Meet the Other Phone. Flexible and made to last.

Meet the Other Phone.
Flexible and made to last.

Buy now

Please or to access all these features

Elderly parents

When to force the issue re residential care?

81 replies

MrsBennetsPoorNerves · 08/08/2023 11:56

I have responsibilities for an elderly relative and LPoA for finance/health issues. She has no family living nearby but we have been able to manage some things remotely with assistance from paid carers visiting regularly. She has a dementia diagnosis.

She does not recognise herself how vulnerable she is and insists that she doesn't need help. She does need help though, and we're getting to the point where it may no longer be safe for her to live alone. She will not acknowledge this and gets enraged if it is even suggested. She finds the carers irksome as it is, even though she relies heavily on their help.

She is adamant that she wants to stay in her own home but this is increasingly becoming unviable. At what point do we have to force the issue? And when that time comes, how do we actually go about that if she refuses?

I am finding the whole thing very distressi g because I want to respect her views and wishes but she is getting to the point where she is a danger to herself, and it seems that we might have to overrule her preferences because it isn't in her best interests to follow them. Any advice would be welcomed please.

OP posts:
MrsBennetsPoorNerves · 08/08/2023 12:01

Also, when we do get to that point, what do we do if she physically refuses to leave her home? I can't imagine having to manhandle her out of the property but what are we supposed to do if she refuses to go willingly? Do people end up getting sectioned in those circumstances?

It's horrible watching the decline of someone you love, and seeing their own agency over their life gradually getting eroded.Sad

OP posts:
kimonoblues · 08/08/2023 12:03

If she has money and/or owns her own house then staying at home is an option
You can do an equity release to pay for carers. At some point the council step in to pay for the care when the end is near.

You need a full understanding of her financial position. But as you have POA and she wants to stay at home then it is your duty to make that happen for her if possible.

MrsBennetsPoorNerves · 08/08/2023 12:04

Finally, where can I go for info about financing residential care? She has assets (savings, a house etc) but I know that care costs are extortionate... what happens if we burn through all of her assets and run out of money?! If she starts off in a private care home, would she end up having to move if she ran out of funds?

OP posts:
MrsBennetsPoorNerves · 08/08/2023 12:08

Thank you for your reply. For the time being, we are increasing the amount of home care to enable her to stay at home, but she is extremely resistant to this. She has savings that will pay for the care in the short term and we could look at equity release in the longer term.

I just feel that she is so isolated at home and some form of residential care with opportunities for social interaction would be beneficial to her.

OP posts:
kimonoblues · 08/08/2023 12:08

You start with finding out exactly how much money she has
You then identify the type of care that she needs and get a cost for that to be provided at home . Lets say £4-7k a month
You get a council assessment to see if she meets their criteria to pay all or part
You then start using her cash/pension income to pay for the care
When that reduces you can take out an equity loan on the house to continue the care at home

How old is she? That helps you to decide how much costs are likely to be.
You have to try and follow her wishes if they are possible.

kimonoblues · 08/08/2023 12:09

Being blunt people moved into care homes tend to die more quickly. Those at home tend to have better care and live longer- so it is more expensive.

MrsBennetsPoorNerves · 08/08/2023 12:10

Thank you, that's very helpful. She is early 80s. Financially pretty comfortable.

OP posts:
MrsBennetsPoorNerves · 08/08/2023 12:12

Thank you, I didn't know that.

Not really too worried about the expense as she has money...just worried about what happens if and when we run out of that money. E.g. if she stays at home and needs a lot of care, what happens if we burn through all of her savings/max out whatever we can get through equity release?

OP posts:
Honeyroar · 08/08/2023 12:20

This is trotted out a lot on mumsnet (sorry, not a personal attack!). It’s not always the case. My mother in law thrived in a home for several years (one she didn’t want to go to) but wouldn’t have lasted much longer at home, she was really going down hill. Plus the elderly who fall at home and end up lying on the floor for hours die pretty quickly too. It happened to my father, who was completely independent, but went downhill massively after a fall and died in hospital two months later.

OP the home my mil went into were very good at helping persuade her to come. She listened to them much more. Initially we said it was respite care while we all went on holiday. She did ask to go home a lot, but she asked that when she was in her own house too. She thought her previous house was home.

MrsBennetsPoorNerves · 08/08/2023 12:35

Thank you, it's helpful to hear different perspectives.

One of my concerns is the lack of social interaction for my relative...I feel that her condition is deteriorating more quickly because of the lack of stimulation. I thought that being in a home might help with this. It would also help to reduce social isolation etc. She can talk to family members on the phone and we try to visit etc, but on a day to day basis, her only real interaction is with the carers. It seems like a very lonely existence to me, and I think she would be so much happier to be around people, participating in activities etc...she is still a sociable person despite being easily confused etc. I looked into a local befriending charity but they have a very long waiting list.

