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.

Has your mother had any investigation into the cause of her falls?
You mention confusion, my MIL was confused and suffered several falls. The worst one was in Spain, she’d fallen once again, a friend of my in laws was concerned and persuaded my FIL to bring her home and take her to her doctor.
The confusion was in fact vascular dementia caused by a series of small strokes, the cause of the ‘falls’.

Ring up the hospital and speak to her social worker

You're not getting the full story from mum and you've some worries that can be addressed

I agree with many others.
By the sounds of it this is rehab!
She needs a rehab ward or rehab placement which is paid for by NHS.
Chat to occupational/physical therapy with your mum in the hospital regarding what the long term baseline is likely to be.

Enablenent care is arranged by the NHS as part of a discharge package. It is not means tested. It sounds as if she should not have been discharged the first time without this package.

I would call the hospital and ask to talk to the discharge co ordinator. Express your concerns and be factual about what your Mum can and can’t do.

Ongoing (Continuing) care is under Adult Services and is means tested. Age UK have a really good guide on their website.

If she's unable to go home & they need her out of hospital then she may be transferred to a bed in a care home as a rehabilitation option but nhss hould pay for 6 weeks for this. Happened to my MIL , she did end up staying in the care home actually & paid for own care once she/we had made that decision.

Care home beds are often booked by NHS for rehab purposes.

I would ask about a step down bed. If she is medical well then this would be an option

Slightly different tack but if you haven’t already got POA them try to get both I.e. Health & Welfare and Property & Financial affairs.

The POA will make it easier to get information direct from HCP/SS and to advocate for your Mum.

and while all this is going on, sort out Power of Attorney for both health and finance if you haven’t already. Hopefully the confusion will just be because she’s overwhelmed, ill and a bit scared and anxious, but if it’s the start of something more profound you want those in place asap.

If carers were booked to provide meals but didn't then you should be straight on to the care company/LA and complain. That's one of the core reasons for having them!

I’m another saying this is rehab and should be covered by the NHS for 6 weeks - mum may not be getting the full story - I’d suggest you speak to the discharge team at the hospital

I've had a long conversation with mum's OT.
Because mum is non weight bearing, it's not considered to be rehab. She falls into the gap between being medically fit to be discharged from hospital but unable to be allowed to go home because she wouldn't be safe.

However, the OT has spoken to mum this morning and it seems like mum has agreed that a care home will be the best option. The OT has given her (and me) more info on timescales and what happens next.

It's not ideal but we don't seem to have any other option at the moment.
The OT has also asked for a call from the social worker because she wasn't happy about the way this has been handled.

Thanks for everyone's help with this.
Social care is such a mess and trying to make sense of it all isn't easy.

For those who mentioned Power of attorney. We applied for it at the end of April....it's still being processed.

I'm still not sure this is correct, my mother was most definitely non weight bearing as she was in a wheel chair and she had a 6 week free care package.

Will the care home provide any sort of rehab? What's the long-term prognosis with her leg - I take it she's to be non weight-bearing until it heals up a bit and the infection clears, but what about after that? The worry here is that she goes into a care home supposedly on a temporary basis and then becomes deconditioned, which happens very easily with elderly people if they don't get physio or exercises, and loses so much mobility that she can't go home. It sounds to me that if she's not going in specifically for rehab then she probably won't get any unless you push for it. It is very very common for elderly people to go into care homes for what is supposed to be temporary step-down care and then they lose their independence and stay there.

I've been told by the OT that mum will be moved out of bed at least once a day. She has exercises that she needs to do.
She will then be re-assessed in about 4wks to see if she can put weight on her leg.
At that point she will be eligible for 6wks free rehab care.

What I don't understand is this. If she was weight bearing, she could go to a care home, they'd get her out of bed and moving around. And look after her other needs, food, hygiene etc. And it would be paid for as rehab.

But she can't get herself out of bed, the care home staff will have to do that. Otherwise she will be getting exactly the same support. Moving in and out of bed, hygiene, food etc.
So why is one rehab and the other isn't? I'll be having that discussion with the social worker, who's scared my mum so much talking about money, that mum would rather come home.

