What is the process for determining that a nursing home v. residential home required,?

[limetrees32]

Are there different assessments?
One for applying for funding and another by the nursing home itself?
Who conducts them, how are they made?
Sorry if this is silly question, I have no knowledge in this area.

I assume you'll be getting public funding so my answers are based on that.

There aren't different assessments. The social worker will carry out an assessment and decide whether the client needs to be in residential or nursing care.
When you know what type of home you need you can visit 2 or 3 local ones and choose one. A senior staff member at the home will then carry out their own assessment to make sure that they can meet the clients need and will then either agree to take them or say that they can't meet their needs.

And thats basically it!

This is in no way meant to sound harsh just realistic: If you are at this stage in your questioning then there is almost no chance of funding. My experience is to qualify at all you (the person) is/are at the point of being way way beyond needing help and as the person organising it you keep fighting for it but have lost the will. apply ad request it to get used to how it works. In reality book some private at home help for now.

When it was decided that my DM needed more help than she could get at home she was assessed by a social worker and assessed as needing residential, not nursing care - her needs were "social" (washing, dressing, feeding, toileting) rather than "medical" (complex nursing needs) and she was offered a place in two different homes. We turned down the first because we knew several people who had worked there and found it a really unpleasant atmosphere. The second was a residential and nursing home with a place in the residential wing. It wasn't convenient for visiting but it was a lovely place with a loving and caring atmosphere so we agreed for her to go there. Even when she deteriorated she didn't need to move to the nursing wing, she just received extra care where she was.

Sorry OP - Are they at home? Do they already have a care package? or currently in hospital? It can be slightly different routes depending on your starting point

Sorry for delay responding .
Currently in hospital .10 week stay ,capacity deemed retained ,discharged home 7 days ago with care package .
Readmitted 3 days ago .
Insulin dependent diabetic plus other health issues .Can mobilise with zimmer and difficulty .
Short term memory very impaired .Often doesn't know where she is .
Lives alone.

Do you think they have capacity?

Can they understand information about why being at home isn't safe?
Can they retain that information?
Can they weigh that information up?

If the answer is no to any of these questions the person doesn't have capacity and you should point this out to the assessor with concrete examples.

This can be useful if part of the stumbling block is the perception that the person involved has capacity and is saying they want to stay at home.

If person is self funding and you believe they don't have capacity and you have PoA you can just crack on and organise it. If no PoA or they do have capacity I can't really help.

nhs continuing care need to assess, you need to stress lack of capacity and unable to manage BETWEEN care visits, they are highly unlikely to qualify for funding unless it’s a nursing placement because the funding is for medical not social care

The distinction is whether a nurse is required to be on duty at all times rather than just care staff. Care staff can give meds, assist with personal care and do most stuff. Nursing needs are usually things like catheters, feeding tubes, needing hoisting, having medical needs like having seizures. Some temporary nursing needs like a wound dressing can be managed by district nurses coming into the home.

If in hospital the discharge planning team will assess with input from the ward nursing/ medical team

Were you hoping for a particular outcome?

NHS continuing care funding is a whole separate issue from whether the person has nursing needs and is very rarely awarded. It will be screened for but hardly anyone gets it.

If the person has nursing needs they get a nursing contribution (FNC) but still have to pay the rest of the fees if self funding or the council pay if not self funding. The NHS would very rarely continue to pay only for terminal illness or a very high level of need much more than this sounds.

My mum is in a residential unit of the care home and they still have a nurse on 24 hours. The carers don't give medication the nurses do. We were recomend that as mum was deteriorating she may benefit from going to the nursing unit but they think as she is settled there and the staff know her well they think that moving her would be too much of an upheaval for her so she is staying there.

1. The discharge planning team makes an assessment of need and of finances (or determine if self funding)
2. Care homes with vacancies then make their own assessments of whether they can meet the assessed needs before offering care. The care homes usually have their vacancies on a system (brokerage) that discharge planning can access to match vacancies to patients. Patient will not be allowed to wait in hospital for a specific care home to come up. They will have to take whatever comes up to a large degree especially if LA funded.

That is presumably possible because there is a nursing unit on the same site (often care homes have a residential and a nursing wing). If they don’t have nursing (many dont as it’s expensive to employ nurses) then she would have had to move.

