What care options for my Dad now?

[Timetable99]

My dad has just been discharged from hospital and needs 2x a day care, mostly to ensure he takes his meds, personal care etc. He has an undiagnosed personality disorder and has form for randomly being verbally abusive and "difficult". He verbally abused the care staff coordinator/assessor who came to visit him today and the assessor walked out, saying he won't risk having his staff being harassed and upset by someone so aggressive.
What are our options for my Dad's care now? Has he fucked up all chances of NHS care (and presumably private staff won't take him on either?) Grateful for any advice from anyone with experience of this.

No exact experience of this, but he should have had a social worker at the hospital who coordinated an assessment of his care needs before being discharged. I’d contact them. Otherwise call your local adult social services.

Thanks @SparklingLime I'll do some ringing round tomorrow.

Was he aggressive towards staff in hospital? Do you know if this was taken into account in his discharge care plan?

www.nhs.uk/conditions/social-care-and-support-guide/care-after-a-hospital-stay/arranging-care-before-you-leave-hospital/

The nurses found him difficult and uncooperative at times but this doesn't seem to have been included in his plan. Thanks for your help @sparklinglime as I've got a number to call tomorrow and finally feels like we might be getting somewhere

Good luck. You could also post on the Elderly Parents board.

When I worked on the wards we would discharge those sort of patients to EMI units (elderly mentally infirm) where the staff were specially trained etc. I’m not sure if that was mainly for severe dementia though and would depend on whether he still has capacity.

As a former private care worker, there should be a social services assessment and if he is aggressive his care plan should include that and recommend a double up for visits for both his and the carers protection.

I regularly attended a client who had ptsd and could be aggressive and violent in their outbursts. It was bloody terrifying to see but the client was never violent towards us, they just had triggers that would set off screaming and lashing out.

Speak to adult social services and ensure he has a full and comprehensive assessment, but there are plenty of private companies who can assist you

@AluckyEllie

When I worked on the wards we would discharge those sort of patients to EMI units (elderly mentally infirm) where the staff were specially trained etc. I’m not sure if that was mainly for severe dementia though and would depend on whether he still has capacity.

EMI are for people that are at serious risk of neglect and have behavioural problems and are not safe or can put others at risk.

OP, it seems that your dad needs support via the mental health team including SW. They help facilitate or find trained support workers or care staff that are experienced with mental health conditions.

hi op,I work in care and there will be agencies thst will take your dad on but if suggest contact as tomorrow so they can do a proper assessment. it maybe thst you need to seel it your day is not a carer,also he may prefer male staff
most females I care for prefer ladies and older men sometimes prefer men so worth suggesting all this

Ring your local Adult Care Department and request a Care Act assessment. If eligible for support, social services brokerage department will find a care agency but if your father has over £50k in savings, he will have to self fund a package of care, brokerage can still help find a POC though. If under this financial threshold, he will have a financial assessment to determine his contribution to care costs.

I’ll preface this by saying that I’m a qualified Long Term Care planner. A number of posters above mention financial thresholds (which is actually £23k-ish, not £50k as another poster mentioned) but that is only relevant to Local Authority provided care. There are essentially 3 routes to funding - NHS, Local Authority & self-funded.

Your father’s behavioural challenges would actually work in his favour in terms of securing NHS Continuing Healthcare. NHS CHC is a completely free, non-means tested package of care available in any setting. It’s notoriously difficult to qualify for, but difficult behaviour is one of the aspects that carries the most weighting as part of the assessment. Ask the hospital if your father has had an NHS CHC assessment prior to discharge; if not, request to speak to the NHS CHC co-ordinator to arrange one.

If his primary need is healthcare (by virtue of his behaviour and mental challenges) rather than simply social care, he may well be eligible for fully funded care via NHS CHC. Obviously, having a firm diagnosis would be helpful in terms of pushing his case.

