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  • FIRST POST
    • Mr Dufray
    • By Mr Dufray 4th Dec 19, 9:56 PM
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    Mr Dufray
    Nursing home fees + annuities – advice sought
    • #1
    • 4th Dec 19, 9:56 PM
    Nursing home fees + annuities – advice sought 4th Dec 19 at 9:56 PM
    Hello. Our 81-year-old Mother (I am one of her three children in their fifties) lives is in an HC-One nursing home at a yearly cost of around £55,000 plus private therapy support and the upkeep of existing house, around £10,000 on top. So £65,000 in total. She went into this home in late 2015 with our Dad (who died earlier this year). Before both fell ill (our Mum from a severe brain injury following a bike accident) they had cash savings of around £500,000 and a property worth £300,000. Several years of nursing home care for both parents have cut the savings pot to £180,000. The house remains.

    There is some pressure within our family to look at moving her back home with a live-in carer to look after her at a cost of around £1,000 a week via an agency (similar cost to the HC-One home). When the £180k savings pot runs out one sibling says they are prepared to support the care costs as long as they are paid back by the sale of the house (though the sale of this may ultimately involve equity release). We are being encouraged by a friend of our Mother’s to look at annuity options and discuss the issue with equity release annuity specialists.

    This is all new territory to all of us – especially the annuity side involving a very compromised person – and there are mixed feelings about moving Mother from a care home to her home. She would be reliant on one sole carer for much of the time with little distraction. Because of her brain injury she cannot read, write, reason logically, see reliably or listen to the radio/watch TV. She cannot stand or walk safely and battles constant fatigue. But she has a strong core self that is recognisable to friends and family.

    Our mother hates the idea of someone taking care of her in her home but would have no option if she returned there. We all, I know, want to be in our own home. Though care homes get a bad press they provide a measure of community and (very) modest stimulation which our Mum would not get at home. Finding the right carer via an agency would be difficult. Our mother has very strong ideas about her diet also. We are struggling to know what to do for the best.

    Any suggestions welcome.

    Thanks
    Last edited by Mr Dufray; 05-12-2019 at 8:44 PM.
Page 1
    • Keep pedalling
    • By Keep pedalling 4th Dec 19, 10:08 PM
    • 7,219 Posts
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    Keep pedalling
    • #2
    • 4th Dec 19, 10:08 PM
    • #2
    • 4th Dec 19, 10:08 PM
    It sounds like she still has the mental faculties to make her own decisions on this , so the best thing you can do is support her in this, and tell the others to take a running jump.

    Do any of you have power of attorney in place? If not she should look at appointing attorneys she trusts to make the same decisions she would, not ones that seem to be aimed at retaining the family home. If a family member does want it to remain within the family, why don’t they just buy it from her?
    • AnotherJoe
    • By AnotherJoe 4th Dec 19, 10:24 PM
    • 16,378 Posts
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    AnotherJoe
    • #3
    • 4th Dec 19, 10:24 PM
    • #3
    • 4th Dec 19, 10:24 PM
    I dont understand the issue here, whats the rationale to move her back home?

    The costs are the same.
    What does your mum want want to do?
    As for supporting the costs, you can buy annuities that will do that, though they are expensive.
    Is the one relative that says they will shell out the costs once the £180k has run out, prepared to do that for say 20 years if mum lives that long and the profit from a house sale is long irrelevant?? Not exactly the same but this may make them think again.
    • badmemory
    • By badmemory 5th Dec 19, 3:02 AM
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    badmemory
    • #4
    • 5th Dec 19, 3:02 AM
    • #4
    • 5th Dec 19, 3:02 AM
    Unless I have misunderstood she does not want a family member providing personal care. Therefore there it would not seem to be acceptable for her to be cared for at home.
    • Mr Dufray
    • By Mr Dufray 5th Dec 19, 8:17 AM
    • 6 Posts
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    Mr Dufray
    • #5
    • 5th Dec 19, 8:17 AM
    • #5
    • 5th Dec 19, 8:17 AM
    Thanks very much for the replies. Power of attorney is established, yes. Mum hates the 'fuss' of nursing homes and the relentless invasion of her privacy. But she doesn't grasp the intensity of her vulnerability. She can get herself to the care home bathroom en suite loo but cannot shower herself or run a bath. She is registered as partially sighted but has profound balance problems as a result of the TBI.

