Adult care home - personal budget (Berkshire)

Wanna_Bee_Free

I am likely to be helping my father choose a care home to move into next week. He has 24 hour needs, is at risk of falling and has continence issues. At the moment he has no nursing needs beyond continence issues and help taking his pills. His capability has gone down a lot following a fall in April. He lives in Berkshire. His social worker has confirmed he will be self-funded initially but I have no figure for what the personal care budget before income deductions would be when his money runs out. Will they pay for a care home in a different county or does it need to be the same one? He is currently in receipt of Attendance Allowance and has a private pension in addition to the state pension. To know the max amount they offer as a personal budget before they deduct all his pension money would be fine as I just don't want to choose somewhere unaffordable for him in the medium-term.

I am not working and not in his household. My sister is in receipt of benefits so we can't do a third party top up if we choose somewhere too expensive while he is self-funding and I would prefer he doesn't have to move because we chose a care home whose fees exceeds the personal budget once his savings have gone.

Any other advice for me choosing a home for the first time very welcome. I have found the Age UK info very useful so far today. https://www.ageuk.org.uk/information-advice/care/arranging-care/care-homes/

NedS

If the local authority is paying for the care and the care recipient is expected to contribute from income, the care recipient is entitled to retain the Personal Expenses Allowance which is £31.80/week in England.

If he is initially paying for his own care, I would suggest you choose a care home he is happy with in the county in which he wishes to remain. Once his capital falls below the threshold (£23,250 in England), you can request an urgent financial review from the local authority under which he lives. If the local authority wish to move him to a cheaper care home (not sure if they do this?), it would almost certainly be within the same county, and you could have input into that decision.

You should notify Attendance Allowance of any move into a care home, and it's important to tell them he is self-funding. He will keep his AA payments, but is expected to use them (as part of his income) to pay towards his care.

Costs for self-funded residential care typically fall in the £1000-2000 per week range. Choosing a care home which also accepts Local Authority funding may help reduce the risk of a move later.

If you have no experience of care homes, go an visit a few. Use a site like carehome.co.uk to locate and shortlist candidates. Read their CQC report if available. Finally, as my wife says, apply the 'sniff test' on first visit - does it smell fresh and clean?

It maybe worth involving the LA at this stage anyway, even if you know Dad is initially going to be self funding. You can request a care assessment and a financial review, during which the LA should be able to give you a lot of helpful information and maybe answer a lot of your questions about what may happen further down the line.

elsien

It might vary a bit because of area but a quick Google shows West Berkshire giving this as their current standard rate for residential rather than nursing homes. (table at the bottom of the page.)

if your father goes somewhere as a self- funder then if it’s not too much above the standard rate the council and care home can make up to an agreement to meet in the middle when the person is no longer self funding so that someone can stay and not have to move on.

It is not uncommon for care homes to charge self-funders more than the local authority will pay for people they are funding in the same care home, so that could be a question that you ask when you are gathering information.

Ask what is extra on top of the basic fees. Chiropody et cetera is normally ana chargeable extra.

Also have a look on the CQC websites for the care homes you are thinking of. Unfortunately, a lot of the inspections are very out of date, but at least that could tell you which ones might be needing improvement. Or to ask more about the areas of concern that were flagged up in the past. With the caveat that a relative’s care home passed with flying colours after an initial failed inspection despite the actual practice not having changed. They just got better at the paperwork.

There is no legal minimum staffing level in care homes, so that is another I would ask about. Do they have activity workers because if they don’t activities tend to be extremely basic because the normal staff don’t have time to do them.

Do they support people to go out if they want to go out -you would be surprised at the number of places that don’t? And in your dad’s case, will he have his own wheelchair or will he be relying on a shared one in the care home?

Food is really important to a lot of people so again check how the menu works and what happens if they don’t like what’s on offer.
And how much of his own belongings he likely to be able to fit into whatever size room offer? The local authority area that I work in won’t fund shared rooms anymore anyway but again your dad doesn’t want to be shifted from a single to a shared room to cut costs in the future.

What do they have in the way of accessible outside spaces if that’s important to your dad?
And I would probably focus less than what it looks like and more on your observations of the staff and how they are working with people. One of the worst care homes I go into is the one that looks most impressive to the first term visitor.

Also ask about the availability of rooms. Again one place I visit (converted old building rather than purpose built) new people tend to get shoved up in the small hot rooms in the attic because they are the ones that tend to become available first. If they are showing you a nice room, clarify that is similar to what he will get.

If you are choosing a care home, ask the social worker about out of area because although people should be able to live in whatever area they like “it’s not on the framework” can crop up as an issue. Just of something to note for future reference. In those circumstances I would suggest your dad lives in the area that he wants to live and than later, particularly if it’s meeting his needs and it’s cheaper than Berkshire it’s going be easier to argue for him to stay.

