Nursing/Care Homes for the elderley?

Paul,

Given your grandfather's mental state, putting him into a care home may be more unsettling and dis-orienting for him. In my experience with my grandmother, moving her out of her house was extremely confusing for her. Have you considered Oxford Aunts?

http://www.oxfordaunts.co.uk

Good luck

Ian

Paul

I think you posted about your grandfather before - back when the Forum had private messaging.

Anyway, I wish you well. Dementia does require specialist care - well I think so anyway. The old ways are all very well but dementia can be more than just a handful.

Deane

I found that Age Concern to be a good starting point when researching this type of problem. I used them a few years ago while hunting for information covering power of attorney and care homes. I wish you well.

If placing into a home is the only option.

Then go and visit a few homes and have a good look see.

It is always adviseable to choose a home when you can make that choice, rather than placed in any home that has a bed.

Another thing which is not always mentioned:
Life is for the living.

Relatives have lives to lead.

I see far too many old children caring for aged parents and it destroys their lives.

75 year olds looking after 90 year olds is not a funny scenario.

also 55 year olds looking after 75 year old parents and 90 year old grandparents is a very difficult situation and one i have seen many times.

A difficult decision has to be made.

I wish you luck

regards David

I've worked in care both at home and for wages. So has my ex-wife.

This is a truth - rest homes are only as good as their staff. As you look through a candidate home, if you can, ask as many staff members as possible how long they have worked there.

As someone who has managed/worked in various relevant independent/N.H.S. settings & participated in having relatives when necessary for them looked after in RHHA - now NCSC - homes, my advice is by all means check out a few, but more importantly instigate a CPA (Care Programme Approach) meeting a.s.a.p. via your relative's Social Services or GP.

I totally agree that 'Homes' are as good as the staff/management. I hope that you obtain suitable care for your relative. At least it seems as if property will not have to be sold to fund good care.

Lots of good sense in the above. I'd mention a few things that may help you negotiate the jungle.

Residential Homes; basically like a more supportive 'hotel'. Lowish carer to resident ratio, carers are not nurses.

Nursing Homes; for patients with nursing needs. EMI (Elderly Mental Illness) units have psychiatric nursing skills. NH=higher carer to patient ratios, more care+, more cost+. A few institutions are dual registered allowing patients to move to the 'nursing beds' if they become more dependent.

SServs (often in conjunction with a district nurse and possibly a community psychiatric nurse) will perform an assessment of his needs, this decides what level or type of 'home' they would be prepared to fund (assuming you are not self-funding). Homes also have a duty not to take on patients who are unsuitable-they would fall foul of their registration to take more dependent patients than they are trained to care for. Assessments usually take into account the possible progression of dementia but generally SServs do not tend to push NH placements for reasons of cost and typically low availability.

Consider getting a respite stay arranged, in other words a two week 'trial run'. This may help everyone with the choice and the concept; BUT.

The harsh reality may be that the move is unpopular with your dad, and may make everyone else feel guilty too. The move could make his confusion and behaviour worse for a while too with the change of routines and environment. My advice, take a deep breath. Be clear what you are trying to acheive, accept it may be a compromise but possibly is in the best interests of all. It may also be true that within a short time he does not recall home, or indeed understand he has ever been anywhere else.

Patients in residential care/nursing care still have falls. They just have more people to pick them up.

Choosing a home is not easy. Try to see past the furnishings and environment to the staff and managment, these are far, far more important. Ask around, your GP may know ones to avoid and they have usually no 'vested interests' so should be independent.

I hope these things help.

bruce

Paul,

Some very good advice here. Best summary so far is Bruce. As one who also works in this area I would add a few things.

1) Not sure which part of the UK you are in but starting point is indeed to start with SW, however, SWs often ignore social security and other benefit issues and, to that end, you need to start asking questions on that issue from day one. Not least you need to have full details of his income/capital and you need to see the Care Plan as proposed. There is an increasingly strong argument that anyone assessed as needing the higher levels of nursing care in either a resi. care or nursing home should challenge any attempt to fund that via an LA placement and should argue that the person meets the continuing care criteria for free NHS care. It's a sensitive area of push/pull between PCTs and SSDs but that shouldn't put you off if that's what the care plan says.