    If she were to return home she would need to negotiate steep stairs (with the help of the agency carer) for the upstairs bath/shower tho' there is a downstairs loo next to a study. The study could be converted to a bedroom. Almost all her neighbours at home are elderly so limited support – nor would we want to rely on this.
    Last edited by Mr Dufray; 05-12-2019 at 10:56 PM.
    • Linton
    • By Linton 5th Dec 19, 9:24 AM
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    Linton
    • #6
    • 5th Dec 19, 9:24 AM
    • #6
    • 5th Dec 19, 9:24 AM
    If Mum is judged to be mentally competent I agree with the others that the best thing you can do is to accept that she has the right to make the decision and you should support her in implementing it. Would it be worthwhile/possible to ask social services to carry out a care needs assessment of what would be required for her to live safely in her own home? Perhaps modifications to the house and paid for home care would resolve the situation or if not she may be prepared to accept advice from an experienced and independent 3rd party on her options that she would not accept from her family.
    • JGB1955
    • By JGB1955 5th Dec 19, 9:35 AM
    • 390 Posts
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    JGB1955
    • #7
    • 5th Dec 19, 9:35 AM
    • #7
    • 5th Dec 19, 9:35 AM
    Bear in mind that whilst she currently has 24 hour care, once she is at home, even with a live-in carer, that care will reduce to about 8 hours a day.
    • Mr Dufray
    • By Mr Dufray 5th Dec 19, 9:40 AM
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    Mr Dufray
    • #8
    • 5th Dec 19, 9:40 AM
    • #8
    • 5th Dec 19, 9:40 AM
    Thanks for the replies. It would be 24-hour live-in care from an agency, very likely, with back-up to cover illness/holidays/time off.
    • hb2
    • By hb2 5th Dec 19, 10:01 AM
    • 559 Posts
    • 2,072 Thanks
    hb2
    • #9
    • 5th Dec 19, 10:01 AM
    • #9
    • 5th Dec 19, 10:01 AM
    24/7 care usually equates to at least 3 carers, that doesn't take account of carer sickness or holiday.
    • Malthusian
    • By Malthusian 5th Dec 19, 12:35 PM
    • 7,115 Posts
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    Malthusian
    If Mum hates being in a nursing home and would hate being in her own home with live-in carers as well, then I struggle to see what moving her back into her own home achieves. Or how it is in her interests.

    All it seems to achieve is to remove the extra care and stimulation she would receive in a nursing home.

    If she moves back then her savings will last less than three years and then she will have two options. First is to sell the house and move again, either to a new house with live-in carers or back into a care home. Two moves in three years for someone in that position doesn't sound like a terrific idea to me. Most people would be stressed out by two moves in three years in the prime of their lives.

    Alternatively she could take out equity release, which would allow her to pay her nursing fees for a few more years if it's a reasonably valuable house. But if that ran out she'd have to sell the house and pay back the loan and a large chunk of interest, and after that she could easily be in a precarious position.

    I disagree with Keep Pedalling that she has mental capacity. "Because of her brain injury she cannot read, write, reason logically, see reliably or listen to the radio/watch TV." [emph added] That doesn't in itself amount to not having capacity but it's going down that road.

    If she actually does have capacity then there's little stopping her from ringing a care agency and a taxi company and moving back herself. If she's unable to do that and the Attorneys will be primarily responsible for arranging the logistics then they need to consider her best interests.

    The attorneys should see an Independent Financial Adviser (e.g. a member of SOLLA) to discuss whether an Immediate Needs Annuity would be appropriate. If her life expectancy is short the £180k in savings may cover it, but it depends on what the underwriters think.