It's so hard to know what to do for the best.

OP posts:
refreshingseahorse · 08/08/2023 12:40

Would she consider a day centre? Even if it's a couple of days a week it would provide some social interaction. They often provide transport there and back.

HappilyContentTheseDays · 08/08/2023 12:40

We had this with my mother. It is possible to force residential care but it is a difficult way to go.

My mother had Alzheimer's, a full diagnosis, everything. They organised carers but my mother hated them, she would scream at them and try to hit them with her walking stick, so they were very reluctant to come. My sister and I had POA and had access to all the finances, a lot of the money was tied up in the house but there were enough funds.

Because my mother could say "no" she was deemed to have enough cognition for them not to put her in care. This was despite the fact that she could no longer go outside (she would get lost/be out at midnight, undressed etc.) and the fact she had no idea who we (her daughters) were, or where she was or what day it was....

Nor was she feeding herself properly, she also fell down the stairs and was lying there for hours until a carer happened to turn up and find her, but then she point blank refused to be seen by a doctor. After the stairs fall, she was afraid to go upstairs at all, so - as the bathroom was upstairs - she wasn't washing and had begun to "do her business" in random kitchen items, such as saucepans. It was dreadful....she even had social services visit but they wouldn't do anything just because she could still scream "no".

This was the point we decided we had to force the issue. It was awful, my sister was in tears. We asked for a meeting and it was attended by the doctor, social worker, Alzheimer's psychologist, ourselves and two carers. They were still reluctant to intervene until my sister said we'd had enough, we were at breaking point. I also pointed out that if they did nothing, and my mother fell down the stairs again and broke her neck, I would personally be holding them culpable. This seemed to do the trick and they hastily changed their minds.

The reason they are reluctant to force care is that yes, the person does have to be sectioned and relatives have to consent to this. An ambulance and psychiatric nurses turn up to take the individual away and when the screaming starts they have to section and force them into an ambulance. In my mother's case they pre-informed the police and two police officers were present to ensure everything was done properly and as gently as possible in the circumstances. It is very distressing for the individual involved.

The individual is taken to an elderly psychiatric ward for assessment and usually spends 6 weeks there while being assessed. We went to visit every day; the reality was that although my mother wanted to "go home" she had already forgotten the trauma of her being there. And when we showed her photographs of the family home she neither recognised them nor even remembered it.

The assessment decides what sort of care is required and it allows relatives to look at finances and sort everything out. There are long waits for local authority care but if the family can afford it, the individual can be discharged to a private nursing home....we had to sell the family home to release the money to pay for private care, but usually a home will take the individual if they know money from a sale is coming in due course.

For my mother it really was the best thing....the home we found was very loving and caring, and we knew she was safe and happier than when she'd struggled on her own. As time went by she remembered nothing at all anyway, and became content and smiley...and eventually incomprehensible. For those saying care homes are a bad thing, I'd say not necessarily. Our mother lived for another 7 years in that home, she certainly wouldn't have lived that long outside of it. And she had a very gentle, peaceful and fully-loved last few years of her life. Looking back I would do exactly the same, it was the right thing to do in her particular case.

Care homes often receive such bad press and people are reluctant to 'say how it really is' when dealing with the elderly and dementia, but I hope my experiences helps to inform others having to face the same decision.

cansu · 08/08/2023 12:40

I think the idea that homes are great for social interaction is not always correct. If she ends up in a home with people with dementia she is unlikely to get much social company.

DibbleDooDah · 08/08/2023 12:44

I agree that moving into residential care actually significantly improved the lives of my grandparents, one of whom had Alzheimer’s. I would also add that not all care homes are equal and you do get what you pay for.

The money DID run out when my gran was still alive. She lived in their house with carers until three years before my grandfather passed away. They were both in homes at the same time for three years, the house was sold etc. When the money did run out the council viewed that at the age of 96 and having been there for five years that it wasn’t in anybody’s best interests to be moved so they continued funding.

Her home was literally like a hotel. She could move some of her own furniture in (not the bed), had three course meals at fancy tables, loads of activities going on etc. She was reluctant to move in initially but she did a respite care / try before you buy stay for two weeks. She never left!!!!

People only hear the bad side of care homes and I think this actually really scares some people.

She can say she doesn’t want to move into a home BUT you can surely negotiate some visits with her so she can actually see what they are like. Try and get over the fear of the unknown.

