continuing care for my elderly father?

[recompense41]

Hi all,

 

My 80 year old Father has a history of depression. He was admitted to the local hospital's mental health unit last year for a period of several months. It was then deemed he could cope at home with people coming in from social services twice a day to help him. Initially he was told he'd have to pay for this service and a means assessment was done. After several months and no deductions were made I enquired into this. I was told he didn't have to pay as this came under continuing care from the hospital. It then came to the point that my Father could no longer cope at home and he was found a place in a nearby residential home. He was told by social services he'd have to sell his flat to pay for this as the continuing care would no longer apply. My brother and I did some research and felt the best option would be to apply for deferred payments. That way he would not lose so much equity in his home. We have power of attorney and want what is best for him naturally.

 

My question is - although he's in a residential home, is he entitled to some help under continuing care? It seems odd that the care in his own home was free yet no aspect of his care in the residential home is. As well as severe depression ( he says he wants to die and lies on his bed all day) he has very bad psoriasis covering most of his body which causes him extreme discomfort. He also has osteo-arthritis in his knees. He is very weak and often has to be helped up into a sitting position.

 

Any advice would be gratefully received.

[trixter444]

Hi,

 

Not sure about a residential home but if he is in a nursing home then he can certainly be put forward for the continuing care assessment. Speak to the Matron of the residential home and social services to get the ball rolling.

 

Good luck:)

[recompense41]

Thanks for your reply. That's partly where my problem is - the care manger at social services didn't even know about deferred payments and kept insisting that my father's home would have to be sold. Due to that and other instances I don't have much faith in them.

 

I have raised concerns that I feel he needs to be in a nursing home rather than a residential home due to the level of his problems but social services don't agree.

[trixter444]

Hi recompense

 

Financially wise, if he has an estate worth more than £20500, then yes it is pretty much standard that to pay for his care the property would have to be sold. However, if he is granted continuing care then thats a different matter, continuing care would pay for his care. Deferred payments usually apply to short term care not long term.

 

I would contact your social worker and tell them you want to arrange a care review, that way the social worker, yourself and somebody from the home will have a meeting, usually at the home, to discuss what needs he requires and voice any worries you may have. Does he have any alzheimers/dementia at all? Is he mobile?

 

Trix

[Rob S]

I would take a look at this site for info on the issue of Continuing care:-

 

NHS funded Continuing Care and the Coughlan case

 

I am going through the process for my father at the moment. Social services will be keen for the property to be sold to extract as much as possible out of your fathers estate, but the continuing care assessment should be done. One point to investigate is the fact the care was provided while he was living at home so why he doesn't qualify because he is now in a home is odd. If he has been moved into a home then surely his condition has worsened.

[recompense41]

Thank you both for your replies. That website is very useful.

 

My father has been accepted for deferred payments. Apparently as long as there is enough equity to pay for at least 5 years care then he is eligible even though it is long term. He is only very slightly mobile, using a frame to get from the bed to the toilet etc. He has not been diagnosed with dementia but when I visit he constantly asks what day it is and what time it is and can't remember names of people he has known for decades. His main problem is his severe depression. He is on Lithium and other medication and while he was in the psychiatric unit he was given ECT treatment. He has shown very little if any improvement. He takes no interest in watching the TV, or reading, or associating with the other residents and is constantly lying down.

 

I will write to the PCT and request an assessment for continuing care. Nothing ventured nothing gained as they say. I feel that the nursing element of his care should be free as it was when he was at home, even if he has to pay the rest for board and lodging etc.

[recompense41]

Not so good tonight - my father seems to have taken a turn for the worse. He's had another fall, the doctor has been out, my father has an infection and is now confused and somewhat delirious. It's very sad.

 

I wrote to the PCT today to ask for an assessment for continuing care. It's hard having to worry about the finances at the same time as his deteriorating physical condition. But I know many of you are in the same position.

[Rob S]

Recompense,

 

I know exactly what you mean. It's not easy trying to look after an ailing parent, especially with the agents of the state hovering like vultures trying to get their hands on any assets they can. It disgusts me how the elderly are treated by the local authority and the NHS. They show little compassion for the elderly and seem to view them as a hindrance. They forget how many people of my parents generation had to fight a war to defend us from tyranny, only to have to face it in their twilight years from people who have forgotten the concept of care, compassion and health care from the cradle to the grave.

[recompense41]

I agree. My father has worked hard all his life, never claimed unemployment etc. He cared for my mother when she was dying of cancer and now that he needs care the state seems very uncaring.

 

I've had a swift response to the letter I posted yesterday. A message has been left on my answerphone to say they will action a review straight away.