    The expectation would be that she would lose money by buying an annuity (that's how insurance works) but the decision needs to be made entirely with her own interests in mind.
    • Mr Dufray
    • By Mr Dufray 5th Dec 19, 2:54 PM
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    Mr Dufray
    Malthusian: all rational and clear – thanks. Our mother cannot reason her situation reliably. There is a Deprivation of Liberty order in place. She took exceptional care of her nutrition and diet before her accident – a very clean life. The TBI has shattered much of her ability to live independently and safely. Much medication (anti-epilepsy, for example) is now taken.

    It is difficult to diagnose the brain and there may be an element of dementia involved. The good care she took of her body means other areas, physically, are in good nick. So any medium-to-long-term underwriting diagnosis is very difficult. We may look at a SOLLA related IFA – thanks very much.
    Last edited by Mr Dufray; 05-12-2019 at 2:58 PM.
    • xylophone
    • By xylophone 5th Dec 19, 4:12 PM
    • 31,704 Posts
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    xylophone
    I am assuming that your mother has already been assessed and does not qualify for Continuing Health Care?

    https://www.ageuk.org.uk/information-advice/health-wellbeing/health-services/nhs-continuing-healthcare/

    You say that your mother favours neither living in her nursing home nor in her own home - in these circumstances there seems little point in moving her from the nursing home to her own home.

    One assumes that she is getting higher rate Attendance Allowance and possibly the nursing care component?

    She also has her state pension and (some other pension provision?)

    so that she may be able to cover her care fees for rather longer than the three years mentioned above?

    Re INCA, see https://forums.moneysavingexpert.com/showthread.php?t=5894044 post 4.

    Is the house currently rented out?
    • Mr Dufray
    • By Mr Dufray 5th Dec 19, 4:19 PM
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    Mr Dufray
    She is regularly assessed for Continuing Health Care. We went through the CHC hoops with our father, who was eligible for CHC funding for around 18 months in the same nursing home. She is getting Attendance Allowance and her state pension, yes. The house is not rented out as it's used as a base at weekends for family visiting. Thanks for your thoughts here.
    • ThemeOne
    • By ThemeOne 5th Dec 19, 4:51 PM
    • 1,438 Posts
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    ThemeOne
    Just a few thoughts.

    When my father was ill, I'd got him into a hospice where he was very content, and then he suddenly got the idea he wanted to move to a nursing home, which he did. I had grave misgivings but he didn't want to listen to me as he'd come under the influence of an old friend on the matter. The move was not a success, even by his own admission, and he passed away about two weeks later.

    No two cases are the same obviously, but reading your story did ring a few bells, and if I could do it all again I think I'd have made more effort to get him to stay at the hospice.

    Prior to the hospice my father had a care package in his own home but another thing I found was that an ordinary house can be such a dangerous place for an elderly person with declining health.
    • Malthusian
    • By Malthusian 5th Dec 19, 5:02 PM
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    Malthusian
    The house is not rented out as it's used as a base at weekends for family visiting. Thanks for your thoughts here.
    Originally posted by Mr Dufray
    The family should be paying a commercial rate to rent her house unless she has the capacity to actively gift them free use of it. If a Deprivation of Liberty order is in place that sounds highly dubious.

    The attorneys are on extremely dodgy ground if they're trying to claim it's in her interests for the family members not to pay for an AirBNB or hotel.

    In your posts there is no indication that mum wants to return home (only "some pressure within our family"), and no reason it would be in her interests for her to return home, which means her house should be on the market and the family should stop treating it as a free hotel.
    • Mr Dufray
    • By Mr Dufray 5th Dec 19, 6:15 PM
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    Mr Dufray
    Hi Malthusian and ThemeOne. Thanks for your thoughts. On the ‘free hotel’ aspect, due to the intensity of their illnesses – both complex – the three children try to support the situation. All of us live a substantial distance away. Supporting intense long-term illness, including regular long-distance driving, is expensive and demanding. There are also daily phone calls and emails to the nursing home, private therapists and paperwork to be organised. Much bill-paying and record-keeping. Our incomes and circumstances are all different but we all have to be careful.
    Last edited by Mr Dufray; 05-12-2019 at 10:52 PM.
    • paddyz
    • By paddyz 5th Dec 19, 10:38 PM
    • 121 Posts
    • 583 Thanks
    paddyz
    It doesn’t sound ideal to me for various reasons, after living in a care home for 5 years mum would have gotten used to group living and social interaction in a secure setting, returning home could mean mum might become non responsive to her care as she feels it’s her home and the carers are not wanted so it could be a battle.

