Elderly dad in rehab

[Loopylou38]

Hi , my dad had a stroke in May and was in hospital for quite a while then caught Covid/pneumonia which has set him back with his recovery . I’m out of the country at the moment but he was eventually sent to rehab and I’ve been told by a relative that there isn’t much progress due to other health issues
He also has copd so his breathing is pretty much walking is very difficult .
Im returning home next week as the physio would like to discharge him on the 21st aug which doesn’t give us much time

i understand that they will need to put a plan in place but sadly he needs 24 hour care now prior to the stroke he was living independently.

I honestly don’t know where to start with all this it’s going to kill him being told he can’t go home his property is very small so doubt a carer could be there over night

secondly going home would be lonely as carers come and go, I’d love for him to go home but it’s impossible

how do I find a good care home ? The cqc and carehome.com are so confusing I just want the best for him
any advice please ? Can rehab discharge him if we haven’t found a place that we’re happy with ? Thankyou

Thankyou EmmaEmerald, we don’t have any cash up front , putting him in a placement of their choice really worries me as it’ll just be anywhere that has a bed . Some care homes have awful care

Hi there, I can’t promise to be correct but can give guidance from experience and research. If you have power of attorney on health and well being and your parent doesn’t have capacity you make the decisions for them and must be involved in the process. And if you find and choose somewhere it may be he will fully fund it whereas respite care for those with less than £23250 organised through social services or NHS is partially funded or for 6 weeks with NHS I believe fully funded regardless of wealth. E.g MiL had 6 week fully funded care at home package, BUT I did the cleaning, the washing and the shopping. No one asked it just seemed to be assumed….

MiL then got sent to 12 weeks respite nursing home and financial assessment meant she paid from her income as she has less than threshold. The social worker found the nursing home - there are very few vacancies - we were shown it and met lead nurse but don’t think we could have refused unless we found one and paid ourselves! Which at £7000 pcm was not going to happen. It ultimately depends on whether it is entirely self funded and whether you have PoA on health and well being. For safeguarding reasons no hospital should discharge someone unless a proper care plan is in place. But If someone with capacity makes their own choices they cannot stop them, E.g. people discharging themselves against advice.

regardless of wealth attendance allowance can be applied for; and as discussed CHC assessment may be applicable. Lots of chats and info about this on various forums and charity websites. Fully funded by NHS not means tested but complex assessment and it seems lots of appeals and battles to get it. Also comes with certain guidelines about choice of nursing homes/care.

Hi @Loopylou38 in your very first post you said rehab were looking to discharge him on the 21st August. So them now wanting to find him a placement asap is not a new development. Rehab beds are rare and there will be another stroke patient currently taking up a hospital bed in need of rehab. Your dad's had his rehab and needs to leave.

If you are worried about where they will place him the best thing you can do is find a place you want him to go. If they have places in Home A, Home B and Home C and you have already said you would like Home B they will likely place him there.

Have you got a shortlist of carehomes? If not you need to start making one today. Look at reviews on carehome.co.uk. Research the homes you like on google and Facebook (my mum's care home has a Facebook page), ask friends and neighbours for recommendation, join local Facebook groups and ask if they know anything about local care homes.

When you have a few potentials call them up and ask to visit - you might be able to do that at the weekend but mgrs might only work mon-fri. Look at the residents, the cleanliness, the staff, any activities, ask about the cost and current vacancies (the mgr may also advise when you say he will be self funding but don't know how it works as he has no cash).

Then you can work out your top and second choice. If these don't have vacancies now you will have to take a short term place till they become available. But he can't stay in rehab while you wait for a place at your top choice. If you only want to move him once then you may have to sacrifice your top choice home and go with your second, third or even fourth choice.

If you tell us the town or area where you are looking we might be able to provide recommendations or places to avoid.

That’s irrelevant, it's what his needs are now that matter.

Difficult as it is for you, you can’t expect him to occupy a medical bed when he doesn’t need it and there is a nursing home bed available, even of it isn’t the one you want. You can argue for him not to be discharged, but you can’t demand it.

I fully understand that he can’t occupy a rehab bed we waited weeks for the bed I just want to make sure that he’s placed in somewhere that’s dutiable for him
Im looking at stanmore or Harrow in London

https://www.carehome.co.uk/caresearchh_results.cfm/searchtown/Stanmore-London#locations-top

Here's a list of ones around Stanmore. Take a look. Some have reviews and ratings.

If the hospital he is in operates a Discharge To Assess (D2A) policy then it is absolutely possible they will discharge him to any care home they have a block booked bed in to wait out the assessments from adult social care - whilst it is a discharge from the physical hospital building his care remains the responsibility of the hospital (including the funding) until the adult social care assessments are completed. It's seen as the equivalent as being moved to a convalescent ward rather than a proper discharge.

It's vanishingly rare for adult social care to come and do their assessments on the wards now.

part of the assessment Adult Social Care will do with him/you will be discussing if he wants to stay in the care home the NHS have discharged him too or look at other places they suggest. They will also consider CHC eligibility etc at this stage.

You should also do an estimate of his total assets. Eg if he sold his home and added the money he got to his savings how much would he have. Just a rough estimate will be ok for now.

And similarly total up his income plus add £5k as once in a care home he will be able to claim attendance allowance. Even just on state pension plus attendance allowance this would be £15k a year.

This is relevant to calculate roughly how long he can afford to self fund for. For example let's assume he has £150k assets and £15k income a year and the care home is £1500 a week or £78k a year. He can afford around 2 years of care before his assets drop to £23k and the council need to start contributing. (Assuming my mental arithmetic is correct)

The shorter the time he can self fund the more likely the council will need to step in. And therefore the more you need to discuss with them upfront what happens when his money runs out. If you put him in the most luxurious place there is and his money runs out after 18 months the council could force a move at that point.

Thankyou all so much for your help and advice it’s a minefield & so stressful
i viewed a lovely care home yesterday but it’s out of his council borough & expensive I’m not quite sure what the budgets are with the councils contribution when funds run out
we just turned up and a lady was happy to show us around , it was very cheerful and most of the residents were up walking around & sitting together in the dining area . This really pleased me as some of the care homes I viewed the residents were in bed .

Have you been told if you are looking for a residential home or a nursing home OP? If it's a residential home are they expecting to be able to meet his needs in the long term or would a dual setting place be better suited (where a home has both residential and nursing beds).

In terms of his COPD have they talked about prognosis?

I mean this gently but if your dad is struggling to sit out for longer than a hour at a time do you think he'll be one of the people walking around the home? Have they told you how he transfers ie-hoist, stedy, frame? How many staff need to assist to help with a transfer? What kind of chair will be suitable for him to sit out in? Will he be getting a hospital bed upon discharge? Is the catheter long term?

It would be a residential home. The prognosis for his COPD is that he can’t live on his own as he’s at risk of choking when he has a fit of coughing . He might not be one of the residents walking around the home but at least he would sit out and socialise a bit .
He only needs one carer to move from bed to chair with a Sara Stedy. He sits in an upright arm chair to allow his lungs to expand .
We have a meeting next week with rehab and I have my questions written down ,

The catheter seems long term although I am trying for a urology referral

My apologies OP, it seems you have been given the answers which is great. I hope you find a place that you are both happy with, there are some amazing places around.

Thankyou so much Hairyfairy01, I hope so 🙏