[recompense41]

A further update - received a call from the home yesterday evening to say my father had fallen and cut his head and was now at A&E. I went to the A&E as soon as I heard. No-one from the home had come with him in the ambulance. After being admitted around 6pm he finally got a bed on the ward at gone midnight. He didn't need stitches for his cut, but he was even more confused. It's sad that he's fallen (yet again) but maybe the move to the hospital will force the re-assessment and he'll get the care that he so obviously needs. In his state a residential home is not enough.

 

Would it not have been reasonable for someone from the home to come with him to A & E, at least initially until relatives could get there? He was in no condition to answer all their questions on his own.

[trixter444]

No it is would not have been too much trouble at all to send a carer with your father to hospital, I always ensure a carer goes to hospital with any resident of mine, and that is a rule I have always stuck by. I also ensure that they photocopy all relevent paperwork to take with them to the hospital so the resident isnt asked difficult questions. The resident knows the carer, even with the state of mind your father is in. It is sad that he has fallen again but they will have to reassess him now, he is obviously in need of nursing care not residential, especially being a high falls risk, that should have spoken volumes to social services and the home he is in. have you asked the home why nobody went with your father? My guess is they will say not enough staff on duty to go! I would rather my carers worked short than a resident go to hospital on their own. I am fortunate enough to have very good care assistants who understand their job and the need to do their duty of care for the residents, however I do understand that not all homes are the same.

 

Keep us updated on how he gets on

 

Trix x

[recompense41]

Thanks for your reply. I did phone the home yesterday to ask why no-one went with him. They said that was their policy. They also mentioned staffing levels and the fact that the carer would be stranded at the hospital. They did say though that all his information and notes would go with him. The manger did agree that he needs to be reassessed as he has deteriorated quite rapidly.

 

My father will remain in the hospital at least until Monday. Will keep you updated.

 

Thanks again. It's good to be able to talk about this.

[trixter444]

What they will most probably do is keep your father in hospital until confirmation of him being nursing has been decided, and then you will probably be asked to go and look at nursing homes within your area and decide on one where they can meet your father's needs the best. It is important to find out what level and category of nursing he is when looking around nursing homes. Some homes do General nursing and EMI nursing, others do just one or the other. Social services should give you a list of homes within your area that will cater for your father's needs, I suggest that before viewing any of them, you ring them up individually to ask if they do that category of care you are looking for otherwise you will have wasted trips to homes that cannot meet his needs.

 

Let me know how you get on.

 

Trix x

[recompense41]

Thanks Trix, that's very useful advice.

 

Will keep you updated as to progress.

 

Dee

[recompense41]

An update:

 

I have written to the hospital social services and requested in writing the reason for/criteria used to determine that my father didn't need to pay for care in his own home following discharge from hospital last year.

 

I have written to the care home and asked for a copy of his care notes/ accident reports.

 

I hope the response to these will help me in my fight to get continuing care for my father.

 

He is a little more settled in hospital but still very confused and too frail to get out of bed. I believe an assessment will be carried out today.

[recompense41]

Hello again

 

I spoke to two people at the hospital yesterday and voiced my concerns regarding my father being returned to the residential home once he is deemed fit enough to leave hospital. They confirmed that he would need nursing care and not residential. They also said he is likely to be in hospital for several weeks while a full assessment is carried out.

 

While my primary concern is for his health, I'm also trying to safeguard his financial interests. Should I now cancel his placement in the residential home or would that seem rather hasty? I could use the time while he is in hospital to look for possible suitable nursing homes.

[trixter444]

Hi Recompense

 

Get your social worker involved asap (if they arent already!) and get them to advise you on what category of nursing he is. When you have that info, they should give you a list of nursing homes in your area that you can visit. Give them all a ring when you get the list and check that they do the category of care as it would be a waste of your time to visit homes that dont cater for the care you need. e.g some homes only do general nursing, some only do EMI Nursing, some do both, so it is important to find out what type of nursing he is. Visit as many as you can within your area (you dont usually have to make an appointment if you are looking round a home, just avoid mealtimes). Make notes as you are going round if you wish, take note of the staffing levels to ensure it is well staffed, and all homes are regulated by CSCI - Commission for Social Care Inspection, go on their website and you can view the latest inspection reports of the homes you visit.

 

Let me know how you get on, hope Ive given you some useful info.

 

Trix x

[recompense41]

Thanks very much, that's very useful advice. When I visited today I asked again and a hospital care manager will be appointed to him tomorrow. They said he had to be lifted with a hoist today so it looks as though he will need a high level of nursing care. He is not eating and only has energy drinks. His mental state is a great cause for concern too as he has hit a member of the hospital staff ( something he wouldn't dream of normally) and he was talking as though the IRA were out to get him. It's very sad. To be totally frank I'm not sure he'll make it out of the hospital. I will however look at care homes as soon as I know the level he needs.

