Mum told she has to pay for care home but can't go home

[NellyTheCake]

Six wks ago my mum fell and broke her leg. She had an operation to put a pin in it and was sent home after 2 weeks. No care package was put in place.

Within a week she was back in hospital. She'd fallen a number of times at home. She had an infection. And her kidney function was almost nothing because she'd hardly eaten or drunk anything. Her leg was too painful to stand on, so she just sat in a chair all day then went to bed.

Her leg is now in a cast, which it wasn't before. She may need another operation. But she's been told she can not put any weight on it. She has to stay in bed.

Her choices are a hospital bed at home and carers coming in. Or she pays to go into a care home.

Naturally she's scared to go home. She's had carers before after another fall. And they were very hit and miss whether they turned up. It seems unlikely they will cook her meals for her. And she has other medical needs that mean she can need to get to a toilet quite quickly.

So she will be alone at home and unable to get out of bed if she needs anything.

The care home seems the safer option but the social worker has told her she has to pay for this. My mum has just enough money to pay but is worried she won't then have enough to pay the bills for her house. She could be in the care home for a couple of months. And will need ongoing physio.

I'm very limited in what I can do to help. I live 5hrs drive away. Single parent. Self employed, if I don't work I'll have no income. There is one relative around 30mins drive from mum but she works full time and is a single parent. She has helped where possible but her help is limited.

It seems wrong that she should have to pay for a care home when she clearly can't manage without. But I don't know if she's been given the right information and what I can do to challenge this, if anything.

Can she come stay with you?

If your mother has savings about the threshold of £23’500 then she will be charged full cost for her care. This is not the social workers decision, this is set by central government, therefore it cannot be challenged.

When her savings fall below the threshold, then social care will pay. The care home may want a contribution from the family per week. There are non top up fee care homes and cheaper care homes which may suit her budget more.

the social worker will not be monitoring your moms savings to see when she may fall below the threshold. This is something you can do and when she is a couple of weeks away from falling below the threshold, give the social a call and request a review.

Can you make some calls to double check on the accuracy of the information?
I’m sorry I can’t be of any more help, but speaking to the source seems the best way to find out for sure.
It’s a terrible situation. I hope she’ll be okay.
And surely you could find a carer who would cook for her - that seems basic.
Good luck.

What has the social worker said about finances?

Tbh this sounds like a rehab period as she's expected to improve, rather than social care. I would try to speak to the occupational therapist on the ward - they can be really key people. What are the expectations for recovery?

This doesn't sound right at all. I think you need to speak to the social worker yourself. She isn't moving into a care home permanently, just until she recovers. The hospital should not have discharged her without a care package. Maybe speak to PALS as well to get the facts about the care plan.

If she is being asked to pay then it means she has significant savings. What are savings for if not situations like this?

If she has no savings or they are below the threshold then you should talk to the social worker.

The first post is correct. You can also temporarily stop utilities and request to stop council tax (at discretion of the la) does she have a mortgage? You could request a payment holiday. So that should free up a lot of the bills. But yes if her savings drop below threshold then social care have to pay although they then have a say in what the care looks like so if they feel she would manage at home they may choose that option as it's cheaper.

Thanks for your replies.
She can't stay with me. I don't have space for a hospital bed or a ground floor bathroom.

I'm concerned that mum comes across as quite confident and in control. But having been to see her a few times in hospital, I can tell she gets easily confused and isn't taking in all the infomation. She's unable to give me a straight answer about what has been done to her leg and what physio etc she's had.

I agree that this is more like rehab that social care so I thought at least 6 weeks would be covered.

I'll try and speak to the OT today and see what is planned. And what has actually been said.

This applies to people moving permanently into a care home. Not respite or rehab. Unless the rules have all changed recently.

Meant to say - I'm just basing this on my grandma who had several short stays in a care home that she had to pay for from her savings then she moved in permanently and had to part pay.

If she needs rehab is there not a rehab hospital option? That would be free for your mum. Presumably not as it has not been offered but worth asking.

This is written by people flogging a service, but explains CHC funding - continuing-healthcare.co.uk/continuing-healthcare-checklist-and-process/?gclid=Cj0KCQjw39uYBhCLARIsAD_SzMT6cOc_yR-zodUrmAjP5GynwPhJTrSKbQ0iEKr1otDcTe7Hz2QTtjIaAkpKEALw_wcB
They have a link to a checklist anyway which it would be worth looking at in case there is any chance your mum would get a high enough score for CHC funding (is hard to get).

