Advice on my authority to pay for a care agency?

[prodigal-son]

Greetings all. I'm new here and would appreciate some advice. Searching the forum and reading the factsheets I've found much good stuff and many poignant stories, but no specific answer.

So … Can I get a care agency (self-funding) in place when my dad won't sign their forms and I'm not getting much help from social services? I don't have a health and welfare POA but I do have an EPA (the old type) for his financial affairs.

I've twice tried to bring in agencies, but Dad has insisted he's fine and without his signature neither company would go any further. In once of the factsheets I read that a financial POA should work (for residential care) if you're self-funding, but the agencies didn't seem to accept that.

Background: My dad has dementia and lives alone. With the help of an informal paid carer he has been managing pretty well. However, it's only going to get worse and I'm also worried about other illnesses, falls and so on. He ended up in A&E the other night and I think we're overdue to move up to the next level of care. I live 5 hours' drive away, I'm not going to care for him and I can't expect the existing carer to be available at all times. With a good agency I assume we'd have more flexibility.

SS are not really interested because Dad wears a shirt and tie, his flat is clean and he says he can manage. I admire his independence and I agree he's mentally competent for many day-to-day tasks, including some shopping – even though without his current carer I'm sure he would often run out of food. However, I think it's obvious he does not have capacity to understand how difficult it would be to get care if he were ill or injured. He has never in his life shown much regard for other people, and I guess it boils down to that.

The irony is that Dad is happy to chat to anyone who calls, including his current carer, who he doesn't remember from one visit to the next. If another carer showed up "just to check on him" he'd be fine with that. I'm not trying to get him to accept any particular kind of care against his will, just to have some help in place for when we really need it. Any ideas?

 

[MaNaAk]

Welcome toTP!

I only had POA for finance when we first had carers for and with the EPA l would have thought you would be fine. I started work on the second POA when I had to consider respite care for dad and when he needed a cataract operation. I couldn't tell dad that carers were coming in so I told him a love lie by saying that there was someone/friend coming to keep him company. You will have to do this when getting your dad to sign the form by saying dad I need you to sign this form because ..... You will need to vary the facts and maybe say that he is doing something for your peace of mind. This is very difficult job that we carers have to do but you are doing it for his own good.

Good luck

MaNaAk

 

[Sirena]

I don't understand why the agencies will not accept your EPA. I have financial LPA and I arranged a care agency for my mother. The care director gave me all the paperwork and I signed the contract and arranged the monthly payments. The EPA should work in the same way.

Social services will not be interested if your dad is self funding, so I wouldn't pursue that route. I got SS to assess my mother, she said she didn't need help and they took her at her word and we didn't see them for dust. But they told me that when she did need help they wouldn't provide it anyway as she was self funding. So I went ahead and made the arrangements. I found an agency by googling "dementia care at home" and the location. I struck lucky, they were brilliant and provided care for 18 months, until she moved to a care home.

I don't have health & welfare LPA but that has never been a problem at all when arranging care for my mother.

 

[prodigal-son]

Thank you both very much. I will try again with the agencies. I'd mentioned to them in passing that I'd be dealing with the finances, but I didn't make a point of the POA when it came to their assessment and the signature.

@MaNaAk, I assume you were talking about getting a signature for the POA rather than the carers, but in either way it would be difficult. Dad really does not like signing stuff, even when it's perfectly reasonable. And to be honest I think it's a bit late for a POA, though I could certainly try. Even getting witnesses is a nightmare these days.

@Sirena, thanks for the comment about Social Services. I was thinking maybe I'd need them to decide this was in his best interests, and that this would be difficult – even though the need is blindingly obvious.

I'm surprised the financial POA carries such clout in a matter that clearly covers a lot more than finance. The care home we were talking to previously would have snatched the money and no questions asked. The two agencies seemed more careful, but I'll try again. Thanks!

 

[Beate]

Yes, it does help if you actually mention that you have POA.
Even better, take a copy and show it to them - that might do the trick!

