Discharged from hospital to a carehome

[mrshoho]

I'd be grateful for any advice. My dm 83, spent 3 weeks in hospital following a pulmonary embolism and was recently discharged to a nursing home under the 4-6 week NHS agreement. She is able to sit in her chair but needs assistance to get in and out and she can't seem to walk any steps at all. She is eating small amounts and has lost quite a bit of weight. Her memory now seems to be limited to only the moment she is in. In the hospital up until the day before she was discharged, she was needing supplementary oxygen but since going to the home she has not had any. I saw her yesterday and she appeared comfortable and calm which was reassuring but it seems obvious to me that remaining in a nursing home would be the best option now.

We have received a financial assessment form from the LA to complete but I'm confused as to who will do the assessment to determine what level of care is required. Is this something the carehome will do? It is a lovely place but we are finding it difficult to speak to someone to find out what the longer term plan is. Should we ask if a continuing NHS care assessment can be done? She seems reliant on full support for all her care needs now. My parents own their own home but my Dad is living there so I understand they won't need to sell their home. They have savings of about £26k altogether although the majority is held in my Mum's individual bank account. We had applied for attendance allowance but she was then admitted to hospital shortly afterwards so I wonder if we should contact them to cancel the application now? Would the LA say she needs to return home after the 4-6 week period?

Usually Social Services will do the assessment, but at the moment your mum is on a “reablement” package, the purpose of which is to get her to a state where she can move home and to assess what long term care she will need. So they will be recording what help they are giving her in order to recommend to SS what she needs long term.

The LA won’t say she’s needs to move home if the assessment is that her needs can’t be met there.

I think anything in her individual account is likely to be regarded as hers.

My gut feeling would be not to cancel the AA application yet, wait to see what happens. But you won’t get AA if the LA is contributing to nursing home fees. And you have a duty to tell them if your mum is more than 28 days in hospital or goes into a care or nursing home.

You can ask for a continuing NHS care assessment, but it won’t be awarded on care needs, only on nursing needs. If the LA agrees she is best in a nursing home, you’ll find that they will initiate the assessment.

You’re right that the home won’t be included in the assessment if your dad is living there.

It sounds like your mum has been discharged under the 'discharge to assess' process which essentially is about getting people out of acute hospital beds as soon as they no longer require medical treatment in hospital, and allow the things that used to 'block beds' and slow down discharge such as social care assessments, waiting for equipment etc to be waited for in a different setting.

This 4-6 week period is funded by the NHS and the local authority will have agreed to have carried out their social care assessment within this timeframe. It is standard procedure for NHS continuing healthcare eligibility to also be considered during this assessment period.

It's likely they will give her a couple of weeks to settle and for staff there to get a good picture of her needs before you are contacted about the social care assessment.

If there is an indication that she may be eligible for fully funded continuing healthcare then the first stage of applying for this will be a checklist completed by a social worker or nurse. You will be told what the outcome of this is but ultimately unless your mums care needs are particularly complex, unpredictable or intense it's unlikely that she will be eligible.

The social care assessment can then be completed and the social worker completing it will recommend what kind of care and support they feel your mum needs at the end of the discharge to assess funded placement.

Does anyone have Lasting Power of Attorney for your mum?

Thank you both for this. So we can complete the financial assessments and the carehome and social services should sort out the needs assessments. I along with my brother hold lasting power of attorney for health and financial decisions. It has been really frustrating though as the hospital did very little to keep us informed of her treatment and continued to take what my Mum was saying despite the obvious dementia. We told them from day 1 about the LPA but we had to continually ask for updates and were sometimes surprised with procedures they had carried out based on my mum's agreement. It is similar at the home but some of this could be that she has been in isolation since arriving. We are hoping to find out what physio and other therapies will be given if any? The staff appear very kind and friendly I thought a meeting with the family and the manager would be arranged. We feel like the annoying family having to keep asking for information!

I wouldn't worry too much about the financial assessment forms at this stage, whilst it's very organised of the local authority to have sent you the forms already they are skirting on the edges of lawfulness in doing so unless you requested them.

It won't have been done deliberately it will be an automated process initiated when the local authority has created a record for your mum and someone has made a presumption that she will most likely require a financial assessment at some point.

From what you have said I would imagine she is under the threshold to pay the full costs of her care so the financial assessment will just be to determine what contribution she may need to make to her care, wherever/however that may be provided in the future.

My advice would be to give the care home a photocopy of the LPAs for her records.

In my local authority Discharge to Assess social care assessments/CHC assessments are usually taking place at around 2-3 weeks post discharge from hospital (no earlier due to 14 day isolation periods at care homes) so if she hasn't been there that long yet expect a phone call to discuss it reasonably soon.

Thank you Hatgirl. This makes sense as before she was admitted to hospital I had been in touch with social services to ask for a care needs and financial assessment. We had been using private carers twice a day but finding that more care would be needed. She was also meant to have a home visit from the memory clinic to assess her dementia and we have been asking if they can do this visit at the home? She hasnt got a formal diagnosis as yet only that the telephone screening showed moderate to severe back in June. Things seemed to have changed so much this year I find it hard to believe. That also makes sense about the isolation period when she entered the home so I expect we will hear further in time.

though as the hospital did very little to keep us informed of her treatment and continued to take what my Mum was saying despite the obvious dementia. The health PoA can't become operational while she has capacity, and capacity is on a decision by decision basis - she may have capacity to make a decision about whetehr she want tea or coffee, or whether she wants a particular treatment, even though she might not have capacity to make a difficult financial decision.

If anything I say contradicts hatgirl - go with hatgirl.