MrsBennetsPoorNerves · 08/08/2023 12:50

Thank you for your responses.

@refreshingseahorse I don't know if she would consider day care, or if there might be suitable options near her. She lives quite rurally, which doesn't help. I think she would be very resistant but we might be able to persuade her to try. Essentially, she dislikes anything that appears to her to be "professional help" of any sort, because she perceives that to be an admission that she isn't capable of managing things independently. She doesn't mind family helping, but she declined all suggestions about moving to be closer to family members who could have supported her. I will research options and see what might be available.

@HappilyContentTheseDays , I am so sorry to hear about what happened with your mother. It sounds traumatic and fills me with dread, but it seems that you made the best possible decision for her under the circumstances.Flowers

@cansu, thank you. Perhaps I am over estimating the opportunities that a care home might provide.

OP posts:
MrsBennetsPoorNerves · 08/08/2023 12:55

Thank you. A "try before you buy" approach sounds like it might be really helpful if we could at least give it a go.

It's good that the local authority picked up the cost when her own funds ran out. I guess I would be concerned about paying for a "nice" private home and then having to move her if and when her money ran out. She isn't short on funds, but obviously, we don't know how many years of care we would potentially be paying for. Same if she stays at home tbh. If her needs are great, it is going to get expensive and resources are finite!

OP posts:
DappledOliveGroves · 08/08/2023 12:55

We essentially forced the issue with my mother. She wasn't safe at the sheltered accommodation that she'd been living at for around 10 years, meaning she had to go somewhere. We found a care home, then her brother and SIL took her out on 'moving day' - they went off to a National Trust place or similar, whilst we moved all my mother's possessions to the new home - and then they took my mother to the care home. It was essentially presented as a fait accompli. Within a few weeks, she'd forgotten that she'd ever lived anywhere else.

Funding wise, once my mother's savings fell below the £23k threshold, we completed a financial assessment form with the local authority and they took over the funding shortfall; my mother is still at the same care home, but the home has different rates for those self-funding and for those wholly or partially funded by the local authority.

user1469908434 · 08/08/2023 12:56

I was in exactly this situation a few years ago with an elderly relative who I was POA for, but wasn’t my parent with no other relatives keen enough to be of any practical help.
I think, if they are still considered to have capacity, you just have to wait until there is a crisis. And having capacity seems to me to be a pretty low bar! My relative could tell you who the prime minister was, discuss stories in the paper etc, but had zero idea if they’d taken their tablets or had anything to drink, if they’d Locked the door, turned the gas off etc.

They ended up having a fall which resulted in a hospital stay, and going to a privately funded home to convalesce. After a few days, they announced they liked it so much they wanted to stay, so house was sold and they lived there very happily for 5 years, (and then a further 9 months or so where their physical health declined, which wasn’t fun for anyone…but that’s another story!)

Have a search round local homes so that when the inevitable disaster happens you have some idea what is available to you. It’s really tough, you have my sympathy OP.

lastminutewednesday · 08/08/2023 13:07

She will need a mental capacity assessment if she doesn't want to go into care/have dom care at home if you think she needs it and isn't mentally able to make that choice.
Contact your LA or GP and they will help you arrange this. If they find she doesn't have capacity a best interests decision will be taken.

When her money/assets in the case of care homes go down to £23500 the LA take over payment for care costs. Unless she has a health issue (dementia doesn't always count) in which case it will be the NHS (Continuing Health care funding).

Nonsense to say people in care homes get worse care and die quicker! Having managed both care homes and domiciliary care, standards in homes are generally much higher than in Dom care, and it's more Reliable unless you get a horrible
Care home. Lots of research needed into what homes are good near you if that's the route you go down.
It's hard to ensure good care is being given by Dom care staff who are in between 20 people's homes a day, often working alone, for half an hour in each! Most dom care staff are great but they don't get time between jobs and have to rush often. And and apples are harder to weed out when they are working with vulnerable people who don't know to complain.

Could she be persuaded to get help but disguised as a more genteel sounding ladies companion? You used to see this advertised in the Lady Magazine all the time (now see websites such as Carem or caresourcer). They match carers with families who then pay the carer direct-so private Dom care if you like and you can specify what needs doing-and they are more likely to do things like going out with the person or activities in the house and be able to say stay for an afternoon or whatever as opposed to the half hour visit you might get from traditional Dom care.

I do this currently for an older person near me. Started off taking her out, shopping, light domestic tasks and helping her wash her hair once a week. Now because she is very unwell with dementia it's a lot more personal care on top. But she has found that easier to accept as the time has gone on as we had the relationship established in the first place. I get paid £18 ph (SE) for reference. Would that work for your relative if your sort of couched it as a bit of help and companionship first off?