 

[doodle1]

Ok you have an old fashioned EPA . Have you registered it with the Office of the Public Guardian?. If so it covers both finance and health and welfare. I do know this as I have one for my mum . When it is registered the person with dementia cannot make any decisions as he/ she is registered as not having mental capacity. You may have to get his gp to sign the form . Personally I would get this sorted asap. You don't have to involve SS at all to sort out care. My mum is self funded and I organised everything from 24/7 care at home starting from an original basis of one hours care a day to her move into a care home last year. Every PWD will think they don't need care. Please also read the threads on' hostess mode' where the PWD presents as totally capable to the outside world even when you know this is completely untrue.
Feel free to pm me .
Good luck

 

[Baker17]

Ok you have an old fashioned EPA . Have you registered it with the Office of the Public Guardian?. If so it covers both finance and health and welfare. I do know this as I have one for my mum . When it is registered the person with dementia cannot make any decisions as he/ she is registered as not having mental capacity. You may have to get his gp to sign the form . Personally I would get this sorted asap. You don't have to involve SS at all to sort out care. My mum is self funded and I organised everything from 24/7 care at home starting from an original basis of one hours care a day to her move into a care home last year. Every PWD will think they don't need care. Please also read the threads on' hostess mode' where the PWD presents as totally capable to the outside world even when you know this is completely untrue.
Feel free to pm me .
Good luck

It’s interesting you say that about the EPA, that’s what I had for my OH and when it came to talking to SS they said “oh so you don’t have health and welfare POA, they then managed to take things out of my hands regarding decisions about residential care when my OH reached the level where they contribute and due to invisibles they moved my OH against my wishes

 

[Sirena]

@Sirena, thanks for the comment about Social Services. I was thinking maybe I'd need them to decide this was in his best interests, and that this would be difficult – even though the need is blindingly obvious.

I'm surprised the financial POA carries such clout in a matter that clearly covers a lot more than finance. The care home we were talking to previously would have snatched the money and no questions asked. The two agencies seemed more careful, but I'll try again. Thanks!

I am sure you will find an agency who will have no problem with you organising and signing for care.

SS will just complicate matters (supposing they are interested in the first place). I did actually involve them a second time, but they took so long to get back to me that when they visited I'd already had carers in place for over a week. The SW said "you're providing much better care than we would, we just provide crisis management". And that was the end of her involvement.

Problems will only arise re 'best interests' if you do something which your dad objects to mightily. So if you wanted to move him to a care home and he refused to go, that would require a best interests meeting. But the current issue of him not wanting carers in can be easily overcome. You said he likes talking to people, so just don't call them carers, think of a story which he'll accept and he should be fine with it.

If/when it comes to the point of needing a care home, bear in mind that SS aim to keep people in their own homes even if it is (as you say) blindingly obvious they are no longer safe there. So if they deemed your dad to have capacity to make his own decisions and he said he wanted to stay at home (which he almost certainly would) he'd stay at home until a crisis happened, like a serious fall.

 

[prodigal-son]

Thanks everyone for the further information and your good wishes. It's getting a bit critical now so I hope I'll succeed in finding an agency within the next few days.

Ok you have an old fashioned EPA . Have you registered it with the Office of the Public Guardian?. If so it covers both finance and health and welfare.

It's registered, thanks, and based on everyone's comments about self funding I'm sure it will be fine. For the record, though, from what I can see an EPA does not cover health and welfare any more than a financial LPA does. The current gov.uk web page says: "You can help make or make decisions about someone’s property and money if they appointed you using an enduring power of attorney (EPA)."

Problems will only arise re 'best interests' if you do something which your dad objects to mightily. So if you wanted to move him to a care home and he refused to go, that would require a best interests meeting.

Thank you for that. At some point I suppose I'll need to do that, and yes, he will object mightily. I wonder if moving from Dorset to a care home in Norfolk will make that easier or harder…

 

[Sirena]

Thank you for that. At some point I suppose I'll need to do that, and yes, he will object mightily. I wonder if moving from Dorset to a care home in Norfolk will make that easier or harder…

If he's self-funding moving counties it should in theory make little difference. I moved my mother from her home in London to a care home near me on the south coast with no problem. SS involvement could complicate things if he insists on staying near his current home, although hopefully they would see that isn't in his best interests to be that distance away from his son.

However, a care home will want to assess him in person to ensure they can meet his needs. So you would either need to take him to your chosen care home for assessment (not practical if a long distance is involved) or find out what alternative arrangement they will accept. My mother's care home accepted an assessment from the director of her care agency.

(And yes you're right about EPA not covering H&W, but as I said I don't have H&W LPA and it hasn't been an issue when dealing with care.)

Good luck with finding an agency.

