Help From Social Services

notlongnow_2

Has the hospital set up this meeting or have you arranged it yourself? It should be the hospital referring to the hospital social worker who will, in turn arrange appropriate meetings and then pass onto social services.

Why will the residential home you mention not be able to care for him? It is a common misconception that because someone is elderly and has 'problems' that they must be nursing....not always the case.

A catheter can be managed in a residential home, as can oral medication(for examples). Unless the client requires complex medical intervention such as PEG feeds, syringe drivers IV's (again...examples)there would be nothing a nurse could do that a carer couldnt do exactly the same. Residential homes always have numbers for the district nurses should they need a nurse for eg..blocked catheter, or for regular meds or dressings or just for advice. Having had a previous stroke is not a 'nursing need'.

Why dont the medical staff think he can go home? Obviously I know nothing about your father but almost anyone can go home if they so wish. He can have hoists, hospital bed, special mattress etc etc. He could also have nightsitters but these would be classed as extras to the day carers I believe, and would unlikely to be everynight. Through the district nurses in my area (south yorks) you would get one maybe 2 a week..I know that doesnt seem many but when there are only maybe 4 night sitters on duty and a heck of a lot of poorly people im afraid thats all that could be provided in my area.

You could even take him home and then if it was too much for your mum, you could get in touch with social services who could place your dad in respite(a place of safety for all concerned until something more permanent could be arranged...but you gotta pay im afraid.)

You have a lot of options open to you and a lot of health proffessionals will try to push their point of view onto you. Only the other day the government is wanting to plough millions into community care so that if people want to be nursed at home if possible, then they can.

Ill try to find a link for you.

Sorry...waffling again, but its so important you make the choice that you and your family are happy with.

p.s Ive known patients who have been in stroke units for months.

Zebra

A lot to think about there - thanks.

Think we need to see what social services have to say and then have a think about what's best.

I'll get in touch with a couple of agencies before the meeting to see the options available in our area, and then maybe post again if that's ok.

Thanks to you all for your advice.

notlongnow_2

http://www.adviceguide.org.uk/index/your_family/family/community_care.htm#CommunityCareWhatarecommunitycareservice


not sure if this helps.

Savvy_Sue

Have a look on the Silver Savers board for posts about CHC - as I understand it, the FIRST thing which should happen is that your dad's needs should be assessed from a HEALTH point of view, and this is not something which Social Services can do as part of their "how much dosh have you got, who's paying us or you?" questioning.

If your Dad has enough HEALTH needs, then the NHS has to pay for his further care, even if it's not in a hospital. He may not have, but if, for example, he's got problems with continence I believe this is a HEALTH need not a care need.

Your mum's home is protected as long as she is living in it.

And hugs, it's a difficult time all round when these decisions have to be faced.

Zebra

As an update:

We had the meeting with social services and the ward sister this morning.

The hospital wanted him moved out of the stroke unit, as he is not classed as acute anymore, and they only have a limited number of beds, which is fair enough.
We all agreed that it would be best to move him to a "community" ward for further observation until he can either return home (which nobody actually thinks will happen unless there's a major change in his condition), or we find a suitable nursing home.
And this afternoon he was moved to another hospital over 20 miles away, which doesn't make visiting easy.

The social services said he would need an assessment from the PCT to see if he requires continuing nursing care.
Early on in the meeting they said that probably wouldn't be the case, but later on in the meeting without the ward sister and after they'd been told about his condition, the fact that he's lost his trunk balance and can't even sit up, his loss of sight and general confusion and emotions, and the fact that he'd had an epileptic fit in hospital, they thought he might be entitled - we shall see.
They were quite put-out that the sister wouldn't let them see the medical records, even though my dad had given them permission, and gave them a brief resume instead.
They also said that they would have to complete a checklist before the assessment which we could see. I asked whether they could do that there and then, and they said it would be better if they do it later when he's in the community ward! Better for who I asked - they didn't answer!

We mentioned to the sister about a couple of aspects of his care we weren't sure about - he seems to be very confused and distressed now, something that wasn't the case for the first week or so after he was admitted.
There has been a noro-virus outbreak which closed the ward for a few days so it might be that which has knocked him for six, although his eyesight does seem to have deteriorated quite a lot.
Saying that, the care that he's been geting from the nurses and staff has been first rate, in what must be one of the hardest wards to work in. :T
Anyway the social services thought we weren't happy with things and suggested we have a meeting with the consultant to discuss his treatment, which we will do asap.

So, he'll be staying in the new hospital now until he's been assessed and we've decided where to move him to after that.

Thanks to you all for your help and kind words.

Ps. Sorry Savvy-Sue for not thanking you earlier - I hadn't seen your post until today - thank you!

Savvy_Sue

No problem Zebra. The system's changed recently so that you have to opt-in to subscriptions so you might want to change your User CP Options to keep tabs on this!

However, I suggest you look on Silver Savers for threads about CHC, because you may well need them ...

