Preparing for care assessment next week

[FiniteSagacity]

Finally have an appointment next week for a care assessment with LA ASC social worker where DF is living.

I am focussed on getting a professional to assess his needs and to tell DF what level of care he needs.

I need this from the visit because DF does not listen to his children and is in complete denial about the state he is in.

Most importantly, if social worker thinks DF needs to be in residential care, I need it to be said to him and in front of him (district nurses are saying residential care).

It’s a horribly complicated mess financially (DF does not have enough income for the visiting carers he currently has, very little money in savings but does have a house in a different area than where he is living that he is yet to agree to sell). We’d sell the house in a heartbeat (although it would be more complicated than that) but DF needs to agree to sell.

Looking for advice on what to get ready, have to hand and ask/say for the visit please - to keep it focussed on DF’s needs and these being made clear to DF.

Sounds like you don't have LPOA - ?

In my LA if he owns a property that is not his place of residence he will be self funding. If they assess him as needing to be in a residential care home they will discuss this with him and being in his best interest but if he has capacity and doesn't want to go they can't place him in residential care.

The Most important thing is not to speak for him or about him while he is in the room. If you want to talk to the assessor, ask her if you can have a private word before she sees him.

Once the assessment has started, don’t be temped to prompt his answers. It is essential that the assessor can see for themselves.

A word of warning from my own experience. They are unlikely to make him take residential care even if it is in his best interest. Unless he is a danger to himself or others he will have to make that decision for himself. There is a very loose interpretation of danger to himself.

@ShrubRose both LPAs are signed but still going through the registration process and DF has massively declined in the last 6 weeks since he signed.

Thanks @Ginnandtonic I think DF will be self-funding but we’re in such a tricky position that he has so little money. The house must be sold but it probably can’t happen fast enough.

Very glad to hear that they are in process.

@Dottiethekangaroo social workers can't make anyone move into.residential care if they have capacity and refuse. You can only make a "best interests" decision if you carry out an MCA assessment and the person is found to lack capacity to make a decision about their accommodation.

If he agrees they will wait for the property to be sold for their fees you just need to let them know what's happening.

@Dottiethekangaroo thank you - this is the kind of thing I need to know.

I’ve spoken at length to the ASC team on a regular basis since requesting the care assessment. Unfortunately there have been lots of things to update them on (and to keep him as a priority). Now his assessment appointment is booked, I’ve spoken to the social worker over the phone already.

So on the day I do think I need to let DF answer all the questions and he’ll show how bad things are.

I’ve seen it suggested that it can be helpful to have a diary of things that have actually happened - falls, worrying behaviours, things the district nurse and carers have reported - and I can prepare that but maybe I should print or offer to email rather than talk about it in front of DF?

@EmmaGrundyForPM what is the MCA - Mental Capacity Assessment?

Do I ask the GP to do that?

What is hard is that in September DF was still driving, living in his own house and buying his own groceries.

There were incidents in the last few years but the decline has been very rapid.

@unicornsarereal72 I’m not sure if DF being ‘out of area’ might affect this.

DF is currently in sheltered accommodation with visiting care near a sibling - not near his house or the LA where he has paid council tax for 50+ years.

This felt like the best interests solution and closest to what DF wanted when we thought DF could still live alone - but district nurses are saying DF needs more and we lurch from one crisis to another with multiple falls this week.

Deferred payment can be agreed with social services. They will put a charge on the property for when it is sold. Regardless of where it is.

https://www.ageuk.org.uk/globalassets/age-uk/documents/factsheets/fs38propertyyandpayinggforresidentiallcarefcs.pdf

i think it is a good idea to print your concerns and hand it to the assessor. Definitely do it in diary form with his falls and crisis.

Developments in DF’s condition - should I call social worker and say I have more to add before the appointment?
We’ve waited so long for this appointment for so long but DF seems to deteriorate on a daily basis. It’s so hard.

Personally I would wait and give it to them on the day of the assessment. They have a heavy caseload and it could get overlooked.

Some further advice if you would like it from my own vast experience.
Get a book and date every interaction you have with social services.
Write down the time you made the call, the name of the person you are dealing with and what was agreed. Phone umbers of all the departments. You will find yourself repeating the same information over and over.
this is going to be a long haul and it makes a huge difference if you can quote exactly what was agreed and when.

I would also get a change of address form from the post office and his address to yours so that correspondence does not get missed.

Thank you @Dottiethekangaroo - very good advice about recording who spoke to.

Everyone seems quick to say whichever other agency should be doing things - but no one seems to be able to do anything themselves… it all feels like we’re being sent around in circles and people are taking advantage of our naivety - they seem to want to get DF off their desk by saying ‘x deals with that, not y’ - no one seems to actually deal with it when you speak to them though.

