙄. He didn’t check she was cleaning herself properly and she often smelt badly. Her going into hospital was the crisis that finally precipitated change though.

We (well, DH and SIL) convinced him on grounds of safety and keeping MIL safe and as healthy as she could be, he eventually had to admit he could not do this at home. The two things that convinced him were double incontinence, which was going to be hard even with 4 daily visits from carers, and general lack of mobility. And also his own quality of life, he’s in quite good health and still has a life to live.

If it’s thought she would be likely to return home without the need for care, she could be offered 6 weeks “reablement” funded by NHS - not applicable here since it’s already been decided that she needs long term care.

So SS will pay and reclaim from her a figure based on her income and savings, but not including the house because FIL is still in it.

If her income and savings are sufficient to pay for the care home (savings more than £23k) she will be a self funder, and will keep her AA.

If SS make any contribution, she will lose AA.

If her “primary need” is deemed to be medical, she could in theory be completely funded by NHS - “CHC”. In practice this only happens if her needs are so fluctuating and unpredictable that she needs nursing decisions every day. Needing help with feeding, taking medicines, washing and dressing, having pressure sores and incontinence aren’t enough. So apply for CHC, but don’t expect to get it. It’ll be reassessed every year - a depressing process as it charts the decline - but there may come a time when she does become eligible.

As above, about discharge from hospital: from what happened with Mum, I agree about coaching FIL to not budge on this! Despite my sister and I both being very clear with the hospital there was no-one to meet her needs (we live two and five hours away, both of us single parents), they then (without telling us!) pressured a friend of hers into agreeing she could be discharged into his care, with carers coming in a few times a day.

Within 24 hours he had become overwhelmed, panicked, vanished, and had turned off his phone so we couldn't find out what was going on. The first we knew about the discharge was when my mum's neighbours were calling us up saying that she was in a state and alone, and that we needed to 'do' something. Fortunately, the local PCSO stepped in, and got some excellent social workers involved, and got Mum swiftly taken to a local care home, where she remains four years on.

So, that was a long way of saying: even if you are clear with the hospital that she can't be discharged, don't assume this will be the end of it! FIL may get worked on to agree to her coming back. I appreciate that hospital staff have enormous pressures on them, but I hadn't imagined they would do this to my Mum.

Thanks. She is still in hospital, FiL has visited. Although there is still no diagnosis re dementia or anything else, we are making tentative enquiries of nursing homes.
Unfortunately, FiL and SiL are both acting on their emotions, and have agreed between them that the best place for her is at home!
Luckily DH can be very pragmatic in these circumstances as has reminded them that the hospital won't discharge her until they are happy that she doesn't need to be in hospital, and that she has adequate support for that to happen.
FiL's main concern is if she gets in a distressed state at night, and he isn't there for her. I assured him that she is not alone as there are always staff on duty; also that she never remembers these episodes, so isn't upset by them, he got quite upset with me, because he gets upset when with her, and she is distressed in the moment, that she must remember them.
It's very difficult to reassure him as he projects so much, and feels this would upset him, so it must have the same effect on her.
He has accepted that she won't be discharged until at the earliest Tuesday.
Thank you all for the benefit of your advice and experience. I will be signing off now. Cheers

You say FIL has POA for your MIL. Is there a back up POA in place?

If FIL is in his 90s what happens to MIL if FIL passes away?

Luckily DH can be very pragmatic in these circumstances as has reminded them that the hospital won't discharge her until they are happy that she doesn't need to be in hospital, and that she has adequate support for that to happen.

This is not accurate. Hospital will be desperate to discharge to free up a bed. My MIL was discharged from hospital to home, with dh waiting for her there. She couldn't remember her home at all. She couldn't walk. Her bedroom was upstairs and the only loo downstairs.

Dh had to ring 999 for her to be readmitted to hospital. It was traumatising.