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  1. #1
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    Does a carer have to accept social services recommended care and pay for it?

    My mother has just come out of hospital after a seizure of unknown cause. Before they released her back home to my dad, social services carried out a care plan and now have carers attending my mum 4 times a day to change/feed her, get her up and put her to bed. She is in very late stages dementia and can’t do anything for herself. Before now my dad has looked after my mum mainly by himself with no problems but the hospital/social services wouldn’t discharge her without a care plan in place. A financial assessment has been done and they have declared that my dad pretty much has to pay for most of the care out of his own money (around £500 a week). He thinks this is excessive and doesn’t really see the need of the carers – or at least having them come four times a day.
    So what we really basically want to know is:
    1) Is it my dad’s decision whether or not to have the carers attend every day or at all? Nothing has been said about my dad not being capable and social services did say he could “scale down the amount of care after a bit if he wanted”. He has been happily coping OK for the past 5 years.
    2) Although he does have saving s and own his own house – we thought there was something in the assessment whereby if the person being assessed has critical care needs (my mother can’t eat, walk, change herself or go to the toilet) that her care would be automatically paid for? Or do I have that wrong?

    Any information or similar experiences would be gratefully received.
    Thanks!

  2. #2
    Registered User Pete R's Avatar
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    Quote Originally Posted by alex18 View Post
    My mother has just come out of hospital after a seizure of unknown cause. Before they released her back home to my dad, social services carried out a care plan and now have carers attending my mum 4 times a day to change/feed her, get her up and put her to bed. She is in very late stages dementia and can’t do anything for herself. Before now my dad has looked after my mum mainly by himself with no problems but the hospital/social services wouldn’t discharge her without a care plan in place. A financial assessment has been done and they have declared that my dad pretty much has to pay for most of the care out of his own money (around £500 a week). He thinks this is excessive and doesn’t really see the need of the carers – or at least having them come four times a day.
    So what we really basically want to know is:
    1) Is it my dad’s decision whether or not to have the carers attend every day or at all? Nothing has been said about my dad not being capable and social services did say he could “scale down the amount of care after a bit if he wanted”. He has been happily coping OK for the past 5 years.
    2) Although he does have saving s and own his own house – we thought there was something in the assessment whereby if the person being assessed has critical care needs (my mother can’t eat, walk, change herself or go to the toilet) that her care would be automatically paid for? Or do I have that wrong?

    Any information or similar experiences would be gratefully received.
    Thanks!
    Hi alex18 and welcome to TP.

    First question is does your Dad have Power of Attorney for your Mother Health and Welfare? Without this you do really have to try and work with Social Services as they can turn "funny" if they think that your Mother is not getting appropriate care.

    Whatever money/property that your Dad owns has no bearing on what is charged. Your Mother alone should have been subject to a Financial Assessment to see what she could afford to pay. If she has saving over £23,250 then it is normal for her to be charged the full amount.

    As for her having critical care needs and the state fully funded your Mother would have to go through a full CHC assessment first and the criteria is fairly high to be successful.
    This link explains.......
    http://www.nhs.uk/Conditions/social-...uing-care.aspx

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  3. #3
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    Many thanks Pete!

    Yes my dad has had power of attorney for years and there has been no mention from social services about him not being capable of looking after my mum. He does a great job of it. But he is now afraid if he tries to stop the carers coming they will take out a court order against him or something!

    They have joint accounts and have savings and a financial assessment has been done. It was after this they said he'd have to pay for the care.

    They also had another assessment just last week (I presume it was the CHC assessment) where they said it's unlikely the care will be paid for as her needs are being managed, but it will go before a board of members to decide. If that's the case I don't see why we couldn't say we don't want the carers to come anymore if they're claiming her needs are being managed. If they then turn around and say that we needed the carers to manage her needs, then wouldn't that mean they should pay for them? I'll have a look at the continuing healthcare checklist in the link you've kindly provided.

    Thanks again!

  4. #4
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    i am assuming your Dad is elderly Alex. It seems a very heavy burden for him to do all that caring for your Mum by himself. If, as you say, your Mum can't do a thing then that's an awful lot for anybody to deal with.

  5. #5
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    Quote Originally Posted by alex18 View Post
    So what we really basically want to know is:
    1) Is it my dad’s decision whether or not to have the carers attend every day or at all? Nothing has been said about my dad not being capable and social services did say he could “scale down the amount of care after a bit if he wanted”. He has been happily coping OK for the past 5 years.
    2) Although he does have saving s and own his own house – we thought there was something in the assessment whereby if the person being assessed has critical care needs (my mother can’t eat, walk, change herself or go to the toilet) that her care would be automatically paid for? Or do I have that wrong?