Sadly I suspect I’ll need that diary for the inevitable complaint to either council, NHS or both 😬

I have never been so angry. It is all so woefully inefficient and could be so much better for everyone.

Sadly, that echoes my own experience.

I thought I’d just update that we had the care assessment and it felt like it went okay - but no one is going to do anything (see horribly complicated financial situation) as DF is not eligible for social housing and will have to self-fund (I had worked this out).

After a horrific weekend, chasing GP and lots of unpaid tlc from family, things seems to be a little more positive this week in part due to new (private) care team (which can only be afforded for a short time).

Going to have to spend less time with DF and more on the mess he left for us to sort out.

But my objective that DF is known to social services is met and the actual social worker was great with DF, reinforcing lots of the advice that he will not take from family (still noted everything in diary though).

Still interested in any other experiences of care assessments and how they helped - or didn’t - especially with complex medical needs and/or financial complexity.

Or follow up / change of circumstances care assessments (assume these are a thing and we’d be at the back of the queue starting again?).

I feel like I’ve ticked an admin task off in pencil. To be continued (like all the other unpaid admin that needs to be chased through the system).

We found with FIL that he would only listen to the social worker. We found the good ones realised that they needed to be straight with him and were skilled at making it clear what help was and wasn't available in no uncertain terms. The poor ones weren't clear and straight and that meant he listened to his gobshite barrack room lawyer know nothing friends.

I’m sorry if I’ve missed it but I’m not sure I understand your fathers situation. He’s currently living in (private?) sheltered housing, and moved there from his own home at some point in the recent past? And it’s quite far away so he’s not living in the same administrative area? Now he is increasingly unable able to live in the sheltered housing because he is struggling physically / falling, and the nurses who see him at his current home say that he needs more care?

And the house that would be sold to pay for care is the one that he owns, the one that he lived in before moving to the sheltered housing?

i guess the key question atm is: does he have capacity to decide what happens next, or not. Did he choose to move to the sheltered housing? What did he expect to happen to his own house at that point? Is he able to communicate his wishes to you and if so, what are they?

@rickyrickygrimes I’ll try to clarify simply although briefly is hard, sorry in advance.

DF is stubbornly independent and an extreme hoarder. Until last Summer he was living independently in his own home (and buying more hoard). Also continuing to refuse offers of any practical help, no obvious mental decline. As @countrygirl99 says, parents don’t listen to their children. At this point we didn’t know anything about multi-agency or care assessments or anything we just kept trying to help at the edges and have DF to stay over regularly in more comfortable places. None of us have a spare room but a couple of nights here and there of musical sofa bed/inflatable mattress is doable for family.

DF has had weekly/twice a week medical appointments for years and always insisted on managing it all himself. Clinic nurses who have known DF years wanted to switch to home visits.

It’s not as simple as it sounds but DF’s house was not considered safe for the nurses. Carers and a care package kept being mentioned but first line council agencies were threatening environmental health condemning his house, whereas DF wanted a miracle so he could stay in his own home.

Inevitable crises led to family being asked to rescue DF which we stupidly did because we naively believed it would be temporary because the agencies lied and none of us are in DF’s LA area so rescue meant change to out of area GP for medical appointment continuity.

Many, many, many phone calls to agencies later we understood that we needed to keep asking for a care assessment - but even if we eventually got an assessment, the financial assessment would mean self-funding. DF is not wealthy with very little in savings (see continuing to buy hoard).

Passing DF around here and there wasn’t sustainable so we found a sheltered option that would take a private renter nearer and had a meeting with a care company. DF was still in denial but understood his own space was necessary.

Adult Social Care finally called back and by chance, we were on the way to a hospital falls clinic. ASC said DF should have reablement 6 week package and this started as the tenancy started so private care put on hold. Care provision was a really rollercoaster process with DF, partly a personalities thing DF still in denial.

ASC were keen to do care assessment after 6 weeks - I was too honest about finances - so I think this was motivated so they could stop paying.

So to answer your questions:

DF still owns his house, different area from the sheltered. DF cannot live there, no one should. DF has allowed me to get an idea of possible value from local estate agent.

DF can communicate and still comes across as mentally very with it - we got LPAs signed okay supported by solicitor.

DF did like the sheltered place but it was hobson’s choice as he can’t go home or continue to be passed around his family.

We have tried to do a budget and finances were discussed at the care assessment, so DF does know it’s dire but is avoiding discussing money. He might be able to do a few months of carers (as costs of both sheltered + care will exceed income and eat into savings, house costs obviously continue for now too).

DF does have complex health needs, nurses now visit every single day. Prescribed accessibility equipment and continence products are really appreciated.

But I don’t think CHC would be likely to be granted and not eligible for social housing.

Just as an aside- does your dad claim Attendance Allowance or another disability benefit because if self funding this could help a bit with paying for care ?