 

[Spamar]

I had EPA for OH, and there’s still one lurking somewhere if I need it. I was told that it didn’t cover health and welfare, so I got a separate one for that. Fortunately OH was not difficult about signing ( he was eating biscuits, the whole pack bar two!). But it might be too late for that in your case.
I had no difficulty in getting respite and, later, full time care for him. But I guess it’s easier for a wife than a son!
Good luck.

 

[doodle1]

To be honest I have found everyone from gp to hospital consultants to care homes accept the registered EPA as for H and W too. And I have had to produce it a lot

 

[nitram]

Ok you have an old fashioned EPA . Have you registered it with the Office of the Public Guardian?. If so it covers both finance and health and welfare.

An EPA does not give power over health and welfare decisions

It does give the power to spend the donor's funds on heath and welfare provisions.

This >>> official sample<<< of a correctly completed EPA shows there is no mention of anything other than finance and affairs

With an LPA the donor, as well as generally granting power over H&W decisions, has to specifically choose between:
I want to give my attorneys authority to give or refuse consent to life-sustaining treatment on my behalf.
and
I do not want to give my attorneys authority to give or refuse consent to life-sustaining treatment on my behalf.

Although I had H&W LPA I never offered it, nor was I asked for it, I just assumed control keeping the LPA as ace in case somebody said 'you can't do that you don't have LPA'

I think the LPA only becomes essential where there is contention between family members which is obvious to clinicians.

 

[la lucia]

I don't understand why the agencies will not accept your EPA. I have financial LPA and I arranged a care agency for my mother. The care director gave me all the paperwork and I signed the contract and arranged the monthly payments. The EPA should work in the same way.

Social services will not be interested if your dad is self funding, so I wouldn't pursue that route. I got SS to assess my mother, she said she didn't need help and they took her at her word and we didn't see them for dust. But they told me that when she did need help they wouldn't provide it anyway as she was self funding. So I went ahead and made the arrangements. I found an agency by googling "dementia care at home" and the location. I struck lucky, they were brilliant and provided care for 18 months, until she moved to a care home.

I don't have health & welfare LPA but that has never been a problem at all when arranging care for my mother.

The social services part of the post is not true in every area. We are fully self-funding but we organise care through our local authority who commission the care, bill us themselves and enable self-funders to obtain local authority rates which are obviously cheaper than paying direct to agencies. Some local authorities do this, some don't. It's definitely always worth checking.

 

[Sirena]

The social services part of the post is not true in every area. We are fully self-funding but we organise care through our local authority who commission the care, bill us themselves and enable self-funders to obtain local authority rates which are obviously cheaper than paying direct to agencies. Some local authorities do this, some don't. It's definitely always worth checking.

That wasn't the case for my mother, but as you say could be helpful others.
Does that depend on you using SS approved agencies, or do you have a full choice of who you use? Can you arrange as many hours a day as you like, or is it time-limited? My mother started on 4 hours a day and ended up on 6 hours (and then needed supervision 24/7 so moved to a CH).

 

[la lucia]

That wasn't the case for my mother, but as you say could be helpful others.
Does that depend on you using SS approved agencies, or do you have a full choice of who you use? Can you arrange as many hours a day as you like, or is it time-limited? My mother started on 4 hours a day and ended up on 6 hours (and then needed supervision 24/7 so moved to a CH).

They use all the agencies in the area if the agencies have capacity obviously, the only thing they won't commission is private PAs. They don't try and control anything. I can refuse or accept as I wish.

They just commission and bill they don't have anything to do with how many hours someone has. It's not costing them anything except for a few office hours we're fully self-funding we just benefit from the local authority rate. They do the same for care home places too.

As I said, some local authorities do this and some don't. There's a lot of variations in dementia services around the country it's always best to investigate locally.

 

[Sirena]

@la lucia Thanks - that sounds a good arrangement.

 

[prodigal-son]

Dad's due to return home from hospital on Tuesday and we now have proper care in place, fingers crossed. Poole SS were extremely helpful once they realised what a state he's in. They found two agencies that were willing to start quickly, and I chose one of them. We're perhaps not as lucky as @la lucia, since the choice was limited to agencies they have contracts with, but the one we chose was on our shortlist anyway so I'm not complaining. We will be paying the agency directly but we get a good rate.

This was definitely a best-interests decision rather than one based on the EPA. Still, the SS person has been great at convincing Dad that in the future he should move nearer to me. Since I assume all this has been recorded, I hope it will smooth the way when the time comes.

Again, thanks for all your great advice.