Mum needs a nursing home after car accident

[GlassLampshades]

Hello,

Can anyone point me in the direction of amazing resources, podcasts, websites etc where I can start to understand this whole new world that I've just arrived into?

My mum is late sixties and was in a car accident at the beginning of the year. She has a brain injury as a result, is currently in a specialist unit, and has been told she needs to leave as they can't do any more for her.

They advise a nursing home at mum's cost. My mum is bed bound due to the brain injury which has caused paralysis. She can use her hands and arms and can sometimes pull herself up to sit, but requires 2 / 3 people to move her. She does not use the toilet and only moves out of bed with a hoist to a chair where she sits for a few hours a day. She can hold a simple conversation but has clear cognitive issues, doesn't seem to grasp her situation, no short term memory.

I need to quickly understand how we go about financing this. My dad is also late sixties and in the family home in good health. The house is wholly unsuitable (a crumbling victorian terrace) for him and he would like to sell in the near future. The social worker says a decision needs to be made on Monday.

Thank you everyone. Incredibly useful information. I will start reading the links provided. Sorry I've messed up quoting replies etc.

I really appreciate all your input.

Contact Beacon who are there to advise and support on the matter of Continuing Health Care Funding. www.beaconchc.co.uk

I go this for my late OH - but only after an appeal.

She needs a full care needs assessment, a financial assessment which is all done by the ward and therapists. Does she have capacity to make a decision, not sure why there is a DOL in place, you'll need to ask, she's not able to leave by herself so it maybe lack of capacity so is there lasting power of attorney in place. Don't be intimidated by the sw, she cannot be discharged until there is a safe environment to move to. You also need to see what her insurance covered.

That’s good that you’ll go with him. Come back and talk through it afterwards!

Have an urgent and frank conversation with your dad OP about not agreeing to anything until he has discussed it with you. He may find himself railroaded into decisions that are not in his or your mum’s best interests. Maybe even practice some phrases with him for saying no, because it is so hard in the moment when the pressure is on from the hospital and the social worker and emotional distress is also in the mix.

Finding a suitable home takes time. Finding a suitable home once your mother has been discharged home will take even longer because she will plummet down the priority list for everyone except you and your dad. They cannot just discharge her as long as your dad keeps saying no, no, no. It certainly sounds like she couldn’t come home without extensive adaptations and equipment which is clearly nowhere near ready.

I echo the comments about re continuing healthcare and insurance. Insurance probably first to rule it out as a potential source of funding and then CHC. CHC will probably say no - appeal it. You can find the decision support tool for CHC online to get a feel for the kind of things that are assessed.

I’m so sorry for you and your dad that this has happened to your mum. There IS a way to find a workable and safe solution for all but frankly it may mean hardening yourself and being a total pain in the arse to the point of seeming heartless. It will be worth it to get your mum where she needs to be.

A neighbour was run over recently and needed a fortnights care.

They are claiming from the 3rd partys insurers.

Does it look like there will be a claim against another party for your mother>

@GlassLampshades From what you have said about your Mum's finances, she would be under threshold and the Local Authority would need to pay for a care home, although dependent on how far below the threshold, she may have to contribute.

As you move forward with this I want you to see this through the eyes of the social worker and their motivations when they deal with you

Local Authorities have tight budgets and it looks like your mum would be funded in full by the LA as she does not have huge assets outside of the home which can't be touched.

Care homes are expensive and the LA would have to pick up the tab, therefore, a cheaper option for them is to try and get her discharged home with equipment and a care package, at a guess, something like 3 calls a day with 2 carers depending on how she needs to be transferred. Your Dad would then need to do the care for the remaining 21 hours a day (approx).

So, when they do the means assessment they will apply pressure for the latter option of a return home, even though a care home is better for your Mum and your Dad's own health and wellbeing.

This is so hard for you and your family! It maybe worth having a chat with your mum's consultant - my late father refused to take on board my insistence the reality of my mum's care needs because he was overwhelmed and was talking about bringing her home when that really wasn't an option for either of them - the consultant was able to lay things out clearly and tell him what was in her best interests and my dad then accepted and was able with the help of the hospital to make plans.

You must be in total shock. Your poor poor mum. My dad went into a nursing home after a stroke and they’ve been amazing to him. I would say get the best you can afford, there was such a difference between the normal ones and the fancy ones although that comes at a price. But he’s checked in every 15 minutes and they’re very good at getting medical assistance.

Does your mum have any claim arising from the car accident? That may need to be taken into account.

If she needs 3 people rather than 2 people for her care, that basically cuts off care at home, however much your dad would like to do it.

While she may be self-funding, they can't touch the home your dad lives in. This will likely leave a lot less money available and she will be local authority funding v quickly.

It does sound like you need to be there to hear what is being said first hand and to advocate on behalf of both your parents. It sounds very difficult.

A financial assessment should only be done once it has been established that someone does not qualify for NHS Continuing Care Funding, for which no financial assessment is required - it is solely based on nursing need. See link to Beacon above.

Financial assessments are only done by the local authority via social services - but only when it is established that it is a social services matter and not CHC funding (from the NHS) as above.

Do not get sucked into financial assessments until the basic principle of who is responsible for the care has been established - health service or social services.

Beware! - without the proper support and advice you will be bamboozled into thinking that CHC funding does not apply - I have watched it happening so often!