MrsBennetsPoorNerves · 08/08/2023 13:09

Thank you @DappledOliveGroves , helpful to know how you managed the move and reassuring that she quickly forgot that she had ever lived elsewhere.

@user1469908434, sounds like a similar situation to me. She is not my parent but there is limited help from wider family. I just want to do what's best for her.

OP posts:
Iwasafool · 08/08/2023 13:12

Are there any local homes that offer day care? We have one and I see the minibus picking up a couple of people in my road. They spend the day there, eat and do activities. I think it would be a nice introduction and let her get to know the staff and maybe make some friends.

Appleofmyeye2023 · 08/08/2023 13:12

An elderly person will not be sectioned unless they’re deemed a real risk to themselves or others.
before that there is a process called DOLs (deprevation of liberty)
i know this as my dad has been in a psychiatric assessment centre since April with DOLs in place. But not sectioned. He has some mental capacity, can hold a conversation, but is having extreme visual hallucinations and is delusional with persecution. He is 86. He is mild at times, and at others he is aggressive, dogmatic, and increasingly violent. He was being “assessed” in that unit through visiting CPNS , psychiatrists etc but his day to day care was manag3d by staff of care workers with psychiatric support training.
he was only sectioned last week, after he pulled a cupboard off the wall, had got into another patient room and had tried to attack another patient. Only then was he sectioned and moved to a psychiatric hospital ward with 1:1 24 hour supervision.

prior to his deteriaiotion last week, the LA we were looking to get him out of psychiatric assessment centre to a long term placement, that included care homes with specialist dementia unit(despite him not having dementia diagnosis yet - it’s not clear at all ). Even there theyd do a DOLs At that stage.

Sectioning is not used until a patience has lost mental capability. The bar for that is, rightly, extremely high. All the time your relative can express her opinion, however misguided, sectioning will not be done unless she becomes a danger to others

i also know that sectioning is a last resort, as my exh developed psychotic mood disorder. He was hearing voices,aggressive and delusional - but he was never once sectioned or even admitted to hospital voluntarily at any point of time he was in crisis. There are, simply put, not enough beds and the situation has to be desperate. He was discharged same day form A&E to go home with me with a prescription for antipsychotics I had to fill, then cared for “in the community” , which is basically “drug and dump” . Not staff fault - there is a massive lack of funding.

You have the LPOA : this means , with doctors signature to state she does not have mental capacity to decide for herself, you can activate it. Once you have done this you are acting in her best interest and can force the issue. It is a massive step. You need to meet the bar that is set by the office of guardianship to ensure you behave legally. But this is what you have LPOA. At that point the next step is the needs assessment with social services. This determines her nursing and social care needs and will determine what type of home is suitable, what options are, and who will need to fund.

there are good guides out there on internet about all these issues
https://www.alzheimers.org.uk/get-support/help-dementia-care/care-homes-who-decides-when
https://www.nhs.uk/conditions/dementia/care-homes/
https://www.ageuk.org.uk/information-advice/health-wellbeing/conditions-illnesses/dementia/getting-care-and-support/
etc etc

Care homes: When is the right time and who decides?

Advice and practical tips for carers on when is the right time for a person to be moved to a care home.

https://www.alzheimers.org.uk/get-support/help-dementia-care/care-homes-who-decides-when

lastminutewednesday · 08/08/2023 13:13

*Curam sorry-more helpful if I spell it right!

If she lives very ritually you might find bigger Dom
Care providers won't go to the house anyway as they can't fit a longer journey into their rounds and the petrol cost is a lot so they can't make it pay. Therefore private carers might be your best option though you may have to pay their mileage

lastminutewednesday · 08/08/2023 13:15

Rurally!!! Not ritually! Bloody phone!

MrsBennetsPoorNerves · 08/08/2023 13:18

Thank you @lastminutewednesday, that's helpful.

I don't know if we could persuade her to consider a "companion". I think she would be resistant to anyone we had to pay tbh, but I think it would do her the world of good to be able to go out for an afternoon etc.

I have now understood from this thread that local authorities will take over paying for care costs once the individual's funds dip below a certain level. The bit I don't fully understand is how they decide whether to leave people where they are or move them to a cheaper facility. My concern would be about disrupting her by moving her once she had settled in somewhere. Don't want to skimp on care by paying for a cheaper option when she could potentially afford better, but on the other hand, we have no idea how long she will go on and I don't want her to have to deal with a sudden change/drop in standards further down the line when the money runs out. Not sure if that makes sense to anyone!!

OP posts:
Swipe left for the next trending thread