Funding for grandparent in care home

kimwp

My grandmother has had to go into a care home as it's no longer safe for her to live at home (dementia), however the social worker has assessed that she doesn't merit funding because she has capacity to make decisions. When she was at home, my parents were unable to leave the house for more than 2-3 hours otherwise they would come back to a semi -naked woman with faeces around the house where she had tried to clean herself (double incontinence). They would often be up in the night due to my gran falling over and being unable to get herself back up. She needs to be reminded to wash her hands and given drinks and food to make sure she drinks (otherwise she would forget) and eats hygienically (otherwise she leaves food out of the fridge and picks through it with her fingers). My parents were suffering badly with carer stress before she went into the home, but the money my gran has is running out so funding is needed.

To my mind (while I would much rather she wasn't) she needs to be in care, can anyone advise with options for getting funding?

HillStreetBlues

First port of call challenge decision.
https://www.which.co.uk/consumer-rights/advice/challenging-a-local-authority-decision-aEpZZ8G5Iysy

elsien

Funding is based on the outcome of financial assessment and level of support needs, not on capacity. You can have capacity and still live in a care home with local authority funding so I’m querying your parents understanding of the reason.

The only reason I can think of why funding wouldn’t be  agreed is if they are saying that she doesn’t need the level of support that residential care homes provide. Or she’s living in a care home that is more expensive than the local authority will pay for. So who chose the care home and was the local authority involved at that point? Was it a best interests decision and who made it - is there a power-of-attorney in place?

You need to clarify the exact reason that has been given. Ask for the reasons in writing. If they’re saying it’s based on not needing 24/7 care has she had a proper care act assessment? Did your parents have an assessment of their needs as carers? Is she considered to have capacity around her care and support needs? What level of support are the care home saying that she needs day and night? Is it possible that the local authority are saying that she could stay at home with more support, which would be the less restrictive option. 
If it is based on them saying she doesn’t need residential care then you need to use the local authority formal complaints procedure if you/she disagrees. 

Obviously if she does have capacity around where she lives, then the local authority should be having those discussions with her (you can have a dementia diagnosis and still have capacity in some areas) but not funding purely based on capacity is just not what happens, and I suspect some miscommunication.

Is it possible that she is objecting to being in the care home, and the social worker has assessed that she has the capacity to make that decision in which case there is no legal mechanism to keep her there if she chooses not to stay. But that is about her rights, not about funding. Whose house was she living in - her own or your parents?
Do you know if she is subject to a Deprivation of liberty standard authorisation (DoLS)?

OutdoorQueen

Some people with long term health needs, including dementia, qualify for funding via NHS Continuing Healthcare.  I’m wondering if this is what has been refused.  I understand it is difficult to access.    

https://www.dementiauk.org/information-and-support/financial-and-legal-support/guide-to-continuing-healthcare-chc-funding/

elsien

That would only be relevant though if she was in a nursing home but had no identified nursing needs. In which case the local authority would look at a move to residential instead of nursing, but  they would then still fund the residential home if she met the criteria of needing 24 hour care and had assets below the financial threshold.

kimwp

OutdoorQueen said:

Some people with long term health needs, including dementia, qualify for funding via NHS Continuing Healthcare.  I’m wondering if this is what has been refused.  I understand it is difficult to access.    

https://www.dementiauk.org/information-and-support/financial-and-legal-support/guide-to-continuing-healthcare-chc-funding/

Yes, I'm pretty sure it's this one.

elsien

Refusal of CHC funding does not mean no funding at all. See my previous answer.

kimwp

Her GP said it wasn't safe for her to be at home any more - he was concerned that she'd do something like forget to use the stair lift and fall down the stairs.

elsien

Okay, let’s go back a step or two.
Who made the decision for your grandmother to move to a care home, who chose the care home and is it nursing or residential? Or dual registered? And is there a health/welfare power-of-attorney?

CHC funding is for nursing care. That is full health funding for people whose needs are all health related which is hard to get. A dementia diagnosis in and of itself does not count as a primary health need in this context. 

Then there is what is called the FNC nursing top up, which is for people whose primary needs are social care. The local authority pay the majority of the fees but health pay an element on top for those additional nursing needs.

If she’s not entitled to any health funding at all, then she cannot stay in a nursing home unless they are dual registered.  That is to do with care home registration and the legalities.
.
But if she is assessed to need 24 hour care, the local authority will still pay for residential care if she cannot pay for it herself. Being turned down for CHC funding does not mean she cannot have 24 hour care paid for by the local authority.  It does alter the place in which that care may be provided and for some people means that they have to move to a different care home.

kimwp

I had to do a bit of digging. She had DOLs when she first went to the home. My father decided she needed to go there on her GP 's advice. It has a nursing floor, a residential floor and a dementia floor- she is on the dementia floor. She doesn't want to be there, she says she feels like she is in a prison. Everyone wanted to keep her at (my parents') home, it just wasn't possible any more.
I'll do some more digging re the other questions, thank you for your help so far.

elsien

This is nothing to do with the funding, but I feel I need to say it anyway. If your grandmother continues to lack capacity around the care and support needs, then she should still be on a DoLS and have a relevant person’s representative which is often a family member.
.

If she is objecting, even if everyone else feels it’s the best place for her to be, she has the legal right to appeal against being there to the court of protection and her representative has an obligation to help her with that regardless of their own views. Particularly if your dad doesn’t have power-of-attorney for health and welfare, and there wasn’t a proper best interest process in making the decision.

That doesn’t mean she would be able to go home again. If it’s your parents house and they say no they can’t manage, it is clearly their decision to make. 

I’ve supported several people to apply to court when they’ve been objecting and some have moved on to a less restrictive environment and for others the court has decided that the care home is the best place for them. 

But it does mean independent scrutiny of her situation, and seeing if there’s any way that it could be made less burdensome for her. Such as a different unit or place that suits her better. Or for one person that I worked with, the local authority paying extra so she could get out more often with one to one staffing.
I do know how hard it is when someone is where they really don’t want to be and there’s little other realistic option. One of my client spent years shouting at me, telling me I was useless for not getting her out of there. That would be even harder for a family member. Sometimes small changes can still help.

Back on track - any more funding questions please ask and I’ll see f I can help.