What does "care package" actually mean?

[PinotPony]

My elderly uncle is currently in hospital following a fall. He is confused and thinks the nurses are trying to poison him so keeps pulling his iv out.

My aunt cannot cope with him at home. His mobility is very poor but he refuses to use a Walker. He often doesn't make it to the toilet in time. He is quite belligerent and insists that he can do things for himself. His bedroom is upstairs so she has to help him up and down. My aunt is not strong enough to push his wheelchair so my dad will sometimes take his brother out for a walk.

My aunt is coming to the realisation that she does not want him to return home when he is discharged. She is at the end of her tether, absolutely exhausted. Their children support her and intend to talk to him about it together.

She has called SS but they won't get involved until he is medically fit for discharge. The hospital say he'll need a "care package"... but are really vague about it. Does this just mean care at home? I really don't think carers coming into the home will be enough. My poor aunt would still have to deal with him the rest of the time. He needs 24 hour care.

I'd be grateful for any advice on the steps we take to get him into a care home. Surely we don't wait until he's unnecessarily taking up an nhs hospital bed before setting this up?!

Your aunt needs to tell the hospital she can't look after him

Please don't be alarmed, as every hospital will be different. My mum had a fall and after a few days they said they would discharge her with a once a day carer. I burst into tears and said there was no way in hell I could manage that. They then told me not to panic and they would not risk an unsafe discharge but it was a really scary prospect.

I think they would have then kept her maybe another week or so but a few days later I sorted out a (private) place in a care home.

But I don't even live with her and even then we - sis and I - had to be very clear that we couldn't look after her. I have mental health issues so told them that too.

what's the funding situation? Has his GP been involved?

It depends on the needs of the patient but I think you can ask (insist) for them to go into a care home straight from hospital and it will be paid for for six weeks by social services. Your aunt would need to say she can't cope with him at home. If you found a nice home, you might find that at the end of six weeks, he doesn't want go come home but is happy to stay there.

Op, contact hospital social work team and explain there is no safe discharge.

if it’s his home it might be difficult to stop him returning but there will be a discharge meeting that family can attend.

care package is common from hospital to assess his needs, but you don’t have to accept it,

options?
if medically fit then hospital will discharge,

does he need care home or extra care sheltered (24/7 staffing)?

what does he want? Appreciate you are asking about Aunt but he has rights too.

A care package means social services are involved and if he goes home will arrange carers who have to be paid for. My DF insisted on going into a home because he sensed that he was going to deteriorate, which he did, and didn’t want my mum to have to look after him. If he will be self funding then you can simply find a suitable home. If you are going to need assistance paying for the home you will have to fight social services because they don’t want to pay and wont pay top prices.

Oh I think you are meant to ask for a six week reablement package on discharge. For some reason, the words seem to be important.

when we took her out of hospital, they said because we were going private, "the system" considered her to be off their hands, but then the GP sorted out a physio who is coming to see her next week. (She's back home from the care home).

It’s all about the funding

if he is funding, you have whatever you want to purchase

if not, he’ll be assessed and whatever needs offered. That could mean a trial at home with CP for a while- with long term 24 hour care if that fails. Depends on findings from assessment

good luck- sounds really difficult

at this stage it is hospital social work/discharge coordinator rather than local authority that you need to be talking to. your aunt needs to be clear that she can't manage him at home and that if he is returned home she will be moving out. as mentioned above 'unsafe discharge' are the magic words along with 'carer breakdown'.

When my Mother had a care package it was carers 4 times a day for six weeks
She didn’t like it said it was an infringement of her civil liberties!

This is what happens in our Borough. The confusion may be delirium - social services will assess mental capacity. Your aunt needs to be clear with them that she can't cope.

Oh yeah. As,soon as SS hear the words self-funding, you might as well be adrift at sea. You might get a phone call if you're lucky.
But I do know several people who would be self-funders if they were to go into a home, getting free weeks in a care home because they couldn't manage at home. Most then either stayed in that home or moved and self-funded after sx weeks.
Your aunt needs to describe the worst day ever with him, not an average day. If SS and the NHS can shuffle off responsibility onto a relative so they don't have to do anything, they will.

The SW will assess his needs and what he wants and try to achieve the level of care that maintains the most amount of independence while keeping him safe. If they think he can be managed at home with carers visiting, that's what they will put in place. They will only place him in a residential setting if he actually needs it.

Your aunt needs to make clear she cannot assist with his physical care anymore and needs respite from it all sometimes.

As for where he lives ...the bottom line is that presumably it is his home too and he has a right to live in it if he wants to. It is never easy. Also wouldn't be easy for your aunt having carers in and out of what is also her home. Ultimately, if he isn't assessed to NEED a residential care setting, where they decide he lives is a relationship issue, not a care issue. It's difficult all round.