2) I would be wary of "trial periods". There are potentially serious benefit implications that you need to be aware of before you agree to any such activity.

3) Check out your LA and your PCT. Do they have a Welfare Rights Service? If so, then gather the income/capital details and go get some advice on the implications of the various settings.

4) If you think it's feasible that a stay at home could carry on for a little while then explore the Independent Living Fund (that should give the Social Worker nightmares).

Anything else, just ask.

Mike

One point I would add when checking out homes. Try to make a visit or some contact in the early evening. When looking for a home for my father we were surprised how often the residents were haveing their final meal of the day at or before 5 pm and how most of the staff especially the more able and qualified had left by 5ish. leaving a very long dreary lonely evening for residents - before an early bed time.
David

Thanks all for the advice offered so far.

I don't have too much to add right now, hence the stoney silence, and it seems pointless typing for the sake of it.

Anyone info on the financial implications would be appreciated.

As I said, the house does not belong to my Grandad (always been the case, not some sort of recent thing) but he does have about £20k or so in the building society.

If something does need to be done, in whatever form, my view is that you can't take it with you, on the other hand though he has spent his life working hard and paying tax so naturally any State/NHS assistance would be the first port of call.

Paul

Apart from instigating real useful meetings as you/I have mentioned with Soc. Services/GP via e.g. CPA, you can look online or nip into a SS office to clarify 'capital' rules re approx. £20000.

Not surprisingly, many 'Homes' will jump at chance to absorb potential/actual resident's capital, but there are plenty of 'top-ups' from State.

The figure of £8-16k capital seems to come to mind as regards straight State payments for 'Home' fees, but you need to check this out.

The important thing is that your relative gets correct good care - money being spent doesn't matter.

Dear Chumpy,

I agree with your sentiment.

It seems a shame that the only person not supposed to benefit from their own savings is the person whose savings they are.

Surely to end ones days in an environment which meets the needs is more important than an HEIR buying a new car, great holiday etc.

Shame about grandad had a lousy last 6 months.

But hey he left me £30k and i got my dream Porsche Carrera 4.

Great guy grandad.

Boy did he suffer.

SHAME.

regards a cynic

DAVOhorn, I may be misinterpreting your comments but I'm sat here biting my tongue very hard and trying to remain polite.

I have no problem with my Grandads savings being used to pay for care for him, if that is what is needed.

What I suspect that any sane person would do first though, would be to find out what you are entitled to from the state after 60 years of working and paying your taxes and national insurance etc - that amount of savings won't last long if you're paying for everything out of your own pocket.

Frankly I couldn't care about what I'm left, and getting "a Porsche" isn't that high on the priority list right now. It reflects badly on me if the way I've wording things makes it sound like that, but tbh I'm offended at the insinuation.

Dear Paul,,
I was not intending to insult anyone by my statements.

My statements are based upon personal knowledge of instances where this scenario has occurred.

Worst incident i knew of was old girl froze to death in armchair by coal fire. Teeth frozen in glass of water at side of chair. No coal had been purchased to maintain fire.

Old girl wanted to leave money for relatives. This was achieved but old girl froze to death to achieve this.


Certainly the state helps where it is necessary and unfortunately there is an emphasis upon using savings accrued over ones life.

Moral is dont save or have assets and you will be funded by state.

If you have led a responsible life then state may not be forthcoming.

Sad but true.

regards David

No worries, sounds like I mistook your comments as being against me

It does raise an interesting point though. What is to stop someone who is elderly from transferring any assets they have into the name of a relative and then claiming "I have nothing"?

I suspect there is a law against it, but I'm curious what it is?

Paul

My wife informs me very reliably as she arranged for her mum to go from distant private domestic residence into local BUPA Reg. Nursing Home (now NCSC regulated since April 2002) that back in 2002 the DSS 'capital' allowance per individual was £19000 - figure might have been increased since).

