Dementia, stage 4 cancer. Care entitlement and nursing homes?

[Pariswithkids]

We have cared for dmil for 8 years. This used to be care we shared with DHs brother (we both adapted our homes) but 12 months ago brother couldn’t continue with it. Dementia is now very advanced, incontinence, sometimes doubly and this week we got breast and lymphoma cancer diagnosis. Mobility is deteriorating very rapidly it feels, she sometimes can’t get on the stairlift now and has to stay in bed. She’s managed it today however. It just feels like the end is nigh and I don’t really know what to do. I don’t want her to get stuck one day and and up in a hospital ward.

should we be considering nursing home? DH is worried about this because when his brother sorted the house sale and poa the solicitor said to take £800 each per month as reasonable care fees for themselves to keep her below the 23k threshold and because they had both had to give up work, so this is what they do. Is that wrong? DH is worried our assets could now be in jeopardy to fund care?

or because of the cancer diagnosis, the dr seems to suggest it’s terminal, are we entitled to maybe some home nursing or something?

i just don’t know where to start and what’s best and it feels she’s got quite unwell quite quickly now

thank you

When my DM started palliative care at home the GP managed all the medical care side and we had an initial meeting about mum's wishes etc and a care package was funded. We also got a social care assessment for potential home adaptations though it was too late by the time they got in touch.

Agree he should pay back this money. Who has Power of Attorney because paying himself for care he didn't provide is not reasonable use of her funds which she presumably couldn't consent to ?

When my cousin gave up work to care for my uncle after he had a stroke, he wanted to pay her a salary, but his lawyer said that as my cousin had POA, he wasn’t allowed to do so. He left her more money in his will than her siblings, to compensate for this.

He’s lying, and if he’s still taking money from her he’s stealing.

But when he died the house would have automatically gone to her.

I'm not able to comment on the finances, but my Dad had cancer and after a month in a hospice, he was moved to a nursing home on the recommendation of his palliative care team. And it was a terrible decision - the nursing staff weren't able to cope with managing Dad's symptoms, had weirdly timed drug rounds and Dad sank like a stone within days of admission. I have no words for the horror of having to argue and fight to have someone adequately medicated.

If you do consider a nursing home, make sure that they have extensive previous experience of cancer care especially end of life and that they don't heavily rely on agency nurses.

What needs to happen moving forwards is for your DH to sit down with his brother and look very closely at their mother’s finances. Presumably someone has POA and is able to manage her money seeing as they both receive £800 a month from her. I would be asking your MIL about her will - does she have one, where is it, what are her wishes.
I’d also look to see did both brothers receive an equal amount of money when her house was sold. Your DH needs to make it very clear that the almost £10k he has been paying himself fraudulently from their DM needs to be paid back into her bank account immediately and it is to be used to pay for any additional care she may now need.
If she does go into a home, there will be a financial assessment carried out by the local authority. They will require a minimum of 6 month’s bank statements from her accounts. This will show the money going out and will raise questions. There’s nothing that can be done about that now. It’s a whole can of worms, and your BIL is fully responsible.

The 7 years exemption relates to gifts being exempt from IHT, not deprivation of assets, which is indefinite.

however, it is my understanding that the assets need to have been moved with the intention of depriving them (eg gifted to a relative) for there to be an issue. There may or may not be an issue for this usage, which clearly was to allow for care/living.

DBro may not be lying - he may have asked about the length of time for gifts to be exempt from IHT. If the assumption when the house was sold was that she would spend the rest of her life living with you both, then deprivation of assets wouldn’t have been a key focus, as it’s only relevant if the LA is contributing to care costs.

And people don’t always think ahead to a time when that might not be possible.

No. But I've rarely seen anyone receive CHC as they seem to die before the assessment is completed.
Ask your GP for a district nurse referral.

If BIL is no longer providing care, you could use the £800 previously paid to him to fund a private care service to help you with personal care. Also, make sure you know how to lift & hoist properly, as things will get harder now and you need to stay well.

Carers UK are a good source of help, as is the Mobilise FB page. Have you had a Carer's Assessment done recently? If not, get one sorted out so that you have support as you move into palliative. Contact your local Hospice and find out if they have Hospice at Home.

If she had had to pay for residential care for the last 8 years it would have cost her £300k plus. You and her sons caring for her, has cost her about £150k plus the cost of the adaptations to both homes. I don't really see that as grounds for deprivation of assets ?

