Care needs assessment

[Phlerp]

Mum has dementia. Following a hip fracture and hospital stay in September she is now doubly incontinent and has mobility issues (can walk short distances with a Zimmer, but needs someone to help her get up and make sure she doesn't fall over). She was discharged from hospital with carers 4 times a day.

Having her at home in that state caused my dad's mental health to plummet (anxiety, depression, insomnia), and in January he reached crisis point so we moved her into a care home, initially as respite, but then full time. She's currently self funding (and has enough money for about a year of care) so we haven't involved social services yet, but having read the Age UK information leaflets they suggested getting a care needs assessment when moving onto a care home even if initially self funding.

We've got the assessment coming up, but I'm now worried that they will say she doesn't need 24hr care... Is that likely? If they did assess her as able to go home, it wouldn't make any practical difference for the next year, but would cause my dad a lot of stress as we wouldn't have the certainty that she could remain in the care home long term.

Does anyone know what a care needs assessment involves? Would they take my dad's mental health into consideration? He always wanted to care for her at home but he just couldn't cope 😞

Would it be better to cancel the assessment until she's at the point where her money is running out? Would they be less likely to say she isn't eligible of she has been in a care home a long time?

(NB mum doesn't have capacity to make these decisions for herself. She can't hold a conversation at all and just sits and dozes really... 😞)

Don't cancel it. But be prepared to ask for another when the money does run out, if needed.

Thanks @SilverBlue56 . Do you think they're likely to assess her as needing 24hr care? And would that assessment be likely to change after a year living in a care home setting?

@Phlerp we did things this way around - don’t cancel as it’s helpful to be known to social services now even though as @SilverBlue56 says you’ll need to ask again a few months before private funds are coming to the financial threshold.

I think it’s important to be very clear that 4 carer visits at home was already tried - this was a threshold for the local authority. We privately funded a respite stay in desperation and chose to make it permanent, so the care needs assessment came when already in the nursing home but we had already tried 4 visits a day.

We had an excellent social worker who talked to the person and family separately to completely understand how we ended up with 24 hour care, the only debate was whether nursing care was really needed as we’d chosen a nursing home - but the NHS very quickly agreed Funded Nursing Care (home asked NHS for this assessment).

I’m no expert and there are people on here who work in adult social care who might be able to advise but if there’s any suggestion that 24 hour care is not needed, you should push for a carers assessment for your Dad.

Also check the home takes local authority funded residents so if funding does get picked up in the future, your Mum won’t be asked to move (unlikely to be in her best interests but local authorities might want to move to a place they have a contract with).

They will very much take into account that your father can’t look after her anymore.

If it came to that, your dad should just threaten to move out.

IMO you will probably need to be extremely firm in insisting that your father cannot have her at home any more, and be clear that other family help simply isn’t available.

If you haven’t already, do check out the Alzheimer’s Society Talking Point forum for carers of people with dementia. For too many years it was a lifeline for me - both FiL and DM had dementia, one after the other. Whatever you’re going through, someone will have been there and will know exactly what it’s like.

All the best.

Does anyone have power of attorney fir her. The carehome will keep records of her care needs, the assessment will look at how much she can do for herself, how much help she needs with what they call daily living activities. If she lacks capacity them either poa or a deputy will make decisions around her care and where she is safe, has she had a capacity assessment, is there a dols in place.

I'm not an expert but have been through this recently with my dad. I'm sorry you are in this position too.

First thing is to get power of attorney for your mum, if she still has capacity to agree to this.

As far as I know the care needs assessment should not account for your dad caring for her. He should make it clear that he can't provide any care for her. Also make it clear if she is at risk of a fall if left unattended.

It might also be worth getting your parents finances in order, for example putting their money into separate accounts. They should not be able to take the house into account if your dad is still living there. It might be worth speaking to a financial adviser about this.

I agree you need to be firm and say no one in the house is able to help her. I don't see how they can say 4 visits is enough if your Dad can't help.

It's best not to try and work out what they will say or do
Give them the facts and let them do the assessment.

In all likelihood whatever the outcome now, in 8-9 months when you ask them to do another one as self funding is running out, she will be worse so will meet the threshold even if she didn't before.

I’m an adults social worker. Does your mum have capacity because that will be the deciding factor on what happens really.
If she does, the social worker will lead on what she wants to do and look at ways to make it happen. Of course they should work with the family first, but if she wanted to go home we wouldn’t legally be able to stop her.

If she lacks capacity then it becomes a best interest decision. Usually if someone has been in a care home for a while they become “de-skilled” and more reliant on staff to help. Which helps to form an argument of her remaining where she is. Does she have night needs, e.g waking often or needing repositioning? This will also strengthen an argument for her to remain in care as this cannot be managed easily at home.

Thanks all that's really helpful.

@Username2101 @MissMoneyFairy no she doesn't have capacity, also no LPA for health and welfare unfortunately.

She's not too bad at night, although she has fallen out of bed before and the care home now have bed guards up overnight.

On your update all her care needs to be in her best interests, as she lacks capacity and there's no poa. Who made the decision she could move to the carehome and, agreed payment and signed the contract. Will you apply for deputyship now. Bedrails are a form of restraint so that needs a safety assessment, consent and agreement by someone

@MissMoneyFairy it was my dad (he has LPA for finances).

Yes, the care home filled out some forms re the bed rails after she fell.

The carehome sound great, all her care, and assessment, should be in her best interests which deputyship can allow, if you want you can ask to see her careplan and all the risk assessment and consent forms including bedrails, mobility, emergency evacuation, use of photographs on social media.

I would personally cancel the needs assessment because there is no particular reason to have one at the moment, and it is stressing you out - so why do it?

I moved my mother to a care home when it was no longer safe for her to be at home, even with daily carers. I had finance LPA and she was self funding. The care home did their own assessment of her needs, social services had no input.

When her money ran out after several years in the care home, I contacted Social Services (about 5 months before her funds were due to run down to the £23k threshold) and they went in to assess her. By that point she had late stage dementia and no one would have deemed it possible for her to 'go home'.

I did not have H&W LPA for my mother, but it was never an issue.

Thanks all. We went ahead with the assessment and I think it went ok in some respects (SW said she'd have the report done by the end of next week) but I was a bit annoyed about one aspect - it would be helpful to hear opinions if anyone can comment? @Username2101 ?

The SW was obviously asking lots of questions to understand how much my mum understands about where she is, and what her preferences are. The SW was asking about where mum lived now and it became pretty clear that mum was content where she is, but she didn't believe it was a care home. SW asked how she would feel if she knew she was in a care home and mum replied "horrified" 😞. SW then kept on at her and kept refering to where she was as a "care home" - almost trying to reason with her that she was, in fact, in a care home.

Thankfully I don't think (or at least I hope) that the reality didn't sink in for my mum. If she actually understood where she was and what her condition was she would be utterly distraught (the care home is excellent and day to day she is absolutely fine, but it's the principle of being in a "care home" that would upset her iyswim).

Is that standard for this kind of assessment? I realise they have to ask questions, but all the advice I've seen about dementia is that you should let people live in their own reality (especially when they have clearly stated that knowing the truth would distress them!)

I dont see anything wrong with saying she is currently living in a carehome, it may be where she permanently stays now and if she's happy there that's good, it doesn't sound as if the conversation upset her or caused any distress. There will be other staff and occasions when they say its a carehome. The sw may have also been trying to assess her understanding, capacity and memory.