Once his confusion improves the nurses and therapists will assess him on the ward. They will carry out a care needs assessment, looking at what he can or cannot do for himself like getting in and out of bed, washing, getting dressed, going to the toilet, walking. If he has capacity to make his own decisions then he has every right to return home with or without carers. Your aunt needs to tell the staff that she cannot manage and they are both at risk if things dont change. The staff will allocate him a social worker or a discharge worker, they should speak to him and your aunt. If he insists on going home the therapists may do a home visit, arrange equipment, move a hospital style bed downstairs, get carers in. If your aunt really cannot cooe she needs a carers assessment and just refuse to get involved. The staff may arrange rehab aftercare but nothing will happen while he is confused. Whats their situation with finances and poa.

Things that need to happen first:
Establish cause of his confusion: is this delirium or pre-existing cognitive decline?
Resolve delirium.
Ask your uncle what he wants.
Capacity assessment relating to residence and care needs.

Then your uncle, his family and health care and social care professionals discuss and plan from there.

Maybe one of the children could offer for your Aunt to stay with them for a short time for some respite / rest. The hospital could then be informed there would be no one at home to care for him in between carer visits were they to discharge him.If your Aunt stated she couldn’t or was not prepared to carry on caring for him, I assume they would undertake a financial assessment regarding contributions for a care home.

I feel really sorry for your aunt..what a dreadful and worrying situation to be in. We found ourselves in a similar situation several years ago with OH's mother, who was dementing rapidly, and falling over frequently.

He needs to be in a home....one that will meet his needs. If that happens, your aunt will not have to leave her home.

SS are absolutely hopeless. They will do anything to get people off their books. Do NOT be pressurised into having him at home with a so-called 'care package' (ridiculous phrase). It is clear that your aunt is not able to care for him. When dealing with SS, it's NO NO NO all the way. Then they will have to deal with it.

Is the confusion a temporary thing? If he's had a fall I presume he's had a catheter fitted so is he also being treated for a UTI?
Realistically a care package will be carers 4x a day unless you're self funded. IME yes a few years ago they would get sent to a care home for 6 weeks where it would then be determined if they could go home afterwards. Nowadays though unless there is a high risk to their safety they'll be sent home with carers. Happened to my neighbour, she ended up leaving the external doors wide open and putting the oven on and forgetting it so it caused fires before she was given 'approval' to go to into a home. DH nan couldn't walk, she only ever got carers 4x a day - if she needed the toilet before a carer came she'd just have to soil herself. It's shit.

Thank you for all the replies. That's all very useful information.

I don't have all the details of his cognitive function but is has certainly declined since admission. It may be related to infection... he was on oxygen for a chest infection.. s may resolve.

However, even if he regains his cognitive ability, his physical issues mean discharge home is simply not safe. He can stand but can barely lift his feet. He has to shuffle whilst leaning heavily on someone... my petite aunt! At a family party last year it took two men 15 minutes to support him to walk to the bathroom.

Given the significant cost of private care homes, and the fact that she'll remain in the marital home, I think they'll need financial assistance.

We'll make it clear that any discharge will be "unsafe" and highlight the risk to both of them if he returns home. We'll explore the idea of 6 weeks respite care as that sounds like a good measure until something more permanent can be put in place.

It is so very sad. I'm sure he'll want to come home but it's just not fair on her. She looks absolutely done in by it all.

As far as I know, your aunt could continue to live in the marital home, and the cost of your uncle’s care would be paid back to the council when the home is eventually sold.
I’m not a SW but that’s my understanding of the funding when you own an asset( like half the marital home)

There’s such a shortage of carers and long term care places, he might well have at least stabilised post infection

This.

Being unable to walk OP won't normally qualify you for a care home place though. SS answer will be to move the bed downstairs, supply a commode and then send carers in 4 x a day.
I'm not saying it to be snipy, it's just about managing expectations. Prepare for him being sent home with carers and if he does get offered a place then treat it as a bonus. IME my DH nan was refused a place in 2019 and she was far worse than my Nan was in 2015 when she was given a place quite easily.

I forgot to say about this, unless things have changed in the last couple of years depending on how the property is owned (joint tenants vs tenants in common) they could potentially take more than half of the marital home.

I think the value of half the marital home, but not more than half . From my understanding. And any savings are also used for care, until savings go below 21k

Unless it's changed in the last 10 years if they are joint tenants then I believe they can take more than half. My dad did a lot of research about it and ended up getting my Nan and grandad changed to tenants in common so if one of them went into care SS could only take 50% (minus the £21k or whatever it is they're allowed to have).

It can be carers, physios, ot, district nurse, equipment etc depending on his assessed needs. Sometimes called an interim community care or Reablement team. It may be that a care home is a better environment short or longer term to provide this but the assumption is typically a return home. You need to be assertive as to the limitations of any support his family can provide. There should be a discharge coordinator or sw at the hospital who will assess needs and provision who you can speak to.

Care is horribly expensive, and local councils are massively struggling due to a lack of govt funding, so there's not always much social services can do. Your aunt needs to prepare for a large bill, if she refuses to let him move back home with carets coming in. Friends paid upward of £1000 a week for a subsidised place in a church care home about 10 years ago. I have no idea how much it is now, but I know we were shocked by the fees. Social care is on its knees.