I've been through this for both sets of grandparents (LPA for health and financial). Make sure you bring the discussion back to health (CHC) and care (LA) needs before you fill out any sort of financial assessment / let them start discussing money. Age UK are brillant in offering advice and support. All assessments (CHC checklist, full CHC DST if needed, FNC assessment for nursing care, LA care needs assessment in that order) must be complete before the resident / family starts paying / financial assessment completed (even if this goes beyond the 4-6 weeks funding - the CHC and LA must still pay) and its not uncommon for either misunderstandings or blatant lies to be told to the family in order to get them to start paying. Feel free to DM me if you want to discuss further / want further resources. I'm a lawyer and I found the process very difficult. It was only happening upon an excellent social worker that wasn't scared of the system who confirmed that our reading of the documents was correct. Have a look at the Hospital Discharge Policy and Age UK guides. There's also a great guide by Caretobedifferent. Basically Google everything, become familiar with all the abbreviations and dont be scared to challenge the process. It wasn't about the money for us but the fact that their care needs were getting overlooked in the rush to get us to pay. They are now all on full CHC.

Oh and make sure you attend all meetings and request a copy of the medical records if the CCG request a full DST after a positive CHC checklist (through the GP surgery....which may have changed because of her new address). I turned up at the care needs assessment without invitation (with LPA ready in bag if needed) and rather than offending the social worker, it actually brought to light a whole load of issues which allowed the social worker to go into the DST and challenge the CHC that actually there needed to be full funding. There's a lot of politics about funding in the background to all these decisions between the CCG (NHS) and LA but you can have a vital input. Do not leave it to the care home as they are run off their feet at present and make sure you make notes on your visits to your Mum as these proved invaluable when the care records didn't back up the deterioration / specific examples that we had seen. This is even more important at present where assessments are still mainly being conducted on Teams. Make a note of all conversations, get things in writing over email rather than phone call and as awful and cyclical as it sounds do not take things at face value. My mum really struggled as she just wanted to be a daughter and the system is flawed but ultimately ensuring the process is followed through properly means your Mums true needs will shine through rather than being rushed and placed in the wrong setting for her needs.

My friend was discharged to a nursing home at the start of the pandemic. His social worker, who was fantastic and met with my friend and myself to decide the best plan. As it was clear he couldn't go home. Then the council contacted me to do his financial assessments. Which was difficult as I had very little idea about his finances.

Thank you so much for this invaluable advice. I will certainly take on your points and read further around this whole situation. It does feel at the moment that there is not one specific person within the various systems that is looking after my Mum. Social services said she had been allocated to the early intervention team when I phoned but no-one seemed able to give any clear information about the next steps etc. We think she has been placed under a temporary GP linked to the home but are awaiting further information. I will email the financial assessment contact tomorrow and ask if this should wait until the care assessments have been completed. This is the letter we received and as you can see it gives a date of 31st August for all forms and supporting evidence to be returned.

Hi OP, yes you will tend to find that there isn't one person responsible for the entire process. There will be a social worker but they will often refer to 'health' correctly being outside their remit (they mean the CCG) so if I were you, I'd ring or email the LA and ask them where they are up to in the care act process, ask them whether a checklist has been completed by the CCG (they have a direct line to them and you should have received a copy if so). If not, ask them to do one (no harm in doing so) and that you will be filling in the financial assessment after these have been completed. Follow it up with an email and then wait for the system to take over.

And when you get the checklist make sure its all correct. The care home in my nans case put a new nurse into the interview with the CCG and even the social worker was astounded she had scored negative. When we checked it had been done on things like 'has she actually had any falls' rather than the risk of those falls (which were being well-managed for the very reason that she was in a care home not at home). We got a new checklist completed that day and although its hard to keep having the confidence to challenge the experts, you know your mum as well as them (if not better) and the process is designed to be patient centered and for the patient to have a key voice (with a LPA and a loss of capacity thats you) so push them to keep you fully informed. Wishing you all the best with it x

Thank you so so much

Any monies held in a joint account will be divided according to the no of parties to the account. If it's in their two names then they will take half as being her assets. Anything in a sole account they will take the whole amount as being hers.

Hello again I'm just coming back with an update as things are slowly starting to happen. Social services came and met Mum and myself yesterday. He appeared to agree that nursing home residential care was needed and indicated that thiscis what his report would show. I also had a call from our CCG yesterday apologising that my Mother had somehow slipped through the net and they would be doing the check list ASAP. They called today to say the checklist has been done and it has triggered a full assessment. It was quite hard to understand on the phone but I believe she said this will be a joint offer with our local authority? There is a meeting next Tuesday to which I've been invited to join remotely so hopefully I'll get a better idea. In the meantime my Mum had her assessment with the memory clinic last week and was diagnosed with severe dementia and alzheimers. Her short term memory and awareness of her surroundings has completely gone now and she's so helpless and dependent as unable to even use her call bell. Feeling very lonely now as I know I've lost her permanently and all I can do now is be in her corner to ensure she's comfortable and safe.

Its a horrible and isolating time isn't it OP. Is it the DST you have even invited to attend? If so, have a Google of the Decision Support Tool which you will be invited to contribute your thoughts to. I focused too on being there for them in any way I could as the LPA. Best wishes for it all x

Thanks Vesper, yes nothing prepares for having to go through this. I'm indebted to those wonderful carers who make such a difference by their little acts of kindness. I'm embarrassed to say I really don't know what the meeting is but I do know it will be with the NHS, LA, nursing home and us. Her accent was very strong and I had to ask her to repeat it twice but still couldn't understand. I think she said they gather all the information that then goes to a panel for a decision so maybe it is the DST. I will have a read about it.

Thanks and for all who are enduring or have endured this awful time.