My friend's mum had exactly the same issue, a fall and a fracture. Was transferred from hospital to a rehab/ assessment place and was there for 6 weeks, no charge. Now has carers at home, for whom she pays. Arranged by the rehab/ OT as part of her care package. She has physio at home from NHS. Maybe it is a post code lottery thing?

The leg alone prob isn’t long term enough for CHC but then you’re back to why isn’t it being considered rehab & treated in a health funded rehab centre rather than health and social care.

This is how it works locally - and should be the case everywhere. I doubt it is though 😡

I’d argue for rehab - as rehab is health and will therefore be free. Once you’re in the ‘needing help to prepare food’ etc then you are are in social care (paid for) territory.

If she needs re-ablement care she is entitled to have it funded by the NHS for up to six weeks, this includes care home and independent living extra scheme settings.

www.nhs.uk/conditions/social-care-and-support-guide/care-after-a-hospital-stay/care-after-illness-or-hospital-discharge-reablement/

I'd chase this up with the social worker.

Yes. Re- ablement care. I just had this conversation with a friend last weekend as he had managed to get 6 weeks for his mum. So much better than the standard package from SS. Sadly she can only have 6 weeks so the progress she has made will not last.

It sounds like her care will be temporary - speak to social worker about the financial side and say she can’t afford the care home and her bills. I don’t know if you can ‘challenge’ it but pp is right that there’s a savings threshold. Also re the care company she had before that doesn’t sound normal to me - my grandparents have one and they are good; never don’t turn up and my mum is in v regular contact with the carers and the office. Good luck op xxxx

It maybe that mum was told it was free for 6wks as reablement care, but she hasn't taken in that information.

Six weeks would be better than nothing.

Either mum has got it wrong or the social worker is treating it as social care only.

Thanks for the information. I feel better informed to have a discussion with the hospital now.

If she is only getting 6 weeks, I'd really recommend trying to go to one of the therapy sessions and seeing what she's being asked to do - understand where she's at.

Does she get Attendance Allowance? Apply if not. She has now had a number of falls and sounds as if she needs ongoing help. It does not sound as if she has been given a proper Discharge Plan by the hospital. I do not understand why NHS is not arranging and paying for Short term/Intermediate care until she is actually recovered. Perhaps you could discuss with Age Concern. It is shocking that her current hospital stay has been caused by the failure to provide a proper DIscharge Plan for her last hospital stay. She is in an even more vulnerable condition now.

The 6 weeks is for rehab. If she is non weight bearing it isn't rehab. The rehab period will start once she can weight bear again
She just needs looking after until she can mobilise which is why they are saying it needs to be paid for
Can she move from bed/chair to commode safely with a walking frame? Would she remember not to try to mobilise without a carer present?
If she can manage those she could likely manage at home with aids and a proper care package set up with 4x day input

This isn't true. We had people on the free six weeks who had to use a rota stand to transfer where I used to work and we had one lady who was already a resident who used the free six weeks for extra calls after she had broken her leg and was unable to weight bear. The calls were used to help her dress and transfer using a rota stand and then later (once she was able to weight bear) to walk short distances with her to build her confidence up.

I agree,it sounds like continued care which is free. Look into it some more.

If no-one agrees to pay for her placement, then she has to stay in hospital until a safe discharge can be arranged.

The difficulties with social care is the biggest problem facing the NHS right now - if you cannot safely discharge people, hospital throughput becomes blocked.

I think her best bet would be to be discharged home, and then to pay for carers in addition to the basic package. In a carehome there are always people around, but not always immediately to help a specific individual at any particular moment.

If she is unable to return home because of her weightbearing status I would try and argue that this is a 'health' need, rather than a 'social' need and this should be funded by NHS and not means tested.
It was quite clear cut in my trust regarding this pre covid but is less so now unfortunately.
'Reablement' social services care is no longer a thing in our area either post covid.
It is unfortunately unlikely she will make much progress whilst unable to stand on that leg so it may be that a rehab hospital is not appropriate, however in my area they are being used for that purpose at present due to the fact they are the only 'NHS funded' non acute hospital beds. It is a bit of a mess of processes at the moment so make sure you don't just quietly agree and ensure they clarify what your mum is entitled to.