Beacon are a specialist charity who can give advice on this - you can get up to 90 minutes of free advice via them: www.beaconchc.co.uk/how-we-can-help/free-information-and-advice-on-nhs-continuing-healthcare/

This is all really helpful, thank you everyone. He has no savings whatsoever but does own his own home so long term I'm curious about long term care finances but just one thing at a time for now I guess. I rang the LA today and he's on the waiting list for another assessment to be carried out at home. He will need 2 carers attending at once due to his behaviour and there's a backlog of cases in the area to be processed so we can't tell how long he'll be waiting for...but good to know he hasn't completely cut himself off from all options. I'll ring the hospital tomorrow to find out about the CHC so thanks for this @uncomfortablebadger as well as the Beacon tip.

I don't have anything to add other than to say that whilst not common this type of behaviour isn't unique and social services will have experience dealing with it.

That's true @helpfulperson! While I dont blame the first assessor for walking out as he was being insulted to his face, I was a bit surprised and wondered where that left him in terms of whether he was still in the care system or not. I had visions of him being blacklisted!
Everyone I've rang at the LA to clarify the situation today has been lovely and said he's slowed things down for himself but he will be seen to again eventually, and agree @helpfulperson they said it is what it is and they're used to dealing with his needs so that was all very reassuring.

[quote UncomfortableBadger]I’ll preface this by saying that I’m a qualified Long Term Care planner. A number of posters above mention financial thresholds (which is actually £23k-ish, not £50k as another poster mentioned) but that is only relevant to Local Authority provided care. There are essentially 3 routes to funding - NHS, Local Authority & self-funded.

Your father’s behavioural challenges would actually work in his favour in terms of securing NHS Continuing Healthcare. NHS CHC is a completely free, non-means tested package of care available in any setting. It’s notoriously difficult to qualify for, but difficult behaviour is one of the aspects that carries the most weighting as part of the assessment. Ask the hospital if your father has had an NHS CHC assessment prior to discharge; if not, request to speak to the NHS CHC co-ordinator to arrange one.

If his primary need is healthcare (by virtue of his behaviour and mental challenges) rather than simply social care, he may well be eligible for fully funded care via NHS CHC. Obviously, having a firm diagnosis would be helpful in terms of pushing his case.

Beacon are a specialist charity who can give advice on this - you can get up to 90 minutes of free advice via them: www.beaconchc.co.uk/how-we-can-help/free-information-and-advice-on-nhs-continuing-healthcare/[/quote]
The threshold for residential/nursing care is £23250, for community care provision the threshold is £50000.

Speak to his hospital social worker, although this may have been passed to the area team by now.

Contact his GP and explain the issues and ask for a community mental health assessment. Ask the GP to add your contact details on the referral as the first point of contact.

It's highly unlikely that at this stage he will go into care, because with care, he is managing at home with 2 carers, despite being verbally abusive.

We are seeing an increase in care providers giving 28 days notice and pulling out. The Social worker and brokerage will have a duty to find another care provider, but it would help if you ask the social worker to refer to the mental health team too. It's in their best interests to assist otherwise this issue is going to be ongoing.

Maybe look into power of attorney for health and finances, that's if your Dad will allow it.

@windypanda The Upper Capital Limit is set at £23,250 for both types
www.ageuk.org.uk/globalassets/age-uk/documents/factsheets/fs46_paying_for_care_and_support_at_home_fcs.pdf

Local Authorities can choose to be more generous than this but £23,250 is the minimum set by current legislation. I have yet to encounter a “generous” LA!

[quote UncomfortableBadger]@windypanda The Upper Capital Limit is set at £23,250 for both types
www.ageuk.org.uk/globalassets/age-uk/documents/factsheets/fs46_paying_for_care_and_support_at_home_fcs.pdf

Local Authorities can choose to be more generous than this but £23,250 is the minimum set by current legislation. I have yet to encounter a “generous” LA![/quote]
Ahh interesting. Thanks. Derbyshire County Council are generous then, threshold is £50k for care at home