She won't get PIP at all as she is in hospital

Maybe suggest to your Dad that she goes into a nursing home to start with, as a type of step down care from the hospital setting. Hopefully having it put that way seems less final to him as it leaves the possibility that she might eventually come home. Just dont talk that way to the social workers etc and get him to ‘pretend’ to them too

I’m so sorry, this must be incredibly stressful for you all to try and process😢

I can only echo what others have said, financial and needs assessment needs to be completed by adult social care. Hospital staff may be under pressure because they need to create beds but your mum needs suitable care so the discharge team need to step up!

I lost my big brother recently to a car accident, it’s horrific how life can change so suddenly and without any warning♥️💙

Solidarity. Just another vote saying - glad you are planning to be there at the next meeting. Take notes - names and roles, what the options are, what the timescales are, who will do what next, contact numbers.

I have to say that once you are there, you may find that the situation is not quite as your dad remembers it. It is SO hard when he's probably still in a period of shock himself.

Questions to raise if nobody else does are definitely about CHC funding and whether there are any funded nursing home places she could go to in the short term while you look for a long term option. In England where I work there is a thing called Discharge To Assess or D2A which is a period of a few weeks in funded care, out of the most expensive acute hospital beds, while everyone works out what the best plan is. You don't get much choice of home but it is a starting point.

OP, I understand that you are anxious and upset, but why aren’t you answering questions about claiming on your mums or the other drivers car insurance. That is what insurance is for.

I’ve not read the whole thread but wasn’t there insurance? Will that pay out for care? Sorry to read about your mum. Hope things work out.

From experience with my Dad (RIP), if your mother needs to use a hoist to move to a chair/toileting, then that'll require two care assistants - in my Dad's case they visited four times a day. Please point out to your father that this will mean he will never be assured of privacy in his own home - either he'll have to let the carers in, or they'll have a keysafe and just come in when they arrive. I know his instinct will be to have your Mum at home, but please make him aware of the ongoing effect on his own life. I wish you and your family well.

Sorry I haven’t rtft so if this has already been mentioned then I apologise. Was the car accident your mum’s fault? If it was someone else’s then is there a personal injury claim being pursued? Cost of care like this would normally form part of that claim and you can get interim payments from the defendant to fund immediate costs (if liability has been admitted).

I understand that your Mum should be receiving Attendance Allowance. Does she have LPA s in place.
I agree with PPs, do not let your Dad agree with anyone that she should be allowed home.

You don't get it when in hospital

Hi OP.

Firstly you absolutely need to be with your father when he meets the social worker.

They cannot discharge your mother unless she has somewhere to go where her complex needs can be met.

You need to advocate for both your parents and to separate their needs.

Ask your father to raise with the SW that he wants you as his advocate and that no meetings/decisions should be made without your input/support. Be clear you want that on record.

As pp's have said the decision to move your mother back home is very significant. Once there you will really struggle to move her if your father can't cope - and given what you describe I'd be amazed if he could.

On paper it might sound achievable with specialist equipment and carers coming in but they can be hard to source and retain (poor pay). Your mother needs a level of care from your description it would be very hard to provide at home.

You need to ask the SW about D2A ( discharge to assess) where your mother would be eligible for (I think 6 weeks) of funded care. If they can't assess in that time the funding also has to be extended. Has an OT (occupational therapy) assessment been done re: the property and the feasibility of home care?

Ask if any of these assessments have been done and if so ask for the paperwork. Challenge the findings if necessary.

Make sure a CHC checklist (continuing healthcare) has been completed and sent to the ICB (integrated care board). If so was she classed as eligible for a DST (decision support tool) meeting?

If not why not - given your description she should absolutely meet the DST threshold.

The DST meeting is where your mothers SW and a nurse assessor look at 12 domains (eg breathing, mobility, continence, cognition etc) and make a recommendation about funding that the ICB rules on. Funding may be denied, full or partial.

You absolutely need to be present for the CHC checklist if it has not been done and crucially for the DST. Lots of YouTube videos on DST to prepare you and worth a watch.

Re: finances if the property is in joint names then half is her asset. They cannot force your father to sell whilst he is living there to contribute to your mothers care, but if he chooses to sell he may have to hand over her share of the sale (impacting his ability to buy) or sign an agreement with the LA for deferred payments on his death. You need to get advice on this pronto - I'd contact Age UK for advice https://www.ageuk.org.uk/.

Has your mum got an LPA(Legal Power of Attorney - 2 types one care the other finances)? Does your father? If your mother does not it's too late as you can only set up an LPA when you have capacity and it appears she no longer does. Get it sorted for your father now if not done already.

Last point make sure you make clear to your father and the SW that your mother cannot be cared for at home.

They cannot force your father to do this or give timescales - especially if they haven't looked at CHC/D2A.

Hope that helps.

This is a horrible situation, I'm so sorry.

Definitely attend the SW meeting with your dad, to share the burden of making tough decisions. It's also good for someone to offer a second opinion, push SW for clarity, other options etc.

In the meeting, take copious notes, summarise them verbally in the meeting and send them a written summary afterwards so they are held accountable. Don't let them push you into a hasty decision to get your mum off their caseload - I stupidly agreed to a move under pressure and I greatly regret it. If you haven't decided by Monday, realistically are they going to dump your mum on your doorstep without any support? A short-term nursing home place may give you more thinking time like a pp said, but be very clear (ie in writing!) how it's funded and how long it's for if it's not an ideal placement.