    Any information or similar experiences would be gratefully received.
    Thanks!
    Alex, Hi, and welcome to TP. You will find much useful information and advice here.

    Your situation sounds very similar to my in-laws about 3 years ago, after my father-in-law (FIL) had been discharged from hospital after a major operation. My mother-in-law (MIL) who (at that time) had early stages dementia - as well as him - was convinced that he didn't need carers 4 times a day. I don't mean to suggest your dad has dementia, more that she was adamant that she could cope.

    Looking back at that time, I absolutely recognise the barrage of questions that you are asking yourself right now. So my first piece of advice is - SLOW DOWN! There is time to sort it all out. Take a deep breath!

    The first thing is to establish the level of care your mum needs now. I'm assuming she is not entitled to a 6-week re-ablement programme of care? With or without this, it will probably take a few weeks to establish her 'baseline' level of care. Take some time to understand her, your dad's and your own needs. The visiting carers and SS will help you, as a family, work this out. Hopefully you will all come to a stage where you all agree what that level of care is. (We did get there eventually - MIL grudgingly accepted visiting carers.)

    As for paying for the care, Pete R has explained this, so I won't repeat. I agree, it does seem strange that SS can effectively say, "THIS is the level of care you need, you HAVE to have it, and by the way you HAVE to pay for it too"! In most other areas of life, the paying customer chooses whether or not to buy something, and is usually offered a good choice of alternative products or services. It's an economic principle that doesn't quite seem to apply to social care services! But don't worry about that right now - first thing is to make sure BOTH your parents are safe and looked after. (I'm sure your dad will come to appreciate the help in time....)

    Best of luck, keep posting, and let us know how you get on.

  6. #6
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    Hi Alex
    I would suggest accepting the package of care for the first couple o fweeks to assess how much care is really needed an dif the visits are excessive, ring the agency and reduce them. Dad is a self funder and I have reduced his care taking over a lot of it myself. You can't be forced to pay for something you don't need, but give yourself time to assess the situation before cancelling the care as they may have a long waiting list to get them back again.

  7. #7
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    Alex, you said that your father has POA....I'm assuming that is the 'Health' one and not the 'financial' one. The 'Health' POA is the one he would need....otherwise he would have to be very careful about upsetting the social worker (it's best to keep them on board anyway).

    The health workers will also be thinking of your father. They will probably be thinking that he will need help to be a long term carer. So some level of support will be needed....you just have to decide what is appropriate.

    I suppose re-ablement wasn't mentioned (probably too late now). This can provide up to 6 weeks free care but it seems to be getting harder to arrange. There is almost of code of silence about it and I think the criteria are getting tougher. They may want the likelihood of improvement over the course of the 6 weeks.

    Personally I don't have 'Health' POA. We had re-ablement (twice now) after mum broke her hip (both sides). They started at one carer twice a day, 7 days a week (the hospital actually wanted 4 visits a day when they thought we were paying). I was the second carer....I presume your father fulfils that role (they specified 2 carers a visit).

    After 2-3 weeks (when I felt mum had got her balance back & I felt I could cope) I contacted the 'Community response team' (CRT) and told them I was ending on an agreed date....at which point my regular care agency would take over. They do 5 visits a week personal care.

    To be honest the CRT vists were more hassle than they were worth. They would turn up all sorts of odd times. The staff were very well trained though.

    It sounds like your current agency offers quite good value at £500 per week. If they are good then I would try to keep them but start to think about reducing the number of visits. You have to have an honest discussion with your father about what he finds useful. If he injures himself then he will be no use to anyone.

    I would guess a morning & evening visit would be a starting point. Put to bed and get up must be most difficult.

    Feeding during the day is just time consuming. Toileting visits during the day are mostly a waste of time.....something messy always happens as soon as the carer has left and you have to deal with it anyway.

    It is finding a sustainable balance (financially as well as what works best for mum & dad)

    All the best

  8. #8
    Registered User Saffie's Avatar
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    If they then turn around and say that we needed the carers to manage her needs, then wouldn't that mean they should pay for them? I'll have a look at the continuing healthcare checklist in the link you've kindly provided.


    I'm afraid it doesn't work like that. CHC funding is for serious health issues that are managed within a nursing home or an own home situation.
    I'm afraid the problems you have said your mother has do not fall within that category and even many that one would think should do, just don't. The needs your mother has are very common with dementia and as such are viewed as more social than medical concerns. The NHS provides this funding not the SSs.
    As for carers coming to the home, I reiterate what others have said, it is not your father paying for this as only your mother's finances would have been taken into consideration.

