Care Home Decison - need to tell mum now

[FlatOutAgain]

Thank you for the support and advice over quite a long time. I have massively struggled with the decision to put mum into a care home and even a couple of days ago I could not do it. I visited them both early morning yesterday and it was a train wreck. We have everything in place and today after viewing another room that had become available we have made the decsion. We really like the room so need to pay from today although I am not taking mum until next Thursday so she can have Christmas at my house. My sister who lives a few hours away has agreed to come down to help me. Although she has not really been involved I find I now need my big sister to just hold my hand and take charge as the trauma is too much for me to bear on my own. My Dh is brilliant with everything and has managed the whole process but I need emotional help now not practial problem solving help.

The room is nice and cosy with an en-suite at £950 pw. She can self fund for 14 weeks and at the 8 week point we have to inform the LA who will get the ball rolling with a Financial and Care Needs assessment.

We have visited 3 times and it is a very friendly caring home. My dad is going to need a huge amount of support to manage the change and with his own poor health I will have to do quite a lot to help him. I spoke to him yesterday and for the first time he did not say that he wants her to stay home.

I will be telling mum that the Dr. has said she needs care for a couple of weeks to see to her medical needs as she thinks she is dying everyday. As others may know she calls out ambulances on a regular basis and we had to stop her yesterday from calling another. Given her Alzheimers she has no concept of 2 weeks and if things are ok I will just keep telling her that the Dr. says she has improved and will be going home next week (which of course will never come).

Thanks again for the help as we start the next journey.

Does your mum have capacity? If she does it isn't as simple as you deciding that she's going into a home!

Good luck op. Sounds like your dad is coming round to the idea which will give you strength to see it through.

It's a tough time.

@justgettingthroughtheday I have LPoA for both health and welfare and Finance and Property. Mum has diagnosed Alzheimers and has diminished capacity. Dad's mental health is very poor and once again I have LPoA for him as well.

Dad is unable to make a balanced decision due to his own mental health and exhaustion of trying to care for mum

It's going to be a very tough time indeed and all at Christmas but Dad needs some rest as even throughout the night mum can be demanding. The night before last she was calling a Dentist at 2am as she had a toothache. Next morning she wants an ambulance and so on and so on. I only hope that she can adjust as when she was in hospital for 3 weeks recently she did have a DoLS due to her behavious (care home informed).

thank you

I am I’m a similar situation with my DM who doesn’t have capacity. We had to do do the financial assessment first, then my DM doesn’t pay for the first 12 weeks which I though everyone was entitled to.

POA for health only kicks in if the person doesn't have capacity to make decisions themselves. You can't just place the person in a care home unless they don't have the mental capacity- has anyone assessed this?

If she protests then she has a right to return home.

Also if you're going to social services for funding so soon, they may not keep her at this same home if it's more money than others.

The 12 weeks is for someone considering a deferred payment on their house, even if they ultimately decide not to do that.

Will the LA fund that home? You don’t want to be in a position where you need to move her twice. In our area they won’t fund the more expensive care homes.

I guess what @justgettingthroughtheday is asking OP is if your mum has had a capacity assessment around where she should live, as capacity is around single decisions, not about lacking or having capacity in general.
The other poster also made a good point about ensuring that the home is indeed one that the LA is willing to fund.

We had to have a capacity test for my mum, a few actually as my mum did have some capacity for some things for quite a while. Then the sicial workers and ourselves had to demonstrate that we’d tried all the less restrictive options (we really did, years of trying) .Only then was there talk of a care home.

I remember your previous threads about her constantly calling ambulances etc. Well done, it’s so hard but you’re doing the right thing.

Sending you so much support - it is such a tough position to be in. The relief of knowing she is being cared for will be immense and although you still have your Dad to look after, at least you know she will be safe.

Be kind to yourself.

Sending support. I have been there with a grandparent. The relief when they finally moved in was off the chart. They settled really well and were extremely well looked after for several years. It was the best thing for them and the family I have no doubt.

Just a hand hold - as I followed since your previous posts (maybe under a different user name). I believe your mum stands good chance of settling in well, as she wants the ambulances/hospital care frequently then hopefully she will feel reassured to be living in a semi-clinical setting with carers in uniforms etc.

Don’t feel guilty - it does seem like the best decision for her, and your dad and you and your own family. Do expect a period of getting used to the new normal though… for all of you.

Happy Christmas and wish you good luck for a smooth moving in day

We did it much as you did it OP.
Mum had fallen again, had a UTI and was not very well. (Couldn't look after herself, keep clean, hydrated, fed etc). Ended up being admitted to hospital.

From there we had a discharge meeting which was "not well enough to return home without a care package in place". I found a care home and arranged for her to go in "for a few weeks" with "regular reviews". I didn't have POA. So we couldn't do the whole office of the public guardian think - we just kept having Doctor-led assessments to see if she was well enough "yet" to go home. It was all we could do. (Dementia is horrible)

I told her she was being moved to a different hospital for a couple of weeks - just until she was completely better. She accepted that. For a while she thought she'd be going home "next week" - but then believed she was at home - or sometimes "at work".

She was happier, well-fed, well cared for and in far less pain than she had been. It was the best thing I did - but also the hardest.

Thank you. Mum does not have capacity but as you rightly say that is our assessment. We have been working with her GP for at least a year and I would believe she would support the decision. Our recent chat with the GP was to try to get some relief for Dad and with the GP we agreed that Dad could give Mum diazapam when she 'got too much' and he could no longer cope or he just needed some sleep. He has been medicating her for the last few weeks to the point he is not just giving her a tablet when she gets out of control. That is no way for either of them to live and the decision is in truth more for dad than mum. His own cognition has suffered and he is not the man he was. Living with mum has fasttracked dad to very poor mental health and this along with his physicality he is also in trouble.