It is very very common for elderly people to go into care homes for what is supposed to be temporary step-down care and then they lose their independence and stay there.
This happened to my dad not very long ago. And mum is scared it will happen to her. I've told the OT about my dad's case and she has noted it as something to be aware of.

I'd definitely keep questioning it OP. Age UK site was invaluable when I was going through similar.

But... that doesn't make any sense! If she's got exercises and is being sat out and will be reassessed, that's rehab! They sound as if they have put her in the box marked 'no rehab potential' in order to discharge her, but are either in fact giving her a sort of crappy rehab as either a not very good attempt to improve things, or as a sweetie to throw at her to stop her asking for more funding or input.

My experience of the medical team and the social worker when my mum was being discharged was that they spoke 2 completely different languages. It was almost impossible to marry up what the two teams were saying. The discharge I'm afraid was disastrous, though we got a good outcome in the end; only because my sister went absolutely postal on the entire system. She saved my mum.

I fostered a dog for very elderly chap who wasn't weight bearing for 5.5 weeks, after leg operation. He went to rehab not Care home. Back home 6m ago, now.

No-one can keep your mum in a care home without her consent. It sounds like she has capacity to make decisions for herself, even if they are unwise. Push for rehab and ensure this is active rehab ie plan for regular physio when the break has healed to get her weight bearing again, physio in to assess equipment at home afterwards plus care package.

How old is your mum? What's causing your mum to have frequent falls?

A care home is not usually suggested upon discharge from hospital unless its a permanent option usually. You said your mum is medically fit but aside from the non weight bearing issue can your mum look after herself and cook her own meals?

But... that doesn't make any sense! If she's got exercises and is being sat out and will be reassessed, that's rehab!

Exactly!! But they say the rehab doesn't start until she is weight bearing.

Push for rehab and ensure this is active rehab ie plan for regular physio when the break has healed to get her weight bearing again, physio in to assess equipment at home afterwards plus care package.

There is a plan for regular physio once she is weight bearing. And she has physio exercises to do now. But somehow what she does now isn't called rehab.
I'm still arguing that it is but I'm going round in circles.

How old is your mum? What's causing your mum to have frequent falls?
Mum is 80. This fall was an accident. She slipped on a wet floor. After they discharged her the first time, she kept falling because her leg was so painful she couldn't stand up for long.

You said your mum is medically fit but aside from the non weight bearing issue can your mum look after herself and cook her own meals?
Mum happily lives by herself, goes out and about with friends at least once a week, cooks for herself. She has a cleaner and gardener but otherwise is very independent.
She's so annoyed with herself that a careless error has caused so many problems. And is worried she's going to be stuck in a bed in a care home and forgotten about.

I'm still waiting for the social worker to call me, but I'm still arguing with the hospital about what happens next.
Mum's not quite ready for discharge so we have a little bit of time to keep fighting this.

Ok so having read latest I understand

She has a nasty complex break in her leg that will take more than 6 weeks to recover
She's staying in hosipuralfor then to review in 4 weeks whilst giving break time to heal , passive leg movement exercises , to plan to start active physio rehab once she can put weight on her leg.

Then she can move to a discharge to assess bed - rehab/ reablement care in care home for up to 6 weeks. This is usually non chargeable in many areas, but other areas of solely provided by social care it may be chargeable. She cannot stay there longer than 6 weeks though if it's a rehab bed in care home-so the timing is important . They can't send her there too early as she'd end up being moved to an ordinary care home which wouldn't have level of MDT rehab support.

With that plan that she could be well and mobile enough to return home with care package as she further recovers. She may not need the care for ever but may need it initially when she goes home to be re-able a bit more

It was a failed discharge first time she went home, I find it shocking that she wasn't offered at least 4x daily care at home for meals drinks toilet personal care, causing her all those risks and to fall many times which may have undone some of previous leg repair. Surgeon won't be happy!!