Care options for elderly mother

longwalks1

Hi everyone.  MIL is still in hospital, recovered from the fall but 5 weeks in bed means shes now lost what strength she had and cant get up out of bed, or even from a chair.  We now think she'll need round the clock care and are edging towards a live in carer.  She's upset a few nurses in hospital with her ways and isnt a huge fan or others, so think a care/residential home just wont be for her.

Where do we start to look for live in carers?  I had a 1/2 hour search this morning and all seem to be through companies and charging in excess of £1100 a week.  I'm probably wrong but i thought that a little expensive?  Any advice on finding a carer etc, and what to ask them would be greatly appreciated

I think (rightly so) the hospital are wanting the bed back and want to get mum out now she's recovered from her fall

JGB1955

£1,100 a week sounds about right.  That will provide 8 hours of 'care' a day.  One of my father's live-in carers used to (fairly regularly) be picked up at about 10:00 p.m. and go out clubbing until the small hours.  There is no '24 hour' presence, as such. In addition you will have to pay an allowance for the carer's food.  Add that to the cost of running the house and paying all day-to-day expenses and, suddenly, a swanky nursing/residential home seems cheap as chips!  I speak from experience.

elsien

You need to think about the level of care and how many people it needs. And what equipment she should have. 
So if she is using a hoist (for example) she may need two people for that and a single live in carer won't  be enough.   That is the reason my grandmother ended up in a care home - she could afford one carer but the double-ups  put it out of her financial reach. 
I do think you need to have proper assessments of her needs - OT, physio etc, care act - done before she comes home to clarify the level of support that she does need to return home safely. Some trusts have rehab wards which people go to (almost as a holding bed) when they no longer need an acute bed but it's not safe for them to return home as things stand.
Could you ask about that? 
You will also need more than one carer because they tend to alternate one or two weeks on/off. I think there is also an obligation to give 2 hours time off every day (remembering from when a friend did this work), and cover for illness, holidays etc which is why agencies or a reliable pool of people is what is required.  A live in carer would also not be expected to be up all night, so if the person's sense of time has gone awry this can also be a relevant factor as you may then need a wake night carer. 

Have you looked at her having a CHC nursing needs assessment - they can give some support at home which could mitigate costs but they generally won't pay for full time care at home. 

elsien

Found this which you might find helpful.
The Complete Guide to Live-in Care (updated for 2022) (primecarers.co.uk)

Keep_pedalling

Most live in carers are provided through specialist companies and they take care of things like the carers pension and provide cover for holidays and periods of sickness, which would be difficult if you managed to hire someone directly.

£1100 per week does not sound unreasonable and it could be quite a bit more than that depending on her needs.

diystarter7

longwalks1 said:

Hi everyone.  MIL is still in hospital, recovered from the fall but 5 weeks in bed means shes now lost what strength she had and cant get up out of bed, or even from a chair.  We now think she'll need round the clock care and are edging towards a live in carer.  She's upset a few nurses in hospital with her ways and isnt a huge fan or others, so think a care/residential home just wont be for her.

Where do we start to look for live in carers?  I had a 1/2 hour search this morning and all seem to be through companies and charging in excess of £1100 a week.  I'm probably wrong but i thought that a little expensive?  Any advice on finding a carer etc, and what to ask them would be greatly appreciated

I think (rightly so) the hospital are wanting the bed back and want to get mum out now she's recovered from her fall

Hi

Contact the LA and seek a full assessment if MiL agrees and seek their help in setting up a carer.
My BiL employed a personal carer for their mum and hours varied. The lady was self-employed, they just gave her the money
nd she was a lot, lot cheaper than the via agency lot. This carer came on the back of recommendations from a friend and carer had paperwork - but do your checks.

LA as I said may have leaflets/advice etc for self-funding care

This may help

https://www.which.co.uk/reviews/later-life-care/article/home-care-guides/how-to-employ-private-carers-alcB07s4rsFQ


NB: Have you guys considers PT, or private PT - what did the hospital say would MiL benefit from that and if so, consider private PT
to speed up recovery.

