How much influence does a GP have over care home decision?

[Gooden]

Would appreciate any insight. My mum is my grandmothers carer. My grandmother is 87 and had a fall two years ago none since. She lives in a one bed council flat. She is mentally capable and physically a bit frail but not too bad - eg. I took her shopping to the local town today and she walked around but couldn't go out on her own. She still goes out to restaurants with family for example.

My mum also lives in a one bed flat and is desperate to get DGM into a home because she (my mother) isn't coping. She pops in most days and arranges appointments etc but IMO DGM isn't that bad to look after. She needs help showering but is mainly independent at home. Carers come in twice a day to help with basic tasks she may need and more often than not she doesn't need much they just chat to her and make some toast or something. She is however lonely.

My mum is desperate to get her into a home. Social services have said a few months ago she doesn't need one but my mum said she has deteriorated since then. I am at university so only see them in holidays but speak to gran most days on the phone. None of us own a property or have significant savings so it would have to be a council funded place. I personally don't think she needs to go into a home - DGM will go along with anything so isn't expressing a strong will either way.

Mum's close friend is the local GP and she has asked them a lot to recommended to social services that Gran goes into a home which they've now said they will do. Does this mean as a medical professional is recommending it that it will happen? How much influence does the person's doctor have over this decision?

Hi, technically GP has no decision in whether a person needs a care home . They can make a recommendation but it’s not something they can push through.

social services will only put someone in a care home if there is absolutely no other alternatives. Care at home etc. if your nan has capacity to make her own decisions she cannot be forced to leave her property.

but sometimes people think they don’t have a choice and will go along with something. Make sure you tell your nan it’s her decision either way. A good social care worker would try and keep someone at home

None as far as i am aware, i am currently involved in locating a care home for my MIL.

You said that you would appreciate insight so here goes.

You will have no idea of what is really going on for your mum and grandmother on a day to day basis.

All you have experienced is how your grandmother presents with you, based on your relationship with you.

Your mother however has to support your grandmother on a daily basis, and whatever demands that entails.

I have a daughter like you who seeks to tell those (whose own lives are on hold because of an aging parent) what is best for her grandparent and what we ought to do.

I can tell you it is exhausting both emotionally and physically, and there are four of us trying to spread the load.

My advice is sit down with your mum and support her, find out how hard it is for her.

Even better pack her off to a friend or somewhere nice for a week and you go cover your mums duties, and see how you get on.

Sorry to be harsh but you really have no idea

it is nothing to do with the GP & I bet if paying for it was coming out of their budget they wouldn’t be so keen to help! Social services are part of the local authority & it is up to them to carry out a needs assessment. Once they’ve done that they will decide if they believe she needs a care home but as your Gran has capacity they certainly can’t force her to go into a home.

rather than try and get your nan into a home, your mum would be better off getting some support for herself as your grans carer - she should ask for a carers assessment and see if there is a carers organisation local to her. There might be other things available that she’s not aware of

But to be fair, a care home isn’t the only alternative. If you are providing such a high level of care it’s impacting on your wellbeing you’re entitled to an assessment in your own right and potentially get some support to take the pressure off yourself. If all avenues are explored obviously a care home is a good option but it should be a last resort because they rob people of their independence. I hope you find the right option for both you and your parent. It’s a very difficult job to be a carer.

I suggest you look at how much support your DM actually provides for your gran before deciding if she needs a care home. If she has not got the funds to pay herself, then the LA would do a needs assessment to determine if she should go in a home. As a basic ball park figure, if she requires more than 4 carer visits a day, then they would advise residential care.

A care home placement should only be for someone who cannot safely have their needs met at home. It’s all about risk and normally the crux rests on whether or not they need support overnight.

It sounds like your mum is struggling. It might well be that your nan needs more care visits rather than a home, but unless you are in your mum’s shoes you are probably not aware of the full situation.

Maybe see if your mum can apply for some day centre type places - my grandma got visits to those funded (can't remember how, though!) and it included a mini bus to come and pick her up. She would spend 1-2 days a week there and there were activities and people to talk to - would lessen the burden of her feeling lonely and maybe give your mum a couple of days off. Realistically if your grandma is capable of being at home the council won't rush to fund a place in a care home for her, but it might be that she needs additional visits from carers a day or, like I say, other stuff to support so your mum doesn't have it all on her.

Just to add based on responses on this thread, there is the issue of people, usually women i might add, becoming a carer by default.

If the OP mum withdrew her support then in all likelihood the OP’s grandmother would be assessed as needing a care home.

But the OP Mum cannot bring herself to do that, then she becomes trapped.

I'm a senior social worker in Adults services and the answer is none. Advice is useful but the local authority are the decision-makers unless there is an LPA for H&W.

Just to add to my above comment, the LPA Would only apply if your mum has been deemed to lack capacity in relation to her care & accommodation needs by the SW

Social Services will only fund a care home if your nan is unsafe with 4 carer visits a day. They will try that first. What is your.mum doing for your nan? Your description makes it sound like your nan just needs more social interaction but is there more to it than that? Even that can be exhausting. It's relentless if it is needed every day / there is pressure never to miss/ go multiple times a day. Maybe offer to pay for a day centre a couple of times a week to take some of the load off your mum if you are determined your nan shouldn't go into a home.