I agree with this.
I worked part time for years in order to look after PIL and it was very hard work and relentless.
Families can't win. Attendance allowance is peanuts, caring reduces earning power, we are all supposed to care for elderly relatives to reduce the burden on the state, Then when we use some of the elderly people's assets to make things a bit easier we get accused of deprivation of assets.

OP I suggest you speak to AGE UK in the first instance. You need to put together all the financial information though, so you can get accurate advice.

This is correct, and as such can be seen as deprivation of assets.

@endofthelinefinally @Dymaxion the links below show the rules that need to be followed.

@Pariswithkids does your MIL still have capacity? (Has this been formally assessed?)

Ooops didn't post the link!

www.moorebarlow.com/blog/can-i-be-paid-to-care-for-a-relative/

No CHC don't look into finances.

But quite often you have to go via the local authority to get a CHC assessment unless you have nurses already involved.

In my local authority the Safeguarding Adults Team have done a lot of work with the CHC assessor nursing team around spotting financial abuse and referring it back to us.

Because that's what this is, financial abuse of a vulnerable adult, and benefit fraud.

Based on what my mother was paying in her care home (dementia care) which was over £1000 a week, if your MIL had been in care for 7 to 8 years after she sold her house, it would have cost at least £300,000 on top of any pension contributions she had! Possibly less if she also had savings that could have been used. Unless she had a high value house 8 years ago, the money might well have run out now anyway so possibly nothing to worry about re deprivation of assets.

@mummyh2016 this is extremely common - get elderly relative to sell house and give child the money - child builds a granny annex for the elderly relative - year or two later they can't cope and she has to go in a nursing home which the public pay for. However, as I said above - it probably won't be one of the nicest nursing homes.

Thats not how it works @Ilovetocrochet and it doesn't sound like MIL even needed that level of care until recently. It's only now she might need the money to pay for it that the family are panicking because the money has already been spent.

The situation now is that the family are also going to actively avoid seeking external support and advice so the financial discrepancies don't come to light.

I see the aftermath of this as a social worker all the time where families keep people at home long past where it's safe for someone to not be in nursing care and it's nearly always because of finances.

OPs DH clearly knows that what they have been doing is wrong otherwise he wouldn't be worried about it. Him and his brother have taken a gamble and there is a danger it might not pay off.

But a family member absolutely cannot be paid anywhere near how a care home would cost, they can't be paid what a professional domiciliary carer would be paid.
The BIL stopped providing ANY care a year ago, and is STILL claiming carers allowance.
He also oversaw his mum's savings being divided up so she would remain under the funding threshold.
Whatever happens in this case, there has absolutely been purposeful deprivation of assets to avoid paying for potential care needs.

We were in a similar position with my Mum, also 92 but sadly passed away last month. We cared for her exclusively until her final three weeks, at which point the palliative care team stepped in and said that her care needs were greater than we could meet. As she was considered end of life her care needs were met under CHC so we never had to directly deal with financial assessments.

Like your MIL, my Mum had sold her house many years prior and had gifted most of the proceeds of that sale to me and my siblings. In my case I then used those proceeds to buy a bigger house which Mum lived in together with my family, leaving minimal cash assets of her own. Over time we made the necessary adjustments to enable her to continue living here, using her attendance allowance to help pay for things. I cannot say whether the gift of house sale proceeds would have given rise to a deprivation of assets issue as we never got to a point of having to ask, but I can say that when I spoke to the council about care (just before the palliative care team stepped in) there were no questions raised about Mum’s disposal of assets that had taken place some 19 years earlier when her house was sold.

if your MIL’s condition is terminal then I would strongly suggest that you get a referral to the palliative care team as they proved to be the key enablers in getting the care that Mum needed put into place and also facilitated the application for CHC funding.

Good luck.

@GoldenMalicious I'm sorry you went through that with your mum.
In your case your mum would not have had a full financial assessment as she was deemed to meet the CHC criteria. It's during the financial assessment that these things are discovered.

Are you my social worker or are you all the same? Mines a cold fish too.

she’s actually just shat her shat herself. I’ve showered her, told her it’s the first time it’s ever happened (it’s about 3 x a week) and not to worry. I’ve done her hot water bottle made her a hot cross bun and a cup of tea and put her to bed.

Your assumptions are disgusting. She came to us when she no longer could be alone, she was wandering, falling, not eating and not taking meds. She absolutely needed care.

where do you get that I won’t get external help? What’s wrong with you? You’re in the wrong job!