Ensure MiL  property is falls friendly, seek advice from hospital PT and seek an alarm pendant/wrist pendant for falls alerts etc

Even consider a live in carer if MiL will put up with that works out much cheaper than 1100 a week
Even a self-employed carer, 40 hours a week at 20 quid  is 800 a week and you can adjust the hours etc.

Good luck

-
PS - word of caution - many people when they become frail, limited mobility and been indpendt and decisive resent help etc and will rarely get on with anuyone - but often there is someone out there that can help and MiL will be happy with and you too

lr1277

Please consider the following: (Sorry this post turned out a lot longer than I originally intended):
What is your MIL’s mobility like? Can she manage stairs? In her home does she need to use stairs to get from say bedroom to living room? If you can visit her in hospital before her discharge, you should see her mobility for yourself. The physio staff and nurses can sometimes present a rosy picture of the patient's mobility which doesn't materialise when the patient is at thome.

In my dad's case, we were told he could walk and manage one flight of stairs before his discharge. We got home by taxi. The taxi driver and I helped dad walk into the house. Then after a rest he climbed the stairs (with me behind him) to his bedroom. The only times he went downstairs after that was being carried by ambulance staff to be taken to hospital (and bought back to the bedroom by ambulance staff).

After that we were asked to consider if we could accommodate one floor living. That is bathroom and bed on the ground floor. We didn't have the room for that setup so elected to have dad live upstairs in the bedroom, which had an ensuite bathroom. The ambulance staff will take the patient upstairs and help them to bed, but after that, you do what you can with the carers. Also you don't need a bathroom. A commode supplied by the local authority might suffice.The other advantage of having dad upstairs was that dad was in one bedroom and mum was in the other. So she could hear unexpected noises/movements. If she was upstairs and he was downstairs, she would not have known about certain problems till the next day, unless she went to check on him regularly during the night.

In terms of one floor living, to keep dad stimulated (on the advice of his doctor) we put in both a CD player and TV into the bedroom. After a while dad was not interested in the TV but he continued to listed to the music.

As I said in my earlier post, the carers demanded that we replace the double bed with a single sized hospital sized bed. But that is because sometimes both carers were needed to move dad to the bathroom and one carer could not reach across the double bed.

Your MIL maybe in better shape when she comes than my dad was, but if there is deterioration in her condition......

Talking of stimulation, the double bed was paralled to the window. When we got the hospital bed, we placed it so it faced the window. Also this made it possible to put up a bracket for the TV as not all walls were suitable for a bracket.

We also paid for a physio to come once or twice a week to work with dad to increase his strength. This was private because the visits from the NHS/council physios were sporadic and not consistent. Not their fault due to their workload, but nothing regular.

Again this applies to dad and possibly not your MIL.

Even with the hospital bed, dad would sometimes fall out of bed, especially at night. The medical staff counseled againt putting the guard rails up, incase dad's limbs got entangled in them and he couldn't free himself. So the bed was lowered to the lowest position every night and mats (supplied by the local authority) were placed around the bed. Because mum was living with dad 24hrs a day, she would sometimes find dad on the floor and could call the ambulance. This was to check he was ok and had not damaged himself and then also to put dad back into bed. She could not get dad back into the bed herself. If you get a live in carer, you should ask the question of  what they would do if MIL fell out bed during the night.

The other point mum made was as she was his 'main' carer, she was caring 24hrs a day. She wasn't in a shift pattern like the carers. There was nobody around to take over he role on a regular basis. This was very tiriing for her.

I suppose I should add because she was dad's full time carer, she wouldn't sleep fully during the night, so was tired during the day and tried to nap for an hour or 2 during the afternoon. But the problem with that was that different medical staff wanted to visit during all  times of the day. So sometimes she wouldn't get to nap during the day which made her even more tired.

