Need advice ASAP - meeting tomorrow - kicking my gran out! CHC ass stopped?

loolabell

Registered User
Jan 13, 2020
10
0
I have a meeting with my 95 year olds Grand mothers private nursing home tomorrow morning and at this time of day, are struggling to get some facts that I am hoping to use, to support and protect my Grandmother from being kicked out on her ear!

In summary, she was admitted in June 2019 straight from hospital following a broken leg. She was diagnosed with early onset of dementia in 2015 and was becoming institutionalised at the local hospital following the repair to her femur. The private nursing home assessed her, and said that she had a place, great we thought. Everything has been excellent until recently, now she has deterioration over recent weeks and they want her out out out.

Prior to this: On December 19th 2019, a CHC was done following a change in her needs. My mother and I attended a meeting with a senior nurse and she attained two A's, which we were advised meant she would reach the next level of assessment. We were told that as it was so close to Xmas there would be a slight delay. About 2 days after this assessment, my grandmother had her first 'episode'. She was put into bed, (normally in a wheelchair) sides up, where she screamed, shouted and threw stuff. She would n't listen to anyone (she is also French and deaf!) not even my mother or I could calm her. After a day or so, she eventually crashed, slept solid for a few days (with exhaustion!) and resumed her previous demeanour when she awoke. Refusing food, and very weak though.

On December 22 my mother visited her, when on signing in, the house manager publicly approached my mother (infront of staff and visitos) and asked my mother if the senior nurse had spoken to her and that she needs to find another care home due to the complaints from residents and their families. My mother was shocked, upset, concerned on the effect that this would have on my gran, but also how unprofessional it was.

I visited the next day, my gran was calm, and I went to she Senior nurse and asked him to clarify what was that conversation that was casually broached in the reception the day before. His exact words, go and enjoy Christmas, but in the New Year, she has to go to a specialist dementia unit, where they can care for her.

At this point, I'm thinking, why did they take her on, knowing that she had the condition, it was only going to get worse. And moving her now, and at her age, would be a huge upheaval. But as she had calmed down, and picked up remarkably over the Christmas period, we assumed that this was perhaps an underlying UTI, which she frequently gets. Nothing more was said.

Until last Monday 6th January, on visiting her, she seemed irritated again, and was in bed, cotted up again. She'd been 'shouty' according to the Senior Nurse. She told me they didn't like her French loud voice! As my mother and I were leaving, the Senior nurse asked if we could arrange a meeting with both mum and I with the House Manager. As we knew what this was likely to be about, we started the trawling the internet for homes. By Wednesday morning,my mother had a call. She was having another episode, they want to charge us for a nurse to sit with her....but we are already paying for a 24 hour nursing home, you want more money on top of the £1600 per week......and come to think of it, what's going on with the CHC.

By Wednesday night, my gran was still howling, they told us that they called the Doc. By Thursday morning, she hadn't calmed down at all. We called again and home said that they can't do anything for her. Each time making sure that we were in ear shot of the howling. They refused to sedate her as it wasn't ethical, even though my mum has power of attorney, and said it was in her best interest.

My mum called the GP surgery Thursday morning. They hadn't been called on the Wednesday! SHe asked if they could go and assist ASAP. On Thursday pm, we called the home again, each time making sure my gran is in ear shot, howling. The doc couldn't do anything they said! Once again, mum called the Docs. They advised that infact they had left diazepam and antibiotics for an underlying UTI. Why didn't the home state this when we enquired, why lie about that the doc had been, when they hadn't called them?

Thursday afternoon, we asked the care home for a copy of the contract, presumably we get 28 days notice to find her another home? By then hopefully we'll have the CHC completed. We called the local CCG, they advised that no CHC has been received! We call Beacon for advice, they advised to not move Gran until CHC is completed, they said it sounds like she would qualify. We were advised to escalate to fastrack, due to her rapid deterioration and that it would be in her best interests. We duly sent an email to the Senior Nurse requesting this on Thursday afternoon, and then called to make a meeting with the House Manager for the next day. She couldn't make Friday, and then said, that she didn't think we needed a meeting anymore! I think we do.

So, (if your still with me) sorry its so long....

They have not responded to our request to fast track the CHC and CCG have advised today, that there is still no CHC (fastrack or otherwise) (today being 13/01/2020)

Mum found her contract, they state that they only have to give 48 hours written notice if the patient is aggressive and violent (well as much as a 6 stone 95 year incapacitated, dementia ridden French, deaf woman can be from her cotted bed!) We've not had this in writing yet, but I expect we'll get it tomorrow at the meeting.

Do we have the right to stay put, until they complete the CHC? (Backdated to 19/12)

Sorry its such a long one....I called round today to try to get some advice, but going from pillar to post, the last number given for advise closed their lines at 4.45....

