How does adult social care work in practice ?

[Kevinbaconsrealwife]

Hi and thanks in advance for any advice, help or anecdotes…all will be received gratefully..

To cut a very long story short, my wonderful 84 year old dad is in hospital again after yet more falls and increasing frailty…between myself and 2 wonderful friends/ unofficial carers we have “ managed “ him at home for over 2 years but he is such a fall risk now , that it’s well beyond anything we can deal with…he is also urine incontinent…..so the hospital have said we will need to have a conversation about moving forward with adult social services…..but in reality, how does this actually work? He has capacity but such little physical capability now I don’t know how he will manage at home even with 3/4 care visits a day…I’m just no longer prepared ( or able) to “ be there” for every fall, ambulance call out etc etc…..dad has said he doesn’t want to go into a care home but would go into rehab for a couple of weeks for monitoring etc , but again I have zero experience…..he has been a smoker for 62 years…I thought this would “ get him” long before his little legs gave way…..sad time for him and us….oh and we have a joint bank account with approx £20,000 in it and he has approx £40,000 equity in his home …

thoughts and advice please wise women of MN…thank you in advance xx

In some ways it is simpler if he doesn’t have money - in some ways much more difficult.

Call social services (try just googling Adult Social Services for your area) and request an assessment. If he’s admitted while he’s waiting, tell the medical team and ask if they will refer him to hospital social work.

Then see what they say - though I would see them with him if you possibly can (you might have to camp by his bedside for a while to catch them). They will probably try visits at first on a Discharge to Assess pathway- stay in touch and tell them if you don’t think it’s working. If that collapses, they will ask him to choose a care home.

I would go and visit a few now maybe that take LA payments - at that end of the market, the good ones can be great if tatty - the one my mum is in is homey and suits her - but the bad ones are terrible.

Thank you very much for your reply, it has helped clarify x

I would add that you and the wonderful friends need to have a clear idea of what you are willing to do for your dad going forward, and to be in a position where your voice is heard. Have you told your father that you cannot / will not continue to provide care at home? Have his friends also been clear about that? The danger is that if he tells the hospital social care team that my lovely daughter and two good friends are helping me at home, they will take him at his word and make plans / discharge him on that basis.

You do need to proactively make your voice heard - by camping out in the hospital or by contacting the social care team.

ASC don't discharge from a ward on someone saying this. Nurses in A&E might but not if they have benn referred to ASC as we would check all of that out first.

Request an assessment- there may be a hospital discharge team that do this otherwise contact your local authority adult social services team. They will try to keep him at home with a package of care ie; carers which he’ll be financially assessed for and will probably need to pay for. We have a post discharge reablement team which is free up to 6 weeks and they assess whilst supporting to see what the longer term support need might be.

There are also lots of assistive technologies and equipment that can also help. Things like falls sensors, Telecare etc and aids like toilet raises and rails etc. As part of the assessment your dad will be referred to the respective teams that assess for that equipment and/or physio if there is a particular reason why he’s falling like getting up too fast etc.

He can’t be forced into residential care - as long as he understands the risks, he is likely to stay at home if that is what he wants. Would he consider moving to somewhere like an extra care sheltered unit? 24 hour staff but your own flat and you still retain some independence.

Really? It’s happened to us, MIL (completely immobile, doubly incontinent, Parkinson’s and dementia) was on the point of being discharged home after 3 months in hospital due to FIL initially saying that he and SIL would / could care for her at home in their tiny flat. The aids and lifting devices had been delivered and everything before a different social worker stepped in and recognised it was completely unsafe, even with carers coming. We also had to get FIL to say out loud that he couldn’t care for her safely at home before they would back off.

Discharge to assess worked well for FIL when he had a fall, and was found to be in as bad way and needing a lot more care than he admitted. At the time it looked like a home was the only option and he actively wanted to go into one as he would be ‘looked after’. But 6 months on, he’s still in his own house, has gained weight and improved mobility, and taking his medication regularly has really helped. He’s not exactly happy (lonely and early dementia) but I think on balance he prefers to be at home.

My DF is in a similar situation, in hospital (rehab) for three months now following a serious spinal injury from a fall, he can no longer stand or walk and has very little use of his arms but no dementia or mental decline. The rehab team have been pro-active and have sent an OT round to the house. Their house is on a hillside and there are stairs all over the place, the only room suitable for him is too small to fit a hospital bed, wheelchair, hoist and armchair which would be his minimum care needs, then there's toiletting, he is now in the ASC/discharge process through the hospital. They haven't put us under any pressure to discharge to home, we have all agreed a care home is necessary, even mum who badly wants him home can see that it just can't work. DB and I are both too far away and with too many other commitments to visit more than twice a week and even carersx4 isn't enough.

Thank you all very very much for your replies and I’m so sad that you are all going through similar and worse….xx

@Kevinbaconsrealwife My social services refused to assess DM. They are meant to have one in the home after being discharged from hospital. If you are around, they are reluctant.

As a result Dm paid for help for 2 hours a week from a private company. That was all they could offer. My days and ms phoned over 20 care providers. It’s a nightmare. This worked ok until DM fell again (aged 99 by now) and was admitted to hospital. The OT assed her in hospital and said she needed a care home. I was relieved but Dm had to pay. She did have higher savings though but it was £5350 a month 2 years ago now.

You need to ask about your dad’s savings and equity because I think they both count but I’m not sure. The social services should assess him but here its 4 visits a day and around 15 mins a visit. It sounds like a care home is the answer. Home care is sketchy and it’s not enough but the hospital should discuss his release with you and safety matters.

Many thanks and sorry to hear your poor mum had a fall bless her x