In reality your nan probably needs loads of help that carers don't do like help with admin, cleaning, paying bills, changing light bulbs and all the little day to day things you don't think twice about because they are zero effort when you are young.

And your nan can't go out by herself so that all medical appointments, hairdresser, all shopping - food, clothes, Christmas and birthday presents etc. You mum is probably planning her life around your nan's needs.

It seems that DM is putting her life on hold to visit DGM daily as DGM is lonely - I'm amazed she is lonely if she has carers twice a day. But I would think the best thing is visitors for DGM who aren't your DM.
Is there an elderly call in and chat service or telephone service for DGM - could she go to a day centre. You'd need to arrange a regular taxi to take her.
Unfortunately being at home all day DGM is expecting DM to be her companion and entertainer which imv is very unfair. Would DGM go to church on a Sunday - taxi needed again.
I can't see her being put in a care home whilst she is able to get about ok.

It’s nothing to do with the GP. In our area Social Services will not consider paying for someone to go into a Care home unless the have dementia but they will provide home care.

I'm a GP, we have zero input. If you're not self funding then it has to be shown that carers four times a day is unsafe. It's a social services decision and from the information given your gran is nowhere close to meeting that threshold, sorry.

The main reason people go into care homes is incontinence. @Pat888 I'm amazed she is lonely if she has carers twice a day.

Many carers, I am assuming she is single handed are here on visas, especially in domiciliary care. Often English is not their first language and they will do the bare minimum. It is not their job of choice.

Does she have regular carers? Do they take her out? 2 x 15 min visits if that do not really fill a day.

As ppl suggests go yourself and see what is actually going on.

You say she needs help showering, but the carers often aren’t doing anything apart from chatting? Does that mean your mother is helping her shower? She should stop that and let-the carers do it. She shouldn’t do anything herself that the carers can do.

You could see whether your GM is eligible for Attendance Allowance. That would pay for a bit more help,or for her to go to a day centre which might help with the loneliness

If your mother is spending more than 35 hours helping your GM (including time making appointments, doing shopping etc), AND she’s earning less than £151 a week AND she’s not getting state pension or other state benefit, she could be eligible to receive carers’ allowance.

I'm amazed she is lonely if she has carers twice a day Really? Imagine the only person you saw was your cleaner. Do you think that would alleviate your loneliness?

The main reason people go into care homes is incontinence. Is it? I would have expected it to be falls.

Thank you all for the information that's very useful. I think I need to let DM know that she's wasting her time hounding the GP to write letters and recommendations.

The day care suggestions are good and I think this could be useful I'll look into it.

Yes my mum showers gran because she says she wouldn't be comfortable with a carer doing it. My mum does to some extent have her life on hold in that when she goes on holiday she has to make arrangements that factor in my gran's care, but otherwise she visits for 10-15 minutes a day, unless there is an appointment. She does however liaise with all the medical professionals so has admin and caring to do in that sense.

My reservations about a home come from the fact that I think it's more for my mum than my gran. My mum even said someone told her to call 999 to get my gran into hospital and then insist she be discharged to a nursing home - she has no reason to call 999. My mum wanted to do this until I said no.

If she's currently coping with two carer visits a day she's unlikely to be assessed by social services as needing a care home.

The benchmark is generally not coping with four visits per day.

The GP will have very little input in this.

Ultimately your mum needs to contact social services and say she's unable to meet her care needs or describe the deterioration to them in a way which makes it clear she needs assessed again with a view to increasing the number of carer visits per day. She will not be put into a home simply because your mum thinks she's lonely.

I think you should butt out frankly. If your dm wants to hassle GPs that's up to her.

It's also not on you to assess your dgm's care needs, you're not her social worker.

If she's lonely then a care home could be a brilliant place for her to be.

I get the impression you're 'concerned' because you want your dm to carry on as she is, not because you're putting your lonely dgm first.

Care homes are not brilliant places. It’s not for lonely people. It’s for people who have a high level of need that cannot be met in the community. We’ve moved away from institutionalising older people. Her mum can take a step back and tell grandmother sorry no I’m not doing it. It’s extreme to try and get her in to a care home when she could have a carer come once a day to help her shower. Care homes for someone her grandmothers age will be 90% full of people with dementia. She will stripped of all her independence. So she is absolutely right to advocate for her nan. No one has a gun to her mums head. She can tell her mum and social services sorry I can’t do this anymore. If her grandmother isn’t willing to accept carers at home, accepting carer in care home will be even more distressing

@titchy I really doubt a nursing home is a better environment than someone's own home.

You’re absolutely doing the right thing. You mum is not an impartial party. It benefits her to have the pressure removed. And don’t get me wrong she should. She shouldn’t have to manage on her own as caring is a difficult thing and she’s obviously not managing, but a tough convo needs to be had with your nan about accepting support from other people. That your mums not managing and it’s not fair to all be on your mum. But that doesn’t mean that the only alternative is a care home