Paul - re early distribution of assets to avoid payment of suppport costs. The Social Security can and will ask if there has been a distribution of assets - from what I can remember the rules are very similar to inheritance tax rules on asset distribution. ie the earlier it is done the better, there is a taper relief type allowance.

Also if the person or family is paying for the rest home care home in full then there is an entitlement to an attendance allowance to help pay for the direct care

As in all cases double check - Social Security will not volunteer you information - you have to ask the correct questions to get the useful information.

Paul,

PM me full details and I will breakdown all the financial considerations for you although you'll still be better going thru. a welfare rights service in your area.

Mike H.

Does anyone know anything about the effectiveness and impartiality of the CSCI?

Long story short the current situation is that we're looking at homes due to the situation changing, and other than visiting and asking questions and trying to get a feel for the place, official reports/inspections seem a useful source of info.

cheers,
Paul

M impression is that, rather like league tables for schools, they are only going to tell part of the answer. Tis is in part because they may be comparing 'apples and pears'. I also suspect that the reports are poor at identifying the rather nebulous issues of real 'care'. Another problem is that high staff turnover in some care homes may make a report qiickly out of date.

As a further source of information I would ask the relatives of current residents, and you might ask the staff of the local practice (GP's and community nurses especially). We get a fairly good idea about the overall quality of various care homes.

Hope your searching is successful. Remember that no home is going to be 'like home', and partly that is the point.

Bruce

Having managed/worked in/being involved with relatives/managers going into such establishments, I have to advise if you can finding out from e.g. other relatives/consumers/clients/staff how the establishment might meet client's/others' real needs.

Sometimes you will get lucky by starting with the closest practical establishment. Good luck - some of the 'standards/auditing' bodies deal with real client-relative-people issues, at other times their motives are questionable.

Many a great deliverer of quality care is 'closed' by people (on bonuses) issuing reports to save local authorities money.

Hmm.. just got back from a visit to a home that I really like the look, feel, atmosphere of. Spoke to a couple of visiting relatives who couldn't fault the place or the staff, and the carer who showed us around said she wouldn't have any hesitation placing her mother/father in there if the time and circumstances called for it. Whilst I didn't speak to any residents there were plenty "out and about" in the various day rooms and lounges.

The owner/matron (stereotypically large too) was explaining that homes sign up to a charter/pledge with the local authority to provide different classes of care at a set price depending on the band the person falls under.

She explained that almost any home who is charging a much higher fee during the self funded period, or expecting anything more than a small top-up fee for facilities like en-suite is being opportunistic simply because they can get away with doing so.

I'm usually very cynical but I got the impression as she owns/runs the place she had a pride in what she was doing rather than a large company who possibly care a little too much about the profits.

The doctor my Grandad usually sees is calling my mum in a bit I believe, we wouldn't expect her to go so far as to suggest somewhere but being a GP I'd assume she visits these places to might have a feel on where's good or bad.

cheers,
Paul

It sounds as if you are 'researching' very well.

Although I won't name them here, I agree entirely with you about comments made sadly about reality of 'large companies' in 'the business' who do not realize that their best advert is good quality care. Good luck to you/yours in placement.

Thanks Chumpy.

Things progressed quite quickly once the Christmas break was out the way, all of the various teams that have to have meetings had them, and we got a call saying there was a room at the home we wanted and he moves there tomorrow.

The encouraging thing is that my Grandad was OK with the idea from the moment it was put to him - it's one thing knowing, and having professionals telling you he's not safe to go back home by himself, but the fact that he's accepted it himself, and that all of this is in his best interests has made it a lot easier than it might have been, and his opinion is the most important one in all of this.

I'll say one thing though, how the hell some of these homes come up with their charges is totally beyond me.

cheers,
Paul

quote:

The encouraging thing is that my Grandad was OK with the idea from the moment it was put to him

I'm pleased this has made it easier. I have seen huge relief when someone who is struggling to cope with their own physical and mental frailties has the burden of looking after themselves reduced. The stress of managing simple everyday tasks is considerable if you are forgetful.

I hope he settles.