Elderly bedridden mother wants to go home - advice please!!!

margaretclare

Yes, she should have a social worker.

About the chest infection, if - as you say - she constantly slips down in her chair and can't breathe then that will predispose to chest infection because she cannot breathe deeply and clear her lungs so fluid stagnates in the lungs and the next thing you know, chest infection. Yes, unlikely to develop in 6 hours but the likelihood is that predisposition was there, maybe a low-grade infection hovering around in the little alveoli in the lungs, unable to be cleared.

About getting funding for a paid nursing home place, experiences of others on this site show that it's extremely difficult to get. Extremely!

LL30

I think you're doing a terrific job, but I'm not quite sure what the professionals are up to!?! I had assumed that a social worker had been allocated as you said that she was going to return home with her 4 x daily package of care, and someone would have had to commission that service - that's the role of a social worker.

What you need to do is this:

Ask the ward to submit a section 2 notification under the Community Care (Delayed discharges) Act to the local authority social work dept. This will get you a social worker - even as a self funder your Mother is entitled to an assessment under the Community Care and NHS Act S.47, this is what you want.

Ask them to attach her continuing healthcare checklist with this so the social worker can see it.

Ask for a copy of the checklist yourself (I can help you decipher this if you would like me to).

The procedure has to be followed - the ward should invoke the process and generally it unfolds from there - not quite sure what's happened in your Mum's case, unless (and please don't take this the wrong way) your Mum has asked for you not to be contacted.

In terms of nursing care, just remember that it is very hard to get. I have a lady returning home this week who is the same as your Mum in many areas of her care needs, she also has some gaping wounds. I took it to a DST to ask for nursing funding and it was refused, the district nurse will come out every 3 days to change her dressings.

There was a ruling in 2011 (I think!) about incontinence, and it is one of the hardest areas for relatives to comprehend. Basically, the high court ruled that for incontinence, whether single or double, it is acceptable to manage it with pads and pants over night, and have four calls to manage it during the day. I have my own personal thoughts on this, but ultimately this is the guidance we work by. There are thousands of bed ridden individuals who are doubly incontinent across the country who are cared for in this way.

Different areas have different ways of working residential home criteria. In my area, the person has to have been in receipt of a full package of care, and it has to have failed for them to be considered. Like you said, a chest infection wouldn't be considered 'a fail' as it was a medical need. Another difficult area for relatives to consider is that their parent will more than likely continue with a pattern of going in and out of hospital, many times over as they get older. Often this is due to medical need, but it is when the social care cannot support their social needs that the social workers have to step in and reconsider the package of care.

Does that help at all? It really is a very complex area, and understanding the difference between social needs and medical needs is really tough - even for the professionals, there's a huge amount of literature on it xx

nightsong

Ok, update here. Thanks so much again, all.

Someone just rang me from the discharge team. Evidently she does have a social worker, the one attached to her ward - her name is Leah and she's going to ring me. So the doctor was just wrong on that.

She had a DST assessment in July apparently. She has not been identified as having a "primary health need". But she does qualify for nursing care contribution of £110 per week. Don't know what the implications of that are?

The discharge man said social services would provide me with more information about where she may be able to go. It seems as if my mother is sticking to her decision not to go home and has told them that, thank goodness.

Errata

margaretclare wrote: »

About getting funding for a paid nursing home place, experiences of others on this site show that it's extremely difficult to get. Extremely!

Don't you think that people tend to post about poor experiences, whereas those who have good experiences don't post?

LL30

nightsong wrote: »

Ok, update here. Thanks so much again, all.

Someone just rang me from the discharge team. Evidently she does have a social worker, the one attached to her ward - her name is Leah and she's going to ring me. So the doctor was just wrong on that.

She had a DST assessment in July apparently. She has not been identified as having a "primary health need". But she does qualify for nursing care contribution of £110 per week. Don't know what the implications of that are?

The discharge man said social services would provide me with more information about where she may be able to go. It seems as if my mother is sticking to her decision not to go home and has told them that, thank goodness.

:j This is good news! The £110 nursing care contribution acts as a 'top up' to residential home fees, making her eligible for a nursing home. Generally (in my area) this means that they are automatically eligible for residential care as they have been identified as having a 'nursing need' - and these generally cannot be managed in the home environment. This does not mean that everyone who gets it does go to a nursing home, sometimes it can be managed in the home environment, but the social worker, along with health will establish if that's possible. I know that sounds contradictory, but if a person wants to go home, the professionals will work to try and make this possible. Usually the £110 nursing care automatically 'turns my hand' and means that I have to commission residential care. Urgh, I don't think I'm explaining this very well at all, my brain is misbehaving today!

You should have been invited to the DST, not sure what's gone on there. I'm very pleased you have got the name of the social worker - I thought it was all very strange. Sounds like the communication hasn't been great. Oh, and I'm not surprised the doctor didn't know about her (they often have no clue about discharge planning).

So, your Mum as a self funder will pay the flat rate fee for the residential care element, and the NHS will pay the £110 top up to make it a nursing home placement. The social worker should be able to help guide you now. Very pleased that you seem to be getting somewhere!

margaretclare

Yes, it really is good news and some progress is being made. You seemed to be going round in circles before.