The way I have reconciled it is that at worst it will give some respite to dad even if mum cannot settle or does not like it at all. There is a 28 day notice period either way which we can afford to pay if it comes to it.

We found the care home via the Care Home Selection process which was recommended to us by Adult Social Care at the LA. The care home accepts LA funding and this was part of the search.

Typicall a single room with en-suite in the area is up to £1300 and this one is £950. One without en-suite would be £850. It seems this is at the lower end so it is our hope that mum would not need to move again as that would be traumatic for everyone.

We did try help at home after mum came out of hospital as they put a care package in place for 6 weeks with 3 visits per day. This unfortunately did not work out with mum hiding everything you could imagine around the house and in the garden. I found her wedding photos in a bush. She also did not want them there and in the end the care plan was ended early. In fact at one point we asked them to switch the plan to dad for a few days which they very kindly did.

The care home is directly opposite mums GPs and we are going to tell her the GP wanted her go to the home for assessment.

I did ask the LA for a care needs assessment but they said to contact them when there was 8-weeks self funding remaining.

Due to the time of year I will contact the GP next week to discuss with her but in the meantime as I say we are looking at the worst case which is she does not settle and we have to get her back home. This will be very difficult as we don't really have anywhere to go at that point.

Honestly we have put so much work into everything to keep it going but for dad's sake we are backed into a corner and cant see any other way out.

thank you for your replies

For those who have not followed this story we did hit rock bottom some months ago when mum absconded from hospital and in the early hours she was picked up by two men in a car. Incredibly they got her home but of course it could have ended very differently. There is a safeguarding plan in place now at the hospital as well as an anticipatory care plan at home to explain to the paramedics to call the gp before they admit mum to hospital. I only say this to highlight it is not just our assessment but rather a catalogue of events that have led us here. Whilst in hospital we had to agree to a DoLS due to her behaviour with the staff and other patients. We put this down to the medication although she recently became aggressive with dad by waving his walking stick at him when he questioned her calling another ambulance.

thank you

Sorry some of the answers are now on my mind.

I have been working with the GP although she does not know about the care home decision. I have spoken to Adult Services and they said to contact them when we reach the point of 8 weeks before we reach 23,250.

The LA said they will arrange the Care needs and Financial Assessment when I call.

Do I need to have the care needs done and/or the GP to sign off before I put mum into care?

As previous she has diagnosed alzheimers and I have a PoA

Thank you (slightly worried I have missed something)

Amazing progress @FlatOutAgain what a really good solution. You will all be so ready for it. @AnonyMum21 makes such a good point about the medical setting and of course she will be locked in securely.
wishing you all some peace

OP it sounds exceptionally hard for you all. The one thing that seems to be missing is a formal capacity assessment. From what you said it's highly likely she would lack capacity. But you have to start from the point of assuming someone has capacity and then prove they don't. Your PoA does not kick in until that has been done.
Your mum may go into the home and just settle. But she may demand she goes back home, and unless you can show it'd be proved she can't make that decision herself then her wishes must be adhered to. It's the law.

I'm a bit thrown by some of the answers here as it's obvious from the thread (and having found this board at all) that this has been a long process and you haven't just gone 'oh let's put Mum in a home' while she's been fine. And if she was under a DOLS while in hospital, she obviously didn't have mental capacity to decide whether to leave at that time, anyway.

I'm very relieved for both your Dad and your Mum that they will each have more care for their own needs.

I personally wouldn't say that you need the GP to sign off the move, any more than you would need that for any house move that she made. Why not have a talk with the manager of the home - they can be very helpful (and formidable) people, and there won't be anything they don't know about this process.

I would warn you that any time your mum is admitted to hospital you are likely to get a phone call to clear her room. We did with my grandad, he had been in hospital less than 24 hours when the matron of the home rang my mum & told her to collect my granddad's belongings. It meant that had he recovered he would have been homeless & we would have had to begin the search for a home again, but unfortunately he passed away.

It's the law under the MCA. Of course the OP is making what she thinks and I'm sure is the very best decision for her mum. My point was that if her mum doesn't want to go to / stay in the care home, her wishes must be adhered to unless she's had a capacity assessment specifically about that particular thing - where to live / support needed - and has been assessed to lack it capacity can fluctuate, so someone may need a DoLs during an admission due to increased confusion, but that may improve.
I just was the OP to be prepared and to ensure all the right assessments have been done.

Out of my depth to comment on paperwork and so am
not dismissing @jellyjellopeea comments. OP, in your shoes I’d definitely ask about that capacity specific assessment. However, without it I would still press ahead. I think OP has v limited options and as @PermanentTemporary advises , the care home manager is the person who can make this work for the good of all. You have to give it a go.
Again,I don’t know about the situation @Nat6999 found herself, but it’s worth filing that info in your head as your DM has form on hospital admission.
But wishing you huge luck @FlatOutAgain , you deserve some luck

I would take advice from the care home on what to tell your mum.

We were advised to tell FIL he was just going for the day - only we never picked him up in the evening.

At the time we thought this was wrong but did as we were told, and of course the care home was entirely right and it turned out by far the best way. The care home was outstanding in it's dementia care and had far more experience than us.

We didn't need to GP to sign off on the move, ILs were self funding and MIL just got on with it. She also had LPA for health.

This did not happen for mum, her room was available for her to return to after several hospital admissions as we were continueing to pay the weekly fees. I think fees were reduced slightly during long stays in hospital.

I have heard of cases when a home has refused to accept a resident back after a hospital stay but this was when they were struggling to meet their needs - usually if behaviour was challenging.