    The house doesn’t sound ideal for her and you might need to adapt it to make it suitable, has mum spent time in her house? Has she stayed overnight? How does she seem to be when she’s in her house?

    Unfortunately not all carers are great, worse case Scenario is mums stuck in the house with a carer that isn’t very good at her job and nobody is really checking what’s going on if you are all living far away.

    If you do decide on this you could sort out some trials try weekends and a week, and you will get to know how she is with private carers

    Forget about the money focus on mum getting the best possible care, she has the money to pay for it at the end of the day

    Plus care needs change, the 24 hour care could end up costing double if you need more care ie 2 carers at a time and mum could also actually end up in care again and have to cope with another move again
    Mortgage start Oct 12 £104,500
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    • Malthusian
    • By Malthusian 6th Dec 19, 10:59 AM
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    Malthusian
    Hi Malthusian and ThemeOne. Thanks for your thoughts. On the ‘free hotel’ aspect, due to the intensity of their illnesses – both complex – the three children try to support the situation. All of us live a substantial distance away. Supporting intense long-term illness, including regular long-distance driving, is expensive and demanding. There are also daily phone calls and emails to the nursing home, private therapists and paperwork to be organised.
    Originally posted by Mr Dufray
    I thought she was in a nursing home. Day-to-day support is their job. What support are the children giving her that makes it in her interests for them not to pay for an AirBNB or a hotel while they are visiting? Why do they need the use of a free house to make phone calls and emails?

    It is in the mother's interest to have visitors, it is not in her interests for them to save money by using her house as a free hotel, that's in the children's interests. It prevents her from selling the house and using the capital in her own best interests to support her care needs and maximise her financial security.

    This is no different from an attorney trying to justify giving the donor's money to the children on the grounds it's to cover their travel expenses for visits. It is not in the donor's interests and is unlawful. Unless there is evidence the donor wanted these gifts to be made, which would include paying their expenses while she was in control of her own affairs and specifying that she wanted these gifts to continue in her Lasting Power of Attorney. If she did those things then fair enough.

    If someone else's elderly mother had been renting a retirement home before moving into care and her entire assets consisted of £480,000 in cash, would the Attorneys think it would be in her interests to use £300,000 of her money to buy a house for them to stay in for free? It is the same decision.
    • adviceforall
    • By adviceforall 8th Dec 19, 5:35 PM
    • 660 Posts
    • 386 Thanks
    adviceforall
    On the subject of carers we had used live in care when our elderly mum came home from hospital after breaking her hip.

    Although live in care, that means they only work for around 8 hours a day, so if she needs help though the night if its more than 2 or 3 times say for the loo then they will say that is too much.

    It just didnt work out for us.. She went into a home and that took so much pressure off my sister and myself. She just needed much more care than 1 carer could give in 8 hours..

    Something to think about..
    • badmemory
    • By badmemory 9th Dec 19, 2:34 AM
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    badmemory
    Do you really want to sit her in front of the TV watching Coronation St or the like (my worst nightmare by the way) or do you want her to have some social interaction which would be much better for her. You would need a minimum of 4 carers to look after someone for a week. Who is going to be there to see they do their jobs properly?


    What a lot of people miss realising about care homes, even the lesser ones, is that people visit & those people see what is going on. Many people have the same visitors every day. Many of those visitors actually "visit" people who don't normally have visitors whilst they are there. Visitors also get to know one another & update on things if they have been missing for a few days.


    For instance, when I was working & could usually only visit in the evenings, the visitor to the person normally sitting next to her in the lounge would talk to both of them, when I went in the evening I would do the same. At the weekend it could occasionally be a 6 way conversation. The more stimulation the better. Once the first bite of dementia takes hold the more stimulation the better, isolation in these cases is bad.
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