Dad's appetite was sometimes very poor so he would only have meal replacement drinks. Dad's GP supplied these on prescription. You can also get get adult pads supplied either by the GP or the local authority. But I can't remembe the exact reason, they weren't as good as the 'adult' huggies you can get in the shops.

I can't remember if I mentioned this ealier regarding appetite, but apparently there is a sensor in your throat that tells your brain that you are hungry. In some people this sensory mechanism stops working in older people so the person never feels hungry. That happened to dad, so we have to use the high protein meal replacement drinks.But it was upsetting to the family to see dad not eat as we knew he had to eat to live and keep his strength up. Bu that was before we knew this tidbit of information and were prescibed the meal replacement drinks.

I don't know if you have already done this, but in order to talk to the GP or the surgery staff about dad, he had to sign a letter saying who the surgery staff could talk to about his condition.Once the surgery received this letter, they happily talked to me about his condition and any prescription problems that arose. If you haven't done this, suggest you get it done before MIL is discharged.

If there is nobody at home to let the carer(s), you will need to install a lockbox for the front door key. I think AgeUK or charities known by the local athority can help with this, if you can't do it yourself.

These are some things for you (and your MIL) to think about. If your MIL is in better shape when she returns home than my dad was when he returned home, you may not have to go to such lengths.

Sorry if I have repeated myself, this was essentially a brain dump of what I remember after dad returned home from one of his hospital visits.

HTH and good luck.

lr1277

On the advice of the doctor, dad was taken for a short walk along the corridor every day by the carers if he was upto it.

Also he could not lie in bed all day so had to sit out in a chair. This allowed the fluid in his chest or lungs to drain. If the fluid doesn't drain, there is an increased chance of chest infection.

So we rented an electric recliner chair and dad was placed on it for a couple of hours in the morning and a couple of hours in the afternoon.

All these actions were to prevent infection which may have necessitated another hospital stay.

Like I said befoe your MIL may not be bad enough to need all these accommodations, but letting you know what happened to dad.

longwalks1

Hi everyone
many thanks for your replies again, and apologies for the delay in replying. MIL has now been moved to a care home and having seen how she is, we don’t think living back at home even with a live in carer is an option now.  She’s almost deaf so communication is now via writing on a whiteboard every time to reply to her during conversations.  She is also adamant that she doesn’t want to live at home with a carer. 

One question, she’s become very confused with some subjects and not others, she still thinks father in law is alive (he passed 9 years ago) and is certain he sat with her for dinner last night. He asked me and my partner to check in the next room as she was certain he was there.  My partner (her daughter) had explained a week ago that dad passed 9 years ago, MIL not having any of it. So today when asked to check if dad was next door, daughter just popped out for a minute and returned to write ‘no I didn’t see him mum, he’s not next door’ then changed the subject. 

I know there’s no right or wrong way to deal with this, but any advice greatly appreciated.  

elsien

I don’t see a huge amount of point upsetting someone by continually reminding them that someone’s died. There is some information that they do need to know sometimes and they do need to be told the important stuff where it’s relevant, but you have to think what is going to be achieved by keeping bringing it up after that. 
I personally don’t think it’s right to lie to people but your daughter’s approach of quite simply saying no I didn’t see him (which is true) would seem okay to me. And maybe think of ways to divert and distract if needed, maybe by talking about some of the nice times they had together or something like that? Or sometimes changing the subject completely. It really does depend on the person and the situation.

 I used to work with a lady who thought her children were still young and she’d left them on their own so she used to panic. I I used to reassure her that they were safe and they were fine, sometimes  I’d say “of course they’re grown up now and can look after themselves” and then we’d start talking about the clothes she’d knitted for them which was one of her favourite topics.

Interesting read here.
When is it okay to lie to someone with dementia? | Alzheimer's Society (alzheimers.org.uk)