Paying for nursing home care question

[AInightingale]

I know I should be addressing this question to a SW, but I can't contact her successfully, so just posting on here for a bit of advice. Elderly mother was living in assisted care (semi independent) and self-funding at a rate which she could afford. Unfortunately she's been hospitalised for a few weeks after a bad fall and has very limited mobility. If the worst comes to the worst and she can't return to her own little flat, even with a care package, and requires nursing home care, how will this be funded, given that the need is health-based? She does also have dementia, which I understand requires self-funding if you have capital (she has a house which will be going on the market at some point). But which condition takes precedence when they are assessing these things?

As far as I understand it the options would be

NHS continuing healthcare (care funded solely by the NHS) - this is awarded if the needs are medical related and not just nursing or personal care. The bar for this seems very high (My MIL was turned down and she has what I consider to be complex needs).

If not eligible for this then:

NHS Funded nursing care - where the needs are nursing related. This pays the nursing care component of care home fees

Also she might be eligible for

Attendance allowance - if she needs support with personal care, although you have to have needed the care for 6 months

Very very difficult to get nhs continuing care….you may think it’s a health need …..but often not

My friends mum didn't get it and she was doubly incontinent, bed bound, needed assistance with eating, washing etc. it's difficult to see how anyone eligible.

Hi OP

If mum needs a care home then she'd be expected to continue to self fund and would need to put the house on the market.

She would not be eligible for a 12 week property disregard as she has lived in a different establishment prior to hospital and care home admission.

I'd suggest prioritising the house sale if she's close to not being able to continue self funding her care.

Thanks for replies, that is quite worrying as it's a massive jump to fund. She doesn't have that much apart from her house, maybe about £14K. We didn't have her needing nursing care quite so soon, probably foolishly with hindsight.

Continuing care is almost impossible to get and is a fraction of the total cost. The social worker and care home will do a financial assessment and will require the sale of the house. It is very stressful but hopefully they will guide you. Speak to Age UK. They are very helpful.

Sorry it is the nursing component that is the tiny amount. Still difficult to get.
Continuing care is impossible.

@AInightingale it sounds like this is the first time a care home has been needed. Do you know yet if the care home is what social worker agrees is necessary from needs assessment before discharge from hospital? Or might they send back to assisted living with visiting care?

A change in needs means they might help with a placement and with part of funding while they assess if a home is right, 12 week disregard is also for this situation where ultimately your mother will be self-funding but no savings. CHC and FNC are what the care home will apply for if care includes a nursing component but it is a part of the bigger funding picture.

There’s also a Deferred Payment Arrangement which means the council pay care home fees until the house is sold, they are then repaid from the sale. They have to help you to have this in place from week 13.

It is complicated (and we’re not out of the woods yet) but these things exist for unforeseen changes in circumstances - and it sounds like independent and assisted living have been tried but aren’t enough to keep your mother safe any more 💐

It sucks doesnt it? How much is her property worth?

Care homes are an average of £1400 PER WEEK. My late Father's was £8k per month 2 years ago! It was in the area he grew up in and he wanted to stay but in the end it didnt matter. He never left the place!

The care home will probably put a charge on the flat so when its sold they will get first dibs.

Continuing Care is very difficult to get for obvious reasons. If you have money why would the state pay for you? Both parents had to sell their houses and self fund. I knew there were people in the care homes who were paid for by the council but councils dont pay £8k per month. He was funding them too!

With my parent we sold their home (the family home but they were the last remaining parent) to pay the care home. It took us a year and I think the council covered part of the cost (loan with a charge against the house) and the care home also allowed the monthly bill to be invoiced but not paid until we sold the house. We had to show my Dad owned his house and the conveyancing solicitors had to confirm the house was on the market and we had instructed them.
It feels alot to deal with, but I don't think you can ever be prepared for your parents decline, so I'm sorry you are going through this.
At least when you are self-funding you can choose the care home which I'm very grateful for as some of them wouldn't have suited my parent.

Is there anyone on here who has managed to get continuing care. It seems to be impossible even if you are 24 hours in bed have double incontinence have to be fed what on earth is worse than that.
I knew there were people in the care homes who were paid for by the council but councils dont pay £8k per month. He was funding them too!
This, you might as well sell up and rent and spend all your money at least they won't get their hands on it. Or someone I know when the husband died he left the house to his daughter so when the wife went in a home they couldn't use it to pay for her care.

