MIL may need care home - in need of advice

[Lottapianos]

MIL has lived alone since FIL died last year. She is in poor health (heart failure, uncontrolled type 2 diabetes, poor mobility). She has carers visit 3 times a week to do housework, cooking, groceries etc. Her SIL lives down the road and looks in on her most days. We live 5 hours away

Her SIL phoned my DP this week and said that she is worried that MIL can no longer manage alone - said that her mobility has become even worse, that she looks grey and very unwell and thinks she needs 24 hour care. SIL used to be a professional career and is v level headed so we're definitely taking this seriously. DP is planning to visit next weekend to find out more

Obviously we will ask MIL what she would like to happen. In the past, she has talked about wanting to move into a care home, but also sheltered housing. We have no idea what to do next. Do we start contacting care homes, arrange visits if they have vacancies? Do we need to contact Social Care for an assessment? She owns her house and has fairly significant savings so would finance her own care. Just in need of any guidance or words of wisdom. Thanks

I'd be looking for a residential bed in a nursing home, so when her needs escalate she can switch over to nursing.
If the home identify she has nursing needs when they assess her they can apply for FNC funding, which might take a bit off the weekly bill.
Have you / DH got POA?

Yes, we both have POA. Thanks x

If she looks grey and unwell she needs to see a doctor before any plans really.

It's a big jump from a few visits a week straight into care.
I'd see if a package of care 2/3/4 calls a day might work first.

I’d be worried that her funds ran out before she needed nursing as opposed to residential care in which case Social Services might want to move her to a cheaper home. But then, if she starts with a care home, she may have to move to a nursing home later.

Nursing homes seem to be mostly full of residents with dementia. She might get more chance of company in a care home.

The suggestion of moving to a daily rather than weekly care package seems a good one. GP assessment before you do anything.

Apply for Attendance Allowance if she’s not already getting it. If she’s self funding, she can still get it in a care home, and it helps a little with the fees.

'The suggestion of moving to a daily rather than weekly care package seems a good one. GP assessment before you do anything.'

Yes, sounds like a good plan. Thanks all

'Apply for Attendance Allowance if she’s not already getting it' - yes, she gets it already

We’ve had two self funded relatives, both with dementia, who eventually needed 24/7 residential care.

In both cases we made the decision ourselves when we thought the time was right (among other things, when both were honestly not safe to be left alone at all any more, even for half an hour.). We looked at many care homes before deciding.
In the case of my mother, the (excellent) care home we finally chose, did ask for a visit by social services - presumably to check that a care home was actually needed and we weren’t just ‘dumping’ her. But it was very much a tick-box sort of exercise - it would soon have been obvious to anybody that her dementia was pretty well advanced.

We did spend a great deal of time in both cases, checking out various care homes before finding what we thought were the best for them - not necessarily the most expensive, I might add!

Two things I’d say when looking - reject any that ask you to make an appointment for an initial look around. A good home should be happy for you to come - except at mealtimes, when staff are always extra busy.

Also, personally I’d be wary of being influenced by very smart, ‘Homes and Gardens decor - IMO it’s often there to impress relatives who are choosing. IMO cosy and homely are more important. One such we looked at had very H&G decor in the public rooms, but the room they were offering was totally unsuitable for my DM - very small, and down a maze of corridors (it was a converted hotel and the room had the presumably original avocado bathroom) - she’d have been permanently lost.
Yet they were perfectly willing to take her.

Another thing, do the staff seem reasonably cheerful? An aunt of dh once put herself into a very outwardly flash and expensive care home for a month, while her helper was away.
I visited her there twice - the staff were all surly and miserable, the atmosphere was not friendly or welcoming at all.The aunt absolutely hated it and couldn’t wait to get home.

I know all too well what a worrying time it can be, so I do wish you all the best.

Unless your MIL lacks mental capacity its up to her what happens to her so these decisions should be driven by what she wants and where she wants to live. Absolutely support her in any applications/ appointments etc, but surely you will be waiting to see and speak with MIL before you do anything at all.

id ask SS for a review first.

'but surely you will be waiting to see and speak with MIL before you do anything at all.'

I made this very clear in my OP

When it comes to paying for care it's really worth looking into purchasing an "immediate needs annuity" which will pay a big share of fees and prevent her savings or income being insufficient to keep her in a place you trust. My mother went into resi care three years ago because of dementia and has been stable (with some ups and downs) since, I used a chunk of her savings to buy the annuity and she shows no sign of any physical decline. It's highly likely she'll be still going in two years by which time the cost of the annuity will have covered the costs of its purchase and will continue until she dies. It's such a relief to know that this part of her care is in place and there will never be a point where her savings have run out.

Nb do speak to a financial advisor who specialises and is qualified to advise on financing elderly care- it was entirely the right thing for my mum but may not be for others, especially if she has a short life expectancy.

OP’s MIL already has heart failure, so her life expectancy certainly won’t exceed her funding. I would get an urgent medical assessment before making any long term care commitments, as the SIL described her as acutely unwell and looking “grey”, which suggests she may have deteriorated towards end stage failure. The discussion may turn out to be about end of life care in home versus hospital, rather than a longer term residential care placement.

when deciding on an immediate needs annuity, look into the statistics of survival in care homes, which are that the average care home stay is 3years and the average nursing home stay is 1year. Of course many people survive longer than that, but there are also many who survive less. A friend bought one for his father, who died 8months later. So as @Mxflamingnoravera says, worth looking into, but that’s not an automatic recommendation to buy.

a reason why annuities for care homes are so expensive is that some people will survive very many years, so an almost unlimited liability for the annuity provider.The new care cap may mean costs come down.

meredint is quite right, the annuity is right for my mum, but won't necessarily be right for yours. I put it here so you can consider it as I was totally unaware of their existence when trying to figure out how my mum's care would be funded.

Either way, you should not be in a position that you have to pay for care, unless you want to and can afford it. Otherwise it should be paid for by her estate or the local authority if she is under the savings cap.