Care home	Full cost per week
Willows Edge Care Home	£1175.30
Notrees Care Home	£1175.30
Birchwood Care Home	£1330.60

twopenny

I can only give second hand experience but yes, friends mother was moved from her home town to one 10miles away. It was a good one but at 95 a worrying time for the lady and family. The family had to fight for where she would go but they did get the chance to do that. Somerset

My great aunt with whom I was close went into an excellent one but I was an 8hr drive away and working, I wasn't given any input and after a few years she had to share a room. Strokes had left her blind and she wasn't allowed her ticking clock, last contact with her home, because it disturbed the other lady. By the time I found out it she wouldn't let me do anything. Hertfordshire.

So yes changes can be made, you should have input as direct family. I think you need to have a direct conversation with whoever's in charge about what happens. Ts & C's can be read to give you an idea but also speak about it .

Presumably there is a contract to sign before the move so read thoroughly.

elsien

What is the position with his house?

I may have misremembered but was your sister sharing the house with him or not? If she was, the property could be disregarded due to her mental health issues qualifying as a disability.

One final thought - ask about what happens if he needs someone with him for hospital appointments. Some places expect family to do it or send them on their own without staff in the Hospital ambulance, which means that if someone has memory issues, they’re not always fully up to speed on what was said.

Is your dad a sociable person or does he prefer his own company? Because if he’s quieter, do they have a quiet lounge rather than just plonking everyone in the same room with a lot of noise going on in the background.

I am sorry if this sounds depressing, and there are some good care homes out there, but some of them are being squeezed in all directions and it can show in the quality of care.

elsien

And however keen they are to get their bed back if you haven’t had time to properly choose somewhere and to look around then push back on the discharge decision.

Wanna_Bee_Free

Hi @elsien @twopenny and @NedS thank you all for your helpful thoughts and your wife's sniff test! The actual figures are a real help and the info about how self-funding can be more expensive. He lives in my sister's house and she is currently sectioned and in residential psychiatric care. This party just keeps getting more fun for me. She will need to sell the house as she isn't earning except carer's allowance and universal credit (thank you to me and folk on here I helped her apply she got that one sorted) and my father has been helping her with utilities and the mortgage. I will reread tomorrow when it's less hot, brain a bit melty this afternoon. I have a list of what's important to him but I don't know if any care home will provide lightly boiled cabbage and raw carrot batons and classical music on a daily basis with the occasional chess game. We'll see. :)

elsien

A little bit of an overview with about the current fee gap nationally. The full report seems to be behind a paywall.

https://www.carehomeprofessional.com/care-home-market-reaches-27bn/

GrubbyGirl_2

I worked in this sector for 20 years before I retired 7 years ago, but I'll caveat my advice with the fact that things may have changed a little. He needs to be assessed both in terms of his care needs and finances. You won't get Social Services to recommend a home but you can ask them which ones they place people in that they fund. If he is in a home that they use then the likelihood of them wanting to move him will be less.

Then do your research and while I agree you should look at CQC reports those become outdated very quickly and there are often years between inspections. All it needs is a management change and care can deteriorate quickly. The best way to find a good home is to ask for recommendations from people who have relatives in there. You can do that through social media. Visit the home, talk to residents and any families there, any good home will not mind you doing that. A couple of other tips 1) Higher price does not mean better care. 2) Look past the decor. One of the best homes in my area was not the greatest to look at, it looked tired and had mismatched carpets and decor but the care was brilliant and I always said that where I want to go when I need it. They invested money in staff not decorating.

People here have mentioned that you can top up when the time comes. I would strongly suggest you don't do that because you are basically writing them a blank cheque as they can change the amount going forward and you've signed to say you'll pay. It may be £10 a week now but it could be £300 a week in future. If there is ever a time when they do say that he needs to move to a cheaper home (unlikely as chances are there won't be any much cheaper), the longer he has been there the harder it is for them to move him as Article 8 of the Human Rights Act kicks in. Just say no. I've recently successfully helped a friend stopping this happen to her 100 year old mother when they wanted to move her into a cheaper home when her money run out.

When he is within 3 months worth of money from the threshold (currently £23,250) ask Social Services to reassess. They take their time so you have to carry on paying but you can insist they refund you but that's less likely if you have given them plenty of notice. He will still have to contribute something to his care until his savings fall to £14,250 but it won't be the full amount.

And finally if he has capacity you really need to set up an LPA for finances as well as health and welfare as this gives you so much more say in his care. Without them in place Social Services are the decision makers if he loses capacity, indeed and LPA can also manage affairs when they still have capacity if that is what he agrees to. Hopefully you already have them in place but if not it's top priority to get done. Families were always shocked to find out that without an LPA in place I was the decision maker not them though the decision maker is required to listen to the family, they do not have to do what the family says.

Good luck in your search and stay strong for his sake

Wanna_Bee_Free

Thank you very much! After him refusing the LPAs are top of the list tomorrow.