Grateful for any information or advice you can offer at this last stage.
Many many thanks
E
 

canary

Registered User
Feb 25, 2014
25,048
0
South coast
Hello @loolabell and welcome to Talking Point.

Im afraid that the scenario of someone with dementia moving into a mixed dementia/non-dementia care/nursing home and then when the dementia progresses the home is unable to meet their needs and are then given notice, is actually quite common. I expect that 6 months ago the home could meet your Grandmothers needs, but in that time the dementia has progressed and now she needs a dedicated dementia home. It is honestly not a good idea to try and fight it. The home is unlikely to back down and do you really want her to stay there when they cant meet her needs?

Is your Grandma self-funded or does she need Local Authority Funding? If she needs funding then you will need to contact Social Services to try and find another home. They may well also be helpful if she is self-funding, but they often leave it to the relatives to sort it out if she is self-funding. I wouldnt worry too much about the CHC decision at this stage (although it is worth chasing up) - it is unlikely to change which sort of nursing home she needs. I would, however mention it to any home you are thinking of just on the offchance that it does make a difference. The main thing is finding a place that can meet her needs.
 

Jessbow

Registered User
Mar 1, 2013
5,713
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Midlands
I may be wrong, but I thought fast -track is for those that are terminally ill.

( dont think it means ''get a move on with the process because you are taking too long)

Who or what has funded her so far?

it does sound as though her needs have changed, and that the howling incent was not isolated, and may well be a problem amongst other residents.

I doubt they will actually 'put her out' if you are seen to being proactive in finding another placement.
Placement can go ahead before the CHC is sorted, although it might be good to ask if a home you view accepts CHC patients- not all do

Its terribly hard x
 

nitram

Registered User
Apr 6, 2011
30,239
0
Bury
I may be wrong, but I thought fast -track is for those that are terminally ill.

Fast track CHC requires an 'appropriate clinician', often the GP , to sign

The individual fulfils the following criterion:
He or she has a rapidly deteriorating condition and the condition may be entering a terminal phase. For the purposes of Fast Track eligibility this constitutes a primary health need. No other test is required.

Once the CCG receive the signed document CHC is granted immediately.
 

loolabell

Registered User
Jan 13, 2020
10
0
Hello @loolabell and welcome to Talking Point.

Im afraid that the scenario of someone with dementia moving into a mixed dementia/non-dementia care/nursing home and then when the dementia progresses the home is unable to meet their needs and are then given notice, is actually quite common. I expect that 6 months ago the home could meet your Grandmothers needs, but in that time the dementia has progressed and now she needs a dedicated dementia home. It is honestly not a good idea to try and fight it. The home is unlikely to back down and do you really want her to stay there when they cant meet her needs?

Is your Grandma self-funded or does she need Local Authority Funding? If she needs funding then you will need to contact Social Services to try and find another home. They may well also be helpful if she is self-funding, but they often leave it to the relatives to sort it out if she is self-funding. I wouldnt worry too much about the CHC decision at this stage (although it is worth chasing up) - it is unlikely to change which sort of nursing home she needs. I would, however mention it to any home you are thinking of just on the offchance that it does make a difference. The main thing is finding a place that can meet her needs.


Hi Canary,

Thanks for your response.

Yes I kid of got that feeling trawling through the internet. Whilst I am disappointed by the decision, I accept that it has to happen.

She is completely self funded, although she has reached the physical and mental depths that I feel sure that she will 100% qualify. (also confirmed off record by a district burse friend) Whilst I know I don't need the CHC to move, I feel that they are more likely to complete it if we have an interest to conclude, ie, they want her out, and I want it done, as she is likely to then have her fees (£1600 per week back dated for the last month) refunded. I think the minute that I take her out, the whole process will start again. I am about to have to sell her house to fund the next nursing home though, as the current home has depleted all of her cash, so given the high chance of funding, it would save the heartache of the sale of her little place.

I just wanted to know if I can use the CHC as leverage tomorrow -

and whether I can request 28 days rather than 48 hours to get her moved?
 

loolabell

Registered User
Jan 13, 2020
10
0
I may be wrong, but I thought fast -track is for those that are terminally ill.

( dont think it means ''get a move on with the process because you are taking too long)

Who or what has funded her so far?

it does sound as though her needs have changed, and that the howling incent was not isolated, and may well be a problem amongst other residents.

I doubt they will actually 'put her out' if you are seen to being proactive in finding another placement.
Placement can go ahead before the CHC is sorted, although it might be good to ask if a home you view accepts CHC patients- not all do

Its terribly hard x
Hi Jessbow,
Nothing has been funded to date, she has covered it 100% herself. My mum has been doing all the running around, but now she can cancer, and has just broken her arm in a fall, and this week its kind of landed on my lap.