This is all very helpful.
I don't want to give too many details but I'm rather piggy in the middle between the person in hospital and some relatives who do have H&W
poa .
I see from the replies here that the relatives are hoping for a nursing home because of the financial implications .
She would be self funding.
I don't think she needs nursing care.
The hospital SW thinks there is capacity but the answer to
Can they understand information about why being at home isn't safe?
Can they retain that information?
Can they weigh that information up?
is a resounding no.
The relatives don't think she has capacity . They are reluctant to act ( move her into a home) until there is an assessment confirming lack of capacity .
I assumed they can't " move her" anyway if she is deemed to have capacity.
They live some 200 miles away and hope that she can have a place near them.
Sounds as though this might complicate things.
Thank you , such helpful input from you all .

If she is self-funding, your relatives can just ask a care home near them if they have spaces, arrange an assessment (ours was over Zoom, followed by a trial period), prove she has access to the necessary money (eg two years worth) then move her in. It is easier if she agrees to it, then you don't have to get into the capacity/ no capacity issue. Has she expressed any wishes, however muddled?

Will the person need the sort of regular care/treatment that must be carried out by a qualified nurse? If so, they need a nursing home.

If they only need what is called ‘social’ care - help with washing dressing, ‘toileting’ as they like to call it, maybe help with eating and drinking, then a residential home is called for.

People often refer to any residential care home as a ‘nursing’ home, which can often cause confusion.

I've done this a few times...
The only difference is the level of care that is needed. The care home will assess your relative to determine the level of care they need. As your relative will be self-funding, you don't need social services and they probably won't help anyway. All you want from them is a list of care homes in your area that accept LA funded residents, just in case funds run out. Find a care home that offers residential, dementia and nursing care so your relative can simply move within the home as their needs evolve.
As for NHS CHC funding - this is almost impossible to secure. There needs to be a very real clinical need for care that can only be provided by nurses/doctors. It's often only awarded for the last few weeks of life.
Join Safeguarding Futures, a Facebook group. Excellent info there. Age Uk are great, too.

@wobbegong I think she feels she needs to be in a home with the security of some care on hand ( as said imo nursing care is not needed) but equally wants to go home.
Understandable , but really not practical and not working.
I think the relatives are reluctant to act .

@Justbecauseyoucandoesntmeanyoushould but can they do this if the person is said to have capacity and is sometimes ambivalent about the move?

I've learned that "I want to go home" is often their way of expressing that they feel uncertain/worried/anxious. "Home" is a feeling, not necessarily a place. It's very hard to hear them saying it but I wouldn't give it too much weight. My relative used to say it while they were at home.

Thank you Justbecause .
She lacks the understanding to process things and she often thinks she's at home when she's in hospital.

Capacity is very tricky. It can fluctuate so it depends who assesses it and when. With most care homes, you move in on a month's trial (check, of course, when you speak to them) so perhaps that would be an approach you could use with her. She could go in and see how she fares.
The care home will still assess her needs and decide what level of care they think she needs. Whatever you do, it isn't cast in stone. One of my relatives started on residential but they realised very quickly that she needed more support and moved her to a higher level of care, where she did very well.
I will say that I've been lucky and I've had only positive experiences with care homes. Some of them are amazing - warm, loving and full of laughter.

After one failed discharge, they should be reassessing capacity and may refuse to discharge her home again (you or the other relatives should definitely be making a fuss about unsafe discharges), which would mean finding a nursing or residential home.

Even if they decide she needs nursing care, that doesn't mean she would qualify for CHC funding - as others have said, you have to be extremely ill and incapacitated to qualify, hardly anyone gets it until they are at end-of-life stage - so she would still be self-funding. That means it will probably be up to the relatives who have PoA to find a suitable home, whether it is near them or near where she is now.

But if she still thinks she has capacity, actually getting her into a home may be quite a delicate operation. With my DF, who had fluctuating capacity, and really, really wanted to go home, but could not be safely looked after there, I made a point of having a conversation with him while a nurse was in the room, and got him to agree to go into a care home to recuperate after hospital, until he was well enough to go home. Of course he was never well enough to go home again, and bounced back and forth between care home and hospital until he died a few months later.

If your relative is self funding then it's between you and the care home and they will assess and say if they can meet needs or feel that nursing care is needed.

If social services are funding or it's a hospital discharge it will be up to the funding body who will determine the right level of care.

There isn't a separate assessment for the funded nursing element really.

I think a lot of moves to care homes and nursing homes are initially on a respite/trial basis and then become long-term.

Thank you all so much .
I don't understand what is staying the relatives hand(s).
I feel better prepared to talk to them now.