Very best wishes to you.

nightsong

And so it all drags on. My mother is currently still in hospital but is due to be transferred to a nursing home any day now. The nursing home is the only one that's a) near enough for my aunt to visit, b) has a space and also c) takes the government's money once the client's runs out (it's a posh part of the South East where most people are pretty well-heeled, unlike my mother - so I assume this is why it's so hard to find a non-completely-private nursing home? Because the fees generally round here are so high, that the gap between what the government will pay and what the home charges is too great?).

So, she doesn't have any choice about where she goes. She won't like it of course, but at least I have the comfort of knowing I didn't make a wrong decision because there was no decision to make.

However once again there is a problem and I would appreciate your advice -

She has a decent sum of money (more than the £24,000 that would exempt her from paying for the home) in a savings account. This needs to be transferred to her current account so she can pay the fees. So I drafted a letter requesting this and my aunt got her to sign it, and took it into the bank.

The bank refused to process it on the grounds that they couldn't recognise the signature. My mother's writing is very shaky now and of course this is only going to get worse.

So, what happens if she can't sign cheques? So far she has been adamant that she won't have standing orders or direct debits (the bank might steal your money, you know) but I'll have to force her into it for paying the home. Even if she could sign the cheques it's just ridiculous for my aunt to have to do all the extra work that would be involved - not that my mother has considered this of course.

But meanwhile she has to effect this transfer, plus pay for various things associated with giving up her flat. Any thoughts please on how she can do this if she can't sign?

Also, should I tell the home what's happening? I did talk to them about it last week - I said she didn't have enough in her current account to pay the fees and I was sorting out a transfer but it might take a while to go through. They seemed remarkably unworried about this, but surely as a commercial organization they want their money promptly?

Just to add to the pressure, DH's father died suddenly and unexpectedly on Sunday. It never rains ...

pmlindyloo

nightsong wrote: »

And so it all drags on. My mother is currently still in hospital but is due to be transferred to a nursing home any day now. The nursing home is the only one that's a) near enough for my aunt to visit, b) has a space and also c) takes the government's money once the client's runs out (it's a posh part of the South East where most people are pretty well-heeled, unlike my mother - so I assume this is why it's so hard to find a non-completely-private nursing home? Because the fees generally round here are so high, that the gap between what the government will pay and what the home charges is too great?).

So, she doesn't have any choice about where she goes. She won't like it of course, but at least I have the comfort of knowing I didn't make a wrong decision because there was no decision to make.

However once again there is a problem and I would appreciate your advice -

She has a decent sum of money (more than the £24,000 that would exempt her from paying for the home) in a savings account. This needs to be transferred to her current account so she can pay the fees. So I drafted a letter requesting this and my aunt got her to sign it, and took it into the bank.

The bank refused to process it on the grounds that they couldn't recognise the signature. My mother's writing is very shaky now and of course this is only going to get worse.

So, what happens if she can't sign cheques? So far she has been adamant that she won't have standing orders or direct debits (the bank might steal your money, you know) but I'll have to force her into it for paying the home. Even if she could sign the cheques it's just ridiculous for my aunt to have to do all the extra work that would be involved - not that my mother has considered this of course.

But meanwhile she has to effect this transfer, plus pay for various things associated with giving up her flat. Any thoughts please on how she can do this if she can't sign?

Also, should I tell the home what's happening? I did talk to them about it last week - I said she didn't have enough in her current account to pay the fees and I was sorting out a transfer but it might take a while to go through. They seemed remarkably unworried about this, but surely as a commercial organization they want their money promptly?

Just to add to the pressure, DH's father died suddenly and unexpectedly on Sunday. It never rains ...

My mum's signature was also very shaky but still continued to write cheques and these were never questioned so some hope for the future! Obviously the letter was more closely scrutinised!

So options:

1) Ask the bank if they would make a visit to the nursing home so that the signature can be verified for transferring the savings account. (Barclays will do this - am not sure about other banks so just ask)
2) Get Lasting Power of Attorney asap. (sorry, can't remember if you have discussed this with your mum)
3) Ask your mum if you/your aunt? can become a signatory to her account - this may not be the correct terminology. Ask the bank about how you/your aunt? can sign cheques on her behalf and get this sorted during the home visit.
4) Try and persuade your mum to set up a DD for the fees (:)) - so much simpler.
5) Would your mum give you/your aunt her debit card and pin number so you could withdraw small amounts of cash? Naughty but so much easier.

Don't worry about the nursing home. They are used to this kind of thing. They will get their money in the end - just keep them informed.

Sorry to hear about your OH's dad.

Mojisola

pmlindyloo wrote: »

3) Ask your mum if you/your aunt? can become a signatory to her account - this may not be the correct terminology. Ask the bank about how you/your aunt? can sign cheques on her behalf and get this sorted during the home visit.

I did this with Dad's account at Barclays - it was very straightforward. It didn't give me any ownership of the account (as with a joint account) but did allow me manage the account on his behalf.

It was a good halfway house before we needed to register the POA. He was quite happy making all his own decisions but just needed someone to sign cheques for him.

nightsong

Thank you both, that's really helpful

I think my aunt took the letter into the bank and actually said to them "can you accept this, the signature's very shaky". Obviously then they had to say no! I daresay she was trying to be helpful.

Several good ideas there for me to pursue and I won't mention it to the home, as you say they'll get the money in the end.