I too thought that it was when you are terminally ill (although she has cancer, but no investigation due to her age) but Beacon advised me that there is no time line as such, but if its in 'her best interests' and if she has a rapid deterioration in her health. As the House Manager stated, she now needs 24 hour care. She literally can't do anything for herself, is French (finds it hard to understand, and be understood), deaf, won't eat, refuses meds, incontinent, and is not behaving....
 

loolabell

Registered User
Jan 13, 2020
10
0
Fast track CHC requires an 'appropriate clinician', often the GP , to sign

The individual fulfils the following criterion:
He or she has a rapidly deteriorating condition and the condition may be entering a terminal phase. For the purposes of Fast Track eligibility this constitutes a primary health need. No other test is required.

Once the CCG receive the signed document CHC is granted immediately.

Hi Nitram,

Thanks for post, that sounds promising. May give GP surgery a call in the morning.

Any ideas why the home doesn't want to pursue the CHC?
 

Moose1966

Registered User
Feb 10, 2017
147
0
Staffordshire
I may be wrong, but I thought fast -track is for those that are terminally ill.

( dont think it means ''get a move on with the process because you are taking too long)

Who or what has funded her so far?

it does sound as though her needs have changed, and that the howling incent was not isolated, and may well be a problem amongst other residents.

I doubt they will actually 'put her out' if you are seen to being proactive in finding another placement.
Placement can go ahead before the CHC is sorted, although it might be good to ask if a home you view accepts CHC patients- not all do

Its terribly hard x
I think the main thing here is to find a suitable place for your gran that can meet her needs and that you know will allow your mum and you to chase up paperwork and funding . Just a warning that even if you get CHC funding through fast track it will be reviewed 3 months down the line . Mums was withdrawn at the review because although she was still very poorly she hadn’t got any worse . She was granted FNC which contributes to her NH care . Good luck and keep positive.
 

loolabell

Registered User
Jan 13, 2020
10
0
I think the main thing here is to find a suitable place for your gran that can meet her needs and that you know will allow your mum and you to chase up paperwork and funding . Just a warning that even if you get CHC funding through fast track it will be reviewed 3 months down the line . Mums was withdrawn at the review because although she was still very poorly she hadn’t got any worse . She was granted FNC which contributes to her NH care . Good luck and keep positive.

Thanks, it looks like we have found one, and they currently have availablility - If she does waulify for funding, I just cant see her getting any better, shes becomer weaker and weaker, has lost so much weight, and now refusing to eat, be sociable - agitated all the time....its terribly sad. It doesn't help that the GP doesn't even really know her.....
 

nitram

Registered User
Apr 6, 2011
30,239
0
Bury
May give GP surgery a call in the morning.

Any ideas why the home doesn't want to pursue the CHC?


From what you have said I doubt if the GP will sign, has she any comorbidities?

Two possible reasons:

  • They may not feel able to cope with her condition
  • CHC payment will probably be considerably less than self funding rate.
Although legally it is not possible to top up CHC - it's an NHS service - loop holes have been found. It is becoming more usually as the CHC cost can now be split between LA (hotel costs) and CCG (medical costs), L:A costs can be topped up.
 

Jessbow

Registered User
Mar 1, 2013
5,713
0
Midlands
Thanks, it looks like we have found one, and they currently have availablility - If she does waulify for funding, I just cant see her getting any better, shes becomer weaker and weaker, has lost so much weight, and now refusing to eat, be sociable - agitated all the time....its terribly sad. It doesn't help that the GP doesn't even really know her.....
Just don't bank on continuing CHC even if you do get it awarded. Will the home with the vacancies a) meet her needs?- will they meet and assess her in person
B) accept CHC funding?
 

Moggymad

Registered User
May 12, 2017
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0
Hi you mentioned that your gran has cancer but that it hasn't been investigated. I am wondering if she has pain meds? Aggression in people with dementia can also be due to pain as well as infection.
 

loolabell

Registered User
Jan 13, 2020
10
0
From what you have said I doubt if the GP will sign, has she any comorbidities?

Two possible reasons:

  • They may not feel able to cope with her condition
  • CHC payment will probably be considerably less than self funding rate.
Although legally it is not possible to top up CHC - it's an NHS service - loop holes have been found. It is becoming more usually as the CHC cost can now be split between LA (hotel costs) and CCG (medical costs), L:A costs can be topped up.

No not really - the cancer popped up in some bloods last year (CA125) following a significant bleed, no action was taken as it was deemed to invasive. Then she had another significant bleed about 2 months ago, and (different county) A & E advised that there were traces shown in scan, but at 94, encouraged us not to investigate further. However shes on blood count watch, due to the amount of blood that she lost.