It is possible that on the community ward they will work on rehab, maybe improve his balance etc.

But you have my sympathies, my dad's been in hospital for over 4 weeks now, before he went in he was out and about every day, and now he's barely been out of bed all that time. He went in with a urine infection, picked up another one, then had the norovirus, just over that. Keeps talking about 'when he's better' but then says how hard it is to make the effort even to sit in a chair, but I don't know how he thinks he's going to get better if he doesn't make that effort!

Zebra

Thanks Sue.

I hope your dad makes a good recovery, are the hospital encouraging him enough to make himself more mobile?

We'll see what happens to my Dad now he's in the new hospital, we were advised by social services to let the hospital believe we will take him home when he's able rather than go into a nursing home, as they said that the hospital may do more rehab and physiotherapy if that was the case.

What's CHC?

monkeyspanner

Zebra wrote: »

Thanks Sue.

I hope your dad makes a good recovery, are the hospital encouraging him enough to make himself more mobile?

We'll see what happens to my Dad now he's in the new hospital, we were advised by social services to let the hospital believe we will take him home when he's able rather than go into a nursing home, as they said that the hospital may do more rehab and physiotherapy if that was the case.

What's CHC?

CHC = NHS Funded Continuing Healthcare
This can be provided in any setting (including home) and is not means tested but there has to be an assessment by the PCT (Primary Care Trust) CHC team. This assessment needs to demonstrate that the patients primary need is health rather than domestic and is notoriously difficult to obtain. For more information on this take a look at this thread.
http://forums.moneysavingexpert.com/showthread.html?t=800521

A initial checklist assessment should be carried out prior to discharge from hospital under CRAG regulations and this then indicates if a full assessment using a DST (decision Support Tool) is required.

I suggest that you familiarise yourself with the funding assistance system for care home fees. For this a good charity site is www.counselandcare.org.uk

If your parents finances are not already separate it would be a good idea to consider separating them as savings in your mum's name would be excluded from any assessment. By this I don't mean your Dad giving everything to your Mum as this would be considered a deliberate deprivation of assets. But it would be a good idea to separate funds in joint accounts as this can complicate matters as funds are used to pay for care if your Dad may be self funding. The family home should not be assessed if your mum continues to live there.

Is your dad receiving Attendance allowance?

Zebra

Thanks Monkeyspanner - I've not had time to read all your thread, but hope your MIL is doing well.

As I mentioned in my previous thread the assessment by the PTC is the next step, and the initial checklist will be done by the social services, and they said we could see a copy, which I think was one of your problems.

Now that he's been moved to a new hospital, I can't see any reason why that checklist and then the assessment can't be done as soon as possible.

We were very surprised that he was moved hospital so suddenly, the idea was first discussed at the meeting in the morning, although no definite arrangement made, and then the next thing we heard was that he had already been moved without us knowing.

All my parents savings are held in joint names (so I believe), so thats something we'll have to look into - thanks.
If my mother deliberately moves any of the money into her own account, can that not be included then?

My dad has been receiving attendance allowance since his first stroke in 2007, but I understand that will stop now that he's in hospital - is that correct?

I think he'll be in hospital for a few weeks yet, so we'll have time to study the assessment report and sort finances out before any decisions are taken.

monkeyspanner

If your dad's share of the savings are less than £23000 (in England) then the council will have to assist in the care home fees as long as your dad's income is less than the care home fees.

If higher than £23000 then your dad will be regarded as self-funding and will be expected to pay the full cost of the fees (unless successful with CHC funding). One thing to bear in mind here is that self-funders generally pay substantially more than the equivalent council agreed rate and that this can cause problems as savings reduce to the upper savings limit and the council have to assist. So if there is a chance of your dad starting off as a self-funder and then the council assisting it would be as well to clarify what would happen to fees in this circumstance as the question of third party top-ups can arise if the council will not assist to the level of the previously agreed self-funding fee arrangement. If this is not clear let me know and I will give an example of what can happen.

The initial assessment of joint accounts is usually ok but follow up assessments can be problematic. e.g.

Joint accounts £60,000
half share £30,000 thus self funding.
20 weeks care at say £400 per week = £8,000
Balance in joint accounts £52,000

At first glance this would appear to indicate a half share of £26,000 i.e. still self funding.
But as the reduction of £8,000 should be coming only from your dad's share, his share has actually fallen to £22,000 so the council should begin to assist. So if joint accounts are kept then it is vital a detailed record to the share balance is kept.

Your mum's share of the savings should be disregarded and she does not need to declare them for the financial assessment.

So I think it is easier if all joint accounts are transfered into separate single name accounts, and this is acceptable. It would however be considered a deprivation of capital if say all £60,000 were transfered to a single name account held by your mum.

Attendance allowance normally stops after 28days in hospital. I say normally because there are rules about multiple stays in hospital over a period of time. If self-funding in a care home I believe attendance allowance continues. AA is not payable if receiving CHC funding.