1. Kintail

    Kintail Registered User

    Jul 1, 2015
    2
    My dad was diagnosed with dementia about four years ago. He continued living at home, with my mum providing an increasing level of care as his condition worsened. Over the past six months, however, dad's condition deteriorated drastically. He was admitted into hospital after seemingly reacting badly to anti-psychotic medication he had been prescribed. Over the course of a month long stay in hospital, dad's condition degenerated much further. He was given 1 to 1 care for much of the time spent in hospital, primarily owing to his falls risk. It was decided that dad would have to move permanently to a care home upon leaving hospital. We struggled to find one which would accept dad and even then, they said that he really needed 1 to 1 care which they could not provide. They agreed to accept him on the basis that we understood that there was an unavoidable risk of falls. Without any other options, and under considerable pressure from the hospital and social work, we agreed to dad moving to this care home.

    Within less than a week of dad moving to the care home, they contacted our social worker and re-iterated the need for 1 to 1 care. The social worker has submitted a funding application for this but we have no realistic expectation that this will be granted. As an interim measure, the local authority agreed to fund 1 to 1 care for a two week period which expires next week.

    Living in Scotland, we have been advised that the local authority is under no obligation to provide funding in excess of £249 per week for personal/nursing care. We have been told that 24/7 1 to 1 care in the current nursing home would cost approximately £10,000 per month. While dad has some savings, they would obviously be consumed very quickly and there doesn't seem to be any onus on the local authority to continue this level of care once dad's money is gone.

    We have asked about NHS Continuing Care and have been told that dad wouldn't qualify as he does not require regaular 'clinical interventions'. I don't believe that the checklist assessment has been completed, but from what I understand, the odds are very much against dementia patients being considered eligible.

    It has been suggested that if the current care home is insisting that 1 to 1 care is necessary, it isn't the right place for dad and perhaps another home would be better suited to his needs without the extreme of 24/7 1 to 1 care. We intend to investigate other care homes, but as the current care home is supposedly a 'specialist in dementia care', our hopes are not high.

    Fundamentally, my mum and I are at a loss on what to do. Plainly, my dad's care needs are not unique, but it seems that the only way he will get the 1 to 1 care he supposedly needs is to pay for it ourselves. We can do this for a time, but after the money runs out, it seems that it will be withdrawn regardless of my dad's needs.

    If anyone can offer advice regarding 1 to 1 care for dementia patients based on their own experiences I'd be very grateful.
     
  2. katek

    katek Registered User

    Jan 19, 2015
    191
    Hi Kintail

    Re your point about Continuing Care, I would insist that a checklist is done, which would probably lead on to a full assessment. The fact that your Dad needs 1-1 all the time - and did so in hospital too - must count for something if he is at risk of falls. Download the 'Decision Support Tool' for NHS CHC and see where you think he would score in both the 'Behaviour' and 'Mobility' domains. I would assume his dementia would score him 'Severe' in 'Cognition' anyway. He would be eligible for CHC if he scored another 'Severe', or possibly (in theory but not often in practice) one 'Severe' and a number of 'Highs'. In the latter case you could argue that the way the domains interact put him at an increased risk of falls.
     
  3. Kintail

    Kintail Registered User

    Jul 1, 2015
    2
    Hi and thanks for your reply.

    We fully intend to insist that the checklist is completed. Having already looked at the scoring criteria, I cannot see how a full assessment could be refused. That said, all the conversations that we have had with consultants, doctors, CPNs etc suggest that dad would not be considered eligible as his needs are not 'clinical'. To me, this seems an arbitrary and meaningless distinction - If someone needs additional care beyond the norm provided by a care home, there should be a route for this to be provided whether via the NHS or local authority.

    We will see how things develop. In the meantime, I'd welcome any further advice which anyone could offer.
     
  4. Lulu

    Lulu Registered User

    Nov 28, 2004
    391
    #4 Lulu, Jul 5, 2015
    Last edited: Jul 5, 2015
    I would insist upon the checklist. We were told that there is no way we could get funding for my Mum, but she went on to get it. My Mum scored severe behaviour, high emotional and psychological, severe cognition, and all these interacted with more domains, including high falls risk. She had no clinical needs as such. You need to look at each domain critically, decide yourself where you think your dad is, have examples, and then go for it. Hope this helps, and the best of luck. There is quite enough to deal with without having to go through this funding process as well.
    Have pm'd you.
     

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