The only meds she is on is paracetamol and currently diazepam for her 'episodes'

If I agree to getting her moved, I see no reason why they don't pursue the CHC, it'll only go back to 19th Dec. As for the new place, I'll have to speak to them....

Do you think if I get Social Services Involved, they would be of any assistance?
 

loolabell

Registered User
Jan 13, 2020
10
0
Hi you mentioned that your gran has cancer but that it hasn't been investigated. I am wondering if she has pain meds? Aggression in people with dementia can also be due to pain as well as infection.

No pain meds other than paracetamol for her painful knees. Wonder if I can ask for a GP a full review? Mum spoke to Doc today, she is on 2mg of diazepam, and still unsettled...I understand that they can give her more, but was advised that they don't like to giver the elderly too much.
 

nitram

Registered User
Apr 6, 2011
30,239
0
Bury
Do you think if I get Social Services Involved, they would be of any assistance?

They have a duty to see she is adequately cared for, however if self funding they are not likely to be of much help.
As she is already self funding in residential/nursing care they will consider her to be cared for .
 

Moggymad

Registered User
May 12, 2017
1,314
0
No pain meds other than paracetamol for her painful knees. Wonder if I can ask for a GP a full review? Mum spoke to Doc today, she is on 2mg of diazepam, and still unsettled...I understand that they can give her more, but was advised that they don't like to giver the elderly too much.

It might be as well to review things with the GP. It might be useful for the CHC application? Does your mum or yourself understand French & what you're gran is 'howling' about? I can't help feeling this may not just be dementia behaviour. How awful this must be for her & yourselves.
I haven't had any experience with applying for CHC as my mums was granted at end of life in hospital & wasn't subject to the usual assessment. However I do feel that the main priority is to get medical help for your gran to make her comfortable as if she is getting towards or at EOL meds should be available for her. Then to ensure based on her needs, that the proposed new NH is able to meet those needs. CHC can follow that. Hoping all goes well.
 

canary

Registered User
Feb 25, 2014
25,048
0
South coast
she now needs 24 hour care. She literally can't do anything for herself, is French (finds it hard to understand, and be understood), deaf, won't eat, refuses meds, incontinent, and is not behaving....
I just thought Id mention that none of these thing by themselves qualify you for CHC - they are all considered social needs, not health.. In order to get CHC you need additional health needs
 

loolabell

Registered User
Jan 13, 2020
10
0
It might be as well to review things with the GP. It might be useful for the CHC application? Does your mum or yourself understand French & what you're gran is 'howling' about? I can't help feeling this may not just be dementia behaviour. How awful this must be for her & yourselves.
I haven't had any experience with applying for CHC as my mums was granted at end of life in hospital & wasn't subject to the usual assessment. However I do feel that the main priority is to get medical help for your gran to make her comfortable as if she is getting towards or at EOL meds should be available for her. Then to ensure based on her needs, that the proposed new NH is able to meet those needs. CHC can follow that. Hoping all goes well.

Thanks for response Moggymads,

I think in the first instance, for us to full understand her needs, I am going to ask for a full GP review prior to me moving her anywhere. How can we understand her needs if she hasn't been fully assessed. I am also going to ask to see the 'care needs assessment' (see if it is has been updated and relevant to this last few weeks. Once we then know what we are looking for, I can go and find it! I don't think that would be an unreasonable request, although I know that they want her out ASAP.

As for her language, we understand her, she speaks good English, but she has a very hard Northern French accent, and few understand it. The shouting is generally about passed members of her family, her daughter, husband, sister, mixed in with old work situations and then some random blurb. I'm just not sure 2mg of diazepam when she has an episode is enough. Will try to get through to GP tomorrow.

Thanks for all advice.....dreading tomorrow!
 

nitram

Registered User
Apr 6, 2011
30,239
0
Bury
Personal experience.
The bar is set high.

Wife,immobile/hoisted, non verbalising, doubly incontinent with catheter, purred food, contracted wrists, in foetal position did not get CHC

Admitted to A&E with AKI, consultant said 'sorry your wife has much life left' , registrar agreed to fast track CHC

After a couple of weeks with no progress, I went into extreme overdrive (now realised fuelled by anger)
Result was fast track by return telex to GP which I later got backdated to the date of the witnessed consultant's statement.

There was a 3 month review, my wife died a few days short of this,

 

Jessbow

Registered User
Mar 1, 2013
5,713
0
Midlands
Hope you get a reasonable outcome from your meeting today.

At the end of the day, if they dont feel they are meeting her needs, or that she doesnt 'fit in' with their other residents, they will ask her to be moved.

Would I want my gran to remain somewhere , where the staff say they cannot meet her needs? No I wouldn't.