Rights over elder care and "continuous care assessment"

[mamhaf]

Does anyone know what a family's rights are to refuse a "continuous care assessment" for an elderly relative please?

My gran, who is extremely old, is in a private nursing home funded by social services.

Over the past year, her dementia has worsened and social services are keen to get her off their books and into an elderly mentally ill (EMI) unit in hospital.

This seems to be based on financial reasons as it costs them £80 a week for her to stay in the nursing home - this is what the home has told us privately.

She's being well looked after there and the home feel it's likely to be the end of her if she is forced to move.

I'm not her next of kin - my uncle is, but I'm close to her.

Could he simply refuse permission for her to be reassessed and moved? Or could social services go ahead and do it anyway?

tia

I have a feeling - but am not entirely sure -that these are two separate points.

Your uncle may well be able to refuse an assessement as he is acting as her Next of Kin, because that's a medical matter.

But I suspect you can't refuse permission to have her moved from the home. If social services are paying the bills (over £35k a year, not £80 a week), generally, they can decide where she should go. Like it or not, they are entitled, indeed have a duty, to save money.

But it sounds like her dementia may need EMI treatment - many care homes don't cater for those with very severe dementia, and can't keep those with it.

I suggest you consult the carehome as to their opinion of your Gran's health and their thoughts on where she could be cared for best. If the home want her to stay, they can negotiate a discount with social services anyway.

Hope that helps - but I would call Age Concern to discuss this first. They are brilliant at answering funding & some medical process questions.

Thanks auntyitaly.

I took your advice and phoned Age Concern.

Social services have a right to carry out an assessment because they are funding her.

However, they have to act in her best interests, and apparently the psychiatric nurse and manager of the hospital think it is in her best interests to stay where she is.

So I've suggested my uncle gathers written medical evidence that she is better catered for where she is and presents this at the assessment.

There may be a another issue to this as well. If social services deem her to require nursing care and she has a nursing assessment, then the funding for her care would be met by the NHS not social services.

Social services have very limited funding and when I worked for them all funding for clients had to be justified hence lots of assessment to prove the right level of care was being provided.

Aha - yes, it would make sense for them to want to transfer funding to the NHS.

But my uncle seems to have information that in fact they're trying to have her transferred to a psychiatric hospital, so I don't think the proposal would be to keep her at the nursing home and just transfer the money to the NHS.

I'm not entirely sure that social services can carry out a continuing care assessment. They can request one. But as continuing care is funded by NHS they like their own to perform it. (otherwise ss would have a field day transferring patients)

CC assessments are very rigorous and require a lot of detailed evidence from carers, GP and consultants, in your grans case psychiatric nurse. Relatives opinions are often sought.

The assessment then goes before a panel who decide whether the patient/client has needs over and above what social services can cater for.

I wouldn't be too worried at the moment because they have to get a lot of people agreeing to the funding first.

Thanks Nellie. I've suggested my uncle gathers as much written evidence as he can to support the view that she is being well catered for at the nursing home and that moving her would quite likely hasten her demise - she is almost 100.

Apparently the psychiatric nurse is satisfied that her needs are being met at the home and she should not be moved to a hospital.

If necessary I've suggested he tells social services that he would hold them morally and legally liable if they insist on moving her against expert advice and then she dies soon afterwards - apparently it's very common for a move to be so traumatic for very elderly people that it finishes them off, which is what our concern is.

Also, the home have her mental condition well controlled - she can be very aggressive with certain members of staff, so they only send the staff in to her room that she likes which makes her much calmer.

If there is doubt about what constiututes your aunt's 'best interests' you can request a Best Interests Assessment under the Deprivation of Liberty legislation under the Mental Capacity act.

The Local authority should be able to assist or, again, Age Concern can advise.

Good luck