Moving from Care home to Nursing home

noclaf

I have a parent who has been in a care home for the last couple of years(less than 3 years), moved with the assistance of LA who provided a list of care homes and then I chose the preferred option.

Funding is a combination of pensions, attendance allowance (that was previously paid directly to parent and then I think at the point of going into the care home it was redirected by the LA for the care fees but I am not 100% sure on the mechanics). Total savings = less than £23k threshold. Parent has cognitive impairment, deemed as lacking capacity to make decisions and I manage finances and care related decisions

The care home have now mentioned that my parent will need to go into a nursing home as some nursing needs have been identified but its not clear who has made this assessment; the home or nurses who attend the home. I will be asking for clarification on a couple of points.

I am concerned on a few aspects and would appreciate it anyone has been through similar and can suggest any tips or input on following:
- finding a suitable nursing home and whether the LA can help to suggest options as they did initially;
- implications of potentially significant increased care costs and whether my parent wil be eligible for any nursing funding (assume this will be determined by an assessment) and that I will need to find a nursing home that is within the funding limits of the LA
- what questions should I be asking the care home, certainly want to understand how the decision was reached but also timeframes for moving on etc anything else I've missed?

elsien

To move to a nursing home, your mother would need to have assessed nursing needs.

There would be a Continuing Health Care assessment called a DST – decision support tool. The care home would complete  the original eligibility checklist, but the assessment itself would be carried out by the health board/ICB. A social worker would be invited but don’t always turn up if they are short staffed. 

And if your mother lacks capacity around her care needs then you as her family member should be sent relevant  information beforehand and invited to either attend or give written feedback. If you have been missed out of that process, then you would ask for it to be completed again on the grounds that your mother was not able to represent herself.

Unless your mother’s nursing  needs are particularly complex, she would not get full CHC funding but if she had some nursing needs she will get what’s called the FNC ( funded nursing care) top up which pays for the nursing elements on top of the other needs. 

There won’t be an extra cost to her – you do need to check the attendance allowance though because once she’s no longer self-funding  that should stop and  you don’t want an overpayment - her pension et cetera would continue going towards her fees. 

Because your mother is now below the funding threshold the local authority will have be involved in the move to a new placement because they would be funding most of it. You haven’t said if you have power-of-attorney for health and welfare? You might find options are limited because nursing home places are in short supply within the local authority funding bracket, 

Age UK have some good fact sheets around assessments if you want to look it up in a bit more detail. 

Ask the care home about how far through the CHC referral process they are because again if you have health and welfare power-of-attorney for her, you should have been consulted. 

elsien

https://www.ageuk.org.uk/globalassets/age-uk/documents/factsheets/fs20_nhs_continuing_healthcare_and_nhs-funded_nursing_care_fcs.pdf

noclaf

Thanks Elsien, some additional info below for context.

I am a Deputy for my mother (property and affairs only I think...) however manage all of the admin around my mother's care including payment of care fees etc and the care home do always consult me on decisions to be made etc.

At this present time the home have only verbally communicated on a phone call that she will need nursing care and that they cannot provide this and assessment is ongoing. I am not sure what has changed but previously (when she first moved into the home) I was told not to worry as they can cover some degree of nursing aspects with district nurses who come in daily or on ad-hoc basis. However there has been a management overhaul last year/this year so wondering if this is a risk based decision from their perspective to ensure anyone who is remotely close to requiring 'nursing' care should be moved on...self protection if anything goes wrong I assume and they then get the brunt of it from residents family or worse the CQC. Or has there been a change in the NHS rules on what is deemed as 'nursing care'. I could be wrong on both suggestions so will wait/ask status on the assessment and go from there. 

The attendance allowance is a strange one; pre- care home period my mother received it direct into her bank account (lower rate). Once in the care home LA mentioned it would be stopped but then put towards her care costs. I don't recall receiving any AA correspondence over the last two years but assumed it's going towards her care fees and didn't think twice about it. Recently we did receive a letter providing a breakdown of the AA so I need to understand the situation there. In terms of funding, pre- care home period we had 3x home visits from LA-arranged carers that was funded by both my mother's funds and assume a LA top up (based on LA financial assessment) and the same happened when she moved into the care home, there was an assessment by LA and then a breakdown of what she will pay and any allowance etc. So the funding model has always been the same, both her pensions are used to pay the care fees as set by the LA and assume this is being topped up by the LA and AA lower rate. I'm unsure whether my mother is therefore deemed as 'self funding'. I am not surprised at the shortage of nursing care places that will fall within the LA's funding limits hence that is a big concern.....i.e: if there is a significant jump in the care fees.

elsien

I’m not 100% certain but I think once she moved into care, if the local authority pay any element of the care costs once the savings go below 23 1/2 K then the attendance allowance should stop. 

That would be your responsibility to inform the DWP as her deputy rather than the local authority’s so I would strongly suggest that you do check it out. 

If your mother’s savings go below the £14,250 limit then she legally cannot pay extra towards her own care from those savings. Between 14,250 and 23,500 she pays a tariff. As soon as she hits any of those capital limits, you would need to contact the local authority for an updated financial assessment. 

Her income/pensions will then continue to go towards her care leaving her weekly allowance with the local authority picking up the rest of the bill outside of any nursing top up. 

 So then the choices are between accepting what is available and which the local authority will pay for, or a family member paying a voluntary third-party top up. It is sometimes suggested that the third-party top up is obligatory. This is completely untrue and is too much of a financial  commitment for most  families to be able to think about. 

https://www.ageuk.org.uk/information-advice/care/paying-for-care/paying-for-a-care-home/

To answer your other questions, there hasn’t been a change in the rules around nursing care. And minor nursing needs such as occasional skin integrity issues can be managed  in a residential home by district nurses. But when someone’s nursing needs change district nurses are not going to be coming in every day and residential homes can’t keep people with clearly identified ongoing nursing needs unless they are dual registered. Nursing homes have a nurse there 24/7 and tend to have higher staffing levels because of the additional care needs. 

It’s not a risk-based decision, it’s a “we’re not registered with CQC for this” decision. 

noclaf

I will look into the AA and contact the DWP to clarify. Before she went into the care home, I spoke to the DWP who confirmed they would stop the AA as it would then be used towards her care fees and during her time in the care home, I have not seen any AA credits on her account. Also worth mentioning she has always been below the 23.5k savings threshold from before the point of initial LA assessment and till present. 

Is it at all feasible that some nursing homes fees are similar to care homes that don't provide nursing care? Or....is that unlikely on the basis that nursing care will always mean higher costs due to the need for more trained nursing staff etc

elsien

No, nursing homes will be more expensive. But it won’t cost your mum any more than she is already paying because she is below that 23 1/2 K limit - the local authority will have a higher limit for nursing care than they do for residential care. After all, they can’t refuse to place someone when they can’t stay where they are because  their needs have changed.