Care Home fees

lozzark

suki1001 wrote: »

That sounds a lot of times for that to have happened. Did he use his peg at night, or during the day. the machine should give a specific dose, so in theory it shouldn't be possible to overfeed someone. However if someone isn't trained properly it can be unsafe.

If someone is fed at night they must be kept at an angle of at least 45 degrees or they're at risk of choking. I can't believe they didn't receive the correct information, it sounds very negligent to me, but that is just my opinion and maybe there was another reason he was prone to the aspirate pnemonia. I've looked after people who've had peg feeds and your dad's experience doesn't sit comfortably with me, but like I say it's only on the peg itself and not medical conditions.

In regards to the fees, it does sound odd you were told 2 different things, especially when your dad wasn't given a choice. Can you speak to social services again?

For a long while he was fed day and night via a machine that delivered the feed continuously in small doses. This worked well. But just before he was release to the care home, the dietitian decided to use bolus feeds. These are tubs of ensure delivered by a big syringe. That is when it all went wrong. The dietitian said they should be delivered manually over 20 minutes, but the nurses took about 20 seconds. He also complained that the feed was not going through the pyloric sphincter. The angles were all right, but reflux occurred because he complained to me about a burning sensation in his back. When he was admitted back to hospital back from the care home, the overnight nurse saw he had vomited. He thought t was blood, but it was in fact chocolate feed. Pneumonia was confirmed at the hospital.
Although the discussion is interesting, it won't bring my dad back and it does not help me with how to handle the local authority. I'm quite happy to speak to them, but what approach do I adopt?
I'm quite sure someone was negligent somewhere, but I'd have some difficulty working out who was culpable and why. I really don't want to chase a negligence claim which may cost a fortune without a specific case.

Torry_Quine

lozzark wrote: »

For a long while he was fed day and night via a machine that delivered the feed continuously in small doses. This worked well. But just before he was release to the care home, the dietitian decided to use bolus feeds. These are tubs of ensure delivered by a big syringe. That is when it all went wrong. The dietitian said they should be delivered manually over 20 minutes, but the nurses took about 20 seconds. He also complained that the feed was not going through the pyloric sphincter. The angles were all right, but reflux occurred because he complained to me about a burning sensation in his back. When he was admitted back to hospital back from the care home, the overnight nurse saw he had vomited. He thought t was blood, but it was in fact chocolate feed. Pneumonia was confirmed at the hospital.
Although the discussion is interesting, it won't bring my dad back and it does not help me with how to handle the local authority. I'm quite happy to speak to them, but what approach do I adopt?
I'm quite sure someone was negligent somewhere, but I'd have some difficulty working out who was culpable and why. I really don't want to chase a negligence claim which may cost a fortune without a specific case.

Something went very wrong here although I'm not sure how he could tell that the feed wasn't going through the pylorus. His feed should have been given via the pump slowly over several hours. My aunt got hers at 25mls an hour. The only time she got anything via syringe was medication and water to flush it.

As I said was any paper work signed to say anything about payment as this would go a long way in proving any liability.

troubleinparadise

I'm sorry for the sad loss of your dad - my relative died of aspiration pneumonia, but under different circumstances.

Was your father assigned a social worker when he was moving from the hospital to the care home? Because I think that would be the normal process, and a financial assessment should be made. Especially given that he was the husband and carer for a person with a diagnosis of dementia. Contact social services to find out. Age Uk have some good information on their website.

Re the peg feeding; aspiration is still a risk even with a peg feeding tube unfortunately. But I'm very sorry that your dad may have not had the best care he should have, and it is difficult to pick up the pieces under those circumstances with unanswered questions.

suki1001

lozzark wrote: »

For a long while he was fed day and night via a machine that delivered the feed continuously in small doses. This worked well. But just before he was release to the care home, the dietitian decided to use bolus feeds. These are tubs of ensure delivered by a big syringe. That is when it all went wrong. The dietitian said they should be delivered manually over 20 minutes, but the nurses took about 20 seconds. He also complained that the feed was not going through the pyloric sphincter. The angles were all right, but reflux occurred because he complained to me about a burning sensation in his back. When he was admitted back to hospital back from the care home, the overnight nurse saw he had vomited. He thought t was blood, but it was in fact chocolate feed. Pneumonia was confirmed at the hospital.
Although the discussion is interesting, it won't bring my dad back and it does not help me with how to handle the local authority. I'm quite happy to speak to them, but what approach do I adopt?
I'm quite sure someone was negligent somewhere, but I'd have some difficulty working out who was culpable and why. I really don't want to chase a negligence claim which may cost a fortune without a specific case.