 

Thanks again

 

Dee

[trixter444]

Glad to hear their putting their moving and handling training to use using the hoist! Its surprising what a hospital environment does to people who arent normally aggressive. Good to hear that a care manager is being allocated to him, they will assess him asap and do the necessary. As soon as they have assessed him they will tell you what to do, it can be very quick so be prepared to be running round looking for nursing homes, as they will want their hospital bed back as soon as, sad but true. I have seen many people the way your father is, and as soon as they are settled in a home, you get a better picture of how he is. It can be very upsetting seeing him now as to how he was in the residential home but they will do everything to help. The fact that he is not eating could be down to a couple of reasons - forgetting to eat is quite common if he has dementia. The fact that he is on energy drinks mean he is at least certainly getting his vitamins etc. See what the care manager says, if you have any specific questions please feel free to PM me.

 

Trix x

[recompense41]

Thanks again for your advice. I've just phoned the hospital as yesterday they said he would be appointed a hospital care manager today and I wanted to get her name and contact number. i was then told he wouldn't be appointed a hospital care manager, but they would wait until he is at his optimum, and then get his residential home to come in an assess him! I keep telling them a residential home is not enough for his needs but they don't listen. I can't see that he's made a miraculous recovery overnight. It would be wonderful if he had, and I'll have to assess for myself when I visit later today, but I seem to be going round in circles. I'm told a different story every time.

[trixter444]

Hi Recompense,

 

A member of the residential home will probably go out to see your father, just to confirm what needs he now requires and to ensure that they would no longer be able to cope with him in the residential home being the way he is. He WILL be appointed a care manager if he hasnt already, and they will get things moving as they only have so long to sort it out or they are issued "fines", plus they will want the bed back at some point, but they will only move him if he is fit to move - whether that be 3 days or 3 weeks. As soon as they have decided he is ready to leave, that is when the running round begins.

 

Hope you manage to get a straight answer when you go visitingagain.

 

Trix x

[recompense41]

Some good news: my Father seems to be much more stable. I still don't believe he is fit enough to go back to the residential home, but he is looking and sounding much better than he did a few days ago. His lithium levels were way too high when he went into hospital and now that has been stabilised he is making more sense. His memory is still almost non-existent - he can't remember the home he came out of a week ago - but it's a good improvement overall. He's still not mobile though.

 

As an aside - I was quite shocked by the staffing levels at the hospital ward. The nurse going off duty from the day shift (she had been there 13 hours) said there were only three staff all day (for a ward of 36 patients in 6 bays). I heard the night staff that took over telephoning complaining there were only two staff on duty for the night shift, one trained and one untrained! It's shocking, not only the working conditions for the staff, but also the risk at which it puts the patients.

[gizmo111]

Nursing is very hard work - I have had both my parents pass away in the last 30 months and both times have been astounded by the hospital staffs dedication and patience, long after I reached the end of my tether.

 

My father needed to go to a nursing home, andwas assesed by the PCT on the Continuing Health Care criteria. I have to say here that I am a child care social worker but still didn;t have a clue on our rights etc. I asked advice from colleagues in that area and was advised to (all of which I did)

 

1 Question every penny - My dad never paid for care I questioned constantly his rights under CHC.

 

2. Don't choose the first nursing home - pick the one feels comfortable - I did -my dad felt he was in a 5 star hotel for the last 10 months of his life with the most fantastic staff.

 

3. Don't let the bed manager pressurise you until you have what you feel happy with - lots of disagreements and threats from her here to get my dad out of hospital - but i got what my dad wanted

 

4. Look after yourself and your family - easier said than done

 

This is probably the hardest time of your life, but just take each day as it comes and pay special attention ot no 4.

Don't be embarased by any of yur dad's actions he is not himself, but still needs and will recognise you love and attention.

 

Keep us posted

 

Good Luck

[recompense41]

That's some very sound advice there - thanks. It must have been a very difficult time for you losing both your parents in a relatively short period.

 

 

My mother died of breast cancer back in 1990 and I still miss her very much. My father looked after her until the last three weeks when she was very well cared for in the hospice. My father has been lonely ever since. The latest on my father is that he appears relatively stable and an updated assessment should be done tomorrow.

 

I agree one needs to look after oneself and one's family. You have to try to keep healthy to carry on. You can't neglect your immediate family while caring for an elderly parent. Being a divorced parent of two teenagers it's quite a juggling act but I know many are in the same situation.

 

Wil keep you updated

 

Dee

[recompense41]

Still not much info from either the hospital or the care manager or indeed the psychiatric unit. If I phone the care manager I'm told she's busy and she'll phone me back - and doesn't. I phoned the hospital and the care manager was due to come out today but didn't. The ward is closed due to diarrhoea. I try the psychiatric unit (as they were due to be involved in the assessment) and get put through to an answer phone so I leave a message. I try the residential home and ask to speak to the manager and I'm told she's busy and will ring me back sometime. Grrrr................ Am I being impatient or am I being fobbed off? I know these people are very busy but I can't seem to get anywhere.