Elderly Parents and Care in their own home

[Guardsman18]

Hi. I need some help and hope that by asking here someone may have an answer. I'll try not to make it too long!

Mum is 80, Dad is 85. Dad has cancer and has had surgery but was told by consultant last month that he didn't need to see him any more as there wasn't anything further they could do. He was upset by this and seems to have rapidly gone down hill.

Mum has a heart problem (valve replacement years ago but is too old now to have another op.) She is his main carer eg washing, dressing, toilet accidents etc.

She had to go into hospital on Wednesday having suffered a heart attack, begged to be let home as worried about Dad. (My brother and I were with him but he took imodium and didn't wash which is ok for just a day).

Mum probably had the attack because she is finding it very difficult to wash him etc so carers are now going there tomorrow to wash him. Great. At least they're accepting some help.

Mum has been told that this care will be for 6 weeks and then they will have to sort out private care.

Is that correct? Dad is terminally ill. They are not wealthy by any means but will pay obviously as it's too much for Mum to do. Wondering about NHS continuing healthcare.

Thanks for reading. This is all so new and I want to do what is right for them.

I should have said in our house.

Well she has been given the incorrect advice, but until the OP confirms one way or another we've no idea who it is that has incorrectly advised them!

My guess is that some kind of screening assessment team (depending on which part of the country the OP is in this could be funded by either the LA or the NHS or both) has put in a 'free' interim support package for 6 weeks to stabilise the situation and based on scant financial information has pre-empted the financial assessment and advised/warned that after the 6 weeks is up its likely that OPs parents will have to pay for any care they receive.

That is not the same as being told they will have to sort it out privately themselves, although some LAs/social care workers do try and steer some self funders in this direction as it's ultimately less work for them so I'm not going to try and suggest that the OPs parents may have been (incorrectly) told this, but I really hope that isn't what has happened.

I really hope that what is going to happen is a further social care assessment toward the end of the six weeks 'interim support package'. If they haven't had a full assessment which considers entitlement for CHC then they need one and this is what OP needs to push for.

I'm not doubting what you are saying about your DDs needs at all in relation to CHC, just saying that it's like trying to compare apples and oranges.

Thank you so much for your replies. This is really helpful.

We have progress. An emergency 'package' has been put in place and a lovely lady came this morning and washed him and helped him dress.

I will push for the CHC.

Mum is worried about giving me and my brother POA as someone has told her that if Dad dies, then she will have to ask us to get any money for her. Maybe that's another issue? We do have a friend who's a solicitor so maybe that's the way forward?

The carer said this morning that it wouldn't be six weeks and that's it as Dad is terminally ill. I just need to keep on top of things and know what I'm talking about.

Thank you x

Nope they would have individual LPoAs. Or your mum wouldn't have to have one at all if she didn't want to.

If your dad died/lost mental capacity it would have no bearing on your mother's LPoA if she did get one herself.

The idea behind them is that once you have lost the mental capacity to manage your own affairs that you have pre-designated someone else to do it on your behalf, it doesn't give anyone permission to do anything without your say so until you have actually lost capacity.

Any solicitor experienced in these matters is highly likely to recommend getting one for finances. You can also get them for health and welfare decisions (e.g around going into a care home when it is needed) but understandably some people are bit more reluctant to go down this route.

As a social worker I would always strongly recommend to everyone (especially anyone with any kind of financial assets) to have both LPoAs in place as it gives your close family/friends the right to act on what they feel your wishes would be if you were no longer able to, rather than those decisions ultimately being made by the state instead.

Age UK would be able to give your parents some impartial advice around POA if you contacted them.

Mum is worried about giving me and my brother POA as someone has told her that if Dad dies, then she will have to ask us to get any money for her. Maybe that's another issue? We do have a friend who's a solicitor so maybe that's the way forward?

No, that's not how POA works at all!! It only kicks in IF and WHEN the elderly person needs it to - if she's mentally incapacitated, eg with dementia. Make an appt with a solicitor who specialises in POA and who can explain it to your mum! You may not need to use it but it's SO helpful to have it.

Has your Dad got a community Palliative Care Nurse (often called a Macmillan Nurse but not always) - it sounds like he needs one.

They should be on top of sorting out what support he needs care wise. He may be eligible for NHS Continuing Care and he may not, it isn't automatic if you are terminally ill but again the Macmillan Nurse would know and be able to push things in the right direction.

In terms of POA - whether it is worth doing now depends on his prognosis as they take time to be processed (very sorry to be so blunt). They are only of use if he loses capacity - a good Advance Care Plan would be a better use of your time than money and effort on a POA if time is short, especially if finances are held jointly.

If all money is held in your Dad's name, the simplest thing to do is to make their current account (or wherever they hold their money) a joint account so your mum can access money and pay the bills when he is too unwell to do so as POA is onerous even when you have one. It is likely she will want to be by his bedside, not going down to the bank to show them paperwork. It also means that when Dad dies she can automatically keep using the accounts.

Practically speaking it is quite unusual to use a POA for health in a cancer patient for decision making (speaking as someone who works in end of life care). They are much more heavily used and useful in dementia and illnesses where there is longterm loss of capacity.

Once again - your Dad needs a Macmillan nurse to talk this through with. He needs a sensible estimation of what his prognosis is, which will help guide whether he is entitled to CHC, what to do about POAs and finances and help all of you plan what he and your mum want in the coming weeks.

If it helps you to reassure your Mum, both of my parents and my aunt have POAs - they are also 'just in case' documents and needn't just be for when you lose mental capacity. If you break your arm and can't write a cheque, or break your leg and can't get to the bank, you can ask your attorney to deal with things for you.

I intend to set one up for me with both of my sons as soon as they are both 18. It's peace of mind to know that if I can't do something, they can do it for me.