    Sorry, I've only just noticed that you are a new member. Welcome to TP.
    Last edited by Saffie; 19-07-2017 at 03:37 PM.
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  9. #9
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    Quote Originally Posted by DMac View Post
    Alex, Hi, and welcome to TP. You will find much useful information and advice here.

    Your situation sounds very similar to my in-laws about 3 years ago, after my father-in-law (FIL) had been discharged from hospital after a major operation. My mother-in-law (MIL) who (at that time) had early stages dementia - as well as him - was convinced that he didn't need carers 4 times a day. I don't mean to suggest your dad has dementia, more that she was adamant that she could cope.

    Looking back at that time, I absolutely recognise the barrage of questions that you are asking yourself right now. So my first piece of advice is - SLOW DOWN! There is time to sort it all out. Take a deep breath!

    The first thing is to establish the level of care your mum needs now. I'm assuming she is not entitled to a 6-week re-ablement programme of care? With or without this, it will probably take a few weeks to establish her 'baseline' level of care. Take some time to understand her, your dad's and your own needs. The visiting carers and SS will help you, as a family, work this out. Hopefully you will all come to a stage where you all agree what that level of care is. (We did get there eventually - MIL grudgingly accepted visiting carers.)

    As for paying for the care, Pete R has explained this, so I won't repeat. I agree, it does seem strange that SS can effectively say, "THIS is the level of care you need, you HAVE to have it, and by the way you HAVE to pay for it too"! In most other areas of life, the paying customer chooses whether or not to buy something, and is usually offered a good choice of alternative products or services. It's an economic principle that doesn't quite seem to apply to social care services! But don't worry about that right now - first thing is to make sure BOTH your parents are safe and looked after. (I'm sure your dad will come to appreciate the help in time....)

    Best of luck, keep posting, and let us know how you get on.
    Excellent advice from DMac. Just adding that SS do have a legal duty of care to any vulnerable adult. (Ironically, there are too many situations where they seem not be aware of this and have to be kicked into action by carers who are desperate for some support/respite.) So I think that's why they can't simply treat this as an economic transaction; they could be accused of neglect if they don't provide the needed care.

    Of course I don't know your family or circumstances, but I can only offer my own experience. My FIL insisted he didn't need any help looking after MIL with severe dementia (but fewer of the other health issues you describe for your mum). We couldn't persuade him to try any of the support options or take even a few hours break. In the end, this fatally compromised his own health; he refused treatment because it would mean leaving MIL with someone else even for one day and he was totally physically and emotionally exhausted. The end result? He died within two weeks of her and we had a double funeral. Please try to persuade your dad that for mum's sake, as well as his own, he needs to share the burden a bit. Maybe that's why SS are insisting on some carer support?

    Give it a try for a few weeks; if it's not working out, you would then have some independent views from the carers to support your wishes.
    "Life is what happens to you while you're busy making other plans" -John Lennon ('Beautiful Boy')

  10. #10
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    hello Alex18
    welcome to TP, where members are brilliant at offering suggestions and information, and sharing their experience, as you are discovering
    My dad cared for my mum after she had a stroke, some years ago - he did a brilliant job of looking after her - he also did a brilliant job of covering how hard the situation was becoming for him, so the carers who visited in the morning and evening had no real idea of how tough it was for them both - neither did I until I visited and stayed with them for an extended period, so dad couldn't hide much from me
    he took his marriage vows seriously and very much felt that it was the 2 of them against the world, which was becoming destructive, he was wearing himself out
    I'm not saying this is the situation with your parents, just suggesting that you make sure your dad isn't in need of more support than he says he wants - maybe the care needs assessor is doing their best to help both your parents cope
    best wishes
    And all shall be well and
    All manner of thing shall be well
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  11. #11
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    Quote Originally Posted by Shedrech View Post
    he took his marriage vows seriously and very much felt that it was the 2 of them against the world, which was becoming destructive, he was wearing himself out
    Yes, that describes my FIL's attitude perfectly....
    "Life is what happens to you while you're busy making other plans" -John Lennon ('Beautiful Boy')

  12. #12
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    Thank you all for your very helpful advise and info.

    We're now awaiting a decision on payment for the care (the assessor has taken the case to the board) though we are expecting they'll say we have to pay. The odd thing is we were told by the assessor who saw my mother regularly when she was in hospital that she thought we had a very strong case for my mother having critical care needs and having the care paid for. She was due to come and do the assessment herself when my mum came home - but then was replaced by someone else at the last minute...

    My dad actually seems a little more accepting of the care now, although like other posters have commented the timings of their visits are a bit erratic and I think the midday visits aren't that helpful. Also I didn't realise we could maybe only have one carer visit instead of two at a time - and my dad could assist the one carer getting my mum in and out of bed etc if he wished? So thanks for that info too.

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