My DF and my DFil both got CHC, it's high health needs but importantly health needs that are unpredictable/vary. So there are 12 domains eg breathing, medication etc. Eg if medication is given at regular times and a carer could do it then it will he a low score. If medication needs regular reassessing and dose changing by a health professional then it will be higher score . And there's fast track for terminally ill within 6 months...

I doubt my mum's house is worth more than £120K. Not in a great state of repair really. My late father wanted to get rid of it when they were in their seventies and go into sheltered housing, but she didn't want to move. He would be annoyed by all this, probably foreseeing it, but it's inevitable for so many people. I really have fingers crossed that she is able to go back to her AL place with a care package (she'll probably need help with toileting/showering) because she had settled there quite happily. Another move would be horrible.

Chc is only rewarded for complex needs and end of life care, mu relative was awarded it about a week before he died so that didn't help. The hospital and therapists will assess her and, if appropriate, she may benefit from up to 6 weeks free reablement if they think it would help her, if they decide she can go back to her own home they can also suggest and arrange some adaptions and equipment. Do you have power of attorney. How does the assisted living flat get paid for, does she own it or rent and also has another house.

CHC is very hard to get. Your needs need to be very complex. I've seen it be awarded for people that need a lot of health professional input. E.G nurses 24/7 or unmanageable health needs like complex diabetes.

I'm not exactly sure if in your situation you would be able to get a deferred payment, and even if you did it could take months. The council may fund without prejudice whilst the house is sold, then money to be paid back. 12 week disregard won't be possible in this situation unfortunately.

Fingers crossed she can have some sort of reablement and be supported to go back to her flat but just be mindful to get the ducks in a row so to speak.

She rents at about £300 per week and pays for it via savings and AA/pensions she gets. But there's a huge jump to care home costs obviously. House has been a nightmare to clear out even though she moved out months ago, we were taking our time but unfortunately events have overtaken us! POA drawn up but not triggered yet.

@AInightingale once visiting care gets to 4 times a day, the cost of rent + bills + food + cleaner = close to care home

I hope you can work out what makes your mother happy and is also manageable for you.

But @RockandRoller is right about getting ducks in a row as falls can be the start of increasing needs.

@apeachandapear is also right that looking at options while you’re likely to go in self-funding means choice.

I work in a care home - it's really really hard to get CHC funding from NHS, it really needs to be an end of life situation.
FNC that pays for the nursing element is paid directly to the home and generally doesn't impact the fees you have to pay.
The other option is a contribution from you LA through social services - it sounds like this is the most likely avenue for you to be able to access funding x

If you are bed bound and doubly incontienent then no….because those needs are predictable…..it’s those that are unpredictable that tend to be successful with CHC

Those needs are neither unpredictable or complex and don't require nursing input - they can be met by social care so are social needs rather than health needs

Examples of unpredictable/complex are people who are vented or require suction, or who have uncontrolled seizures or require qualified nurses on hand

Having registeted nurses in a nursing home doesn't qualify residents chc funding unless it's fast track end of life or complex care .

It's the difference between nursing needs -ie. these are needs specifically related to the a medical diagnosis - not everyone will have these needs e.g tracheostomy care, complex pain management needing syringe drivers/ bowel care due to stoma/paralysis.

Continence needs/feeding/mobility are care needs - they are needs that every person has but in this situation the person can no longer carry them out independently and needs someone else's support to do that.

It is the same as paying someone to care for your baby - the baby needs support in feeding/continence/being kept safe but is not unwell.

I have lots of CHC patients on my caseload and have had every CHC assessment I've ever carried out awarded. However, unfortunately, being bed bound, incontinent, and being fed would not get CHC awarded. I think the whole system needs reorganising, to be honest. At the same time, if the NHS paid for everyone who was bed bound to receive CHC, there would be no money left for anything else. I'm not saying that's right. Things really do need to change.

'Thing really do have to change.'
I wonder if in the future we'll end up paying some kind of 'care insurance' throughout our lives to fund high dependency care if we need it at some point. It's all very well the local authority ordering people to use their savings/sell their homes, but home ownership is becoming less common and many people under 30 now have no chance of it at all. How on earth will the state afford it?

That's an interesting point, we happily (well not always happily) pay for childcare, but people get very upset about paying for care when the dependents are older and paying it from their pocket not the inheritees.
We have to be more grown up about this, either pay more tax so elderly (& disabled care) is universally funded, or used to it being self-funded, or move the relative into your home and look after them yourselves (not many of us wish to do this)