I'm really sorry it did go off topic, you have enough on your plate already, I can understand why you don't want to take this one any further, but I would have thought the nursing home were culpable for not giving the correct care for your dad. I won't go any further on this, but if you want to ask me any questions please feel free.

In regards to the fees, have you contacted Social Services again? They seem to organise care packages, so I would have thought they would know where the land lay, plus they'll have notes.

Purleygirl

I'm sorry for you, it must be a very stressful time for you. Would you consider talking to Citizens Advice? I'm sure that someone there will be able to tell whether or not you have a case to pursue.

lozzark

Torry_Quine wrote: »

OP On the fees was anything signed saying that fees were payable?

In a word No! Do you think that makes any difference? Verbal contracts are potentially enforceable. However, I think in this case they would not be enforceable because they were not "complete". In particular the care home fee amount was not specified. Unfortunately there are rules governing care home culpability irrespective of what was agreed.

My dad would not have agreed to pay any fees, let alone the full amount. He also told the family that he would not be charged.

Note that the letter from social services says he had been "asked" to contribute to his care. It does not say he agreed, nor the amount stipulated.

I really do not trust the social service reps not to lie. If they are going to lie, I'd like it done under oath in front of a Judge.

lozzark

Purleygirl wrote: »

I'm sorry for you, it must be a very stressful time for you. Would you consider talking to Citizens Advice? I'm sure that someone there will be able to tell whether or not you have a case to pursue.

Everyone says obtain advice from Citizens Advice. That would be nice, but have you seen the waiting list?

Perryl_2

Hi Lozzark, if you haven't already, it might be worth speaking to the care home themselves, and to ask them if they have any paperwork from the LA which will help you work out where you stand contractually, especially if they never sent anything besides the letter about a contribution. Explain to them the situation, they can probably help guide you as well as they deal with the LA and the many different pay schemes that there are.

I have a relative that works in the industry so I'll try to get them to take a look at what info you've already given in the morning and see if I can get some more sound advice for you.

pmlindyloo

There are several points here that need to be separated and that you need to find the answers to.

Did your dad have an assessment done by social services before discharge and what was the recommendation?

If the discharge to the nursing home was made so that your dad could have an extra period of recovery but did not need the acute services of the hospital then this should be paid by the NHS. (For example, my elderly mother had a period of 6 weeks in a nursing home as part of her reabilitation after breaking her ankle - paid for by the NHS.)

If the discharge to the nursing home was made as a trial period for a time to see whether a nursing home was suitable or whether going back home was an option then this would be paid by your dad (after the financial assessment.)

The treatment of your dad at the nursing home is a separate, though obviously an importnat issue.

Certainly. at the very least your dad's discharge was handled badly (very very common I'm afraid)

You need to speak to Social Services, your dad's consultant and the care home to find out exactly what the reccommendation was on discharge and who was funding it.

You say that you were paying the top up fees which suggests that the LA was funding the nursing home. Therefore, did your dad pay anything towards the fees at all? When the LA are funding the usual procedure is for the NHS to pay the nursing care, the LA part of the care fees (with a top up from someone sometimes) and the resident to pay their share from their pensions etc.

You need to get a complete breakdown of the fees and who has paid what.

Good luck!

By the way, don't bother going to CAB. This is an individual case and they would only be able to give you general information and signpost you to certain organisations. Age UK might be better when you have all the relevant facts.

Amanda65

The Relatives & Residents Association https://www.relres.org

Brilliant organisation who have a website and run a helpline to advise on care and costs for those going into care / gone into care and their relatives.